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

Abstract

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.

Delirium Care by Intensive Care Unit Nurses

“…In addition, the nurses reported themselves as having been attacked by patients with delirium. Thus, they all agreed that restraining patients with delirium can be necessary, which was comparable to the results of the study by Yang et al 13 synthesizing nursing experiences of ICU delirium care that the decision to restrain or undo restraints might lie on ICU nurses because they observe and interact with patients most closely. However, the ICU nurses reported that this decision is not governed by standardized rules and is based on clinical observation and judgment, similar to the findings of Song and Wu.…”

“…Furthermore, Song and Wu 12 systematically reviewed qualitative studies on the experience of Chinese ICU nurses in managing patients with delirium and reported that nurses experienced a mix of positive and negative experiences and that the nurses indicated the nonpharmacological approaches to be prioritized as the positive experiences, rather than the nurses indicating that management measures were difficult to implement; specifically, delirium management plans and practices in ICUs lack standardization and systematization as the negative experiences. Finally, Yang et al 13 conducted the synthesis of different systems for nursing care experiences of ICU delirium patients by 3-stage thematic process from 269 qualitative records; regarding prevention of delirium, reorientation by interacting with patients, improving night sleeping, and early mobilization were included, whereas physical restraints and medical sedation were often used by ICU nurses.…”

Does improving sleep for the critically ill reduce the incidence and duration of delirium? An evidence‐based review

“…Furthermore, nurses recognize that their efforts to promote night-time sleep appears to prevent delirium. 4 This theory has biological plausibility and provide clinical evidence. For example, sleep disturbance due to increased sleep pressure often results in features of hypoactive delirium, such as daytime somnolence, which is characterized by inattention and altered mood and circadian rhythm.…”

“…Anecdotally, critical care nurses maintain that patients with disrupted sleep appear to be more likely to develop delirium. Furthermore, nurses recognize that their efforts to promote night‐time sleep appears to prevent delirium 4 . This theory has biological plausibility and provide clinical evidence.…”