Delirium Prevention in Intensive Care

This assignment delves into the critical issue of delirium prevention within intensive care units (ICUs). It examines the various risk factors associated with delirium development in critically ill patients. The assignment also explores established assessment tools used to identify and diagnose delirium in ICU settings. Furthermore, it analyzes effective strategies and interventions aimed at preventing and managing delirium, emphasizing their importance in improving patient outcomes and quality of life.

Running head: RESEARCH PROPOSAL
Research Proposal in nursing
Name of the Student
Name of the University
Author’s note

1RESEARCH PROPOSAL
Table of Contents
Background-....................................................................................................................................2
Aims of study...................................................................................................................................3
Significance and innovation of proposed study...............................................................................3
Expected outcomes and implications of practice.............................................................................4
Research plan- methodology, sampling, data collection.................................................................6
Ethical considerations......................................................................................................................7
Study limitations..............................................................................................................................8
Administration of research..............................................................................................................9
References......................................................................................................................................10

2RESEARCH PROPOSAL
Project title- Intensive care unit delirium: effects of educational intervention programme among
ICU nurses.
Background-
Delirium is an acute fluctuating mental disturbance in the consciousness and attention
cognition. The person has state of mind characterized by restlessness, illusion, This is the
common disturbance is due to the manifestation of dysfunction in the brain. This type of mental
disorder is found in 80% of the intensive care unit. The main factors due to the risk of delirium
are due to exposure to sedatives and analgesics and medications. The recent morbidity and
mortality rate in ICU is contributed by delirium. Patients with delirium face longer stay in
hospital. Research says that the occurrence of the symptoms could be associated during or
several months after the discharge. Little has been known about the accurate strategies and
prevention methods in delirium (Rosa et al, 2017). Still, this is the process of ongoing multiple
investigations. Though the intensive care unit highlights the increase in survival of the patients
nowadays delirium has proven to be a major concern in public health units. Delirium is often
associated with short and long term effects. The symptoms are visible even after several years of
ICU discharge. There is the problem present in the health care units due to lack of knowledge,
assessment and the monitoring of delirium on time. According to the definition of the American
Psychiatric Association delirium is the cognitive impairment which occurs at short episodes.
Delirium has subtypes according to the psychomotor behavioral patterns. The prevalence of
hypoactive delirium is due to the clinicians lack in recognition of the symptoms. Hypoactive
delirium is defined as the decreased responsiveness, withdrawal and apathy. The medical and
surgical cases of ICU cohort studies indicate about 80% of cases of delirium (Kamdar, et al,
2015).

3RESEARCH PROPOSAL
Aims of study
ICU nurses have deficient in knowledge about the management and assessment of
delirium. The main area of concern is the effective use of delirium assessment tools. The nurses
often have lacked in knowledge of the use of assessment tools to identify the occurrence of
delirium. Thus training of nurses can be included for the assessment tools. The nurses should be
advocated about the treatment of the delirium. The minimization of delirium is dependent on the
management and effective knowledge of the nurses. Thus the aim of this study is the pivot based
research study to see the assessment tools of the delirium is effectively used by the nurses. A
team of expert nurses must conduct the study in the intensive care unit to get the quantitative
research and identify the root cause of the problems associated with the assessment of delirium.
It is known that relevance of delirium is not only due to incidence but also due to consequences.
The aim of the study stratifies the future resistance for the less occurrence of the outcome of
delirium.
Significance and innovation of proposed study
The following research proposal is based on the quantitative study of the tools and the
nurse roles in managing the conditions of delirium, This will foster learning and negative
outcomes. It is a type of routine based evaluation of the treatment and assessment process of
nurses regarding the management of delirium. The treatments in ICU which includes the
analgesics like the morphine, meperidine, and atropine can be the cause of the collaborative
effects of delirium (van den Boogaard, 2014). This evidence based study of the evaluation of the
assessment tools used by the nurses is going to be used in future for the nurses to take powerful
interventions for care of the delirium persons. This is about the clarification to the nurses and
helps them to take early measures and detection of delirium. The right dose of sedatives should

