The Effect of Multidimensional Nursing Interventions on the Incidence of Delirium in Patients with COVID‑19
Abstract
Background: In patients with coronavirus disease 2019 (COVID‑19), the incidence of delirium has been increased due to the nature of the disease and the specific protective protocols implemented to control the outbreak of this disease. The purpose of this study was to determine the effect of multidimensional nursing interventions on the incidence of delirium in patients with COVID‑19.
Materials and Methods: A quasiexperimental study (preintervention, postintervention assessment) was conducted in168 patients (84 patients in each group) with COVID‑19 admitted to the general wards of Hazrat Ali‑Asghar Educational Hospital in Shiraz, Iran, between May and June 2021. At first, based on inclusion criteria, the control group was selected to prevent information transmission between the study groups. The control group was treated as usual, but the intervention group received a three‑part intervention that included nurse‑related, patient‑related, and environment‑related measures. A Demographic Information Form and the Richmond Agitation Sedation Score and the Intensive Care Delirium Screening Checklist were completed for each patient. The collected data were analyzed.
Results: 25.30% of patients in the control group and 10.50% of patients in the intervention group experienced delirium (χ2 = 5.72, p < 0.05). The results showed that the incidence of delirium was significantly lower in the intervention group. The mean number of days during which the patients experienced delirium was insignificantly lower in the intervention group (U = 2.56, p > 0.05). The mean length of hospital stay was also significantly lower in the control group (U = ‑2.41, p < 0.05).
Conclusions: The multidimensional nursing interventions effectively reduced the incidence of delirium in patients with COVID‑19.
Keywords
References
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727‑33.
WHO. Rolling Updates on Coronavirus Disease (COVID‑19). WHO Geneve, Switzerland, 2020.
Organization WH. Coronavirus disease (COVID‑19) Weekly Epidemiological Update and Weekly Operational Update. Available from: https://www.who.int/emergencies/diseases/ novel-coronavirus-2019/situation-report. [Last accessed 2022 June 07].
Deana C, Verriello L, Pauletto G, Corradi F, Forfori F, Cammarota G, et al. Insights into neurological dysfunction of critically ill COVID19 patients. Trends Anaesth Crit Care 2021;36:308.
Kotfis K, Roberson SW, Wilson J, Pun B, Ely EW, Jeżowska I, et al. COVID‑19: What do we need to know about ICU delirium during the SARS‑CoV‑2 pandemic? Anaesthesiol Intensive Ther 2020;52:132‑8.
Kotfis K, Williams Roberson S, Wilson JE, Dabrowski W, Pun BT, Ely E. COVID‑19: ICU delirium management during SARS‑CoV‑2 pandemic. Crit Care 2020;24:1‑9.
Li YC, Bai WZ, Hirano N, Hayashida T, Taniguchi T, Sugita Y, et al. Neurotropic virus tracing suggests a membranous-coatingmediated mechanism for transsynaptic communication. J Comp Neurol 2013;521:203‑12.
Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AM, et al. Delirium. Nat Rev Dis Primers 2020;6:1‑26.
Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020;92:552‑5.
Devlin JW, Fong JJ, Howard EP, Skrobik Y, McCoy N, Yasuda C, et al. Assessment of delirium in the intensive care unit: Nursing practices and perceptions. Am J Crit Care 2008;17:555‑65.
O’Hanlon S, Inouye SK. Delirium: A missing piece in the COVID‑19 pandemic puzzle. Age Ageing 2020;49:497‑8.
Ladak AN. A NurseLed Delirium Prevention Program for Hospitalized Older Adults. University of California: Los Angeles; 2020.
Arbabi M, Zebardast J, Noorbala AA, Mohamadi M, Rahimnia M, Larijani R. Efficacy of liaison education and environmental changes on delirium incidence in ICU. Arch Neurosci 2018;5:1-7.
