Medicine and Health Sciences Commons^™

Using The Confusion Assessment Method For The Intensive Care Unit (Cam-Icu) To Decrease Length Of Stay: A Scoping Review, Brooke D. Ward Bsn, Rn, Dnp Agacnp Student, Martina Little Bsn, Rn, Dnp Agacnp Student, Tracy Mcclinton Dnp, Agacnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background

Delirium is a prevalent challenge among ICU patients, impacting approximately 30% of admissions (Brennan et al., 2023). If left untreated, delirium can increase use of restraints, hospital length of stay, intensive care unit length of stay, and ultimately, morbidity and mortality. This scoping review assesses the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to gauge its efficacy in reducing the length of stay in the ICU for adult patients with delirium.

Methods

A literature review from 2018 and 2023, using PubMed, CINAHL, and Medline were utilized for the search along with key words such as: length of …

Promoting Sleep To Decrease Delirium, Stephanie Mayne

MSN Capstone Projects

Delirium is potent risk factor for complications, an increase length of stay, and mortality. Hospital acquired delirium is a prevalent and serious health condition that can occur in patients, especially the older adult population, when admitted to the hospital. It has the ability to be prevented if properly addressed and interventions are set in place to help reduce the occurrence of hospital acquired delirium. Many factors can contribute to the development of delirium, including a disruption of one’s circadian rhythm. Sleep is not always a high priority in the hospital, therefore there are little interventions and goals aimed at improving …

Implementation Of Delirium Bundle On A Hospital Medical/Surgical Unit To Help Decrease The Prevalence Of Delirium, Sanusi Mohammed

Doctor of Nursing Practice Scholarly Projects

Description of the Problem: Delirium is defined as a constellation of symptoms that includes disturbance in attention or awareness, change in cognition, language and perceptual disturbances that develops over a short period of time. Delirium mostly affects adult patients with risk factors including history of dementia, early cognitive impairment, dehydration, and infections. This quality improvement project was implemented on one hospital unit at a large tertiary hospital in the Boston area. This unit has one highest rate of delirium in the entire hospital system. Delirium is associated with high rate of morbidity and mortality. Also, this syndrome leads to longer …

Dnp Final Report: Education Impacting Delirium Knowledge And Recognition, Lynn A. Cox

DNP Final Reports

Background: Delirium is a disturbance of consciousness with an acute onset that varies from hours to days. Patients with delirium have a risk of increased length of stay, increased mortality, morbidity, and long-term cognitive effects. Therefore, the following PICOT question arises: In registered nurses in the acute care setting (P), how does education on use of the CAM (Confusion Assessment Method) tool (I) compared to those units not receiving education (C) affect recognition of delirium (O1) and use of the CAM tool (O2) over 6 weeks? (T)

Purpose: The evidence-based practice project described nurse education and pilot implementation using the …

Sleep Deprivation And Delirium Development In The Icu, Cynthia Howell Msn Fnp-Bc, Stacy Murillo Msn Fnp-Bc, Amy Wilson Msn Fnp-Bc, Tracy Mcclinton Dnp, Ag-Acnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Delirium is an acute syndrome characterized by disturbances in cognition occurring in critically ill patients, particularly those over 65 in the intensive care unit (ICU). Numerous risk factors are associated with delirium development, with sleep being a modifiable factor. This review explores existing literature regarding the relationship between sleep deprivation and delirium development while evaluating the effectiveness of a sleep promotion protocol to decrease the incident of delirium in those ICU patients 65 years or older.

