Synthesis of Intensive Care Nurses' Experiences of Caring for Patients With Delirium

2020 ◽  
Vol 14 (2) ◽  
pp. 55-77
Author(s):  
Zhihua Yang ◽  
Edith Pituskin ◽  
Colleen Norris ◽  
Elizabeth Papathanassoglou
Keyword(s):  
Intensive Care ◽  
Early Mobilization ◽  
Human Interaction ◽  
Screening Tools ◽  
Process Of Care ◽  
Physical Restraints ◽  
Nursing Assessment ◽  
Holistic Nursing ◽  
Intensive Care Nurses ◽  
Delirium Prevention

BackgroundThere is a paucity of studies synthesizing intensive care nurses' experiences of taking care of patients with delirium. A better understanding of nurses' experiences provides an opportunity to identify areas that can be strengthened to improve care.AimTo gain insight into intensive care nurses' experiences of caring for patients with delirium through summarizing the existing qualitative studies in the area.MethodsDatabases of Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL) Plus, PubMed, and ProQuest Dissertations & Theses Global were searched for qualitative or mixed-method primary research studies, resulting in 269 records screened for eligibility. A three-stage thematic synthesis was followed.FindingsNine studies were included in the review. Twelve descriptive themes emerged outlining critical care nurses' experiences in the four aspects of delirium care. For prevention, the common nursing themes were using holistic nursing care to promote nighttime sleep, orientate patients through human interaction, and promote early mobilization. Intensive care nurses' experience of delirium assessment included their perceived utility of screening, their understanding of using a screening tool, and their impression of integrating nursing assessment. In terms of treatment, nurses' experience focused on pharmacological and nonpharmacological methods, as well as their attitude toward the use of physical restraints and chemical sedation. Nurses' overall experience of caring for patients with delirium in intensive care units includedemotional exhaustion, physical fatigue, and the perceived low priority and inconsistency of delirium management.ConclusionsIntensive care nurses' complex experiences of caring for patients with delirium revolved around delirium prevention, assessment, treatment, and the overall process of care. Implications for practice include: multicomponent delirium prevention strategies, integrating the use of screening tools and nursing assessment for delirium detection, focusing on nonpharmacological interventions, and offering on-job support to nurses who care for delirious patients.

Practice Patterns and Opinions on Current Clinical Practice Guidelines Regarding the Management of Delirium in the Intensive Care Unit

2016 ◽  
Vol 30 (2) ◽  
pp. 162-171 ◽  
Author(s):  
Yoonsun Mo ◽  
Anthony E. Zimmermann ◽  
Michael C. Thomas
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Large Scale ◽  
Online Survey ◽  
Early Mobilization ◽  
Screening Tools ◽  
Delirium Management ◽  
New Guidelines ◽  
Pharmacologic Agents

Objective: The aim of this study was to determine current delirium practices in the intensive care unit (ICU) setting and evaluate awareness and adoption of the 2013 Pain, Agitation, and Delirium (PAD) guidelines with emphasis on delirium management. Design, Setting, and Participants: A large-scale, multidisciplinary, online survey was administered to physician, pharmacist, nurse, and mid-level practitioner members of the Society of Critical Care Medicine (SCCM) between September 2014 and October 2014. A total of 635 respondents completed the survey. Measurements and Main Results: Nonpharmacologic interventions such as early mobilization were used in most ICUs (83%) for prevention of delirium. A majority of respondents (97%) reported using pharmacologic agents to treat hyperactive delirium. Ninety percent of the respondents answered that they were aware of the 2013 PAD guidelines, and 75% of respondents felt that their delirium practices have been changed as a result of the new guidelines. In addition, logistic regression analysis of this study showed that respondents who use delirium screening tools were twice more likely to be fully aware of key components of the updated guidelines (odds ratio [OR] = 2.07, 95% confidence interval [CI] = 1.20-3.60). Conclusions: Most critical care practitioners are fully aware and knowledgeable of key recommendations in the new guidelines and have changed their delirium practices accordingly.

