Purpose Patients in the Intensive Care Unit (ICU) experience a variety of symptoms. This descriptive correlational study aimed to determine the prevalence of symptoms and the physiological and situational factors associated with these symptoms in ICU patients. Methods We analyzed the Electronic Medical Records (EMRs) of 1,214 cases admitted to and discharged from the ICUs of a university hospital in Seoul over a 1-year period from June to September 2022. This analysis utilized standardized instruments embedded in EMRs and a natural language analysis framework developed by the researchers. Descriptive statistics, the x 2 test, the Fisher exact test, and multivariate logistic regression were employed to identify common symptoms and their related factors. Results In total, 85.7% of the cases had at least one symptom during their ICU stay, and 36.6% experienced 2 symptoms. Pain was the most frequently experienced symptom, affecting 69.5% of cases, followed by agitation (29.7%), dyspnea (29.7%), and delirium (4.8%). Multivariate logistic regression analysis indicated that the length of ICU stay influenced pain (odds ratio [OR]=1.04; 95% confidence interval [CI], 1.02~1.06; p<.001), delirium (OR=1.08; 95% CI, 1.06~1.11; p<.001), agitation (OR=1.07; 95% CI, 1.05~1.10; p<.001), and dyspnea (OR=1.19; 95% CI, 1.13~1.26; p<.001). Conclusion Pain, agitation, and dyspnea are common in ICU patients and are associated with the length of their ICU stay. Our study identifies factors related to these symptoms that could be targeted to manage and reduce their occurrence, providing a foundation for future research on various symptom assessment tools and natural language transcripts.
Purpose This study investigated the knowledge, performance, and barrier awareness of Intensive Care Unit (ICU) medical staff concerning the prevention and management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in critically ill adult patients, and aimed to identify the factors influencing the performance of evidence-based PADIS management. Methods This cross-sectional and correlational study included 189 medical staff (17 physicians, 172 nurses) working in ICUs in two hospitals and recruited between July 13 and 31, 2022. Multiple linear regression analysis was performed to identify the factors associated with the PADIS-related performance of medical staff. Results The evidence-based performance level for PADIS prevention and management had a mean score of 3.55±0.37 out of 5 points, and the mean knowledge score was 28.23±3.00 out of 33 points. The mean awareness score for barriers to implementing PADIS prevention and management guidelines was 2.91±0.39 out of 5 points. Multiple regression analysis indicated that knowledge of delirium (β=.19, p=.014) and awareness of barriers within the individual domains of medical staff (β=-.20, p=.034) significantly influenced PADIS-related performance. Conclusion To implement evidence-based practices for the prevention and management of PADIS, steps should be taken to improve the knowledge and awareness of medical staff regarding PADIS. This could be improved through organizational support, such as systematic education and staffing. Specifically, an education program centered on delirium could significantly improve PADIS-related knowledge and performance.
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Purpose This study aimed to review the effectiveness of delirium education programs for nurses in acute hospitals. Methods The inclusion criteria were studies on delirium education programs for nurses published in English and Korean from 2012 to 2022. A literature search was conducted in the RISS, KISS, DBpia, PubMed, CINAHL, PsycINFO, and Web of Science databases using the key words of "delirium", "nurse", and "education". Qualitative appraisal of studies was conducted using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool translated by National Evidence-based Healthcare Collaborating Agency (NECA). For meta-analysis, the effect size of the intervention was calculated as standardized mean difference. Results Eighteen studies were selected for the systematic review. While the contents of the education programs were similar, the teaching methods were different. Interventions implemented included traditional learning, e-learning, and blended learning. Teaching methods of delirium education programs for nurses included lecture, discussion, practice, simulation, role-play, and coaching. The systematic review found that delirium education programs for nurses effectively increased post-intervention outcomes in 17 studies. Delirium education programs for nurses have benefits regarding delirium knowledge and performance. In four studies, delirium education program interventions improved delirium nursing performance (95% CI: 0.48~2.44, p=.003). Conclusion These results demonstrate the need for a standardized delirium education program. It is recommended that further studies evaluating the patient outcome effects of delirium education programs should be conducted.
