Monitoring delirium in the intensive care unit: Diagnostic accuracy of the CAM-ICU tool when performed by certified nursing assistants - A prospective multicenter study

Self-efficacy of ICU nurses in delirium care: an analysis of the current status and influencing factors

OBJECTIVE

The aim of this study was to assess the current status of delirium care self-efficacy among nurses in the intensive care unit (ICU) and the level of their knowledge about delirium in the ICU, more importantly, to analyze factors influencing the delirium care self-efficacy of ICU nurses and to provide a theoretical basis for ICU nursing managers to develop strategies for effective delirium care and management.

METHODS

The study was based on a sample of 283 ICU nurses from eight hospitals in Chongqing selected using a convenience sampling method between July 2023 and September 2023. The tools used included a general information questionnaire, the Chinese version of the Delirium Care Self-Efficacy of ICU Nurses Scale, and the Chinese version of the ICU Delirium Knowledge Level Questionnaire.

RESULTS

The self-efficacy score (47.84 ± 9.93) of ICU nurses was positively correlated with the delirium knowledge level score (12.32 ± 3.47, r = 0.591, P < 0.001). Multivariate linear regression analysis identified the gender of the nurse, hospital level (tier), duration of ICU work experience, whether the nurse was a specialized ICU nurse, whether the nurse received delirium-related training, and the level of knowledge about delirium (all P < 0.05) as the influencing factors for the delirium care self-efficacy of ICU nurses.

CONCLUSION

It is recommended that ICU nursing managers offer targeted interventions based on the influencing factors to improve the delirium care self-efficacy of ICU nurses and their delirium knowledge levels, thereby reducing the incidence of delirium and improving the quality of care provided for patients with delirium in the ICU.

Intensive care of a patient undergoing combined multi-organ cluster ("larynx-trachea-thyroid-hypopharynx-esophagus") transplantation: A case report

OBJECTIVE

The aim of this study was to summarize the intensive care experience of a patient undergoing combined multi-organ cluster ("larynx-trachea-thyroid-hypopharynx-esophagus") transplantation.

METHODS

The intensive care management plan for this case was developed by a multidisciplinary team, with focus on 6 aspects: (1) stabilizing the circulation and reducing anastomotic tension by position management to improve the survival chances of transplanted organs, (2) adopting goal-directed analgesia and sedation protocols, as well as preventing anastomotic fistula, (3) implementing a bedside ultrasound-guided nutrition plan, (4) employing "body-mind" synchronous rehabilitation to facilitate functional recovery, (5) taking antirejection treatment and protective isolation measures, (6) monitoring and nursing thyroid function.

RESULTS

During the intensive care, the patient's vital signs were stable. The patient was successfully weaned from the ventilator and transferred to the general ward for further treatment at 9 days postoperatively, and discharged upon recovery at 58 days postoperatively. The patient was in good condition during follow-up.

CONCLUSION

This study provides reference for the care of patients who undergo similar transplantation in the future.

Performance and validation of two ICU delirium assessment and severity tools; a prospective observational study

BACKGROUND

The clinical statistical performance of the Confusion Assessment Method Intensive Care Unit (CAM-ICU, including CAM-ICU-7) and Intensive Care Delirium Screening Checklist (ICDSC) have rarely been studied. Additionally, delirium severity is often not measured due to a lack of validation of delirium assessment tools.

OBJECTIVE

The aim was to determine the statistical performance of both delirium assessment tools in daily practice, and the correlation with the gold standard Delirium Rating Scale (DRS)-R98, for delirium severity.

RESEARCH METHOD

CAM-ICU-7 and ICDSC, performed by nurses were compared with the DRS-R98 assessed by delirium experts, twice weekly. Within a time-window of one hour all assessments were independently performed.

DESIGN

A prospective observational study performed between October and December 2020.

MAIN OUTCOME MEASURES

Sensitivity, specificity, positive and negative predictive value of both tools was determined. The correlation between DRS-R98 and CAM-ICU-7 and ICDSC was used for validation of delirium severity.

RESULTS

In total, 104 CAM-ICU-7 and 105 ICDSC assessments in 86 patients were compared with the DRS-R98. For the CAM-ICU-7 and ICDSC, respectively, the sensitivity was 90% and 95%, the specificity was 92.4% and 92.3%. The positive predictive value was 0.76 and 0.80, and negative predictive value was 0.77 and 0.97. Correlation of the CAM-ICU-7 score and ICDSC score with the DRS-R98 score was 0.74 (95% CI 0.64-0.81) and 0.70 (95%CI 0.59-0.79; both p < 0.001), respectively.

CONCLUSION

Both CAM-ICU-7 and ICDSC demonstrated good statistical performance and correlated well with the delirium severity tool DRS-R98.

IMPLICATIONS FOR CLINICAL PRACTICE

Nurses can either use the CAM-ICU(-7) or the ICDSC in their practice, both are accurate in delirium diagnosis. Total CAM-ICU-7 and ICDSC score reflects delirium severity well; the higher the score, the more severe the delirium. This enables nurses to gauge the impact of their interventions and enhance the well-being of patients experiencing delirium by minimizing distressing occurrences.