Year
2024
Degree Name
Doctor of Philosophy
Department
School of Nursing
Abstract
Background: Delirium is a prevalent acute brain dysfunction in critically ill patients, particularly among older patients and those receiving mechanical ventilation. Delirium is associated with adverse clinical outcomes and increased medical costs. Thus, the effective management of delirium in the intensive care setting is imperative. Preventive interventions and early detection are crucial for the effective management of delirium. Nurses, as frontline healthcare providers, play a crucial role in the effective management of delirium. However, the management of delirium is often hindered by insufficient knowledge and poor adherence to prevention protocols among nursing staff, leading to suboptimal outcomes. Therefore, the overall objective of this doctoral project was to enhance the delirium-related knowledge of undergraduate nursing students and develop a safe and easily applicable non-pharmacological intervention to improve delirium management in the adult intensive care setting.
Aim: To achieve the overall objective, the specific aims were to (1) examine the diagnostic accuracy of commonly used assessment tools to recognise delirium in the adult intensive care setting; (2) investigate the effects of a delirium education module on undergraduate nursing students’ knowledge, confidence, and competence in providing delirium care; (3) assess the effectiveness of non-pharmacological interventions in preventing delirium; and (4) develop a safe and easily applicable non-pharmacological intervention to prevent delirium among mechanically ventilated patients in the adult intensive care setting.
Methods: First, a systematic review and diagnostic meta-analysis were conducted to compare the diagnostic accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting delirium in adult ICU patients. Second, a simulation-based delirium education module was conducted in a medical university in Northern Taiwan, comprising delirium care knowledge dissemination, simulation video viewing, and assessment skill practice through a case scenario. Third, a systematic review and network meta-analysis was conducted to compare the effectiveness of non-pharmacological interventions for preventing delirium. Finally, a randomised controlled trial was conducted to investigate the effectiveness of a MUSic intervention and Earplug (MUSE) strategy and personalised music intervention (PMI) for preventing delirium among mechanically ventilated patients.
Results:
Diagnostic Accuracy of CAM-ICU and ICDSC
The first review included 29 and 12 studies for assessing the diagnostic accuracy of the CAM-ICU and ICDSC, respectively. In the meta-analysis, the pooled sensitivity of the CAM-ICU and ICDSC was comparable (0.84 vs 0.83, p = 0.85). However, the CAM-ICU had higher pooled specificity than did the ICDSC (0.95 vs 0.87, p = 0.04). The lower false positive rate indicated that the CAM-ICU was superior in ruling out patients without delirium.
Education Module for Delirium Knowledge Improvement
A total of 74 undergraduate nursing students were enrolled in this study, of whom 34 and 40 were allocated to intervention and comparison groups, respectively. The finding revealed that a delirium education module, which included a simulation component, enhanced undergraduate nursing students' knowledge, confidence, and competence in providing delirium care when compared with controls.
Comparative Effects of Non-pharmacological Interventions on Delirium Incidence
In the second review article, a total of 29 studies involving 7,005 ICU patients were included in the network meta-analysis. The findings revealed that a multicomponent strategy was the most effective in reducing delirium incidence, especially strategies involving early mobilisation and family participation. However, limited evidence was obtained supporting that a targeted relaxation component reduces the risk of delirium.
MUSE Programme for Preventing Delirium
Sixty-three mechanically ventilated patients were enrolled in this study, with 21 in each group. The results of this study indicated that the MUSE and PMI strategy did not reduce the incidence of delirium significantly while compared to usual care.
Conclusion: This doctoral thesis highlights the importance of incorporating delirium education into undergraduate nursing curricula and implementing a safe intervention to prevent delirium in ICU settings. Simulation-based learning enhanced nursing students’ understanding of practical skills, boosting their confidence and competence in providing delirium care. However, the clinical trial results showed no significant difference of delirium incidence in MUSE and PMI groups compared to usual care. Therefore, future research that integrate other component interventions and include larger sample size to validate and extend these finding is warranted.
Recommended Citation
Chen, Ting-Jhen, Improving the delirium management in intensive care units, Doctor of Philosophy thesis, School of Nursing, University of Wollongong, 2024. https://ro.uow.edu.au/theses1/1876
FoR codes (2008)
1110 NURSING, 111003 Clinical Nursing: Secondary (Acute Care)
Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.