The nurse's role in preventing delirium in critically ill adult/elderly patients
DOI:
https://doi.org/10.15649/cuidarte.1983Keywords:
Delirium, Prevention & Control, Nurse's Role, Critical Care Nursing, Intensive Care UnitsAbstract
Introduction: Delirium is an acute brain dysfunction, associated with increased mortality and morbidity, which often affects critically ill adult/elderly patients. Nurses have a crucial role in the prevention/control of delirium, through the implementation of non-pharmacological interventions. Objective: To know the nursing interventions in the identification, prevention and control of delirium in adult/critical elderly patients. Materials and Methods: An Integrative Literature Review of articles published between 2014 and 2018 was carried out, which identified nursing interventions aimed at the prevention and control of delirium in adult/critical elderly patients. Four searches were carried out, in the electronic databases of EBSCOhost and B-on. Results: 13 studies were identified, which present nursing interventions, mostly non-pharmacological, for the prevention and control of delirium in adult/critical elderly patients. Of these, interventions related to the environment, sleep promotion, early therapeutic intervention, cognitive assessment and patient orientation, interventions systematized in protocols, as well as interventions aimed at the participation of family members, the training of nurses and the teaching of patients are evident. Risk factors for the development of delirium and assessment tools were also identified. Discussion: The prevention of delirium is important and imperative, since its occurrence in critically ill patients is associated with increased mortality, morbidity, length of stay and a high hospital cost. The identification of risk factors for the occurrence of delirium should be included in delirium management protocols. Conclusions: Evidence has shown that nurses are essential in the early identification, prevention and control of delirium, preventing the progression of the disease, contributing to the reduction of morbidity and mortality. The nursing intervention must include the identification of predisposing and/or precipitating factors to contribute to the reduction of the occurrence and/or resolution of delirium.
How to cite this article: Oliveira Cláudia; Garnacho Martins Nobre Cátia Filipa; Dourado Marques Rita Margarida; Madureira Lebre Mendes Maria Manuela; Cruz Pontífice Sousa Patrícia. O papel do enfermeiro na prevenção do delirium no paciente adulto/idoso crítico. Revista Cuidarte. 2022;13(1):e1983. http://dx.doi.org/10.15649/ cuidarte.1983
References
Faria, Rita da Silva Baptista; Moreno, Rui Paulo. Delirium na unidade de cuidados intensivos: uma realidade subdiagnosticada. Rev Bras Ter Intensiva. 2013; 25(2): 137–47. https://www.scielo.br/j/rbti/a/mSgDP58GSPrXt3gzJhzYZTz/abstract/?lang=pt#
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association. 2013. http://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf
Herling SF, Greve IE, Vasilevskis EE, Egerod I, Mortensen CB, Moller AM, et al. Interventions for preventing intensive care unit delirium in adults. Cochrane Database of Syst Rev. 2018; 11(11). https://doi.org/10.1002/14651858.CD009783.pub2
Henao-Castaño ÁM, Amaya-Rey MCDP. Nursing and Patients with Delirium: a Literature Review. Invest Educ Enferm. 2014;32 (1):148–56. http://www.scielo.org.co/scielo.php?script=sci_abstract&pid=S0120-53072014000100017
Gusmao-flores D, Salluh J, Dal-pizzol F, Ritter C, Tomasi CD , Dantas de Lima MAS, et al. The validity and reliability of the Portuguese versions of three tools used to diagnose delirium in critically ill patients. Clinical Science. 2011; 66(11): 1917–22. https://www.scielo.br/j/clin/a/4pWRH5gvkf6ChQNWx7DhFFJ/?lang=en#
Sampaio FMC, da Cruz Sequeira CA. Tradução e validação do Confusion Assessment Method para a população portuguesa. Rev Enferm Ref. 2013; (9): 125–34. https://doi.org/10.12707/riii12127
Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018;46(9):E825. https://doi.org/10.1097/CCM.0000000000003299
Ănima Educação. Manual Revisão Bibliográgica Sistemática Integrativa: a pesquisa baseada nas evidências. Grupo Ănim. Belo Horizonte. 2014. http://biblioteca.cofen.gov.br/wp-content/uploads/2019/06/manual_revisao_bibliografica-sistematica-integrativa.pdf
The Joanna Briggs Institut. Checklist for Diagnostic Test Accuracy Studies. The University of Adelaide. 2017. https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Systematic_Reviews2017_0.pdf
Oliveira CG, Nobre C, Marques R, Sousa P, Madureira M. “The nurse's role in preventing delirium in critically ill adult/elderly patients”. Mendeley Data. 2022. https://doi.org/10.17632/bvf34f32t9.1
Rivosecchi RM, Kane-Gill SL, Svec S, Campbell S, Smithburger PL. The implementation of a nonpharmacologic protocol to prevent intensive care delirium. J Crit Care. 2016;31(1): 206-11. https://doi.org/10.1016/j.jcrc.2015.09.031
Moon K-J, Lee S-M. The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial. Int J Nurs Stud. 2015; 52(9):1423-32.https://doi.org/10.1016/j.ijnurstu.2015.04.021
de Barros MAA, de Oliveira Figueirêdo DST, Melo Fernandes M das G, Ramalho Neto JM, de Freitas Macêdo-Costa KN. Delirium in the elderly in intensive care units: an integrative literature review. Journal of Res: Fundam Care Online. 2015; 7(3): 2738-48. https://doi.org/10.9789/2175-5361.2015.v7i3.2738-2748
Bounds M, Harte S, Kram S, Speroni KG, Brice K, Luschindki MA, et al. Effect of ABCDE bundle implementation on prevalence of delirium in intensive care unit patients. Am J Crit Care. 2016;25(6)535-44. https://doi.org/10.4037/ajcc2016209