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Purpose This study is a prospective observational study that analyzes the factors affecting and the incidence of postoperative delirium in elderly patients under general anesthesia. Methods The study enrolled 193 elderly patients who entered the recovery room after surgery under general anesthesia in a certified tertiary hospital. Data were measured twice-first, before surgery and, second, 30 minutes after the patient entered the recovery room-using the Korean Nursing Delirium Screening Scale. The data were analyzed using x 2 tests, the independent t-test, and logistic regression from SPSS 22.0. Results The incidence of delirium in elderly patients after surgery under general anesthesia was 13.0% (25 of 193 patients). The incidence of delirium was a significant in the following cases: elderly patient, patients who performed physical activity with assistance at pre-operation, those with lower body mass index, those with lower body weight, those with long operative times, and those with high preoperative pain scores. The occurrence of delirium was 16.57 times higher in the presence of comorbidities, 5.74 times higher when hospitalization occurred through the emergency room, and 3.99 times higher when the number of catheters was high. Conclusion Screening for early delirium in the recovery room is important, and it can provide basic data for early nursing intervention in patients suffering from postoperative delirium.
Purpose This study aimed to investigate the effects of a Multicomponent Intervention Program for Preventing Delirium (MIPPD) on the incidence of delirium, self-extubation or self-removal of the catheter, and length of stay among elderly patients in the Intensive Care Unit (ICU). Methods This study employed a nonequivalent control group pretest-posttest non-synchronized design to verify the MIPPD effects. The participants, 73 patients aged over 65 years were admitted to a university hospital's ICU in J province between December 2015 and July 2016. The MIPPD contained the following elements: family caregiver education, delirium assessment, reorientation activities, therapeutic communication, sensory intervention for vision and hearing impairments, management of immobility or limited mobility, family support, and maintenance of sleeping patterns. Under the program, nurses and family members provided immediate intervention to elderly patients with an expected length of stay of at least 48 hours. Results After the MIPPD application, the incidence of delirium in the intervention group was significantly lower (odds ratio=0.19, 95% confidence interval=0.03~0.97) than that in the control group. However, there were no significant differences between the groups in terms of self-extubation or catheter self-removal and length of stay. Conclusions This program can effectively reduce the incidence of delirium. Because prevention is optimal for delirium management, a proactive intervention must be considered; given that, in this study, there were no problems in terms of family engagement, an MIPPD involving family participation should be actively implemented in intensive care unit practice.
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Purpose This descriptive study aimed to present the incidence of delirium and identify risk factors for delirium in Trauma Intensive Care Unit (TICU) patients.
Methods: The participants were 184 patients who were hospitalized in the TICU at a Regional Trauma Center in Gyeonggi-do. Data were collected between April and November 2019. For delirium measurement, the author used the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Diverse dependent variables were collected through electronic medical records. Data were analyzed using descriptive statistics, independent t-test, x2 -test, and binomial logistic regression.
Results: Incidence of delirium in TICU patients was 34.8%. Logistic regression analysis showed that the risk factors for delirium in TICU patients were hemoglobin (Odds Ratio [OR]=0.62, 95% Confidence Interval [CI]=0.43~0.88), injury severity score (OR=1.10, 95% CI=1.01~1.20), length of TICU stay (OR=1.15, 95% CI=1.03~1.29), administered sedatives (OR=6.04, 95% CI=2.47~14.76), and use of restraints (OR=5.75, 95% CI=2.29~14.42).
Conclusion: Based on the results of this study, healthcare providers, especially TICU nurses, should try to detect the signs and symptoms of delirium as early as possible, taking into account the specified risk factors of the patient. Preventive and practical intervention programs considering the risk factors must also be developed to prevent and alleviate delirium in TICU patients in the future.
