Palabras clave
Cómo citar
Resumen
Introducción. El delirium es una alteración cognitiva secundaria a una situación clínica aguda que puede estar presente en el paciente crítico, y la enfermería juega un rol protagónico en la prevención, monitoreo y tratamiento no farmacológico del delirium en el paciente en unidad de cuidado intensivo. Objetivo. Identificar las investigaciones actuales que describen las estrategias que utilizan las enfermeras para la monitorización del delirium en la unidad de cuidado intensivo adulto. Método. Revisión de alcance, utilizando la pregunta orientadora ¿qué estrategias utiliza enfermería en la monitorización del delirium en la unidad de cuidado intensivo?, estudios obtenidos en las bases de datos PubMed, Biblioteca Virtual en Salud, Science Direct y Cochrane. Se realizó una revisión crítica con el instrumento CASPe, los datos se extrajeron, y se llevaron a cabo registros en tablas de gráficos elaboradas para condensar la información. Resultados. Trece estudios se consideraron relevantes y fueron analizados. Las estrategias de monitorización del delirium empleadas por enfermería son, principalmente, el juicio clínico, la observación de la agitación y, en menor medida, el empleo de instrumentos validados para la detección. Conclusión. La enfermería requiere comprender mejor el delirium, y para esto la educación es vital para mejorar su conocimiento, y aumentar la autoconfianza y competencia en la evaluación a través del uso correcto de instrumentos.
Page V, Wesley E. What is delirium in critical care? Critic Care. 2008;12(supl. 3):1-13.
Zamoscik K, Godbold R, Freeman P. Intensive care nurses’ experiences and perceptions of delirium and delirium care. Intensive Crit Care Nurs [Internet]. 2017;40(jun.):94-100. https://www.doi.org/10.1016/j.iccn.2017.01.003
El Hussein M, Hirst S, Salyers V. Factors that contribute to underrecognition of delirium by registered nurses in acute care settings: a scoping review of the literature to explain this phenomenon. J Clin Nurs [Internet]. 2015;24(abr.):906-15. https://www.doi.org/10.1111/jocn.12693
Martins S, Fernandes L. Delirium in Elderly People: A Review. Front Neurol [Internet]. 2012 3(jun.). https://www.doi.org/10.3389/fneur.2012.00101
Panitchote A, Tangvoraphonkchai K, Suebsoh N, Eamma W, Chanthonglarng B, Tiamkao S, et al. Under-recognition of delirium in older adults by nurses in the intensive care unit setting. Aging Clin Exp Res [Internet]. 2015 feb. 12.;27(5):735-740. https://www.doi.org/10.1007/s40520-015-0323-6
Devlin J, Verceles A, Morris P, Ely E, Balas M. Adapting the ABCDEF Bundle to Meet the Needs of Patients Requiring Prolonged Mechanical Ventilation in the Long-Term Acute Care Hospital Setting: Historical Perspectives and Practical Implications. Semin Respir Crit Care Med [Internet]. 2016;37(1):119-135. https://www.doi.org/10.1055/s-0035-1570361
Öztürk Birge A, Tel Aydin H. The effect of nonpharmacological training on delirium identification and intervention strategies of intensive care nurses. Intensive Crit Care Nurs [Internet]. 2017;41(ag.):33-42. https://www.doi.org/10.1016/j.iccn.2016.08.009
Jeong E, Chang SO. Exploring nurses’ recognition of delirium in the elderly by using Q-methodology. Jpn J Nurs Sci [Internet]. 2018;15(4):298-308. https://www.doi.org/10.1111/jjns.12199
Smith JM, Van Aman MN, Schneiderhahn ME, Edelman R, Ercole PM. Assessment of Delirium in Intensive Care Unit Patients: Educational Strategies. J Contin Educ Nurs [Internet]. 2017;48(5):239-244. https://www.doi.org/10.3928/00220124-20170418-09
Hargrave A, Bastiaens J, Bourgeois JA, Neuhaus J, Josephson SA, Chinn J, et al. Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients. Psychosomatics [Internet]. 2017;58(6):594-603. https://www.doi.org/10.1016/j.psym.2017.05.005
Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF Bundle in Critical Care. Crit Care Clin [Internet]. 2017;33(2):225-243. https://www.doi.org/10.1016/j.ccc.2016.12.005
Luetz A, Weiss B, Boettcher S, Burmeister J, Wernecke KD, Spies C. Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study. J Crit Care [Internet]. 2016;35(oct.):168-73. https://www.doi.org/10.1016/j.jcrc.2016.05.028
Peters MDJ, Godfrey CM, Mclnerney P, Baldini C, Khalil H, Parker D. The Joanna Briggs Institute. Reviewers’ Manual 2015. Methodology for JBI Scoping Reviews. Adelaida (Australia): The Joanna Briggs Institute; 2015.