Gòmez Tovar LO , Dìaz Suarez L, Cortès Muñoz F. Evidence -and Betty Neuman’s model- based nursing care to prevent delirium in the intensive care unit. Enfermería Global. 2016;l5(41):64-77. http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=112423414&site=eds-live
Birge AO, Aydin HT. The effect of nonpharmacological training on delirium identification and intervention strategies of intensive care nurses. Intensive Crit Care Nurs. 2017; 41:33-42.https://doi.org/10.1016/j.iccn.2016.08.009
Martinez F, Donoso AM, Marquez C, Labarca E. Implementing a Multicomponent Intervention to Prevent Delirium Among Critically Ill Patients. Crit Care Nurse. 2017; 37(6):36-46. https://doi.org/10.4037/ccn2017531
Munro CL, Cairns P, Ji M, Calero K, Anderson W, Liang Z. Delirium prevention in critically ill adults through an automated reorientation intervention – A pilot randomized controlled trial. Hear Lung J Acute Crit Care. 2017;46 (4):234-8. https://doi.org/10.1016/j.hrtlng.2017.05.002
DiSabatino Smith C, Grami P. Feasibility and effectiness of a delirium prevention bundle in critically ill patients. Am J Crit CARE. 2017;26 (1):19-27. https://doi.org/10.4037/ajcc2017374
Johnson K, Fleury J, McClain D. Music intervention to prevent delirium among older patients admitted to a trauma intensive care unit and a trauma orthopaedic unit. Intensive Crit Care Nurs. 2018; 47:7-14. https://doi.org/10.1016/j.iccn.2018.03.007
Hamzehpour H, Valiee S, Azad Majedi M, Roshani D, Seidi J. The Effect of Care Plan Based on Roy Adaptation Model on the Incidence and Severity of Delirium in Intensive Care Unit Patients: A Randomised Controlled Trial. J Clin Diagnostic Res. 2018; 12(11): 21-5. https://doi.org/10.7860/JCDR/2018/36366.12256
Kang J, Lee M, Ko H, Kim S, Yun S, Jeong Y, et al. Effect of nonpharmacological interventions for the prevention of delirium in the intensive care unit: A systematic review and meta-analysis. J Crit Care. 2018; 48: 372-84. . https://doi.org/10.1016/j.jcrc.2018.09.032
The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’ Manual:2014. Austrália. Universidade de Adelaide. 2014. https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Economic.pdf
Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, et al. Oxford Centre for Evidence-Based Medicine-Levels of Evidence. 2011;1. p. 5653.http://www.cebm.net/index.aspx?o=5653%0A*
Rivosecchi R, Smithburger P, Svec S, Campbell S, Kane-Gill SL. Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review. Crit Care Nurse. 2015;35(1):39-51. https://doi.org/10.4037/ccn2015423
Park SY, Lee HB. Prevention and management of delirium in critically Ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines. Acute Crit Care. 2019;34(2):117-25. https://doaj.org/article/df30bc9e02d34fe59833e11daf9510ea
Pereira JM, Dos Reis Barradas FJ, Caetano Sequeira RM, Pinto Marques MCM, Batista MJ, Galhardas M, et al. Delirium no paciente crítico: fatores de risco modificáveis pelos enfermeiros. Rev Enferm Ref. 2016;(9): 29-36. https://doi.org/10.12707/riv16006
Barnes-daly M, Phillips G, Ely E. Improving Hospital Survival and RedUTIng Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients*. Crit Care Medicine. 2017;45(2):171-8.https://doi.org/10.1097/CCM.0000000000002149
Wassenaar A, Rood P, Schoonhoven L, Teerenstra S, Zegers M, Pickkers P, et al. The impact of nUrsiNg Delirium Preventive INnterventions in the Intensive Care Unit (UNDERPIN-ICU): A study protocol for a multi-centre, stepped wedge randomized controlled trial. Int J Nurs Stud. 2017;68:1-8. https://doi.org/10.1016/j.ijnurstu.2016.11.018
Alves AIG, Rabiais ICM, Nascimento MMA. Promoting Interventions Of Sleep And Comfort In Intensive United Care Patients. Int J Nurs. 2015;2(2):94-103. https://doi.org/10.15640/ijn.v2n2a11
Van de Pol I, Van Iterson M, Maaskant J. Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series analysis. Intensive Crit Care Nurs. 2017;41:18-25. https://doi.org/10.1016/j.iccn.2017.01.008
Van Rompaey, B., Elseviers, M.M., Van Drom, W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception : a randomized controlled trial in intensive care patients. Crit Care. 2012;16(3). https://doi.org/10.1186/cc11330
Pan Y, Jiang Z, Yuan C, Wang L, Zhang J, Tao M, et al. Influence of physical restraint on delirium of adult patients in ICU : A nested case – control study. Journal of Clinical Nursing. 2018;27(9-10):1950-7. https://doi.org/10.1111/jocn.14334
Smithburger PL, Korenoski AS, Kane-Gill SL, Alexander SA. Perceptions of family members, nurses, and physicians on involving patients’ families in delirium prevention. Crit Care Nurse. 2017;37(6):48-58. https://doi.org/10.4037/ccn2017901
Published
How to Cite
Issue
Section
Categories
Altmetrics
Downloads
License
Journal Cuidarte, scientific publication of open access, is licensed under a Creative Commons Attribution (CC BY-NC), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Any other form of use such as reproduction, transformation, public communication or distribution, for profit, requires the prior authorization of the University of Santander UDES.
The names and e-mail addresses entered in the Journal Cuidarte will be used exclusively for the purposes stated by this magazine and will not be available for any other purpose or other person.
The articles published in the Journal Cuidarte represent the criteria of their authors and do not necessarily constitute the official opinion of the University of Santander UDES.