Intensive Care Unit Delirium

2013 ◽  
Vol 27 (2) ◽  
pp. 195-207 ◽  
Author(s):  
Julie Kalabalik ◽  
Luigi Brunetti ◽  
Radwa El-Srougy
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Mobilization ◽  
Patient Characteristics ◽  
Screening Tools ◽  
Clinical Complications ◽  
Icu Delirium

Purpose: The recent literature regarding intensive care unit (ICU) delirium and updated clinical practice guidelines are reviewed. Summary: Recent studies show that ICU delirium in critically ill patients is an independent predictor of higher mortality, longer ICU and hospital stay, and is associated with multiple clinical complications. Delirium has been reported to occur in greater than 80% of hospitalized critically ill patients, yet it remains an underdiagnosed condition. Several subtypes of delirium have been identified including hypoactive, hyperactive, and mixed presentation. Although the exact mechanism is unknown, several factors are thought to interact to cause delirium. Multiple risk factors related to medications, acute illness, the environment, and patient characteristics may contribute to the development of delirium. Practical bedside screening tools have been validated and are recommended to identify ICU patients with delirium. Nonpharmacologic interventions such as early mobilization have resulted in better functional outcomes, decreased incidence and duration of delirium, and more ventilator-free days. Data supporting pharmacologic treatments are limited. Conclusion: Clinicians should become familiar with tools to identify delirium in order to initiate treatment and remove mitigating factors early in hospitalization to prevent delirium. Pharmacists are in a unique position to reduce delirium through minimization of medication-related risk factors and development of protocols.

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

2017 ◽  
Vol 26 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Claudia DiSabatino Smith ◽  
Petra Grami
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Early Mobilization ◽  
Sensory Stimulation ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Surgical Intensive Care ◽  
Delirium Prevention

BackgroundStrategies for preventing delirium include early identification and avoiding or modifying patient, environmental, and iatrogenic factors. Minimal research exists on a prescriptive delirium prevention bundle that details elements or strategies for each bundle component. Even less research has been focused on nurse-driven interventions or components.ObjectiveTo evaluate the effectiveness of a delirium prevention bundle in decreasing delirium incidence in 2 medical-surgical intensive care units in a large Texas medical center.MethodsResearchers used the Confusion Assessment Method for the Intensive Care Unit to assess delirium incidence by using a controlled interventional cohort design with 447 delirium-negative critically ill patients. Bundle components consist of sedation cessation, pain management, sensory stimulation, early mobilization, and sleep promotion.ResultsThe intervention, analyzed by using a logistic regression model, reduced the odds of delirium by 78% (odds ratio, 0.22; P = .001).ConclusionsThe delirium prevention bundle was effective in reducing the incidence of delirium in critically ill medical-surgical patients. Further validation studies are under way.

scholarly journals Antipsychotic Drug Use and Screening for Delirium in Mechanically Ventilated Patients in Canadian Intensive Care Units: An Observational Study

2016 ◽  
Vol 69 (2) ◽  
Author(s):  
Zoé Thiboutot ◽  
Marc M Perreault ◽  
David R Williamson ◽  
Louise Rose ◽  
Sangeeta Mehta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Antipsychotic Drugs ◽  
Screening Tools ◽  
Ventilation Mécanique ◽  
Physical Restraints ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Daily Interruption ◽  
Ventilated Patients

