Delirium in adult patients in intensive care: nursing interventions

Abstract

Background: Delirium is a neuropsychiatric syndrome of high incidence in the critically ill patient. It is characterised by changes in acute attention and cognition, has a multifactorial aetiology and has a negative impact on the patient's clinical situation and future quality of life. Prevention of delirium and early identification can reduce associated morbidity and mortality. Consequently, it is vital that intensive care unit (ICU) nurses perform targeted patient monitoring to identify acute cognitive changes. Objective: To identify nursing interventions directed at the prevention and management of delirium in adult patients in ICU. Method: A scoping review was undertaken based on the principles recommended by the Joanna Briggs Institute. Results: Seven studies were selected for inclusion. Non-pharmacological and pharmacological nursing interventions were identified. Conclusion: The interventions identified were predominantly aimed at the prevention of delirium. The training of nurses and wider clinical team in preventing and identifying this syndrome is crucial.

Nursing Intervention to Prevent and Manage Delirium in Critically Ill Patients: A Scoping Review

“…Table 3 shows the studies that make up the final bibliographic sample and synthesizes the main results that answered the research question [ 2 , 3 , 5 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The included articles have different methodologies and are from the USA [ 2 , 3 , 13 , 17 , 18 , 22 ], South Korea [ 14 , 23 ], Iran [ 16 ], Germany [ 15 ], Portugal [ 5 ], Canada [ 19 ], Poland [ 20 ], China [ 21 ], and India [ 24 ].…”

“…Describe the current state of scientific evidence for diagnostic, preventive, and therapeutic Antipsychotics, dexmedetomidine, statins, and ketamine are not recommended to prevent delirium. Table 3 shows the studies that make up the final bibliographic sample and synthesizes the main results that answered the research question [2,3,5,[13][14][15][16][17][18][19][20][21][22][23][24]. The included articles have different methodologies and are from the USA [2,3,13,17,18,22], South Korea [14,23], Iran [16], Germany [15], Portugal [5], Canada [19], Poland [20], China [21], and India [24].…”

“…Following the non-pharmacological interventions discussed, it was possible to see that they are in line with what is recommended in the ABCDEF bundle, mentioned by several authors, which focuses essentially on the prevention of delirium. The meaning of each of the letters in the mnemonic system was: (A) assessment, prevention, and management of pain; (B) awakening the individual and training spontaneous breathing; (C) selection of sedation and analgesia; (D) assessment, prevention, and management of delirium; (E) early mobilization; and (F) family involvement (Bento and Sousa, 2021). The application of this bundle has been proven to be effective in improving survival, length of stay, duration of delirium, reduction in health costs, and readmission to ICU and/or other institutions after discharge [2,5,23].…”

“…Studies report that up to 80% of critically ill people hospitalized in ICUs develop delirium at some point during their stay [3], and this condition is more prevalent in people receiving mechanical ventilation (60-80%) than in those who are spontaneously ventilated (20-50%) [4]. However, this remains an underdiagnosed condition, as its symptoms are incorrectly associated with other medical conditions [5].…”

“…Although the management of delirium requires coordinated multidisciplinary action, nurses play a fundamental role in the assessment, prevention, identification, and early resolution of delirium through non-pharmacological and pharmacological nursing interventions [ 2 , 5 , 9 ].…”