Critical Analysis of Delirium Care in Intensive Care Nursing

This presentation provides a critical analysis of a qualitative research study focusing on intensive care nurses' experiences and perceptions of delirium and delirium care. The study, conducted in a medical-surgical ICU, explored nurses' understanding of delirium, assessment methods (including the CAM-ICU), perceived barriers to care, and current care practices. Key findings revealed that delirium was often a secondary priority, and there were criticisms of the CAM-ICU method. The study also highlighted mistrust in delirium management, communication difficulties, and the need for non-pharmacological methods and official guidelines. The presentation links the study's findings with previous research, emphasizing the need for improved training and organizational guidelines for delirium assessment and management. The analysis includes a discussion of the study's limitations, such as small sample size and the single-ICU setting, along with recommendations for enhancing delirium care in critical care settings. The presentation is based on the article by Zamoscik, Godbold, & Freeman (2017).

NURSING
RESEARCH
Critical analysis

 Name of the article-
Intensive care nurses' experiences
and perceptions of delirium and deli
rium care
 Name of the student:
 Name of the college:

PURPOSE OF THE STUDY
 How Delirium is perceived by the ICU
nurses?
 How do the nurses think to assess
Delirium in patients?
 Barriers to evaluating the ICU delirium.
 Nurses' evaluation regarding the current
care.

STUDY DESIGN
 It is a qualitative study
 12 nurses from a medical surgical
intensive care unit were part of 2 focus
group sessions.
 The collected data were then subjected
to thematic analysis.
 Keywords : “Focus groups”, “one-on- one
interview”, “thematic analysis”.

SAMPLE SIZE
 12 nurses were allotted from an adult
medical surgical ICU at a large research
hospital in UK.
 Permanent female nursing staffs aged
25 to 43, having experience in the field
for 2-3 years and at ICU for 8 months –
9 years were taken in to consideration.
 Sample size was less.
 Participants were invited via E-mails.

STUDY INTERVENTIONS
 Confusion Assessment Method for the
Intensive Care Unit (CAM-ICU) for the
screening of the delirium in patients.
 Pilot study involving two nurses done to
get an insight to the topic.

STUDY ANALYSIS
 Braun and Clarke’s framework (2006) was
used to do the thematic analysis.
 Seven themes were identified from the study
 Delirium as the secondary priority.
 Unpleasant nature of delirium
 Criticism about the CAM- ICU method.
 Mistrust on Delirium management
 Communication difficulty
 Non pharmacological methods
 Introduction of official guidelines.

LINKING WITH THE PREVIOUS STUDIES
 The findings of a paper by Elfeky and Ali,
(2013), and Law et al., (2012), complies
with the findings with this paper.
 Most of the nurses gave priority to patient
consciousness and pain management.
 Delirium has been considered as the least
priority, while dealing with the critically ill
patients.
 Most of the papers say that Proper
training to the critical care nurses about
delirium assessment is still required.

ETHICAL CONSIDERATIONS & LIMITATIONS
Ethical consideration:-
 The study was approved from University of
Hertfordshire Ethics Committee and by the
managements of the ICU and of the local hospital.
 Official consent was taken from the participants.
Limitations:-
 Small sample size
 The topic was not critically explored during the
focus group discussions.
 all the participants were being selected from one
ICU, hence the findings might not comply with
other clinical settings

IMPLICATIONS& RECOMMENDATIONS
 Recommendations
 Delirium assessment and management.
 Training to the critical care nurses.
 Making organizational guidelines .
Implications
 The study helped to identify the gaps
left in the nursing care in the
identification and management of
Delirium.

REFERENCES
 Bélanger, L., & Ducharme, F. (2011). Patients' and nurses' experiences of
delirium: a review of qualitative studies. Nursing in critical care, 16(6), 303-315.
 Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among
five traditions. Thousand Oaks, CA: Sage Publications.
 Elfeky, H. A., & Ali, F. S. (2013). Nurses’ Practices and Perception of Delirium in
the Intensive Care Units of a Selected University Hospitals in Egypt. Journal of
Education and Practice, 4(19), 61-70.
 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.
 Gesin, G., Russell, B. B., Lin, A. P., Norton, H. J., Evans, S. L., & Devlin, J. W.
(2012). Impact of a delirium screening tool and multifaceted education on nurses’
knowledge of delirium and ability to evaluate it correctly. American Journal of
Critical Care, 21(1), e1-e11.
 Law, T. J., Leistikow, N. A., Hoofring, L., Krumm, S. K., Neufeld, K. J., & Needham,
D. M. (2012). A survey of nurses’ perceptions of the intensive care delirium
screening checklist. Dynamics, 23(4), 18-24.
 Zamoscik, K., Godbold, R., & Freeman, P. (2017).
Intensive care nurses' experiences and perceptions of delirium and delirium care
. Intensive and Critical Care Nursing, 40, 94-100.
doi:http://dx.doi.org/10.1016/j.iccn.2017.01.003