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Geriatri Hastalarında Hemşirelerin Deliryumu Erken Tanımlayabilme Durumunun İncelenmesi

Year 2024, Volume: 28 Issue: 2, 57 - 65, 24.08.2024
https://doi.org/10.62111/ybhd.1453712

Abstract

Özet
Amaç: Bu araştırma, yoğun bakım ünitesinde çalışan hemşirelerin CAM-ICU ölçeğini kullanarak geriatri hastalarında deliryumu erken dönemde tanımlayabilme durumunu değerlendirmek amacıyla planlanmıştır.
Yöntem: Araştırma, tanımlayıcı bir çalışmadır. Çalışmanın örneklemini bir üniversite hastanesinin yoğun bakım ünitelerinde çalışan 88 hemşire oluşturmuştur. Veriler, ‘Hasta Tanıtım Formu’, ‘Hemşire Tanıtım Formu’ ve ‘Yoğun Bakım Ünitesinde Konfüzyon Değerlendirme Ölçeği (CAM-ICU)’ kullanılarak elde edilmiştir. İstatistiksel analizde Pearson Ki Kare, Fisher’s Exact Testi ve Çoklu Ki Kare testleri kullanılmıştır.
Bulgular: Araştırmaya katılan hemşirelerin %84’ü kadın ve %72’si lisans mezunu, %72’si on bir yıl ve üzerinde meslekte çalıştığını bildirmiştir. Hemşirelerin bakım verdiği hastaların yaş ortalamasının 70 olduğu, hastaların %62,5’nin cerrahi yoğun bakım ünitesinde tedavi gördüğü ve %37,5’inin koroner arter bypass greft cerrahisi geçirdiği belirlenmiştir. Çalışmamızda; hemşirenin çalıştığı bölüm ile deliryum belirleme durumu arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur (p<0,05). Lisans mezunu olan hemşirelerin çalıştıkları bölümler ile deliryum belirleme durumu arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur (p<0,05). Meslekte çalışma süresi on bir yıl ve üzerinde olan hemşirelerin çalıştıkları bölümler ile deliryum belirleme durumu arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur. (p<0,05).
Sonuç: Çalışmamızda; lisans mezunu olan, çalışma süresi on bir yıl ve üzerinde olan, cerrahi yoğun bakım ünitesinde çalışan hemşirelerin deliryumu CAM-ICU ölçeğini kullanarak hekim tanısı koymadan tanımlayabildiği saptanmıştır. Bu veriler doğrultusunda; yoğun bakımda çalışan hemşirelerin deliryumu erken dönemde saptayabilmek için deliryum değerlendirme ölçeklerini rutin olarak kullanması ve deliryum konusunda hizmet içi eğitim planlamalarının yapılması gerektiği sonucuna varılmıştır.
Anahtar Kelimeler: Deliryum, geriatri, hemşire, yoğun bakım ünitesi

