Survey among critical care nurses and physicians about delirium management

Abstract

Background: Delirium is a serious complication in patients in intensive care units. Previous surveys on delirium management in daily practice showed low adherence to published guidelines. Aim: To evaluate delirium management in nurses and physicians working in intensive care units in German-speaking countries and to identify related differences between nurses and physicians. Design: The study used an open online survey with multiple-choice responses. Methods: An invitation for participation was spread via journals and electronic resources using a snowball system. Apart from recording socio-demographical characteristics, the survey collected data on delirium assessment, delirium-related processes, non-pharmacological prevention and treatment and barriers for implementation. Differences between nurses and physicians were tested by Fisher's exact test with sequential Bonferroni correction. Results: The survey was conducted in autumn 2016, and 559 clinicians participated. More nurses than physicians reported screening for delirium. The majority of clinicians reported screening for delirium when this was suspected; more than 50% used validated instruments. Half of the clinicians had delirium-related structures implemented, such as two thirds reporting delirium-related processes. Most cited barriers were lack of time and missing knowledge about delirium and its assessment. With significant difference, physicians recommended more than nurses early removal of catheters and daily interprofessional goals for patients. Conclusion: In German-speaking countries, assessment of delirium needs further improvement, leading to accurate assessment. Delirium-related structures and processes appear to be implemented widely, with only a few differences between nurses and physicians. Relevance to clinical practice: Nurses and physicians in this survey reported similar perceptions and attitudes towards management of delirium. Both professions need more knowledge and inter-professional training on when and how to use validated assessment instruments.

The influence of a serious game’s narrative on students’ attitudes and learning experiences regarding delirium: an interview study

“…Interprofessional cooperation is often not addressed in current delirium education [1,18]. Our results suggest, that understanding another person's perspective can enhance co-operation between healthcare professionals.…”

“…Low detection rates of delirium are often related to low delirium awareness, inadequate knowledge and education, lack of time, feeling uncomfortable with delirium assessment, and missing co-operation between professions. However, if the presence of delirium and/or increased risks are detected, such barrierstogether with negative attitudes towards deliriumare also related to suboptimal delirium management [2,14,[17][18][19].…”

Enfermería en la monitorización del delirium en cuidado intensivo adulto: una revisión de alcance

“…En general, las estrategias que emplean las enfermeras para la monitorización del delirium son la observación de la agitación, la evaluación de las funciones cognitivas del paciente y la aplicación de instrumentos de detección. Los estudios sugieren la utilización, principalmente, de instrumentos validados como el CAM-ICU, la Nu-DESC y el ICDSC (16,17,18,22,23,24), la aplicación de estrategias multidisciplinarias (18, 21) y de protocolos de sedación, analgesia y delirium (20). Los resultados se exponen en seis categorías relevantes para responder la pregunta central planteada.…”

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“…They also suggest that such instruments need to be regularly revisited, especially in view of the trend towards less sedation and earlier mobilization in ICUs in various countries (Harrold et al, 2015;Leong et al, 2017). Nydahl et al (2018) also recruited a combination of nurses and doctors (n = 559) through snowball sampling in a study about delirium, but in their case sought to investigate delirium management practices in critical care units in German-speaking countries in Europe. Data were collected through an online questionnaire.…”