Nurses' and physicians' approaches to delirium management in the intensive care unit: A focus group investigation |
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| Affiliation: | 1. Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark;2. Centre for Research in Intensive Care, Tagensvej 22, 2200 Copenhagen N, Denmark;3. Abdominal Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark;4. University of Copenhagen, Health and Medical Sciences, Blegdamsvej 3, 2200 Copenhagen N, Denmark;1. Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands;2. Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands;3. Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;4. Research Department of Anesthesiology & Intensive Care, Isala, Zwolle, The Netherlands;5. Department of Intensive Care Medicine, Maxima Medical Center, Veldhoven, The Netherlands;6. Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands;7. Department of Intensive Care Medicine, Medical Center Haaglanden-Bronovo, The Hague, The Netherlands;8. Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands;9. Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands;10. Department of Intensive Care Medicine, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands;11. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands;12. Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands;13. Department of Geriatric Medicine, Spaarne Gasthuis, Haarlem, The Netherlands;14. Department of Intensive Care, Zuyderland Medical Center, Heerlen, The Netherlands;15. Faculty of Health Sciences, University of Southampton, Southampton, UK;p. Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands;q. Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, The Netherlands;1. Programa de Enfermería, Universidad Surcolombiana, Neiva, Huila, Colombia;2. Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia;1. ICU Staff Nurse, Royal Columbian Hospital, 633 First St., New Westminster, BC, V3L 2H3, Canada;2. Pre-Admission Clinic, Jim Pattison Outpatient Care and Surgery Center, 9750 140 St., Surrey, BC, V3T 0G9, Canada;3. Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada;1. St. James’ Hospital, Dublin 8, Ireland;2. School of Nursing & Midwifery, Trinity College Dublin, Ireland;1. Department of Nursing, Swansea University, Singleton Park, Swansea, SA2 APP, United Kingdom;2. Critical Care, Glangwili Hospital, Dolgwili Road, Carmarthen, SA31 2AF, United Kingdom;1. The Nethersole School of Nursing, 6/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region;2. The Nethersole School of Nursing, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region;3. The Nethersole School of Nursing, 7/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region |
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| Abstract: | ![]()
BackgroundDelirium in the intensive care unit (ICU) is common, but reliable evidence-based recommendations are still limited.ObjectivesThe aim of our study was to explore nurses' and physicians' experiences and approaches to ICU delirium management.MethodOur study had a qualitative multicentre design using interdisciplinary focus groups and framework analysis. Participants were strategically selected to include nurses and physicians with experience in delirium management at five ICUs in four out of five regions in Denmark.ResultsWe conducted eight focus group interviews with 24 nurses and 15 physicians; median ICU experience was 9 years (range 1–35). The main issues identified were (1) the decision to treat or not to treat ICU delirium based on delirium phenotype, (2) the decision to act based on experience or evidence, and (3) the decision to intervene using nursing care or medications. ICU delirium was treated with pharmacological interventions in patients with signs of agitation, hallucinations, and sleep deprivation. The first choice of agent was haloperidol or olanzapine. Agitated and combative patients received benzodiazepines, propofol, or dexmedetomidine. Calm delirious patients were managed with non-pharmacological solutions. Physicians recommended pro re nata (PRN) orders to prevent over medication, whereas nurses opposed PRN orders with the fear that it would increase their responsibilities.ConclusionOur study described an algorithm of contemporary delirium management in Danish ICUs based on qualitative inquiry. When evidence-based solutions are unclear, nurses and physicians rely on personal experience, collective experience, and best available evidence to determine which patients to treat and what methods to use to treat ICU delirium. Delirium management still needs clear objectives and guidelines with evidence-based recommendations for first-line treatment and subsequent treatment options. |
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| Keywords: | Delirium Focus groups Intensive care unit Hermeneutics Nursing care Pharmacological action Qualitative research |
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