Supporting Institution

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References

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  • 2. Tran NN, Hoang T, Ho T. Diagnosis and risk factors for delirium in elderly patients in the emergency rooms and ıntensive care unit of the national geriatric hospital emergency department: A cross-sectional observational study. Int J Gen Med. 2021;14:6505–6515.
  • 3. Oliveira JE Silva L, Berning MJ, Stanich JA, et. al. Risk factors for delirium in older adults in the emergency department: A systematic review and meta-analysis. Ann Emerg Med. 2021;78(4):549-565.
  • 4. Toft K, Tontsch J, Abdelhamid S, et al. Serum biomarkers of delirium in the elderly: A narrative review. Ann.Intensive Care. 2019;9(1):1-19.
  • 5. Eita LH. Nursing knowledge and practices regarding delirium as an underrecognized syndrome in ıntensive care units (ICU psychosis). Egyptian J Health Care. 2021;(12):904-920.
  • 6. Collet MO, Thomsen T, Egerod I. Nurses’ and physicians’ approaches to delirium management in the intensive care unit: A focus group investigation. Aust Crit Care. 2019;(32):299-305.
  • 7. Lee G, Roh YS. Knowledge, barriers, and training needs of nurses working in delirium care. Nursing in critical Care. 2023;28(5),637-644.
  • 8. Singler K, Thomas C. Help–Hospital elder life program–multimodal delirium prevention in elderly patients. Der Internist. 2017;58,125-113.
  • 9. Hoch J, Bauer JM, Bizer M, et al. Nurses’ competence in recognition and management of delirium in older patients: Development and piloting of a self-assessment tool. BMC Geriatr. 2022; 22: 879.
  • 10. Krupa S, Friganović A, Oomen B, et. al. Nurses’ knowledge about delirium in the group of intensive care units patients. Int J Env Res Pub He. 2022;19(5):2758.
  • 11. Çevik B, Akyüz E, Uğurlu Z, et. al. Determining the awareness of nurses working in intensive care units on delirium management. J Başkent Univ Fac Health Sci. 2016;1(1):32-46.
  • 12. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):825-873.
  • 13. Oliven R, Rotfeld M, Gino-Moor S, et al. Early detection and ıntervention for patients with delirium admitted to the department of ınternal medicine: Lessons from a pilot initiative. Dement Geriatr Cogn Dis Extra. 2021;2;11(2):134-139.
  • 14. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-2710.
  • 15. Akıncı S, Rezaki M, Rezaki Özdemir H, et al. Validity and reliability study of the confusion assessment scale in the intensive care unit.Turk J Anaesth Reanim.2005;33(4):333-341.
  • 16. Dos Santos FCM, Rêgo AS, Montenegro WS, et al. Delirium in the intensive care unit: Identifying difficulties in applying the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). BMC Nurs. 2022;21(1):323.
  • 17. Collet MO, Nielsen AH, Larsen LK, et al. Delirium and delirium severity screening in the intensive care-correspondence of screenings tools. Aust Crit Care. Published online July 10, 2023. doi:10.1016/j.aucc.2023.05.007.
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  • 20. LI X, Zhang L, Gong F, et al. Incidence and risk factors for delirium in older patients following intensive care unit admission: A prospective observational study. JNR. 2020; 28(4):101.
  • 21. Roh YS.The training needs of Korean intensive care unit nurses regarding delirium. J Crit Intensive Care, 2021;62,102954.
  • 22. Sanchez D, Brennan K, Al Sayfe M, et al. Frailty, delirium and hospital mortality of older adults admitted to intensive care: The Delirium (Deli) in ICU study. Critical Care, 2020;24(1),1-8.
  • 23. Kirfel A, Guttenthaler V, Mayr A, et al. C. Postoperative delirium is an independent factor influencing the length of stay of elderly patients in the intensive care unit and in hospital. Journal of Anesthesia, 2022;36(3):341-348.
  • 24. Janssen TL, Alberts AR, Hooft L, et al. Prevention of postoperative delirium in elderly patients planned for elective surgery: Systematic review and meta-analysis. Clin Interv Aging. 2019;9;14:1095-1117.
  • 25. Başpınar T. Cerrahi yoğun bakım ünitesinde çalışan hemşirelerin deliryuma yönelik bilgi, tutum ve bakım uygulamalarının değerlendirilmesi. (Yüksek lisans Tez Çalışması). İstinye Üniversitesi, Sağlık Bilimleri Enstitüsü. İstanbul. 2019
  • 26. Varallo R, De Oliveira AM, Zanetti ACB, et al. Drug-induced delirium among older people. New Insights into the Future of Pharmacoepidemiology and Drug Safety,2021;127.
  • 27. Park SY, Lee HB. Prevention and management of delirium in critically ill adult patients in the intensive care unit: A review based on the 2018 PADIS guidelines. Acute Crit Care. 2019;34(2):117-125.
  • 28. Kristiansen S, Konradsen H, Beck M, Nurses experiences of caring for older patients afflicted by delirium in a neurological department. J.Clin.Nurs. 2018;28(5-6):920-930.
  • 29. Krewulak KD, Stelfox HT, Leigh JP, et al. Incidence and prevalence of delirium subtypes in an adult ICU. Critical Care Medicine, 2018;46(12):2029-2035.
  • 30. Yu M, Mi J, Zhang C, et al. Knowledge, attitude and practice regarding hypoactive delirium among ICU nurses: A nationwide cross-sectional study. Nurse Education in Practice, 2023;72:103749.
  • 31. American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics. 2015;63(1):142-150.
  • 32. Guthrie PF, Rayborn S, Butcher HK. Evidence-Based Practice Guideline: Delirium. J Gerontol. 2018;44(2):14–24.

