Delirium assessment in adult intensive care units: do nursing practices hinder or help?

• Main Author: Kandindi, Kamanda
• Format: Others
• Language: en
• Published: 2018
• Online Access: https://hdl.handle.net/10539/25445

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing. Johannesburg, 2018. === Background: Delirium is a well-recognised and severe problem in adult intensive care units. With a reported incidence as high as 80%, it has been associated with increased length of stay, higher costs of care, on-going cognitive impairment and increased mortality. International best practice guidelines recommend nurses perform frequent delirium assessments using validated screening tools for all intensive care patients. Lack of data exists in the South African context regarding nurses’ current sedation and delirium practices and their perceptions towards delirium assessments. Setting: The settings for the study were five adult intensive care units (ICUs) at one academic hospital in Johannesburg. These intensive care units were: trauma ICU, cardiothoracic ICU, coronary care, neurosurgical ICU and General ICU. Purpose: The purpose of this study was to determine nursing practices regarding delirium assessments in the adult intensive care units of an academic hospital in Johannesburg, to make recommendations for clinical practice and education. Design: A quantitative-descriptive and cross-sectional design was utilised in this study. The total sample (n = 105) of registered nurses from the adult intensive care units (n = 5) between the period of 1.08.2017 to 1.09.2017 was used. Non-probability convenience sampling was utilised and data were collected using a questionnaire developed by (Devlin et al., 2008). Results: Overall 100 (n = 100) nurses responded, which yielded a response rate of 95.2% for the study. Delirium assessment was less frequent than sedation assessment (20% vs. 51%; p<0.001). Only 21%, ranked delirium as the most important condition to evaluate, compared with the altered level of consciousness (41%), improper placement of invasive lines (18%) and presence of pain (16%). Preferred methods for assessing delirium included assessing the ability to follow commands (51%), checking for agitation-related situations (41%), the Confusion Assessment Method for the Intensive Care Unit (24%), the Intensive Care Delirium Checklist (15%) and psychiatric consultation (12%). The barrier to assessment included intubation (57%), sedation level (21%) and lack of confidence to use delirium assessment tools (22%).The majority of participants never received an education (56%) or attended a lecture (19%) on delirium. Conclusion: These findings provide further evidence of a theory-practice gap that is likely to exist in South Africa where best practice guidelines in the management of delirium in the ICU settings are not implemented. Recommendations are made for clinical practice and education of intensive care nurses. Key words: delirium assessment, CAM-ICU, intensive care unit, intensive care nurse === LG2018