Kotfis K, Marra A, Ely EW. ICU delirium, a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther [Internet]. 2018;50(2):160-167. https://www.doi.org/10.5603/AIT.a2018.0011.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. La declaración Prisma para informar revisiones sistemáticas y metaanálisis de estudios que evalúan las intervenciones de atención médica: explicación y elaboración. PLoS Medicine [Internet]. 2009;6(7): 1-28. https://www.doi.org/10.1371/journal.pmed.1000100
Lamond E, Murray S, Gibson C. Delirium screening in intensive care: A life saving opportunity. Intensive Crit Care Nurs [Internet]. 2018;44(feb.):105-109. https://www.doi.org/10.1016/j.iccn.2017.04.014
Özsaban A, Acaroglu R. Delirium assessment in intensive care units: practices and perceptions of Turkish nurses. Nurs. Crit. Care [Internet]. 2016 Sep;21(5):271-278. https://doi.org/10.1111/nicc.12127
Nydahl P, Dewes M, Dubb R, Hermes C, Kaltwasser A, Krotsetis S, et al. Survey among critical care nurses and physicians about delirium management. Nurs. Crit. Care [Internet]. 2018;23(1):23-29. https://www.doi.org/10.1111 / nicc.12299
Middle B, Miklancie M. Strategies to improve nurse knowledge of delirium: a call to the adult-gerontology clinical nurse specialist. Clin Nurse Spec [Internet]. 2015;29(4):218-229. https://www.doi.org/10.1097/NUR.0000000000000138
Dale C, Kannas D, Fan V, Daniel S, Deem S, Yanez N, et al. Improved Analgesia, Sedation, and Delirium Protocol Associated with Decreased Duration of Delirium and Mechanical Ventilation. Ann. Am. Thorac. Soc [Internet]. 2014;11(3):367-374. https://www.doi.org/10.1513/AnnalsATS.201306-210OC
Zoremba N, Coburn M. Acute confusional states in hospital. Dtsch Arztebl Int [Internet]. 2019;116(7):101-106. https://www.doi.org/10.3238/arztebl.2019.0101
Boettger S, Nuñez Garcia D, Meyer R, Richter A, Rudiger A, Schubert M, et al. Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium. Swiss Med Wkly [Internet]. 2018; 148:w14597. https://www.doi.org/10.4414/smw.2018.14597
Gélinas C, Bérubé M, Chevrier A, Pun B, Ely E, Skrobik, et al. Delirium Assessment Tools for Use in Critically Ill Adults: A Psychometric Analysis and Systematic Review. Crit Care Nurse [Internet]. 2018;38(1):38-49. https://www.doi.org/10.4037/ccn2018633
Van Velthuijsen E, Zwakhalen S, Warnier R, Mulder W, Verhey F, Kempen G. Psychometric properties and feasibility of instruments for the detection of delirium in older hospitalized patients: a systematic review. Int J Geriatr Psychiatry [Internet]. 2016;31(9):974-989. https://www.doi.org/10.1002/gps.4441
Jones R, Cizginer S, Pavlech L, Albuquerque A, Daiello L, Dharmarajan K, et al. Assessment of Instruments for Measurement of Delirium Severity. A systematic review. JAMA Intern Med [Internet]. 2019;179(2):231-239. https://www.doi.org/10.1001/jamainternmed.2018.6975
Boettger S, Nuñez DG, Meyer R, Richter A, Schubert M, Meagher D, et al. Brief assessment of delirium subtypes: Psychometric evaluation of the Delirium Motor Subtype Scale (DMSS) -4 in the intensive care setting. Palliat Support Care [Internet]. 2017;5:535-543. https://www.doi.org/10.1017/S147895151600105X
Khan B, Perkins A, Gao S, Hui S, Campbell N, Farber M, et al. The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Crit Care Med [Internet]. 2017;45(5):851-857. https://www.doi.org/10.1097/CCM.0000000000002368
Rowley-Conwy G. Barriers to delirium assessment in the intensive care unit: A literature review. Intensive Crit Care Nurs [Internet]. 2018;44(feb.):99-104. doi:10.1016/j.iccn.2017.09.001
Faught D. Delirium: The Nurse’s Role in Prevention, Diagnosis, and Treatment. Medsurg Nurs. 2014;23(5):301-305.