Investigation of Nurses' Early Identification of Delirium in Geriatric Patients

Year 2024, Volume: 28 Issue: 2, 57 - 65, 24.08.2024
https://doi.org/10.62111/ybhd.1453712

Abstract

Objective: This study was planned to evaluate the ability of nurses working in the intensive care unit to detect delirium in geriatric patients at an early stage using the CAM-ICU scale.
Method: The study was a descriptive study. The sample of the study consisted of 88 nurses working in the intensive care units of a university hospital. Data were obtained using the 'Patient Identification Form', 'Nurse Identification Form' and 'Confusion Assessment Scale in Intensive Care Unit (CAM-ICU)'. Pearson Chi-Square, Fisher's Exact Test and Multiple Chi-Square tests were used in statistical analysis.
Results: Of the nurses who participated in the study, 84% were female, 72% were undergraduate graduates, and 72% had been working in the profession for eleven years or more. The mean age of the patients cared for by the nurses was 70 years, 62.5% of the patients were treated in the surgical intensive care unit and 37.5% underwent coronary artery bypass graft surgery. In our study, a statistically significant relationship was found between the department in which the nurse worked and the determination of delirium (p<0.05). A statistically significant relationship was found between the departments in which nurses with bachelor's degree worked and the determination of delirium (p<0.05). A statistically significant relationship was found between the departments in which the nurses working eleven years or more in the profession worked and the determination of delirium (p<0.05).
Conclusion: In our study, it was found that nurses working in a surgical intensive care unit, with a bachelor's degree and eleven years or more in the profession could detect delirium without a physician diagnosis using the CAM-ICU scale. In line with these data, it was concluded that nurses working in intensive care units should routinely use delirium assessment scales to detect delirium at an early stage and in-service planning on delirium should be made.
Keywords: Delirium geriatric, nursing, intensive care

