Pain, Agitation, and Delirium Guidelines: Nurses’ Involvement in Development and Implementation

Abstract

The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses’ involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation.

Capacitação de enfermeiros na utilização de um instrumento de avaliação de delirium

“…The implementation of protocols and guidelines by nurses has a major impact on clinical practice (13) , because in addition to direct and standardized care, it assists in reading the results, comparing it to other indicators and service standards. As delirium has a substantial influence on health care and has become a concern for the professional teams involved in the care, its management is directed by Pain Control Policy, Agitation and Delirium in adult patients of the American College of Critical Care Medicine ( ACCM) and the Society of Critical Care Medicine (SCCM) (11) .…”

Patient early mobilization: A Malaysia's study of nursing practices

“…Nurses play an important role as a patient advocator [19,27], collaborator and executives in nursing practice for mechanically ventilated patient over 24 h a day. In Malaysia, nurses still need to rely on physician's order before refer patient for physiotherapy same goes to some other country [28].…”

“…Early mobilization was usually started according to protocol [3,17,18] and after patient's cardio-respiratory and neurological stabilization [3]. Many protocols were published separately and created [19,20]. However there was no protocol being used for as common as ventilator bundle in Malaysia's intensive care unit (ICU).…”

Delirium in Children: Identification, Prevention, and Management

“…However, little empirical evidence supports specific interventions to improve sleep, particularly in PICU patients. 32 Children with delirium are anecdotally described as "having their days and nights mixed up," and the physical signs of delirium often worsen at night. Structure and continuity are important for children with delirium, and even though the perception may be that a child is "too sick" for a routine schedule, the sicker the patient, the more important is a stable environment and day-night routine.…”

“…Structure and continuity are important for children with delirium, and even though the perception may be that a child is "too sick" for a routine schedule, the sicker the patient, the more important is a stable environment and day-night routine. 4,[32][33][34][35] An individualized schedule should be posted in the patient's room so all members of the health care team and visitors are aware of the plan. The Figure is an example of a daily schedule that can be modified to include the preferences of a patient and the patient's family.…”