Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing Science

Research Advisor

Michael A. Carter, D.N.Sc.


Leanne M. Boehm, Ph.D.; Xueyuan Cao, Ph.D.; Reba A. Umberger, Ph.D.; Mona N. Wicks, Ph.D.


Delirium; Family Caregivers; Intensive Care Unit; Nursing; Psychological Health; Uncertainty


Each year, more than 5 million patients are admitted to an intensive care unit (ICU) in the United States, and up to 80 % of these patients develop delirium. Delirium is a common indicator of acute brain dysfunction in the ICU and a predictor of mortality, longer ICU/hospital stay, and long-term cognitive impairment. Family caregivers are a valuable resource in preventing, detecting, and managing delirium in the ICU. However, witnessing delirium episodes can generate adverse psychological symptoms in family caregivers that may compromise their health and well-being. Research in this area has demonstrated a gap in the literature regarding how ICU delirium impacts family caregivers’ psychological health. The development of these adverse psychological symptoms among family caregivers has contributed to the uncertainty of illness among patients with delirium. Therefore, this dissertation research aimed to understand the psychological impact on family caregivers of patients experiencing delirium in the ICU by exploring the concept of uncertainty and examining the relationship between uncertainty associated with ICU delirium and the psychological health outcomes of family caregivers. Three projects were conducted: an integrative review, a concept analysis, and a descriptive correlational study. The integrative review project revealed the most common adverse psychological outcomes experienced by family caregivers of patients with ICU delirium, such as distress, anxiety, depression, uncertainty, and family caregivers’ need for support based upon a lack of information on delirium. These findings indicate that these unmet needs contributed to the negative psychological symptoms of family caregivers, consequently explaining their experience of uncertainty. The next project, a concept analysis of the uncertainty, was conducted to identify the attributes, antecedents, and consequences of the family caregivers’ uncertainty regarding the patient’s illness. These findings led to an understanding of how uncertainty could impact family caregivers’ psychological health. Collectively, findings from the two projects provided a general knowledge of ICU delirium, uncertainty, and psychological distress that led to the third project. The third project, a descriptive correlational study, was conducted to examine whether ICU delirium’s uncertainty is associated with psychological distress among family caregivers. Findings from this study revealed significant associations between family caregivers’ uncertainty of ICU delirium and psychological distress. Understating the adverse impact of ICU delirium on family caregivers’ psychological health could further inform the development of nursing interventions to mitigate these adverse outcomes. Family caregivers are the backbone of continuous, in-home care. Thus, caring for the family caregivers’ health translates to caring for society as a whole.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.




2022-022-Haji Assa-DOA.pdf (191 kB)
Declaration of Authorship