Method A literature review of peer-reviewed studies from PubMed and additional search engines was completed. Articles reviewed were published within the last five …

Stakeholder Perspectives Of A Pilot Multicomponent Delirium Prevention Intervention For Adult Patients With Advanced Cancer In Palliative Care Units: A Behaviour Change Theory-Based Qualitative Study, Anna Green, Annmarie Hosie, Jane L. Phillips, Slavica Kochovska, Beverly Noble, Meg Brassil, Anne Cumming, Peter G. Lawlor, Shirley H. Bush, Jan M. Davis, Layla Edwards, Jane Hunt, Julie Wilcock, Carl Phillipson, Eugene Wesley Ely, Cynthia Parr, Melanie Lovell, Meera Agar

Nursing Papers and Journal Articles

Background: Theory-based and qualitative evaluations in pilot trials of complex clinical interventions help to understand quantitative results, as well as inform the feasibility and design of subsequent effectiveness and implementation trials.

Aim: To explore patient, family, clinician and volunteer (‘stakeholder’) perspectives of the feasibility and acceptability of a multicomponent non-pharmacological delirium prevention intervention for adult patients with advanced cancer in four Australian palliative care units that participated in a phase II trial, the ‘PRESERVE pilot study’.

Design: A trial-embedded qualitative study via semi-structured interviews and directed content analysis using Michie’s Behaviour Change Wheel and the Theoretical Domains Framework.

Setting/participants: Thirty-nine …

Deterring Delirium In The Intensive Care Unit, Kimberly Allen

MSN Capstone Projects

There is growing concern about the increase in cases of delirium associated with a critical care hospitalization encounter. Discovery of different types of research that can eliminate or at least minimize occurrences of delirium including early recognition, eye masks and earplug usage, and environmental changes have show promise in reducing the risk of ICU delirium.

Effect Of Blue Light On Sleep & Delirium In The Intensive Care Unit, Hunter Montgomery

MSN Capstone Projects

Intensive care units (ICU) across the country are plagued with a silent morbidity that increases monetary costs, patient stay, and nursing retention known as delirium. Delirium can drive up all three of these factors creating an unnecessary burden on hospital and community resources. In response to the silent crisis, a delirium prevention bundle was created to alleviate the burdens that ICU delirium can put on a hospital.

Reviewing implementation strategies showed that employees needed extensive training on recognizing the different types of delirium including hyperactive, mixed, and hypoactive delirium. It was determined that for the delirium bundle to be successful …

Earplugs For Intensive Care Unit Delirium Prevention: Impact Of An Evidence-Based Intervention On Patient Outcomes, Morgan P. Click

MSN Capstone Projects

Delirium is characterized by the abrupt onset of significant confusion that may cause the patient to become agitated, aggressive, unable to focus, and sometimes hallucinate. Intensive care unit (ICU) delirium is a large area of focus for current research to help understand the causes, preventative measures, and potential treatments. This problem isn’t only faced in the hospital setting, but can affect patients long after discharge. The PICOT question guiding this benchmark project stated: In adult ICU patients (P), how does the use of earplugs (I) compared to the use of no earplugs (C) affect the patient’s future risk of ICU …

Clinicians' Delirium Treatment Practice, Practice Change, And Influences: A National Online Survey, Annmarie Hosie, Meera Agar, Gideon A. Caplan, Brian Draper, Stephen Hedger, Debra Rowett, Penny Tuffin, Seong Leang Cheah, Jane L. Phillips, Linda Brown, Manraaj Sidhu, David C. Currow

Nursing Papers and Journal Articles

Background: Recent studies cast doubt on the net effect of antipsychotics for delirium.

Aim: To investigate the influence of these studies and other factors on clinicians’ delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework.

Design: Australia-wide online survey of relevant clinicians.

Setting/participants: Registered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals’ organisations.

Results: Most of the sample (n=475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium …

Elearning Module For Nursing Students To Improve Delirium Identification, Prevention, And Management, Shannon Baker

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Delirium is a serious, acute alteration in cognition and consciousness, which is common amongst older hospitalized patients and has an overwhelmingly negative impact on patient outcomes. Under-recognition by healthcare providers poses a barrier and contributes to poor patient outcomes, including increased morbidity and mortality.

