The Life Course Health Development Model: A theoretical research framework for paediatric delirium

Abstract

Aims and Objectives: The purpose of this article is to create a framework for future research through application and critique of the Life Course Health Development Model to the phenomenon of pediatric delirium. Background: Delirium in the pediatric intensive care unit is associated with increased duration of mechanical ventilation, length of stay, and mortality. Nurses are uniquely positioned at the bedside to identify, prevent, and treat delirium. An understanding of the potential long-term consequences of pediatric delirium is necessary to provide impetus for nursing research and practice change. The Life Course Health Development Model is a valuable tool when considering the multiple mechanisms and processes through which the experience of delirium could affect a child's life trajectory. Design: Critical review of the literature through application and critique of the Life Course Health Development Model in the context of pediatric delirium. Gaps in the current understanding of pediatric delirium, as well as future directions for research and practice, are discussed. Methods: The seven core principles of the model are considered in the context of pediatric delirium. Each of the principles has the potential to further understanding of pediatric delirium and identify areas for future inquiry. This discussion leads to a critique of the ability of the model to lead future research and practice change. Conclusions: The Life Course Health Development Model depicts a process in which the acute and severe stress of critical illness leads to maladaptive neurologic changes that contribute to the development of delirium and impair a child's life trajectory. Relevance to Clinical Practice: By emphasizing the potential lifelong consequences for critically ill children who experience delirium, this application of the Life Course Health Development Model will stimulate discussion, research, and practice change among pediatric clinicians and researchers.

Effect of Programmed Comprehensive Nursing for Postoperative Delirium in Intensive Care Unit Patients

“…Furthermore, the function of the regulatory system will be weakened, and they will become excessively sensitive to external stimuli, which is one of the main reasons for delirium. The patient's body intolerance to severe postoperative pain will directly compromise the patient's body function, which may consequently trigger delirium [ 16 – 19 ]. After surgery, hypoxemia in ICU patients may cause disorientation, hallucinations, irritability, and other negative emotions, with which patients are prone to self-injury, accidental extubation, and falling from bed.…”

Challenges of the Implementation of a Delirium Rate Scale in a Pediatric Intensive Care Unit: A Qualitative Approach

“…Despite the reluctance shown by the nurses interviewed in relation to delirium and the use of detection scales, our interviews point out the importance they attach to the management of environmental and/or family factors as preventive measures, as indicated by the evidence [ 56 , 57 , 58 , 59 ]. However, this care is not provided as specific and intentional care against delirium, but rather as measures of comfort or well-being for the child.…”

Non-pharmacological interventions to prevent and manage delirium in critically ill children in neonatal and paediatric intensive care units (NICU/PICU): a scoping review protocol

“…Due to the high rate of delirium in PICUs/NICUs7 10–13 and the negative consequences,1 12 14 as well as the current neglect of interventions to prevent or to reduce delirium,23–28 there is a need to identify and subsequently develop non-pharmacological interventions.…”

“…The overall occurrence rates of paediatric delirium vary widely depending on the type ranging from 17% to 81% 7 10–13. Delirium is associated with increased mortality,1 12 and children are likely to experience adverse long-term consequences and poorer cognitive and functional development 14. Therefore, preventing delirium in children is a treatment priority.…”