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PURPOSE Delirium is a common symptom among heart surgery patients, and its prevalence is reported to range from 16.0~73.0%. As patients with delirium exhibit multiple negative prognoses, it is important to identify and prevent the risk factors for delirium. However, little research has been conducted to identify the prevalence of delirium and its risk factors among patients who have undergone heart surgery in Korea. Therefore, the aim of this study is to explore the prevalence of delirium and its risk factors in heart surgery patients in the Intensive Care Unit (ICU). METHODS This is a retrospective descriptive correlational study. From 623 patients who entered the ICU after heart surgery in a tertiary referral hospital from September 2016 to August 2017, 421 were selected for this study. Data were collected using electronic medical record. Delirium was evaluated using the Korean Nursing Delirium Screening Scale (Nu-DESC). RESULTS A total of 63 participants (15.0%) were diagnosed with delirium. Multivariate logistic regression analysis of the variables identified that complex surgery (Odds Ratio [OR]=7.24, 95% Confidence Interval [CI]= 2.80~18.74, p<.001), aortic aneurysm surgery (OR=3.30, 95% CI=1.40~7.77, p=.006), creatinine (OR=2.32, 95% CI=1.17~4.60, p=.016), and ICU length of stay (OR=1.72, 95% CI=1.48~1.99, p<.001) were associated with delirium after heart surgery. CONCLUSION The prevalence of delirium after heart surgery in Korean ICU patients is similar to that reported by the American Heart Association study. Type of surgery, lab data, ICU length of stay should be considered in the prevention and management of delirium in heart surgery patients in Korea.
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PURPOSE The aims of this study were to describe the incidence rate of delirium and to identify factors influencing delirium in neurological intensive care unit patients. METHODS The participants were 193 critically ill patients with neurological disorder from Chonbuk national university hospital in Jeonju. Data were collected between April 1 and November 25, 2017 using four structured questionnaires: Confusion Assessment Method for the Intensive Care Unit, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Karnofsky Performance Scale. Data were analyzed using descriptive statistics, independent t-test, χ2 test, Mann-Whitney U test, and logistic regression using the SPSS/WIN 24.0 program. RESULTS The incidence rate of delirium was 11.9%. Delirium was related with age, length of stay in intensive care unit, Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation II score, Karnofsky Performance Scale score, use of physical restraint, antihypertensive drugs, and anticonvulsants. Logistic regression analysis showed that age, length of stay in intensive care unit, use of physical restraint, and anticonvulsants were factors influencing delirium in neurological intensive care unit patients. CONCLUSION Delirium was related to demographic, clinical, medication-related, and environmental factors in patients in neurological intensive care units. Therefore, nurses should consider the patient's age, length of stay intensive care unit, use of physical restraint, and anticonvulsants in assessing delirium in neurological intensive care unit patients. Delirium prevention programs considering these factors may be effective for such patients.
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PURPOSE Although there is a high incidence of delirium with increased age, the risk factors have been too various. We investigated the incidence and risk factors in the older inpatient with neurological disorders. METHODS We reviewed the Electronic Medical Records (EMR) of older patients admitted to a neurology unit from August 2016 to January 2017. We analyzed the incidence and risk factors of delirium in 382 patients in a tertiary hospital. Delirium was determined daily using the Nursing Delirium Screening Scale (Nu-DESC). Demographic, disease, and environmental characteristics were obtained by using structured EMR data. RESULTS The incidence rate of delirium was 6.0% (n=23). Delirium was prevalent in patients who were older, had a lower serum hemoglobin, had hypertension or had diabetes mellitus. Delirium was also observed in patients on antibiotics, having a higher number of drugs or catheters, or receiving mechanical monitoring. A longer hospital stay, being admitted to a sub-intensive care unit, and sleep deprivation were significantly associated with delirium. Multiple logistic regression analysis found older age, having sleep deprivation, a higher number of catheters placed, and having diabetes mellitus to be significant predictors of delirium. CONCLUSION This study shows that age, sleep deprivation, number of catheters, and comorbidity of diabetes mellitus were identified as a risk factor for delirium. And it will guide the development of algorithms through its possible applications for the future in hospitalized older adults.
