The Development, Implementation and Evaluation of a Novel Intervention for Delirium in an Adult Intensive Care Unit

The Family Members Voice Reorientation intervention (FamVR) is a novel voice reorientation program that will record family members’ voices. The recorded voices can be played to the patient by clinical staff to provide orientation, reassurance, and comforting words to critically ill patients. The researcher will conduct the study in two phases. Phase One – Development of FamVR content: This phase comprises the development of the FamVR intervention content in collaboration with relevant stakeholders comprising ICU clinicians, patients and families. The FamVR program content will be stored on an iPad. The program will have four domains which comprise the ICU reorientation, ICU routine, ICU procedure and free category domains. The ICU reorientation domain will contain messages in family members' voices that family members or clinical staff can play to the patient during the early days of admission, during bed moves, in the wake of the day, during change of staff and at bedtime. The ICU routine domain will contain messages that can be played to the patient before routine care, such as washing, oral and eye care, bed lining change, and nursing and medical assessments. The ICU procedure domain can be played to the patient before invasive devices such as central venous lines, oxygen masks, suctioning, urinary catheter insertion, feeding tube insertion and lines for drugs. The free domain will contain messages that the family members choose in the context of everyday events, such as the news about their family, loved ones and events; the researcher and clinical staff will monitor his domain to ensure that appropriate messages are played to the patient. Phase Two – Pilot study implementation in one ICU: Phase Two will start approximately 3 weeks after Phase One. The researcher will consent and educate patients, family members and staff about the FamVR. Then the FamVR will be implemented in one adult ICU. During this time, the clinical staff and the researcher will use an agitation assessment scale to monitor the effect of the FamVR on patients. If patients show increased levels of agitation during the intervention, they will no longer receive FamVR for the duration of their ICU stay. The clinical staff are educated on using the agitation assessment scale because it is currently used in practice. However, the researcher who is an ICU clinician will provide further education about 2 weeks before implementing the intervention through a one-off 1-hour PowerPoint Presentation via Microsoft Teams which will be recorded for staff to replay in their own time. Also, the researcher will provide at least 3 face-to-face education sessions using pictures and the demonstration of the intervention on an iPad to reinforce the clinicians' knowledge and application of the assessment during this study. The family members will play the role of recording their voices in approximately 1 hour recording session; according to the scripts of the domain and the researcher will provide face-to-face education using pictures and iPad demonstration to the family members 3 days before implementing the intervention. The FamVR can be played to the patient in their absence daily as needed for each of the domains, the free category domain will be played at least twice a day. The FamVR will be administered to each patient participant from the time they are intubated in ICU to the time the breathing tube is removed. The researcher will collate information via an observational checklist that will record how long, when and how many times the FamVR was played. This phase will then evaluate the FamVR intervention by exploring the experiences of ICU staff, patients and families of the FamVR via individual interviews. Evaluation: The pilot study implementation of the FamVR intervention is anticipated to last for four months, with 30 participants consented and recruited in the study as guided by pilot studies. The researcher will evaluate the intervention by collecting data on the experiences of patients, family members and clinical staff of integrating the FamVR into the delirium care of their loved ones or patients. Data collection for the patients and family members will be one-to-one semi-structured interviews and recorded via Microsoft Teams. The interview will be recorded audio and visual and will last approximately 60 minutes. Patients can be interviewed as a family unit with the family members or separately if they prefer. The interview will take place in the participants' natural settings to minimise the risk of travelling to the study site and their natural settings will make them more at ease. For clinician participants, the researcher will conduct 3 focus groups with 8-12 participants in each focus group until no new information emerges (data saturation) from the focus group. If data saturation is not achieved, the researcher will undertake further focus groups until data saturation is achieved. The researcher will organise the focus groups to explore the experiences of the clinical staff of the FamVR intervention. The focus groups will comprise of doctors, nurses and physiotherapists. The focus group will be recorded via Microsoft Teams and will last for approximately 60 minutes