Nursing Assessment and Intervention in the Management of Delirium in Intensive Care: A Quantitative Study
DOI:
https://doi.org/10.12707/RVI24.37425Keywords:
delirium, intensive care, nursingAbstract
Background: Delirium remains underdiagnosed and neglected in intensive care units (ICUs), significantly affecting the prognosis and recovery of critically ill patients.
Objectives: To assess nurses’ knowledge of scales used to assess delirium in critically ill patients and to identify reasons for not using them, risk factors for delirium, and nursing interventions used.
Methodology: A quantitative, descriptive, exploratory, and cross-sectional study involving 115 nurses from an ICU. The data collection instrument was a questionnaire.
Results: It was found that 44.3% of nurses were familiar with a scale for assessing delirium in critically ill patients, with the most commonly cited scale being the Confusion Assessment Method for the Intensive Care Unit. Only 5.2% of nurses used a delirium assessment scale, and the most frequently reported nursing intervention was “Promote a quiet environment” (57.9%).
Conclusion: Although nurses often do not assess delirium or assess it inadequately, they still implement interdependent and autonomous interventions to care for critically ill patients with delirium.
Downloads
References
Birge, A. Ö., & Aydin, H. T. (2017). The effect of nonpharmacological training on delirium identification and intervention strategies of intensive care nurses. Intensive and Critical Care Nursing, 41, 33-42. https://pubmed.ncbi.nlm.nih.gov/28214083/
Bohart, S., Møller, A. M., & Herling, S. F. (2019). Do health care professionals worry about delirium? Relatives’ experience of delirium in the intensive care unit: A qualitative interview study. Intensive & Critical Care Nursing, 53, 84-91. https://pubmed.ncbi.nlm.nih.gov/31079979/
Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., … Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/ sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825–e873. https://doi.org/10.1097/CCM.0000000000003299
Kotfis, K., Van Diem-Zaal, I., Williams Roberson, S., Sietnicki, M., Boogaard, M., Shehabi, Y., & Ely, E. W. (2022). The future of intensive care: Delirium should no longer be an issue. Critical Care, 26(1), 200. https://doi.org/10.1186/s13054-022-04077-y
Li, J., Fan, Y., Luo, R., Wang, Y., Yin, N., Qi, W., Huang, T., Zhang, J., & Jing, J. (2025). Envolvimento da família na prevenção do delirium em pacientes gravemente enfermos: Uma revisão sistemática e meta-análise. Revista Internacional de Estudos de Enfermagem, 161, 104937. https://doi.org/10.1016/j.ijnurstu.2024.104937
Morandi, A., Piva, S., Ely, E. W., Myatra, S. N., Salluh, J. I., Amare, D., Misango, D., Azoulay, E., Bellelli, G., Csomos, A., Fan, E., Fagoni, N., Girard, T. D., Heras La Calle, G., Inoue, S., Lim, C.-M., Kaps, R., Kotfis, K., Koh, Y., … Latronico, N. (2017). Worldwide survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/ Management, Early Exercise/Mobility, and Family Empowerment” (ABCDEF) bundle. Critical Care Medicine, 45(11), e1111–e1122. https://doi.org/10.1097/ccm.0000000000002640
Moreira, D. (2019) Diagnósticos de enfermagem relacionados ao delirium. Revista Sou Enfermagem, 3(1), 05-15. https://revista.souenfermagem.com.br
Moss, S. J., Hee, L. C., Doig, C. J., Whalen-Browne, L., Stelfox, H. T., & Fiest, K. M. (2022) Delirium diagnosis without a gold standard: Evaluating diagnostic accuracy of combined delirium assessment tools. PLoS ONE, 17(4), e0267110. https://doi.org/10.1371/journal.pone.0267110
Pallant, J. (2020). SPSS survival manual: A step by step guide to data analysis using IBM SPSS (7th ed.). Routledge. https://doi.org/10.4324/9781003117452
Prayce, R., Quaresma, F., & Neto, I. (2018). Delirium: O 7º parâmetro vital? Revista Científica da Ordem dos Médicos, 31(1), 51-58. https://doi.org/10.20344/amp.9670
Rasheed, A., Amirah, M., Abdallah, M., Parameaswari, P. J., Issa, M., & Alharthy, A. (2018). RAMSAY sedation scale and Richmond agitation sedation scale (RASS): A cross sectional study. Health Science Journal, 12(6), 1-5. https://www.itmedicalteam.pl/articles/ramsay-sedation-scale-and-richmond-agitation-sedation-scalerass-a-cross-sectional-study.pdf
Roh, Y. S. (2021). The training needs of Korean intensive care unit nurses regarding delirium. Intensive and Critical Care Nursing, 62, 102954. https://doi.org/10.1016/j.iccn.2020.102954
Santos, F. C., Rêgo, A. S., Montenegro, W. S., Carvalho, S. T., Cutrim, R. C., Júnior, A. A., Pereira, F. H., Dibai-Filho, A. V., & Bassi-Dibai, D. (2022). Delirium in the intensive care unit: Identifying difficulties in applying the confusion assessment method for the intensive care unit (CAM-ICU). BMC Nursing, 21(1), 1–6. https://doi.org/10.1186/s12912-022-01103-w
Silva, R. C., Silva, A. A., & Marques, P. A. (2011). Analysis of a health team’s records and nurses’ perceptions concerning signs and symptoms of delirium. Revista Latino-Americana de Enfermagem, 19(1), 81–89. https://doi.org/10.1590/s0104-11692011000100012
Sinvani, L., Delle Site, C., Laumenede, T., Patel, V., Ardito, S., Ilyas, A., Hertz, C., Wolf-Klein, G., Pekmezaris, R., Hajizadeh, N., & Thomas, L. (2021). Melhorando a detecção de delirium em unidades de terapia intensiva: Programa de educação e treinamento multicomponente. Journal of the American Geriatrics Society, 69(11), 3249-3257. https://doi.org/10.1111/jgs.17419
Souza, T. L., Azzolin, K. O., & Fernandes, V. R. (2018). Cuidados multiprofissionais para pacientes em delirium em terapia intensiva: Revisão integrativa. Revista Gaúcha de Enfermagem, 39, e2017-0157. https://doi.org/10.1590/1983-1447.2018.2017-0157
Stollings, J. L., Kotfis, K., Chanques, G., Pun, B. T., Pandharipande, P.P., & Ely, E. W. (2021). Delirium in critical illness: Clinical manifestations, outcomes, and management. Intensive Care Medicine, 47(10), 1089-1103. https://doi.org.10.1007/s00134-021-06503-1
Vyveganathan, L., Izaham, A., Mat, W. R., Peng, S. T., Rahman, R. A., & Manap, N. A. (2019). Delirium in critically ill patients: Incidence, risk factors and outcomes. Critical Care in Shock, 22(1), 25-40. https://criticalcareshock.com/2019/02/2711/
Xing, J., Sun, Y., Jie, Y., Yuan, Z., & Liu, W. (2017). Perceptions, attitudes, and current practices regards delirium in China: A survey of 917 critical care nurses and physicians in China. Medicine, 96(39), e8028. https://doi.org.10.1097/MD.0000000000008028
Yang, Z., Pituskin, E., Norris, C., & Papathanassoglou, E. (2020). Synthesis of intensive care nurses’ experiences of caring for patients with delirium. The World of Critical Care Nursing, 14(2), 55–77. https://doi.org.10.1891/WFCCN-D-20-00015
