Introduction: Delirium is a fluctuating cognitive disorder that occurs in admitted patients, especially in patients who are in intensive care units. Nurses due to persistent contact with patients and direct observation of their mental changes play an essential role in delirium evaluation. Early detection of delirium, identification of risk factors, and its prevention methods are critical to reducing complications, mortality, and treatment costs. This study aimed to determine the perception and the practices of nurses in intensive care units to assess delirium and its barriers. Study design: A cross-sectional study. Materials and methods: All nurses working in the intensive care unit (neurology, trauma, surgery, general, and heart) of educational hospitals in Kerman, Iran, were the study population. The data gathering tool was a questionnaire consisting of four sections: demographic information, nurses’ perception, practices, and perceived barriers in delirium assessment. Results: The total score of nurses’ perception in delirium assessment was 19.47 ± 3.36, which was higher than the medium score of the questionnaire (estimated score = 16). In all, 45.5% of nurses reported having delirium treatment protocol in their units, and 12.1% of the nurses considered delirium as a priority of evaluating the patient\'s condition. The most important barrier to delirium assessment was the difficulty of assessing delirium in intubated patients. There was no association between nurses’ perception and practices (p value > 0.05). Conclusion: Designing and implementing educational programs for improving nurses’ practices in this field is necessary. Clinical significance: Healthcare providers, especially nurses, should be aware of the delirium assessment of the ICU patients to provide better care.
Elliott SR. ICU delirium: a survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit. Intensive Crit Care Nursing 2014;30(6):333–338. DOI: 10.1016/j.iccn.2014.06.004.
Demir Korkmaz F, Gok F, Yavuz Karamanoglu A. Cardiovascular surgery nurses’ level of knowledge regarding delirium. Nurs Crit Care 2015;21(5):279–286. DOI: 10.1111/nicc.12184.
Flaigle MC, Ascenzi J, Kudchadkar SR. Identifying barriers to delirium screening and prevention in the pediatric ICU: evaluation of PICU staff knowledge. J Pediatr Nurs 2016;31(1):81–84. DOI: 10.1016/j.pedn.2015.07.009.
Middle B, Miklancie M. Strategies to improve nurse knowledge of delirium: a call to the adult-gerontology clinical nurse specialist. Clin Nur Special 2015;29(4):218–229. DOI: 10.1097/NUR.0000000000000138.
Ribeiro SCL, Nascimento ERPD, Lazzari DD, Jung W, Boes AA, Bertoncello KC. Knowledge of nurses about delirium in critical patients: collective subject discourse. Texto Cont-Enfermag 2015;24(2):513–520. DOI: 10.1590/0104-07072015001702014.
Piao J, Jin Y, Lee SM. Triggers and Nursing influences on delirium in intensive care units. Nurs Crit Care 2018;23(1):8–15. DOI: 10.1111/nicc.12250.
Jannati Y, Bagheri M, Sohrabi M, Yazdani J, Mazdarani S. Incidence of delirium and associated factors before open heart surgery. J Res Develop Nurs Midwif 2013;10(1):33–42.
Trogrlić Z, Ista E, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, et al. Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals. Nurs Crit Care 2017;22(3):133–140. DOI: 10.1111/nicc.12239.
Zamoscik K, Godbold R, Freeman P. Intensive care nurses’ experiences and perceptions of delirium and delirium care. Intensive Crit Care Nursing 2017;40:94–100. DOI: 10.1016/j.iccn.2017.01.003.
Devlin JW, Fong JJ, Howard EP, Skrobik Y, McCoy N, Yasuda C, et al. Assessment of delirium in the intensive care unit: nursing practices and perceptions. Am J Crit Care 2008;17(6):555–565. DOI: 10.4037/ajcc2008.17.6.555.
Kang Y, Moyle W, Cooke M, O'Dwyer ST. An educational programme to improve acute care nurses’ knowledge, attitudes and family caregiver involvement in care of people with cognitive impairment. Scand J Caring Sci 2016;31(3):631–640. DOI: 10.1111/scs.12377.
Law TJ, Leistikow NA, Hoofring L, Krumm S, Neufeld K, Needham D. A survey of nurses’ perceptions of the intensive care delirium screening checklist. Dynamics 2012;23(4):18–24.
Jung J-H, Lim J-H, Kim E-J, An H-C, Kang M-K, Lee J, et al. The experience of delirium care and clinical feasibility of the CAM-ICU in a Korean ICU. Clin Nurs Res 2013;22(1):95–111. DOI: 10.1177/1054773812447187.
Nishimura K, Yokoyama K, Yamauchi N, Koizumi M, Harasawa N, Yasuda T, et al. Sensitivity and specificity of the confusion assessment method for the intensive care unit (CAM-ICU) and the intensive care delirium screening checklist (ICDSC) for detecting post-cardiac surgery delirium: a single-center study in Japan. Heart Lung 2016;45(1):15–20. DOI: 10.1016/j.hrtlng.2015.11.001.
Luetz A, Heymann A, Radtke FM, Chenitir C, Neuhaus U, Nachtigall I, et al. Different assessment tools for intensive care unit delirium: which score to use? Crit Care Med 2010;38(2):409–418. DOI: 10.1097/CCM.0b013e3181cabb42.
Svenningsen H. A shared language regarding sedation and delirium in critically ill patients. Nurs Crit Care 2015;20(4):204–209. DOI: 10.1111/nicc.12187.
Scott P, McIlveney F, Mallice M. Implementation of a validated delirium assessment tool in critically ill adults. Intensive Crit Care Nursing 2013;29(2):96–102. DOI: 10.1016/j.iccn.2012.09.001.
van Eijk MMJ, van Marum RJ, Klijn IAM, de Wit N, Kesecioglu J, Slooter AJC. Comparison of delirium assessment tools in a mixed intensive care unit. Crit Care Med 2009;37(6):1881–1885. DOI: 10.1097/CCM.0b013e3181a00118.
Tomasi CD, Grandi C, Salluh J, Soares M, Giombelli VR, Cascaes S, et al. Comparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes. J Crit Care 2012;27(2):212–217. DOI: 10.1016/j.jcrc.2011.05.015.
van de Steeg L, IJkema R, Wagner C, Langelaan M. The effect of an e-learning course on nursing staff's knowledge of delirium: a before-and-after study. BMC Med Educ 2015;15(1):1. DOI: 10.1186/s12909-015-0289-2.
Rowley-Conwy G. Barriers to delirium assessment in the intensive care unit: A literature review. Intensive Crit Care Nurs 2018;44:99–104. DOI: 10.1016/j.iccn.2017.09.001.
Özsaban A, Acaroglu R. Delirium assessment in intensive care units: practices and perceptions of Turkish nurses. Nurs Crit Care 2016;21(5):271–278. DOI: 10.1111/nicc.12127.
Glynn L, Corry M. Intensive care nurses’ opinions and current practice in relation to delirium in the intensive care setting. Intensive Crit Care Nurs 2015;31(5):269–275. DOI: 10.1016/j.iccn.2015.05.001.
Ely EW, Stephens RK, Jackson JC, Thomason JWW, Truman B, Gordon S, et al. Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med 2004;32(1):106–112. DOI: 10.1097/01.CCM.0000098033.94737.84.
Nydahl P, Dewes M, Dubb R, Hermes C, Kaltwasser A, Krotsetis S, et al. Survey among critical care nurses and physicians about delirium management. Nurs Crit Care 2018;23(1):23–29. DOI: 10.1111/nicc.12299.