BACKGROUND: Post-operative delirium is a complication with long-lasting consequences for both patients and their families. This is particularly true for those transferred to the intensive care unit after surgery, where the incidence of post-operative delirium is high, and patient outcomes are often poor. Despite the acknowledged role of family engagement in delirium management, previous research has mainly focused on patients, with limited exploration of the shared experiences between patients and family members. AIM: This study aims to explore the experiences of patients and family members during episodes of post-operative delirium in the intensive care unit to better understand their unmet needs. STUDY DESIGN: A qualitative descriptive study was conducted at a tertiary general hospital. Eighteen pairs of patients, their family members and two other family members were interviewed. Data were collected through face-to-face semi-structured interviews within the first week after patients' discharge from the intensive care unit and analysed using thematic analysis. RESULTS: Four major themes emerged: (1) the dyadic relationship between patients and family members must be understood in the context of their shared emotional and behavioural experiences
(2) family's history may predispose patients to post-operative delirium
(3) family engagement may prevent the development of post-operative delirium
and (4) inadequate communication between health care providers and patients or families may negatively affect post-operative delirium outcomes. CONCLUSIONS: Post-operative delirium presents significant emotional and physical challenges for both patients and their families. Addressing these challenges requires improved communication between health care providers and families, as well as strategies that emphasize early family support and collaboration in care. RELEVANCE TO CLINICAL PRACTICE: Patients and their families should be considered a unit during post-operative delirium management, and earlier family engagement is essential. Health care systems should adapt intensive care unit practices to meet the dynamic needs of families, promoting more comprehensive support during critical care.