4RESEARCH PROPOSAL
be assessed in the process of the study to prevent the outcome. The absence of norms regarding
the use of restraint is conducted to make a negative contribution to the decision making and legal
support of professionals (Boehm et al, 2017).
Other problems associated are the difficulty to get an adequate restrictions in the aim to
facilitate the patient motions in order to reduce the discomfort. The less use or trying not to us
the sedatives can be proved to be more efficient in the prevention of delirium. Already evidence
based studies have helped to find that antipsychotics like haloperidol cannot be used either for
prevention or in the treatment (Christensen, 2014). Thus the research proposal is to be guided
with the educational interventions and the use of the pharmacological methods for the reduction
of delirium risk. The research is to find the correct dose of the sedatives that is to be used and
those that are to be omitted during the treatment of the patients in ICU. The psychological effects
of different drugs need to be observed through this. The discomforts like sound and noise have
also contributed to the development of delirium (Hosie et al, 2015). The evaluation will also
identify that the noises and lights are in control so that it does not cause discomfort to the patient.
The innovation of the program is that a report is to be generated at the end of the study and
should be analyzed by ANOVA based statistical approach to find the real cause of this mental
disorder in ICU.
Expected outcomes and implications of practice
Since delirium is the main cause of the clinical problems in the hospitals that increase the
days of stay of the patient in the hospital, effective measures need to be taken by the nurses.
Delirium assessment is the basis behind the educational study of the nurses. The expected
outcomes will be that it can give the future directions towards the reduction in the severity,
duration, and outcome of the syndrome. There should be the daily practice of the assessment of

5RESEARCH PROPOSAL
the patients. The assessment tools use can be found out by the process of the study. This will be a
descriptive correlational study design. The patient centered care delivery importance can also be
judged in the process. The statistical difference in the significance identifies the correct
implication of the practices that team of nurses will perform. The evaluation is done to check if
the assessment practices are done well in the ICU. This in the future will help the nurses to
take patient centered care delivery and taking strategic interventions (Kanji et al, 2016).
The accurate implementation of the tools like Confusion Assessment method for ICU or
the intensive care delirium screening checklist is used to decrease the delirium risk factors. The
survey study daily after a shift time by the nurses reflects the concerns in the use of ABCDE
bundle or the safe use of drugs like benzodiazepine (McAndrew et al, 2016). In absence of
proper tool often the cases of delirium remain undetected and consequently untreated. Two of
the main tools like the CAM-ICU and the ICDSC have to be accurately used in the management
and detection. If there is unfavorable compliance regarding the use of the tools then delirium
symptoms remain undetected (Svenningsen et al, 2014). Thus the practice of survey and routine
evaluation gives the realistic view of the quality of care that the organization establishes the cure
and treatment plan for the delirium. The iatrogenic risk factors in the ICU can also be assessed in
the study. Separate metric data will access the environmental conditions and the external cues
like light and sound of the unit (Reade & Finfer, 2014). The report in final will identify the real
cause of the delirium. As it is already known the biological factors are triggered by the
environmental stimuli. The link of the cumulative cause of the disorder can also be identified in
the procedure. Clinical practice guideline could be made taking into account all the issues and
the real cause of the effects. The analgesics and sedatives could then be recommended with
correct dose and safety limits to the patients (Wassenaar, et al, 2015).

6RESEARCH PROPOSAL
Research plan- methodology, sampling, data collection
The research plan is to be constructed on the basis of the survey studies and the nurse
ratings to find the effects of an educational program among the nurses in ICU. The methodology
in the research plan is collecting the data of the questionaries set that would address the nurses
regarding the conditions and the use of the assessment tools, the dose of the medicines and the
environmental factors. This will be cohort based qualitative study. Secondary data is to be
collected, This is going to reflect the education and understanding of the nurses regarding
delirium. The secondary data collection is considered in sampling process because it will be less
expensive here. This is not going to breech the ethical issues as the investigator solely is
considered responsible for the quality of data. The observations here are made through the
questionnaires and survey on particular nurses of ICU (Aitken et al, 2016). The team of experts
involved in the process collects the resources available online journals and the responses of the
nurses are to be analyzed. The numerical values of Linkert-type can be used to find the results of
the samples easily. Next step is the observational analysis using the favorable statistical methods.
It provides the good source of information about the cause of delirium. This is the sampling
process that is to be continued with the frequency counts to get the needs and the effects of
evaluation. The mean counts of the populations and the length of interactions and the instruction
lines are the best methods that can be adopted (Oosterhouse et al, 2016). If suppose the nurses try
to identify the outcomes of a specific sedative that will be used then a case control study is to be
done that will identify the statistical difference that has is affected by the use and not use the
drug, The regression plot is to be made to identify the cause more minutely (Elliott, 2014). The
most important focus in this methodology is considered on the correct sampling source. To get
the best result the study has to be concentrated on a specific and facilitated group of nurses that

