Prevenção e monitorização do delirium no idoso: uma intervenção educativa

Abstract

Objective: to conduct an educational intervention with the nursing team members of an intensive care unit (ICU), aiming to increase knowledge and to introduce improvements in their practices regarding prevention and monitoring of delirium in older patients. Method: this is an action research, in which workshops were conducted with eleven nurses and a nursing technician from an ICU unit in Salvador, Bahia, Brazil. Results: ten problems regarding nursing practices for prevention and monitoring of delirium were identifi ed. Educational, practical, technical, and managerial actions were planned, involving cross-sector connections for planning ways to solve these problems. The groups reported signifi cant changes in the practices, with the implementation of drug-free measures for preventing and managing the situation. Conclusion: the educational intervention contributed to improve the nursing practices in the ICU unit studied, and it also favored the development of critical thinking about the problems mentioned, thus enabling permanent review of offered treatments. Descriptors: Delirium; Dementia; Amnestic Disorder, and Other Cognitive Disorders; Older adults; Nursing Team. RESUMO Objetivo: realizar uma intervenção educativa com membros da equipe de enfermagem de uma unidade de terapia intensiva (UTI), com vistas a ampliar o conhecimento e introduzir melhorias nas suas práticas de prevenção e monitorização do delirium nos pacientes idosos. Método: pesquisa-ação em que foram realizadas ofi cinas com onze enfermeiras e uma técnica em enfermagem de uma UTI de Salvador, Bahia-Brasil. Resultados: dez problemas relacionados a práticas de enfermagem para prevenção e monitorização do delirium foram identifi cados. Planejaram-se ações de caráter educativo, prático, técnico e gerencial, envolvendo a articulação intersetorial para o equacionamento desses problemas. O grupo relatou mudanças signifi cativas nas práticas, com a implementação de medidas não farmacológicas para prevenção e gestão do quadro. Conclusão: a intervenção educativa contribuiu para a melhoria nas práticas da enfermagem da UTI pesquisada, assim como favoreceu o desenvolvimento da consciência crítica acerca da problemática levantada, possibilitando a revisão permanente do cuidado ofertado. Descritores: Delirium; Demência; Transtorno Amnéstico e Outros Transtornos Cognitivos; Idoso; Equipe de Enfermagem. RESUMENObjetivo: realizar intervención educativa en un personal de enfermería de una unidad de cuidados intensivos (UCI), con el objetivo de ampliarles conocimiento e introducirles mejoras en sus prácticas de prevención y monitorización del delirium al tener a las personas mayores como pacientes. Método: investigación-acción en la que se llevaron a cabo talleres con 11 enfermeras y 1 técnica de enfermería de una UCI de Salvador de Bahía. Resultados: se identifi caron diez problemas relacionados a las prácticas de enfermería en la prevención y monitorización del delirium. Se planearon acciones educativas, prácticas, técnicas y de gestión, que implican ...

Cuidado de enfermagem ao idoso com delirium em unidade intensiva

“…It is necessary to adopt strategies to better qualify these professionals regarding the importance of early identification of the problem and use of screening tools for diagnosis. 7,22 A similar result was found in a survey carried out in the Netherlands, in which the daily screening for delirium by nurses was insufficient; however, in this study, only cases registered by the DISCUSSION J Nurs UFPE on line. 2019;13:e239682 https://doi.org/ 10.5205/1981-8963.2019.239682 nurses in the medical records were included.…”

“…Knowledge and practices of the nursing team for the prevention and monitoring of delirium in the elderly 22 Actions of educational, practical, technical and managerial character, involving intersectoral articulation.…”

“…However, signs of the hypoactive type such as lethargy, apathy, and reduced degree of response to stimuli were not considered. [21][22] It is noteworthy that the rates of identification by nurses were higher when the patients included had more severe picture of delirium, and specialists contested the occurrence of the disorder in patients who presented the hypoactive subtype. 23 It is noticed that nurses do not prioritize patients with hypoactive delirium because of their failure to recognize the condition, which is a common problem even among specialists.…”

“…It is notable that the use of the screening scale known as Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is not incorporated into the practice of nurses. [21][22] The delirium index was evaluated through the application of the CAM-ICU by nurses and it was observed that, despite of this, the CAM-ICU is not routinely used in ICUs in Thailand, and clinical manifestation is the main strategy used for identification. 7,23 The Intensive Care Delirium Screening Checklist (ICDSC) was used to assess delirium, but the study did not report whether the use was common 25 .…”

“…13 It is understood that the nursing team has a primary role in the prevention and detection of delirium because nursing is the professional category that provides direct health care and accompany patients 24 hours a day, mainly in ICUs. 7,[14][15] It has been observed that the development of non-pharmacological measures is fundamental in the management and prevention of delirium. [16][17] It is noted that the implementation of educational interventions with nurses in ICUs contributes to improve their knowledge and skills on the recognition of the problem and its standardized evaluation.…”