Liang Surui, Chau Janita Pak Chun, Lo Suzanne Hoi Shan, Zhao Jie, Liu Wenhui
Nursing Department, Shenzhen Hospital of Southern Medical University, Guangdong, China.
Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China.
BMC Nurs. 2022 Aug 25;21(1):235. doi: 10.1186/s12912-022-01019-5.
Delirium is common among critically ill patients, leading to increased mortality, physical dependence, and cognitive impairment. Evidence suggests non-pharmacological delirium prevention practices are effective in preventing delirium. However, only a few studies explore the actual implementation and its associated challenges among critical care nurses.
To explore critical care nurses' perceptions of current non-pharmacological delirium prevention practices in adult intensive care settings, including delirium screening, early mobilisation, sleep promotion, family engagement, and sensory stimulation.
A qualitative design adopting a thematic analysis approach. Semi-structured interviews with 20 critical care nurses were conducted in ten acute hospitals in mainland China.
Three themes emerged: (a) importance of family engagement; (b) influence of organisational factors, and (c) suggestions on implementation. The implementation of non-pharmacological delirium prevention practices was limited by a strict ICU visitation policy, lack of routine delirium screening and delirium training, light and noise disturbances during nighttime hours, frequent resuscitation and new admissions and strict visitation policy. Case-based training, adopting a sensory stimulation protocol, and family engagement may be enablers.
ICU care routine that lacks delirium assessment and the strict family visitation policy made it challenging to implement the complete bundle of non-pharmacological practices. Resource deficiency (understaffing, lack of training) and ICU environment (frequent resuscitation) also limited the implementation of non-pharmacological practices. Clinicians could implement case-based training and sensory-stimulation programs and improve communication with family caregivers by instructing family caregivers to recognise delirium symptoms and delirium prevention strategies.
谵妄在重症患者中很常见，会导致死亡率增加、身体依赖和认知障碍。有证据表明，非药物性谵妄预防措施在预防谵妄方面是有效的。然而，只有少数研究探讨了重症监护护士实际实施这些措施的情况及其相关挑战。
探讨重症监护护士对成人重症监护环境中当前非药物性谵妄预防措施的看法，包括谵妄筛查、早期活动、促进睡眠、家属参与和感官刺激。
采用主题分析方法的定性设计。在中国内地的十家急症医院对20名重症监护护士进行了半结构式访谈。
出现了三个主题：(a)家属参与的重要性；(b)组织因素的影响；(c)实施建议。非药物性谵妄预防措施的实施受到严格的重症监护病房探视政策、缺乏常规谵妄筛查和谵妄培训、夜间的光线和噪音干扰、频繁的复苏和新入院患者以及严格的探视政策的限制。基于案例的培训、采用感官刺激方案和家属参与可能是促进因素。
缺乏谵妄评估的重症监护病房常规护理以及严格的家属探视政策使得全面实施非药物性措施具有挑战性。资源不足（人员配备不足、缺乏培训）和重症监护病房环境（频繁复苏）也限制了非药物性措施的实施。临床医生可以实施基于案例的培训和感官刺激项目，并通过指导家属照顾者识别谵妄症状和谵妄预防策略来改善与他们的沟通。
