Non-pharmacological delirium prevention practices among critical care nurses: a qualitative study

Abstract

Background Delirium is common among critically ill patients, leading to increased mortality, physical dependence, and cognitive impairment. Evidence suggests non-pharmacological delirium prevention practices are effective in preventing delirium. However, only a few studies explore the actual implementation and its associated challenges among critical care nurses. Aim To explore critical care nurses’ perceptions of current non-pharmacological delirium prevention practices in adult intensive care settings, including delirium screening, early mobilisation, sleep promotion, family engagement, and sensory stimulation. Methods A qualitative design adopting a thematic analysis approach. Semi-structured interviews with 20 critical care nurses were conducted in ten acute hospitals in mainland China. Results Three themes emerged: (a) importance of family engagement; (b) influence of organisational factors, and (c) suggestions on implementation. The implementation of non-pharmacological delirium prevention practices was limited by a strict ICU visitation policy, lack of routine delirium screening and delirium training, light and noise disturbances during nighttime hours, frequent resuscitation and new admissions and strict visitation policy. Case-based training, adopting a sensory stimulation protocol, and family engagement may be enablers. Conclusion ICU care routine that lacks delirium assessment and the strict family visitation policy made it challenging to implement the complete bundle of non-pharmacological practices. Resource deficiency (understaffing, lack of training) and ICU environment (frequent resuscitation) also limited the implementation of non-pharmacological practices. Clinicians could implement case-based training and sensory-stimulation programs and improve communication with family caregivers by instructing family caregivers to recognise delirium symptoms and delirium prevention strategies.

Development and Validation of an ICU Delirium Playbook for Provider Education

“…Although consistent delirium detection and prevention practices can benefit both patients (e.g., improved outcomes) and providers (e.g., lower burden), the majority of bedside providers report receiving insufficient delirium education (15)(16)(17)(18)(19)(20)(21). Prior efforts attempted to fill this knowledge gap via one-time lectures and webinars, intensive workshops, bedside simulations, paperbased self-learning, and e-learning modules, but were often limited in scale and sustainability, and/or used nonvalidated knowledge assessment tools (22)(23)(24)(25)(26)(27)(28)(29)(30).…”