Original Article| Volume 31, ISSUE 5, P397-405, October 2016

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Nursing Management of Delirium in the Postanesthesia Care Unit and Intensive Care Unit


      The purpose of the study was to examine nurses' approaches to care of patients with postoperative delirium in the postanesthesia care unit and intensive care unit.


      A descriptive survey design was used.


      Eighty-seven nurses who have been working at a Training and Research Hospital in Erzurum, east of Turkey, were enrolled in this study between October 1 and November 20, 2012.


      83.9% of the nurses reported that they had given pharmacologic therapy for pain management in delirium patients, 39.1% massage, 31.0% rhythmic breathing exercise, and 26.4% music therapy. 90.8% of nurses also stated that they reduced noise and lighting at night to ensure normal sleep pattern.


      Nurses need to be supported to take part in courses, conferences, and training seminars. A standard data tool or scale needs to be used to assess delirium routinely in all patients admitted.


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        • Pisani M.A.
        • Murphy T.E.
        • Van Ness P.H.
        • et al.
        Characteristics associated with delirium in older patients in a medical intensive care unit.
        Arch Intern Med. 2007; 167: 1629-1634
        • Vasilevskis E.E.
        • Morandi A.
        • Boehm L.
        • et al.
        Delirium and sedation recognition using validated instruments: Reliability of bedside intensive care unit nursing assessments from 2007 to 2010.
        J Am Geriatr Soc. 2011; 59: S249-S255
        • Inouye S.K.
        • Westendorp R.G.J.
        • Saczynski J.S.
        Delirium in elderly people.
        Lancet. 2014; 383: 911-922
        • Theuerkauf N.
        • Guenther U.
        • Putensen C.
        Postoperative delirium in the PACU and intensive care unit.
        Trends Anaesh Crit Care. 2012; 2: 148-155
        • Von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • Ely E.W.
        • Shintani A.
        • Truman B.
        • et al.
        Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit.
        JAMA. 2004; 291: 1753-1762
        • Pisani M.A.
        • Kong S.Y.
        • Kasl S.V.
        • et al.
        Days of delirium are associated with 1-year mortality in an older intensive care unit population.
        Am J Respir Crit Care Med. 2009; 180: 1092-1097
        • Shehabi Y.
        • Riker R.R.
        • Bokesch P.M.
        • et al.
        Delirium duration and mortality in lightly sedated mechanically ventilated intensive care patients.
        Crit Care Med. 2010; 38: 2311-2318
        • Xara D.
        • Silva A.
        • Mendonça J.
        • et al.
        Inadequate emergence after anesthesia: Emergence delirium and hypoactive emergence in the postanesthesia care unit.
        J Clin Anesth. 2013; 25: 439-446
        • Girard T.D.
        • Jackson J.C.
        • Pandharipande P.P.
        • et al.
        Delirium as a predictor of long-term cognitive impairment in survivors of critical illness.
        Crit Care Med. 2010; 38: 1513-1520
        • Witlox J.
        • Eurelings L.S.
        • De Jonghe J.F.
        • et al.
        Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: A meta-analysis.
        JAMA. 2010; 304: 443-451
        • van den Boogaard M.
        • Schoonhoven L.
        • Evers A.W.
        • et al.
        Delirium in critically ill patients: Impact on long-term health-related quality of life and cognitive functioning.
        Crit Care Med. 2012; 40: 112-118
        • Rade M.C.
        • Yadeau J.T.
        • Ford C.
        • et al.
        Postoperative delirium in elderly patients after elective hip or knee arthroplasty performed under regional anesthesia.
        HSS J. 2011; 7: 151-156
        • Pandharipande P.
        • Cotton B.A.
        • Shintani A.
        • et al.
        Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients.
        Intensive Care Med. 2007; 33: 1726-1731
        • Hanson M.R.
        • Galvez-Jimenez N.
        Management of dementia and acute confusional states in the perioperative period.