Purpose: To reduce the incidence of delirium amongst acutely ill patients via internet-based education for student nurses on delirium prevention, assessment, and management.

Methods: An eLearning intervention consisting of a virtual lecture with an unfolding case study for undergraduate nursing students. This project utilized the Nurses’ Delirium Knowledge Assessment (NDKA) …

A Delirium Prevalence Audit And A Pre And Post Evaluation Of An Interprofessional Education Intervention To Increase Staff Knowledge About Delirium In Older Adults, Bev Ewens, Karla Seaman, Lisa Whitehead, Mandy Towell-Barnard, Michelle Young

Research outputs 2014 to 2021

Background

Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge …

Recognizing Delirium In The Picu: An Evidence-Based Practice Improvement Project, Abigail Begovich

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Introduction: Pediatric delirium is underrecognized in the pediatric population and can lead to increased length of stay, hospital costs, and post-traumatic stress disorder (PTSD). Using a standardized screening tool to assess for delirium is an easy way for bedside nurses to evaluate patients and intervene as necessary. This quality improvement project aimed to implement the Cornell Assessment of Pediatric Delirium (CAPD) and complete a delirium screening on applicable patients once a shift > 85% over four months.

Methods: Between January 2020 to May 2020, bedside nurses completed a delirium screening assessment on applicable patients, first on paper and then …

Delirium Point Prevalence Studies In Inpatient Settings: A Systematic Review, Binu Koirala, Bryan R. Hansen, Annmarie Hosie, Chakra Budhathoki, Stella Seal, Adam Beaman, Patricia M. Davidson

Nursing Papers and Journal Articles

Aims: To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management.

Background: Delirium—a common and distressing condition manifesting as an acute decline of attention and cognition—is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium.

Design: A systematic review …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Delirium Prevention, Identification And Management In The Oncology Setting: A Unique Partnership With Patients And Their Family Caregivers, Mary Kate Eannielo, Christine M. Waszynski, Kerry A. Milner

Nursing Faculty Publications

Significance & Background: Delirium affects a significant number of hospitalized adults each year resulting in negative patient outcomes and family caregiver distress. Clinical identification of delirium by nurses and use of family caregivers as part of a multicomponent delirium prevention strategy are not consistently implemented in the practice setting despite being best practice.Purpose: An interdisciplinary team in this 800 bed level one trauma center has been created to create and implement this best practice delirium protocol. The purpose of this initiative was to incorporate the family caregiver into this existing multicomponent delirium prevention, detection and management protocol. Interventions: Consistent implementation …

Quiet Time For Mechanically Ventilated Patients In The Medical Intensive Care Unit, Natalie S. Mcandrew, Jane Leske, Jill L. Guttormson, Sheryl Talcott Kelber, Kaylen Moore, Sylvia Dabrowski

College of Nursing Faculty Research and Publications

Objective: Sleep disruption occurs frequently in critically ill patients. The primary aim of this study was to examine the effect of quiet time (QT) on patient sedation frequency, sedation and delirium scores; and to determine if consecutive QTs influenced physiologic measures (heart rate, mean arterial blood pressure and respiratory rate).

Method: A prospective study of a quiet time protocol was conducted with 72 adult patients on mechanical ventilation.

Setting: A Medical Intensive Care Unit (MICU) in the Midwest region of the United States.

Results: Sedation was given less frequently after QT (p = 0.045). Those who were agitated prior …

Educating Family Caregivers For Older Adults About Delirium: A Systematic Review, Margaret J. Bull, Lesley Boaz, Martha G. Jermé

College of Nursing Faculty Research and Publications

Background

Delirium in older adults is considered a medical emergency; it contributes to a cascade of functional decline and to increased mortality. Early recognition of delirium symptoms is critical to prevent these negative consequences. Family caregivers who are educated about delirium could partner with nurses and other healthcare professionals in early recognition of delirium symptoms. Before implementing such partnership models, it is important to examine the effectiveness of educating family caregivers about delirium.