References

  • 1. Yılmaz EB, Çobanoğlu A, Apaydın E. Evaluation of intensive care nurses' knowledge and approaches to delirium: A qualitative study. Turk J Intensive Care. 2023;21:110-118.
  • 2. Tran NN, Hoang T, Ho T. Diagnosis and risk factors for delirium in elderly patients in the emergency rooms and ıntensive care unit of the national geriatric hospital emergency department: A cross-sectional observational study. Int J Gen Med. 2021;14:6505–6515.
  • 3. Oliveira JE Silva L, Berning MJ, Stanich JA, et. al. Risk factors for delirium in older adults in the emergency department: A systematic review and meta-analysis. Ann Emerg Med. 2021;78(4):549-565.
  • 4. Toft K, Tontsch J, Abdelhamid S, et al. Serum biomarkers of delirium in the elderly: A narrative review. Ann.Intensive Care. 2019;9(1):1-19.
  • 5. Eita LH. Nursing knowledge and practices regarding delirium as an underrecognized syndrome in ıntensive care units (ICU psychosis). Egyptian J Health Care. 2021;(12):904-920.
  • 6. Collet MO, Thomsen T, Egerod I. Nurses’ and physicians’ approaches to delirium management in the intensive care unit: A focus group investigation. Aust Crit Care. 2019;(32):299-305.
  • 7. Lee G, Roh YS. Knowledge, barriers, and training needs of nurses working in delirium care. Nursing in critical Care. 2023;28(5),637-644.
  • 8. Singler K, Thomas C. Help–Hospital elder life program–multimodal delirium prevention in elderly patients. Der Internist. 2017;58,125-113.
  • 9. Hoch J, Bauer JM, Bizer M, et al. Nurses’ competence in recognition and management of delirium in older patients: Development and piloting of a self-assessment tool. BMC Geriatr. 2022; 22: 879.
  • 10. Krupa S, Friganović A, Oomen B, et. al. Nurses’ knowledge about delirium in the group of intensive care units patients. Int J Env Res Pub He. 2022;19(5):2758.
  • 11. Çevik B, Akyüz E, Uğurlu Z, et. al. Determining the awareness of nurses working in intensive care units on delirium management. J Başkent Univ Fac Health Sci. 2016;1(1):32-46.
  • 12. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):825-873.
  • 13. Oliven R, Rotfeld M, Gino-Moor S, et al. Early detection and ıntervention for patients with delirium admitted to the department of ınternal medicine: Lessons from a pilot initiative. Dement Geriatr Cogn Dis Extra. 2021;2;11(2):134-139.
  • 14. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-2710.
  • 15. Akıncı S, Rezaki M, Rezaki Özdemir H, et al. Validity and reliability study of the confusion assessment scale in the intensive care unit.Turk J Anaesth Reanim.2005;33(4):333-341.
  • 16. Dos Santos FCM, Rêgo AS, Montenegro WS, et al. Delirium in the intensive care unit: Identifying difficulties in applying the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). BMC Nurs. 2022;21(1):323.
  • 17. Collet MO, Nielsen AH, Larsen LK, et al. Delirium and delirium severity screening in the intensive care-correspondence of screenings tools. Aust Crit Care. Published online July 10, 2023. doi:10.1016/j.aucc.2023.05.007.
  • 18. IBM Corp. Released 2017. IBM SPSS Statistics for Windows Version 25.0. Armonk, NY: IBM Corp. htpps://www.ibm.com/support/pages/how-cite-ibm-spss-statics-or-earlier-versions-spss.
  • 19. Fuchs S, Bode L, Ernst J, et al. Delirium in elderly patients: Prospective prevalence across hospital services. General hospital psychiatry, 2020;67:19-25.
  • 20. LI X, Zhang L, Gong F, et al. Incidence and risk factors for delirium in older patients following intensive care unit admission: A prospective observational study. JNR. 2020; 28(4):101.
  • 21. Roh YS.The training needs of Korean intensive care unit nurses regarding delirium. J Crit Intensive Care, 2021;62,102954.
  • 22. Sanchez D, Brennan K, Al Sayfe M, et al. Frailty, delirium and hospital mortality of older adults admitted to intensive care: The Delirium (Deli) in ICU study. Critical Care, 2020;24(1),1-8.
  • 23. Kirfel A, Guttenthaler V, Mayr A, et al. C. Postoperative delirium is an independent factor influencing the length of stay of elderly patients in the intensive care unit and in hospital. Journal of Anesthesia, 2022;36(3):341-348.
  • 24. Janssen TL, Alberts AR, Hooft L, et al. Prevention of postoperative delirium in elderly patients planned for elective surgery: Systematic review and meta-analysis. Clin Interv Aging. 2019;9;14:1095-1117.
  • 25. Başpınar T. Cerrahi yoğun bakım ünitesinde çalışan hemşirelerin deliryuma yönelik bilgi, tutum ve bakım uygulamalarının değerlendirilmesi. (Yüksek lisans Tez Çalışması). İstinye Üniversitesi, Sağlık Bilimleri Enstitüsü. İstanbul. 2019
  • 26. Varallo R, De Oliveira AM, Zanetti ACB, et al. Drug-induced delirium among older people. New Insights into the Future of Pharmacoepidemiology and Drug Safety,2021;127.
  • 27. Park SY, Lee HB. Prevention and management of delirium in critically ill adult patients in the intensive care unit: A review based on the 2018 PADIS guidelines. Acute Crit Care. 2019;34(2):117-125.
  • 28. Kristiansen S, Konradsen H, Beck M, Nurses experiences of caring for older patients afflicted by delirium in a neurological department. J.Clin.Nurs. 2018;28(5-6):920-930.
  • 29. Krewulak KD, Stelfox HT, Leigh JP, et al. Incidence and prevalence of delirium subtypes in an adult ICU. Critical Care Medicine, 2018;46(12):2029-2035.
  • 30. Yu M, Mi J, Zhang C, et al. Knowledge, attitude and practice regarding hypoactive delirium among ICU nurses: A nationwide cross-sectional study. Nurse Education in Practice, 2023;72:103749.
  • 31. American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics. 2015;63(1):142-150.
  • 32. Guthrie PF, Rayborn S, Butcher HK. Evidence-Based Practice Guideline: Delirium. J Gerontol. 2018;44(2):14–24.
There are 32 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases Nursing​
Journal Section Research
Authors

Pınar Yel 0000-0003-2319-025X

Duygu Akbaş Uysal 0000-0002-7076-9339

Ayfer Karadakovan 0000-0002-7225-6860

Publication Date August 24, 2024
Submission Date March 15, 2024
Acceptance Date May 5, 2024
Published in Issue Year 2024 Volume: 28 Issue: 2

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