Nurses’ Practices and Perception of Delirium in the Intensive Care Units of a Selected University Hospitals in Egypt

Abstract

Delirium is a common but frequently undetected complication in hospitalized critically ill patients leading to poor outcomes, prolonged hospital stays, and increased costs of care. Therefore, because of their daily contact with critically ill patients, critical care nurses are at the frontline of patients’ care and are in a unique position to improve their outcomes through timely identification of individuals at risk, early detection of signs and symptoms of delirium, and providing the needed intervention. Aim of the study: to assess critical care nurses’ practices and perception of delirium among critically ill patients in different critical care settings. Research Design: A descriptive exploratory research design was utilized in this study. Research questions: To achieve the aim of the present study, the following two research questions were formulated: 1-What is the current nurses’ practice of delirium assessment in the critical care units? 2- How critical care nurses perceive delirium among critically ill patients?. Setting: The study was carried out at different Critical Care Departments at Cairo University Hospitals, in Egypt. Sample: A sample of convenience including all nurses (120) working at different critical care departments was included in the current study. Tools of data collection: Two tools were used to collect data pertinent to the current study: Socio demographic data sheet (covers data such as gender, age, years of experience, attended staff development courses, working hours, etc……);  and Nursing practices and perceptions assessment sheet: was adopted from Devlin, et al., (2008). It covers data related to frequency of evaluating patients for level of sedation and presence of delirium; presence of delirium; frequency of using delirium assessment sheet; received education regarding ICU sedation assessment and ICU delirium assessment, and statements that pertain to delirium in the ICU. Results: the current study revealed that inspite of having many years of experience in working with critically ill patients, all ICU nurses (100%) ranked delirium assessment as the fourth priority after level of conscious, pain assessment, handling agitation, and caring for devices. More than half of the studied nurses (54.2%) never assessed delirium, and 100% of nurses never received training about assessing and handling delirium. Conclusion: delirium is an under diagnosed problem in the ICU; it is a common response to the ICU environment. It is challenging to be assessed among critically ill patients and represents a problem that requires active intervention on the part of caregivers. Recommendations: Incorporating cognitive assessment in general, and delirium assessment in particular into nursing education courses; Integration of delirium assessment and management into daily nursing care of critically ill patients, and training critical care nurses about early recognition of delirium among critically ill patients

Key wards: delirium, delirium assessment & nurses' perception and practices.