7RESEARCH PROPOSAL
handle the cases of delirium patients more often. The information needs to be gathered from the
interviews. This can involve by studying a particular phenomena(Fick et al, 2017 ). It will aim to
target the observation and analysis of the natural settings in an organization. The researcher
makes the multivariant analysis to find the real cause and the causes link to the issues. After the
collection of the data, there will be the examination of the data based on the above mentioned
statistical analysis. Further analysis can be made by studying the required database, reports,
number of people involved in the studies. This is a wide research and so it must be seen that less
cost is required. The strategies considered here both will be effective and cost
effective(Pandharipande et al, 2013).
Ethical considerations
The integrity, reliability, and validity of the survey and the research findings will depend
on the adherence to the ethical principles that are to be taken. The best step here includes the
ethical protection of the research participants. Here the respondents are mainly the nurses. The
questions will be made in such a way that it does not breech the privacy of the organization and
the patients on which they are being given the details (Brinkmann, 2014). This is a simple
educational based program. The ethical principles will help determine the researchers what is
wrong and what is right in conducting the study (Silverman, 2016). The principles are respecting
the autonomy, decision making and the dignity of the participants. It is the minimizing the risks
and maximizing the benefits. The main key ethical issues will be respecting the cultural beliefs
and the individual interests. It can also be principles regarding the participation of the nurses in
free will. The ethical standards in the study also should protect the anonymity and the
confidentiality of the nurses and the patient's situations that are considered. The questions
should be sensitive with the operation and the use of the drugs in the organization. They by any

8RESEARCH PROPOSAL
chance should not be leaked to the other organization in any way. The terms of the ethical issues
are to be clearly on the documents.
Study limitations
The research plan is also not free from the limitations. The limitation is in the
methodology that may not interpret the correct and interpreted results as required. The major
factor is the lack of good resources. There could be possible limitations in the number of units of
analysis and the numbers of participants that are required to get the best implementation of the
educational process of nurses about delirium. If the sample size is too small then there could be a
great limitation (McAndrew et al, 2016). This is because it will not be able to predict the
outcome and the aim will not be satisfied. There are no such policies regarding the survey done
in ICU. Therefore there could be the limitation if the written permission of authority is not taken
before the research plan. There will always be the problem regarding the finding of correct and
reliable data. The accurate analysis can be hampered due to this. Citing the prior research
journals if not done then there could be the highest drawback (Kudchadka et al, 2014). The
statistical measurements are huge then there could be problems if not taken into considerations
all the terms correctly. The biased report will reflect false results. Telescoping the events
sequentially otherwise there could be the chance of false predications(Nydahl et al, 2017). The
exaggerations of the events are to be represented with outcomes of embellishing events. There
could be limitations possible if the respondents do not freely give all the correct answers to the
questions. Then there could be cultural bias due to the different cultural thoughts and believes of
the respondents.

9RESEARCH PROPOSAL
Administration of research
The resources that are required prior to the research are referring the online journals,
articles on the websites available. This will help the researcher set the correct and accurate
questions on the use of drugs, the sound and light conditions of the hospital surrounding. Some
of the electronic databases that can be used are the cumulative index to nursing and allied health
literature ( CINAHL), PubMed, Cochrane, Medline and clinical knowledge network. This is
considered by searching with the words like delirium in intensive care units and the assessment
tools. The review articles that are to be read should be from minimum 10 years source. The
ethical considerations and the cultural background of the respondents are to be found out before
making the interview questions. The researchers should have good knowledge of all the parts.
The easy statistical tools are to be kept in mind while constructing the matrix of questions in the
survey. The use of the assessment tools and the drugs in the ICU should also be taken into
account and known very well before setting up the research plan. The budget should be within
1000 Australian dollars.
Following is the timetable for the plan
Date of final draft of research plan 7.9.2017
Date of conducting the survey 17.9.2017
The number of people to de addressed The ICU unit of cardiac department in
multidisciplinary hospital and conduct the
study within the time mentioned
Analysis and results 27.9.2017

10RESEARCH PROPOSAL
References
Aitken, L. M., Mitchell, M., Elliott, R., Davis, C., Wetzig, K., Macfarlane, B., ... & McKinley, S.
(2016). Sleep and delirium in the intensive care: A prospective cohort study of nurses
documentation and patients insights. Australian Critical Care, 29(2), 111.
Boehm, L. M., Vasilevskis, E. E., Dietrich, M. S., Wells, N., Ely, E. W., Pandharipande, P., &
Mion, L. C. (2017). Organizational Domains and Variation in Attitudes of Intensive Care
Providers Toward the ABCDE Bundle. American Journal of Critical Care, 26(3), e18-
e28.
Brinkmann, S. (2014). Interview. In Encyclopedia of Critical Psychology (pp. 1008-1010).
Springer New York.
Christensen, M. (2014). An exploratory study of staff nurses’ knowledge of delirium in the
medical ICU: An Asian perspective. Intensive and Critical Care Nursing, 30(1), 54-60.
Elliott, S. R. (2014). ICU delirium: a survey into nursing and medical staff knowledge of current
practices and perceived barriers towards ICU delirium in the intensive care unit. Intensive
and Critical Care Nursing, 30(6), 333-338.
Fick, D. M., Inouye, S. K., McDermott, C., Ngo, L., Gallagher, J., McDowell, J., ... &
Marcantonio, E. R. (2017). PILOT STUDY OF A DELIRIUM DETECTION
PROTOCOL ADMINISTERED BY AIDES, PHYSICIANS, AND REGISTERED
NURSES. Innovation in Aging, 1(suppl_1), 271-271.