        Neurol Clin. 2004; 22: 413-422
        • Lin Y.
        • Chen J.
        • Wang Z.
        Meta-analysis of factors which influence delirium following cardiac surgery.
        J Card Surg. 2012; 27: 481-492
        • Inouye S.K.
        • Zhang Y.
        • Jones R.N.
        • et al.
        Risk factors for delirium at discharge: Development and validation of a predictive model.
        Arch Intern Med. 2007; 167: 1406-1413
        • Lorenzo M.
        • Aldecoa C.
        • Rico J.
        Delirium in the critically ill patient.
        Trends Anaesth Crit Care. 2013; 3: 257-264
        • Pun B.
        • Gordon S.
        • Peterson J.
        • et al.
        Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers.
        Crit Care Med. 2005; 33: 1199-1205
        • van den Boogaard M.
        • Pickkers P.
        • van der Hoeven H.
        • et al.
        Implementation of a delirium assessment tool in the ICU can influence haloperidol use.
        Crit Care. 2009; 13: 1-7
        • Devlin J.
        • Fong J.
        • Howard E.
        • et al.
        Assessment of delirium in the intensive care unit: Nursing practices and perceptions.
        Am J Crit Care. 2008; 17: 555-565
        • Schreier A.M.
        Nursing care, delirium, and pain management for the hospitalized older adult.
        Pain Manag Nurs. 2010; 11: 177-185
        • Page V.
        • Navarange S.
        • Gama S.
        • et al.
        Routine delirium monitoring in a UK critical care unit.
        Crit Care. 2009; 13: R16
        • O'Regan N.A.
        • Fitzgerald J.
        • Timmons S.
        • et al.
        Delirium: A key challenge for perioperative care.
        Int J Surg. 2013; 11: 136-144
        • Pandharipande P.
        • Banerjee A.
        • McGrane S.
        • et al.
        Liberation and animation for ventilated ICU patients: The ABCDE bundle for the back-end of critical care.
        Crit Care. 2010; 14: 157
        • Morandi A.
        • Brummel N.E.
        • Ely E.W.
        Sedation, delirium and mechanical ventilation: The ‘ABCDE’ approach.
        Curr Opin Crit Care. 2011; 17: 43-49
        • Schweickert W.D.
        • Pohlman M.C.
        • Pohlman A.S.
        • et al.
        Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomized controlled trial.
        Lancet. 2009; 373: 1874-1882
        • Strom T.
        • Martinussen T.
        • Toft P.
        A protocol of no sedation for critically ill patients receiving mechanical ventilation: A randomised trial.
        Lancet. 2010; 375: 475-480
        • Chen C.C.
        • Lin M.T.
        • Tien Y.W.
        • et al.
        Modified hospital elder life program: Effects on abdominal surgery patients.
        J Am Coll Surg. 2011; 213: 245-252
        • Packard R.C.
        Neurologist. 2001; 7: 327-340
        • Akıncı S.B.
        • Sahin A.
        Delirium in intensive care unit.
        Crit Care Nurs. 2005; 5: 26-35
        • Pattison N.
        Psychological implications of admission to critical care.
        Br J Nurs. 2005; 14: 708-714
        • Michaud L.
        • Büla C.
        • Berney A.
        • et al.
        The Delirium Guidelines Development Group. Delirium: Guidelines for general hospitals.
        J Psychosom Res. 2007; 62: 371-383
        • van Rompaey B.
        • Elseviers M.
        • Schuurmans M.
        • et al.
        Risk factors for delirium in intensive care patients: A prospective cohort study.
        Crit Care. 2009; 13: 1-12
        • Kucuk L.
        • Kaya H.
        Psychiatric position during coronary intensive care unit: Delirium how much we know?.
        Maltepe Univ Nurs Sci Art J. 2011; 4: 161-166
        • Sprong P.E.
        • Riekerk B.
        • Hofhuis J.
        • et al.
        Occurrence of delirium is severely underestimated in the ICU during daily care.
        Intensıve Care Med. 2009; 35: 1276-1280
        • Guner P.
        • Geenen O.
        Delirium: An elusive disorder.
        Cumhuriyet Univ Nurs Sch J. 2007; 11: 37-46
        • Cheng-mei S.
        • Dong-xin W.
        • Kai-sheng C.
        • et al.
        Incidence and risk factors of delirium in critically ill patients after non-cardiac surgery.
