Intensive care unit (ICU) delirium is often defined as acute brain dysfunction or agitation in the critically ill patient. The concept of ICU delirium is becoming more relevant in the ICU and is seen as a damaging phenomenon. According to Pierson (2007), a number of studies have found associations between the development of delirium and increased morbidity and mortality as well as with increased lengths of stay in both ICU and hospital stays. Throughout this paper definitions of the concept of ICU delirium will be discussed, surrogate names will be identified and the features and characteristics of the concept will be examined. In addition, case examples will be discussed as well as the relevance of this concept in nursing.
Description of Concept
Review of Literature
In a research article by (Marshall & Soucy, 2003), the purpose of the article was to better understand the concept of ICU delirium, the clinical practice guidelines, and the nursing assessment tools and interventions that could help prevent and earlier identify delirium. After review of the literature the author’s findings concluded that ICU delirium is a complex condition that is seen as an increasing problem and attention needs to be focused on early detection and prevention. The findings as revealed by the author further demonstrates that critical care nurses are in an excellent position to assess and identify behaviors that are prodromal (Marshall & Soucy, 2003).
Arend and Christensen (2009) completed a research study examining the causes and contributory factors that lead to delirium, effects of delirium on patients and the nursing and medical interventions that can improve the management of delirium. Findings from this study, after a systematic and comprehensive literature review, found routine assessment of all patients in the ICU for delirium is crucial for its management and that nurses play an important role in the treatment of these patients. “Nurses are on the front line to detect, manage and even prevent delirium” (Arend & Christensen, 2009).
In an article by Litton (2003), research studies regarding the diagnosis and treatment of delirium was reviewed. The article found delirium in patients went unrecognized by both nurses and physicians, and that change in their behavior was often seen as psychiatric disorder and not a medical problem. The article revealed nurses and other health care professionals need in-depth education about delirium, validated and understandable assessment tools, and astute clinical observational skills (Litton, 2003). The author further determined that with these things in place appropriate management of patients will occur resulting in decreased morbidity and improved long time outcomes.
Definitions of concept
ICU delirium is a complex and difficult term to define; the simple definition for intensive care unit delirium is acute confusion and agitation in the critically ill patient.
Delirium can be defined as an acute confusional state that usually occurs in the face of an underlying organic etiology, such as medical illness or drug use or withdrawal (American Psychiatric Association, 1994).
According to Litton (2003), delirium can also be defined as an acute confusional state, characterized by a fluctuating course, attention concentration deficits, impaired cognition, disorganized thinking, and an altered consciousness level. While there may be inconsistently regarding the definition of delirium, there is universal agreement about the presenting behaviors of ICU delirium such as delusions, hallucinations, disorientation and paranoia (Arend & Christensen, 2009).
During the literature reviewed numerous terms were identified for ICU delirium. Delirium has been described as sundown syndrome, ICU psychosis, acute confusion, ICU syndrome, encephalopathies, and cognitive impairments (Marshall & Soucy, 2003). Other terms used to describe ICU delirium were aggression and agitation...
References: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Association. 1994
Arend, E., & Christensen, M. (2009). Delirium in the intensive care unit: a review. Nursing in Critical Care, 14(3), 145-154.
Litton, K. (2003). Delirium in the critical care patient: what the professional staff needs to know. Critical Care Nursing Quarterly, 26(3), 208-213.
Marshall, M., & Soucy, M. (2003). Delirium in the intensive care unit. Critical Care Nursing Quarterly, 26(3), 172-178.
McNicoll, L., Pisani, M., Zhang, Y., Ely, E., Siegel, M., & Inouye, S. (2003). Delirium in the intensive care unit: occurrence and clinical course in older patients. Journal of the American Geriatrics Society, 51(5), 591-598.
Pierson, D. (2007). Dealing with ICU delirium. Critical Care Alert, 14(12), 89-91.
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