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Hosie, A., Lobb, E., Agar, M., Davidson, P. M., Chye, R., & Phillips, J. (2015). Nurse
perceptions of the Nursing Delirium Screening Scale in two palliative care inpatient
units: a focus group study. Journal of clinical nursing, 24(21-22), 3276-3285.
Kamdar, B. B., Niessen, T., Colantuoni, E., King, L. M., Neufeld, K. J., Bienvenu, O. J., ... &
Needham, D. M. (2015). Delirium transitions in the medical ICU: exploring the role of
sleep quality and other factors. Critical care medicine, 43(1), 135.
Kanji, S., MacPhee, H., Singh, A., Johanson, C., Fairbairn, J., Lloyd, T., ... & Rosenberg, E.
(2016). Validation of the critical care pain observation tool in critically ill patients with
delirium: a prospective cohort study. Critical care medicine, 44(5), 943-947.
Kudchadkar, S. R., Yaster, M., & Punjabi, N. M. (2014). Sedation, sleep promotion, and
delirium screening practices in the care of mechanically ventilated children: a wake-up
call for the pediatric critical care community. Critical care medicine, 42(7), 1592.
McAndrew, N. S., Leske, J., Guttormson, J., Kelber, S. T., Moore, K., & Dabrowski, S. (2016).
Quiet time for mechanically ventilated patients in the medical intensive care
unit. Intensive and Critical Care Nursing, 35, 22-27.
McAndrew, N. S., Leske, J., Guttormson, J., Kelber, S. T., Moore, K., & Dabrowski, S. (2016).
Quiet time for mechanically ventilated patients in the medical intensive care
unit. Intensive and Critical Care Nursing, 35, 22-27.
Nydahl, P., Bartoszek, G., Binder, A., Paschen, L., Margraf, N. G., Witt, K., & Ewers, A. (2017).
Prevalence for delirium in stroke patients: A prospective controlled study. Brain and
Behavior, 7(8).

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Oosterhouse, K. J., Vincent, C., Foreman, M. D., Gruss, V. A., Corte, C., & Berger, B. (2016).
Intensive Care Unit Nurses’ Beliefs About Delirium Assessment and
Management. AACN advanced critical care, 27(4), 379-393.
Pandharipande, P. P., Girard, T. D., Jackson, J. C., Morandi, A., Thompson, J. L., Pun, B. T., ...
& Moons, K. G. (2013). Long-term cognitive impairment after critical illness. New
England Journal of Medicine, 369(14), 1306-1316.
Reade, M. C., & Finfer, S. (2014). Sedation and delirium in the intensive care unit. New England
Journal of Medicine, 370(5), 444-454.
Rosa, R. G., Tonietto, T. F., da Silva, D. B., Gutierres, F. A., Ascoli, A. M., Madeira, L. C., ... &
Cavalcanti, A. B. (2017). Effectiveness and Safety of an Extended ICU Visitation Model
for Delirium Prevention: A Before and After Study. Critical Care Medicine.
Silverman, D. (Ed.). (2016). Qualitative research. Sage.
Svenningsen, H., Tønnesen, E. K., Videbech, P., Frydenberg, M., Christensen, D., & Egerod, I.
(2014). Intensive care delirium–effect on memories and health‐related quality of life–a
follow‐up study. Journal of clinical nursing, 23(5-6), 634-644.
van den Boogaard, M. H. W. A., Schoonhoven, L., Maseda, E., Plowright, C., Jones, C., Luetz,
A., ... & Donders, R. (2014). Recalibration of the delirium prediction model for ICU
patients (PRE-DELIRIC): a multinational observational study. Intensive care
medicine, 40(3), 361-369.
Wassenaar, A., van den Boogaard, M. H. W. A., van Achterberg, T., Slooter, A. J. C., Kuiper, M.
A., Hoogendoorn, M. E., ... & Luetz, A. (2015). Multinational development and

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validation of an early prediction model for delirium in ICU patients. Intensive care
medicine, 41(6), 1048-1056.