Background: Delirium is a well-recognized and severe problem in adult intensive care units. With a reported incidence as high as 80%, it has been associated with increased length of stay, higher costs of care, on-going cognitive impairment and increased mortality. International best practice guidelines recommend nurses perform frequent delirium assessments using validated screening tools for all intensive care unit patients. Lack of data exists in the South African context regarding nurses’ current sedation and delirium practices and their perceptions towards delirium assessments.
Setting: The settings for the study were five adult intensive care units (ICU's) at one 1.200 bedded university-affiliated public hospital in Johannesburg, South Africa.
Design: A quantitative-descriptive survey and cross-sectional design was utilized in this study. The total sample (n=105) of registered nurses from the adult ICU's (n=5) between the period of 1.07.2017 to 1.09.2017 was used. A non-probability sampling method was utilized and data were collected using a questionnaire developed by Devlin et al. (2008).
Results: Overall 105 (n=105) nurses responded, which yielded a response rate of 95.2% for the study. Delirium assessment was less frequent than sedation assessment (20% vs. 51%; p<0.001). Only 21% ranked delirium as the most important condition to evaluate, compared with the altered level of consciousness (41%), improper placement of invasive lines (18%), and presence of pain (16%). Preferred methods for assessing delirium included assessing the ability to follow commands (51%), checking for agitation-related situations (41%), the CAM-ICU (24%), the Intensive Care Delirium Checklist (15%), and psychiatric consultation (12%). The barrier to assessment included intubation (57%), sedation level (21%) and lack of confidence to use delirium assessment tools (22%). The majority of participants never received an education (56%) or attended a lecture (19%) on delirium.
Conclusion: These findings provide further evidence of a theory-practice gap that is likely to exist in South Africa where best practice guidelines in the management of delirium in the ICU settings are not implemented. Recommendations are made for clinical practice and education of intensive care nurses.
Key words: delirium assessment, CAM-ICU, intensive care unit, intensive care nurse
Devlin, J., Fong, J., Howard, E., Skrobik, Y., Yasuda, E. & Marshall, J. 2008. Assessments of delirium in intensive care unit nursing practices and perceptions. American Journal of Critical Care, 17(6): 555-566.
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