        Chin Med J. 2010; 123: 993-999
        • Schuurmans M.J.
        • Duursma S.A.
        • Shortridge-Baggett L.M.
        Early recognition of delirium: Review of the literature.
        J Clin Nurs. 2001; 10: 721-729
        • Dyson M.
        Intensive care unit psychosis, the therapeutic nurse-patient relationship and the influence of the intensive care setting analyses of interrelating factors.
        J Clin Nurs. 1999; 8: 284-290
        • Celis-Rodriguez E.
        • Birchenall C.
        • de la Cal M.A.
        • et al.
        Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients.
        Med Intensiva. 2013; 37: 519-574
        • Monette J.
        • du Fort G.G.
        • Fung S.H.
        • et al.
        Evaluation of the confusion assessment method (CAM) as a screening tool for delirium in the emergency room.
        Gen Hosp Psychiatry. 2001; 23: 20-25
        • Inouye S.K.
        • Foreman M.D.
        • Mion L.C.
        • et al.
        Nurses’ recognition of delirium and its symptoms: Comparison of nurse and researcher ratings.
        Arch Intern Med. 2001; 161: 2467-2473
        • Ely E.W.
        • Siegel M.D.
        • Inouye S.K.
        Delirium in the intensive care unit: An under-recognized syndrome of organ dysfunction.
        Semin Respir Crit Care Med. 2001; 22: 115-126
        • Bjorkelund K.B.
        • Hommel A.
        • Thorngren K.G.
        • et al.
        Reducing delirium in elderly patients with hip fracture: A multi-factorial intervention study.
        Acta Anaesthesiol Scand. 2010; 54: 678-688
        • Tsang L.F.
        Nurse' prediction prevention and management on post-operative delirium in geriatric patients with hip fracture: The development of a protocol to guide care.
        Int J Orthop Trauma Nurs. 2014; 18: 23-34
        • DeCrane S.K.
        • Sands L.
        • Ashland M.
        • et al.
        Factors associated with recovery from early postoperative delirium.
        J Perianesth Nurs. 2011; 26: 231-241
        • Vaurio L.
        • Sands L.
        • Wang Y.
        • et al.
        Postoperative delirium: The importance of pain and pain management.
        Anesth Analg. 2006; 102: 1267-1273
        • Robinson S.
        • Rich C.
        • Weitzel T.
        • et al.
        Delirium prevention for cognitive, sensory and mobility impairments.
        Res Theory Nurs Pract An Int J. 2008; 22: 103-113
        • Forsgren L.M.
        • Eriksson M.
        Delirium-Awareness, observation and interventions in intensive care units: A national survey of Swedish ICU head nurses.
        Intensive Crit Care Nurs. 2010; 26: 296-303
        • Arend E.
        • Christensen M.
        Delirium in the intensive care unit: A review. British Association of Critical Care Nurses.
        Nurs Crit Care. 2009; 14: 145-154
        • Van Rompaey B.
        • Elseivers M.M.
        • Van Drom W.
        • et al.
        The effect of earplugs during the night on the onset of delirium and sleep perception: A randomized controlled trial in intensive care units.
        Crit Care. 2012; 16: R73
        • Inouye S.K.
        • Bogardus Jr., S.T.
        • Charpentier P.A.
        • et al.
        A multicomponent intervention to prevent delirium in hospitalized older patients.
        N Engl J Med. 1999; 340: 669-676
        • Russell S.
        An exploratory study of patients’ perceptions, memories and experiences of an intensive care unit.
        J Adv Nurs. 1999; 29: 783-791
        • McPherson J.A.
        • Wagner C.E.
        • Boehm L.M.
        • et al.
        Delirium in the cardiovascular ICU: Exploring modifiable risk factors.
        Crit Care Med. 2013; 41: 405-413
        • De Jonghe B.
        • Constantin J.M.
        • Changues G.
        • et al.
        • Group Interfaces Sedation
        Physical restraint in mechanically ventilated ICU patients: A survey of French practice.
        Intensive Car Med. 2013; 39: 31-37


      Neziha Karabulut, PhD, RN, Department of Surgical Nursing, The Faculty of The Health Sciences, Atatürk University, Erzurum, Turkey


      Yeşim Yaman Aktaş, PhD, RN, Department of Surgical Nursing, The Faculty of The Health Sciences, Giresun University, Giresun, Turkey