Synthesis of Intensive Care Nurses' Experiences of Caring for Patients With Delirium
DOI:
https://doi.org/10.1891/WFCCN-D-20-00015Keywords:
nurses, experiences, delirium, intensive care units, qualitative reviewAbstract
Background: There is a paucity of studies synthesizing intensive care nurses' experiences of taking care of patients with delirium. A better understanding of nurses' experiences provides an opportunity to identify areas that can be strengthened to improve care.
Aim: To gain insight into intensive care nurses' experiences of caring for patients with delirium through summarizing the existing qualitative studies in the area.
Methods: Databases of Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL) Plus, PubMed, and ProQuest Dissertations & Theses Global were searched for qualitative or mixed-method primary research studies, resulting in 269 records screened for eligibility. A three-stage thematic synthesis was followed.
Findings: Nine studies were included in the review. Twelve descriptive themes emerged outlining critical care nurses' experiences in the four aspects of delirium care. For prevention, the common nursing themes were using holistic nursing care to promote nighttime sleep, orientate patients through human interaction, and promote early mobilization. Intensive care nurses' experience of delirium assessment included their perceived utility of screening, their understanding of using a screening tool, and their impression of integrating nursing assessment. In terms of treatment, nurses' experience focused on pharmacological and nonpharmacological methods, as well as their attitude toward the use of physical restraints and chemical sedation. Nurses' overall experience of caring for patients with delirium in intensive care units includedemotional exhaustion, physical fatigue, and the perceived low priority and inconsistency of delirium management.
Conclusions: Intensive care nurses' complex experiences of caring for patients with delirium revolved around delirium prevention, assessment, treatment, and the overall process of care. Implications for practice include: multicomponent delirium prevention strategies, integrating the use of screening tools and nursing assessment for delirium detection, focusing on nonpharmacological interventions, and offering on-job support to nurses who care for delirious patients.
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