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PURPOSE The purpose of this study was to examine the effects of delirium care training program on the nurses' knowledge of delirium, self-confidence and performance levels in caring patients with delirium. METHODS The study was used a quasi-experimental design. The participants were 131 nurses in general nursing units in B and J hospitals. Sixty four nurses in B hospital were allocated into the experimental group and 67 nurses from J hospital into the control group. The delirium care training program was composed of lecture and clinical practice. Clinical practice of delirium care was applied everyday for 4 consecutive weeks starting from the admission day of the older adults(> or =70 years old), using 'short CAM' and 'nursing checklist for delirium prevention'. RESULTS The knowledge of delirium, self-confidence in caring patients, and performance levels of nursing care were significantly increased in the experimental group compared to the control group. CONCLUSION The findings of this study provided the evidence for the potential utility of the delirium care training program and underscored the needs of broader application of the training program of delirium care for nurses in general nursing units.
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PURPOSE This study was undertaken to identify which delirium screening instrument would be more useful in clinical practice. METHODS Data were collected from 118 nurses from six hospitals in five provinces in Korea. For the delirium screening three instruments were compared: NEECHAM Confusion Scale (NEECHAM), Nursing Delirium Screening Scale (Nu-DESC), Delirium Observation Scale (DOS). The MMSE-K was used for concurrent validity. The nurse subjects were surveyed as to the practical clinical value of each instrument. Cronbach's alpha coefficient and Kuder-Richardson 20 were used to confirm the reliability. RESULTS The range of three scales reliability was .70~.82 and the range of correlation coefficient was .63~.82 with MMSE-K. For sensitivity of NEECHAM, Nu-DESC and DOS was 1.00, 1.00 and 0.81 respectively and specificity NEECHAM, Nu-DESC and DOS was 0.88, 0.89 and 0.89 respectively. Nurses rated the practical use of the DOS scale as significantly easier to use than the NEECHAM and Nu-DESC. CONCLUSION NEECHAM, Nu-DESC and DOS scales were acceptable in terms of reliability, validity, sensitivity and specificity. However, nurses rated the DOS scale as easier scale to use and had more relevance to their practice.
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PURPOSE The study was conducted to survey intensive care unit nurse's knowledge, nursing performance, and stress involving delirium. METHODS The subjects of this study were 278 nurses from three hospitals in Seoul, who had worked at the intensive care unit more than six months. Data were collected using questionnaire from December, 2005 to January, 2006. RESULTS The mean score of knowledge about delirium was 31.60 out of 50 and it was significantly lower among those with clinical experience of 12-35 months and 60-119 months and those who didn't experience conflicts with patients' families. The mean score of nursing performance for delirium was 16.10 out of 23, and it was significantly higher among those who took care of 2 patients. The mean score of stress related to delirium was 63.92 out of 100, and it was significantly higher among those aged over 40, nurses who were university graduates, nurses who experienced conflicts with patients' families, and nurses who took care of 5 patients. CONCLUSION We need to develop systematic education programs in charge of patients with delirium.
Young Whee Lee, Chun Gill Kim, Eun Sook Kong, Kwuy Bun Kim, Nam Cho Kim, Hee Kyung Kim, Mi Soon Song, Soo Yeon Ahn, Kyung Ja Lee, Sung Ok Chang, Si Ja Chon, Nam Ok Cho, Myung Ok Cho, Kyung Sook Choi
J Korean Acad Adult Nurs 2007;19(1):35-44. Published online March 31, 2007
PURPOSE This study was conducted to examine the knowledge level and assessment experience of nurses in regards to delirium, and to utilize the study results as baseline data for planning delirium education programs for nurses. METHODS Subjects were 465 nurses who were working in a general hospital. A 'delirium related knowledge and assessment experience' questionnaire was used to collect data. RESULTS Knowledge levels regarding delirium averaged 70 out of 100, and at each domain, they scored 87 for etiology of delirium, 62 for symptoms, and 69 for nursing management. The knowledge level of delirium was significantly different according to educational level (F=3.851, p=.022), past education related to geriatrics(t=2.471, p=.014), and awareness of need for in-service education on geriatric nursing(F=2.663, p=.032). About 85% of nurses had past experience of dealing with delirious patients and only 7.7% of nurses used delirious state assessment tools. CONCLUSION According to the above results, it is necessary, not only to provide delirium related educational programs for nurses, but also to emphasize the usefulness of applying the assessment tool.