Aims

To examine whether providing education on delirium to family caregivers improved their knowledge, emotional state, or response in reducing the incidence of delirium in older adults. …

Identifying The Barriers And Enablers To Pallative Care Nurses' Recognition And Assessment Of Delirium Symptoms: A Qualitative Study, Annmarie Hosie, M Agar, Elizabeth A. Lobb, P M. Davidson, Jane Phillips

Nursing Papers and Journal Articles

Context: Delirium is under-recognised by nurses, including those working in palliative care settings where the syndrome occurs frequently. Identifying contextual factors that support and/or hinder palliative care nurses’ delirium recognition and assessment capabilities is crucial, to inform development of clinical practice and systems aimed at improving patients’ delirium outcomes.

Objective: To identify nurses’ perceptions of the barriers and enablers to recognising and assessing delirium symptoms in palliative care inpatient settings.

Methods: A series of semi-structured interviews, guided by critical incident technique, were conducted with nurses working in Australian palliative care inpatient settings. A hypoactive delirium vignette prompted participants’ recall of …

Editorial: Nurses’ Role In Improving Interdisciplinary Delirium Care In Inpatient Settings: Steps For Action, Annmarie Hosie, Jane Phillips

Nursing Papers and Journal Articles

No abstract provided.

Family Caregivers’ Knowledge Of Delirium And Preferred Modalities For Receipt Of Information, Margaret J. Bull, Lesley Boaz, Jennifer M. Sjostedt

College of Nursing Faculty Research and Publications

Delirium is a life-threatening, frequently reversible condition that is often a sign of an underlying health problem. In-hospital mortality alone for older adults with delirium ranges from 25% to 33%. Early recognition of delirium is critical because prolonged duration poses a greater risk of poor functional outcomes for older adults. Family caregivers, who are familiar with the older adult’s usual behaviors, are most likely to recognize delirium symptoms but might dismiss them as due to aging. It is important to learn what family caregivers know about delirium to ascertain their need for education. The aims of this study were to …

Public Health Model Identifies Recruitment Barriers Among Older Adults With Delirium And Dementia, Margaret J. Bull, Lesley Boaz, Jennifer M. Sjostedt

College of Nursing Faculty Research and Publications

Recruiting older adults and their family caregivers into research studies presents challenges. Although the literature notes some general recruitment challenges, no studies specifically address the unique challenges of recruiting older adults who have Alzheimer's Disease (AD) and their family caregivers in studies about delirium or suggest using a framework to identify barriers to recruiting this population. In conducting a pilot study about preparing family caregivers to detect delirium symptoms in older adults with (AD) the researchers used the Public Health Model for identifying barriers to recruitment. The goals of this methodological article are to: (1) briefly describe the methodology of …

Delirium Screening: From Research To Point Of Care, Beth Ann Swan, Phd, Crnp, Faan, Sheena Ahlawat, Mph, Christopher N. Sciamanna, Md, Phd

College of Nursing Faculty Papers & Presentations

Delirium is a serious public health problem among older adults and is one of the most common cognitive disorders affecting postoperative older adults. Delirium is a treatable illness that disproportionately places postoperative older adults at increased risk for functional and cognitive decline, as well as increased morbidity and mortality. More than 50 percent of postoperative patients develop delirium during hospitalization. Epidemiologic and clinical studies over the past two decades have provided ample evidence that delirium in hospitalized older adults is under-recognized by nurses and physicians, often leading to untoward events that the safety and well-being of hospitalized older adults.

Delirium: Elders Tell Their Stories And Guide Nursing Practice, Cynthia Mccurren, Sherill Nones Cronin

Peer Reviewed Articles

Delirium is one of the most serious and prevalent cognitive disorders among hospitalized elders. Fourteen elders participated in this phenomenologic study describing the "lived experience " of delirium from the patient's perspective. Implications for nursing practice are derived from their reality and insight.