Deeken F, Sánchez A, Rapp MA, Denkinger M, Brefka S, Spank J, et al. Outcomes of a delirium prevention program in older persons after elective surgery: A stepped‑wedge cluster randomized clinical trial. JAMA Surg 2022;157:e216370.
Unal N, Guvenc G, Naharci M. Evaluation of the effectiveness of delirium prevention care protocol for the patients with hip fracture: A randomised controlled study. J Clin Nurs 2022;31:1082‑94.
Faustino TN, Suzart NA, dos Santos Rabelo RN, Santos JL, Batista GS, de Freitas YS, et al. Effectiveness of combined non‑pharmacological interventions in the prevention of delirium in critically ill patients: A randomized clinical trial. J Crit Care 2022;68:114‑20.
Radhakrishnan NS, Mufti M, Ortiz D, Maye ST, Melara J, Lim D, et al. Implementing Delirium prevention in the Era of COVID‑19. J of Alzheimers Dis 2021;79:31‑6.
Contreras CCT, Páez‑Esteban AN, Rincon‑Romero MK, Carvajal RR, Herrera MM, Castillo AHDd. Nursing intervention to prevent delirium in critically ill adults. Rev Esc Enferm USP 2021;55:e03685.
Baller EB, Hogan CS, Fusunyan MA, Ivkovic A, Luccarelli JW, Madva E, et al. Neurocovid: Pharmacological recommendations for delirium associated with COVID‑19. Psychosomatics 2020;61:585‑96.
Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, et al. The Richmond Agitation–Sedation Scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338‑44.
Farzammanesh A, Jahani S, Rashidi M, Maraghi E, Ravanbakhsh F. The effect of joints range of motion exercises on delirium prevention in patients admitted to intensive care units. Int J Pharm Phytopharm Res 2020;10:105‑13.
Tadrisi SD, Madani SJ, Farmand F , Ebadi A , Karimizarchi AA, Saghafinia M. Richmond agitation–sedation scale validity and reliability in intensive care unit adult patients Persian version. JCCNursing 2009;2:15-21.
Bergeron N, Dubois M‑J, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: Evaluation of a new screening tool. Intensive Care Med 2001;27:859‑64.
Torshizi M, Hekmatpou D, Sharbafchi MR, Afshar H, Ayati MM. Reliability and validity of the persian version of intensive care delirium screening checklist in detection of delirium in intensive care units. J Isfahan Med Sch 2016;34:536‑46.
Song J, Lee M, Jung D. The effects of delirium prevention guidelines on elderly stroke patients. Clin Nurs Res 2018;27:967‑83.
Kratz T, Heinrich M, Schlauß E, Diefenbacher A. Preventing postoperative delirium: A prospective intervention with psychogeriatric liaison on surgical wards in a general hospital. Dtsch Ärztebl Int 2015;112:289.
Schubert M, Bettex D, Steiger P, Schürch R, Haller A, Bogdanovic J, et al. Implementation of a multiprofessional, multicomponent delirium management guideline in two intensive care units, and its effect on patient outcomes and nurse workload: A pre‑post design retrospective cohort study. Swiss Med Wkly 2020;150:w20185.
Guo Y, Sun L, Li L, Jia P, Zhang J, Jiang H, et al. Impact of multicomponent, nonpharmacologic interventions on perioperative cortisol and melatonin levels and postoperative delirium in elderly oral cancer patients. Arch Gerontol Geriatr 2016;62:112‑7.
Kram SL, DiBartolo MC, Hinderer K, Jones RA. Implementation of the ABCDE bundle to improve patient outcomes in the intensive care unit in a rural community hospital. Dimens Crit Care Nurs 2015;34:250‑8.
Chen CC‑H, Li H‑C, Liang J‑T, Lai I‑R, Purnomo JDT, Yang Y‑T, et al. Effect of a modified hospital elder life program on delirium and length of hospital stay in patients undergoing abdominal surgery: A cluster randomized clinical trial. JAMA Surg 2017;152:827‑34.
Refbacks
- There are currently no refbacks.