Nursing activities for prevention, recognizing and treatment of delirium in intensive care units

Uvod: Delirij je akutna organska duševna motnja, ki se pogosto pojavlja pri življenjsko ogroženih pacientih v intenzivnih enotah, a vseeno pogosto ostane neodkrit. Ker ga je z ustreznimi varovalnimi ukrepi mogoče preprečiti, je smiselno, da aktivnosti usmerimo najprej v preprečevanje, če nam to ne uspe, v prepoznavanje in za tem v ustrezno obravnavanje, da simptome in vzroke delirija čimprej odpravimo. Pri vseh aktivnostih smo medicinske sestre zelo pomemben člen zdravstvenega tima, ki obravnava pacienta z delirijem, saj ob njem preživimo največ časa ter ga zato tudi najbolje poznamo in lahko ocenimo in opazimo različne spremembe, tako v duševnem kot telesnem stanju. Namen: Namen diplomskega dela je opredeliti aktivnosti zdravstvene nege za preprečevanje, prepoznavanje in obravnavo delirija v intenzivnih enotah somatskih bolnišnic. Metode dela: V diplomskem delu je bila uporabljena deskriptivna metoda dela, s katero smo pregledali tako tujo in domačo literaturo, ki smo jo iskali v elektronskih podatkovnih bazah (PubMed, Medline, CINAHL, Wiley Online Library). Dostop do omenjenih podatkovnih baz je bil omogočen preko oddaljenega dostopa v digitalni knjižnici Univerze v Ljubljani (DiKul). Slovenska literatura pa je bila iskana preko bibliografskega sistema COBISS.SI in svetovnega spleta. V diplomskem delu je bilo končno vključenih 31 enot literature. Rezultati: Rezultati kažejo, da je veliko aktivnosti, s katerimi je možno tako preprečiti, kot lajšati simptome že razvitega delirija. Ključne aktivnosti tako v preventivi kot obravnavi obsegajo edukacijo zdravstvenih delavcev, identifikacijo dejavnikov tveganja, obvladovanje bolečine, uravnavanje sedacije, zgodnjo mobilizacijo, ustrezno higieno spanja in orientacijo ter informiranost pacienta. V vseh teh aktivnostih morajo medicinske sestre znati prevzeti svojo vlogo in jo s svojo strokovnostjo in izvajanjem različnih intervencij izvesti tako, da v čim večji meri preprečujejo dejavnike tveganja, odkrivajo še neidentificirane delirantne paciente in ustrezno sodelujejo pri obravnavi pacientov, pri katerih se je delirij razvil. Razprava in zaključek: Iz rezultatov je razvidno, da je delirij pogost v populaciji življenjsko ogroženih pacientov, pogosto spregledan, a je za njegovo preprečevanje, prepoznavanje in ustrezno obravnavo možno z ustreznim pristopom, smernicami in protokoli veliko narediti. Ugotovili smo tudi, da je delirij eden izmed tistih zapletov, kjer se ponovno lahko izkaže velika vloga zdravstvene nege pri obravnavi pacienta, sočasno pa tudi, kako zelo pomembno je, da se zdravstvene stroke v najboljše pacientovo dobro med seboj neprestano povezujejo in si pomagajo.Introduction: Delirium is an acute organic mental disorder that often occurs in critically ill patients in intensive care units, but still frequently goes undetected. Since it can be prevented with appropriate safeguards, it makes sense to firstly direct activities towards prevention. If we fail to prevnet it, we have to identify it, and then provide appropriate treatment, to eliminate the symptoms and causes of delirium as soon as possible. In all these activities, nurses are very important members of the medical team that treats a patient with delirium. We spend the most time with them and therefore we know the patient best and can assess and observe various changes, in both mental and physical aspects. Purpose: The purpose of this diploma work is to define nursing activities for the prevention, identification and treatment of delirium in intensive care units of somatic hospitals. Methods: In this thesis, a descriptive method of work was used, in which we reviewed both foreign and Slovene literature, which we searched for in electronic databases (PubMed, Medline, CINAHL, Wiley Online Library). Access to the mentioned databases was provided via remote access in the digital library of the University of Ljubljana (DiKul). Slovenian literature was searched through the COBISS.SI bibliographic system and the World Wide Web. Finally, 31 units of literature were included. Results: The results show that there are many nursing activities that can both prevent and alleviate the symptoms of already developed delirium. Key activities in both prevention and treatment include educating healthcare professionals, identifying risk factors, managing pain, regulating sedation, early mobilization, proper sleep hygiene and orientation. In all these activities, nurses must be able to take their role and, through their expertise and implementation of various interventions, prevent risk factors, detect unidentified delirious patients and appropriately participate in the treatment. Discussion and conclusion: The results show that delirium is common in the critically ill patient population. Though often being overlooked, much can be done to prevent, identify and treat it with the right approach, guidelines and protocols. We also found that delirium is one of those barriers, where the great role of nursing in treating the patient can once again prove, and show how very important it is, that health professions are constantly connecting and helping each other for the patient\u27s benefit