<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Critically ill patients frequently experience delirium, and antipsychotic drugs are often used to manage symptoms.</p><p><strong>Objectives: </strong>To describe the use of antipsychotic drugs and delirium screening tools in mechanically ventilated, critically ill adult patients in Canadian intensive care units (ICUs) and to identify factors associated with the use of antipsychotic drugs.</p><p><strong>Methods: </strong>Pharmacists from 51 Canadian ICUs prospectively collected data on antipsychotic use and delirium screening in all patients for whom invasive mechanical ventilation was initiated during a chosen 2-week period occurring sometime in 2008 or 2009.</p><p><strong>Results: </strong>Data were collected for a total of 712 patients, of whom 115 (16.2%) received at least one dose of an antipsychotic. The antipsychotic prescribed, the total daily dose, and the administration schedule varied across sites. Delirium screening tools, validated for use in mechanically ventilated patients and endorsed by professional society guidelines, were part of routine care in a minority of ICUs (7/51 [13.7%]), and delirium screening was documented for few patients overall (41/712 patients [5.8%]). In a multivariable analysis, administration of antipsychotics was independently associated with longer duration of mechanical ventilation (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.07–1.17), daily interruption of sedation (OR 1.71, 95% CI 1.01–2.90), and use of physical restraints (OR 2.15, 95% CI 1.27–3.65).</p><p><strong>Conclusion: </strong>A minority of mechanically ventilated patients in Canadian ICUs received antipsychotic drugs, and screening for delirium with validated tools was rare. Antipsychotic drug use was independently associated with longer duration of mechanical ventilation, daily interruption of sedation, and use of physical restraints.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Les patients gravement malades souffrent fréquemment de délire, une affection dont les symptômes sont souvent traités à l’aide d’antipsychotiques.</p><p><strong>Objectifs : </strong>Dresser le portrait de l’utilisation des antipsychotiques et des outils de dépistage du délire chez les patients adultes gravement malades sous ventilation mécanique ayant séjourné dans une unité de soins intensifs (USI) canadienne et relever les facteurs associés à l’utilisation des antipsychotiques.</p><p><strong>Méthodes : </strong>Des pharmaciens de 51 USI canadiennes ont recueilli des données de façon prospective sur l’utilisation des antipsychotiques et sur le dépistage de cas de délire auprès de tous les patients placés sous ventilation mécanique effractive au cours d’une période de deux semaines entre 2008 et 2009.</p><p><strong>Résultats : </strong>Les données ont été recueillies chez un total de 712 patients. De ce nombre, 115 (16,2 %) ont reçu au moins une dose d’un antipsychotique. L’antipsychotique prescrit, la posologie quotidienne et l’horaire d’administration variaient d’un établissement à l’autre. Des outils de dépistage du délire (dont l’emploi est validé chez les patients sous ventilation mécanique et approuvé dans les lignes directrices d’associations professionnelles) ne faisaient partie des soins habituels que dans un petit nombre d’USI (7/51 [13,7 %]). De plus, les dépistages du délire n’ont été consignés que pour peu de patients dans l’ensemble (41/712 patients [5,8 %]). Au cours d’une analyse multivariable, on a associé indépendamment l’administration d’antipsychotiques à une durée accrue de la ventilation mécanique (risque relatif approché [RRA] de 1,12, intervalle de confiance [IC] à 95 % de 1,07–1,17), à une interruption quotidienne de la sédation (RRA de 1,71, IC à 95 % de 1,01–2,90) et à l’emploi de contention physique (RRA de 2,15, IC à 95 % de 1,27–3,65).</p><p><strong>Conclusions : </strong>Seul un petit nombre de patients sous ventilation mécanique ayant séjourné dans une USI canadienne ont reçu des antipsychotiques; de plus, des outils validés de dépistage du délire n’ont que rarement été employés. L’utilisation d’antipsychotiques a été indépendamment associée à une durée accrue de la ventilation mécanique, à l’interruption quotidienne de la sédation et à l’emploi de contention physique.</p>

A Comprehensive Model for Medical Information Processing

1983 ◽  
Vol 22 (03) ◽  
pp. 124-130 ◽  
Author(s):  
J. H. Bemmel
Keyword(s):  
Intensive Care ◽  
Information Processing ◽  
Medical Information ◽  
Computer Applications ◽  
Human Interaction ◽  
Comprehensive Model ◽  
Computers In Medicine ◽  
Medical Information Systems ◽  
Research And Education ◽  
The Many

At first sight, the many applications of computers in medicine—from payroll and registration systems to computerized tomography, intensive care and diagnostics—do make a rather chaotic impression. The purpose of this article is to propose a scheme or working model for putting medical information systems in order. The model comprises six »levels of complexity«, running parallel to dependence on human interaction. Several examples are treated to illustrate the scheme. The reason why certain computer applications are more frequently used than others is analyzed. It has to be strongly considered that the differences in complexity and dependence on human involvement are not accidental but fundamental. This has consequences for research and education which are also discussed.

