Dealing with Delirium

A multidisciplinary approach is essential for managing delirium in critical care patients.

Nurses will be better equipped to help critical care patients with delirium thanks to a new multidisciplinary program in Sydney hospitals.

At least 30% of critical care patients experience delirium, with symptoms such as agitation, confusion, sleeping difficulties and memory loss. The condition often impedes recovery in patients, resulting in longer hospital stays, greater reliance on ventilators, and cognitive impairment after discharge. 

“A lot of work has been done on how to identify delirium in critical care patients, but very little on how nurses can manage it,” says Dr Steve Frost, deputy director of the Centre for Applied Nursing Research (CANR) at Western Sydney University and the South Western Sydney Local Health District (SWSLHD).  “It’s an emerging problem in hospitals — not just in aged patients, but in all patients.”

According to Professor Martin Christensen, director of CANR, these factors can create hurdles during the recovery progress. And once patients are home, delirium can affect their daily lives, disturb their sleeping patterns, and make them become more dependent.

Some 34% of patients who return to the emergency department have had an ICU admission in the last six months, according to Christensen. As a result of being in critical care, many returning patients who have experienced delirium during their first admission show symptoms of post-traumatic stress disorder and frailty, marked by a tendency to fall.

Need to know

  • 30% of critical care patients experience delirium.
  • Delirium impedes recovery.
  • Western researchers are developing approaches for managing delirium in critical care patients.    

To help reduce the incidence, severity and duration of delirium in critical care patients, Christensen and his colleagues are developing a multidisciplinary approach for ICU nursing staff. The year-long project began in March 2019 in hospitals across the SWSLHD.

This nurse-led intervention will adopt a range of targeted approaches for managing delirium. For instance, nurses will ensure that patients’ glasses and hearing aids are readily available, particularly during the day. To reduce discomfort and confusion, nurses will avoid moving patients between rooms as much as possible. For patients who struggle to sleep, nurses will provide massages and night lights to help establish a consistent sleep schedule.

The protocol also sets guidelines for helping nurses keep patients in touch with their normal lives. Some of these measures include providing a clock and calendar near the bedside and encouraging families to bring favoured items from home.

In addition to improving outcomes for critical care patients and their families, the project will also help bridge the gap between nursing research and nurses working in hospitals, Christensen says. “Our work is all about bringing together academics and clinical nurses to improve the quality of care for critical care patients,” he says. 

Meet the Academic | Dr Steve Frost

Steve Frost is the Deputy Director of the South Western Sydney Centre for Applied Nursing Research. Steve has been employed as a registered nurse by the SWSLHD since 1994 and started lecturing at Western Sydney University in 2005. Having been a Clinical Nurse Specialist in intensive care, and Clinical Nurse Consultant in the MET Research and Training unit, Simpson Centre for Health Services Research, prior to joining WSU. Steve has a post-graduate certificate in intensive care nursing from Liverpool Hospital, a Masters of Public Health and a PhD in Epidemiology from the University of New South Wales. Steve is a Visiting Scientistic at the Garvan Institute of Medical Research.

Meet the Academic | Professor Martin Christensen

Professor Martin Christensen has been a registered nurse for over 30 years, 15 of which have been as a nursing academic and researcher. His main area of research interest is advancing critical care nursing practice. He has written extensively around issues related to critical nursing and learning and teaching education. Previous to his current role as Director of CANR, Martin developed and ran two Nursing Professorial Units with the core aim to promote and develop translational nursing research. In addition to his current position, Martin is a visiting research fellow with Portsmouth University.

Credit

© WIN-Initiative/Neleman/WIN-Initiative / Getty Images Plus, © Marcelo Leal, © Natanael Melchor

Future-Care is published for Western Sydney University by Nature Research Custom Media, part of Springer Nature.