Exercise as early mobilization in patients using vasoactive drugs

2020 ◽  
Vol 19 (4) ◽  
pp. 301
Author(s):  
Amanda Mariano Morais ◽  
Daiane Naiara Da Penha ◽  
Danila Gonçalves Costa ◽  
Vanessa Beatriz Aparecida Fontes Schweling ◽  
Jaqueline Aparecida Almeida Spadari ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cardiovascular Response ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Scientific Basis ◽  
Routine Practice ◽  
Vasoactive Drugs ◽  
Early Ambulation ◽  
Early Mobility ◽  
The Face

Introduction: The functional benefits of Early Mobilization (EM) capable of minimizing limitations and deformities in the face of immobility are clear, but there are many barriers to conduct EM as a routine practice in the Intensive Care Unit (ICU), including the use of vasoactive drugs (VAD), since it is directly related to weakness acquired in the ICU, in addition to the resistance of the multidisciplinary team to mobilize the patient using VAD. Objective: The objective of this literature review is to raise a scientific basis in the management of critically ill patients using DVAs for EM in the ICU. Methods: It is an integrative review of the literature, with research in the databases: PEDro, Pubmed, Lilacs, with articles published between 2011 and 2018, in Portuguese and English, using the terms: vasoactive drugs, early mobility, exercise in UCI, vasopressor and its equivalents in Portuguese. Results: Nine studies were included that analyzed the EM intervention in patients using VAD, with or without ventilatory support. There was no homogeneous treatment among the researched works, varying between exercises in bed and outside, with passive and / or active action. However, regardless of the conduct, there was an improvement in the cardiovascular response without relevant changes regarding the use of VAD. Conclusion: EM is not contraindicated for patients in the ICU with the use of VAD, and it was shown to be effective and safe without promoting relevant hemodynamic and cardiorespiratory changes, which would determine its absolute contraindication.Keywords: vasodilator agents, early ambulation, intensive care units, physical therapy specialty.

Exercise in intensive care units, safety and hemodynamic monitoring

2020 ◽  
Vol 19 (1) ◽  
pp. 3
Author(s):  
Giulliano Gardenghi
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Hemodynamic Monitoring ◽  
Artificial Respiration ◽  
Exercise Physiology ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Cycle Ergometer ◽  
Search Terms

Introduction: Patients in the intensive care unit (ICU) have several deleterious effects of immobilization, including weakness acquired in the ICU. Exercise appears as an alternative for early mobilization in these patients. Objective: This work aims to highlight the hemodynamic repercussions and the applicability of exercise in the ICU. Methods: An integrative literature review was carried out, with articles published between 2010 and 2018, in the Lilacs, PubMed and Scielo databases, using the following search terms: exercise, cycle ergometer, intensive care units, early mobilization, mechanical ventilation, artificial respiration. Results: 13 articles were included, addressing hemodynamic monitoring and the role of exercise as early mobilization, with or without ventilatory support. The exercise sessions were feasible and safe within the ICU environment. Conclusion: Physical exercise can be performed safely in an ICU environment, if respecting a series of criteria such as those presented here. It is important that the assistant professional seeks to prescribe interventions based on Exercise Physiology that can positively intervene in the functional prognosis in critically ill patients.Keywords: exercise, intensive care units, patient safety.

Early mobilization in intensive care for patients with brain injury: e-Survey of current practices in France

2021 ◽  
Author(s):  
François Feuvrier ◽  
Claire Jourdan ◽  
Olivier Barber ◽  
Margrit Ascher ◽  
Karolina Griffiths ◽  
...  
Keyword(s):  
Intensive Care ◽  
Brain Injury ◽  
Early Mobilization ◽  
Current Practices
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