Faría R, Moreno R. Delirium in intensive care: an under-diagnosed reality. Rev Bras Ter Intensiva [Internet]. 2013;25(2):137-147. https://www.doi.org/10.5935/0103-507X.20130025
Arumugam S, El-Menyar A, Al-Hassani A, Strandvik G, Asim M, Mekkodithal A, et al. Delirium in the intensive care unit. J Emerg Trauma Shock [Internet]. 2017;10(1):37-46. https://www.doi.org/10.4103/0974-2700.199520
Selim A, Ely E. Delirium the under-recognised syndrome: survey of healthcare professionals’ awareness and practice in the intensive care units. J Clin Nurs [Internet]. 2017;26(5-6):813-824. https://www.doi.org/10.1111/jocn.13517
Xing J, Sun Y, Jie Y, Yuan Z, Liu W. Perceptions, attitudes, and current practices regards delirium in China: A survey of 917 critical care nurses and physicians in China. Medicine (Baltimore) [Internet]. 2017;96(39):1-5. https://www.doi.org/10.1097/MD.0000000000008028
Tostes ICGO, Pereira SRM, Almeida LF, et al. Delirium in intensive care: use of the ‘Confusion Assessment Method for the Intensive Care Unit’ by the nurse. Rev Fund Care Online [Internet]. 2018;10(1):2-8. https://www.doi.org/10.9789/2175-5361.2018.v10i1.2-8
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 [Internet]. 2008;17(6):555-565.
Flagg B, Cox L, Mcdowell S, Mwose J, Buelow J. Nursing Identification of Delirium. Clin Nurse Spec [Internet]. 2010;24(5):260-266. https://www.doi.org/10.1097/NUR.0b013e3181ee5f95
Rowley-Conwy G. Critical care nurses' knowledge and practice of delirium assessment. Br J Nurs [Internet]. 2017;26(7):412-417. https://www.doi.org/10.12968/bjon.2017.26.7.412.
Gesin G, Russell BB, Lin AP, Norton HJ, Evans SL, Devlin JW. Impact of a delirium screening tool and multifaceted education on nurses’ knowledge of delirium and ability to evaluate it correctly. Am J Crit Care [Internet]. 2012;21(1):1-11. https://www.doi.org/10.4037/ajcc2012605
Lieow J, Chen F, Song G, Tang P, Kowitlawakul Y, Mukhopadhyay A. Effectiveness of an advanced practice nurse‐led delirium education and training programme. Int Nurs Rev [Internet]. 2019;66(4). https://www.doi.org/10.1111/inr.12519
Van Velthuijsen EL, Zwakhalen SMG, Warnier RMJ, Ambergen T, Mulder WJ, Verhey FRJ, et al. Can education improve clinical practice concerning delirium in older hospitalised patients? Results of a pre-test post-test study on an educational intervention for nursing staff. BMC Med Educ [Internet]. 2018;18(59). https://www.doi.org/10.1186/s12909-018-1177-3
Norman SL, Taha AA. Delirium Knowledge, Self-Confidence, and Attitude in Pediatric Intensive Care Nurses. J Pediatr Nurs [Internet]. 2019;46:6-11. https://www.doi.org/10.1016/j.pedn.2019.01.013
Ramoo V, Abu H, Rai V, Surat Singh SK, Baharudin AA, Danaee M, et al. Educational intervention on delirium assessment using confusion assessment method-ICU (CAM-ICU) in a general intensive care unit. J Clin Nurs [Internet]. 2018;27(21-22):4028-4039. https://www.doi.org/10.1111/jocn.14525
Mansouri P, Javadpour S, Zand F, Ghodsbin F, Sabetian G, Masjedi M, et al. Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: A randomized clinical trial. J Crit Care [Internet]. 2013;28(6):918-922. https://www.doi.org/10.1016/j.jcrc.2013.06.019
Mistarz R, Eliott S, Whitfield A, Ernest D. Bedside nurse-patient interactions do not reliably detect delirium: an observational study. Aust Crit Care [Internet]. 2011;24(2):126-132. https://www.doi.org/10.1016/j.aucc.2011.01.002
Spronk PE, Riekerk B, Hofhuis J, Rommes JH. Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med [Internet]. 2009;35(7):1276-1280. https://www.doi.org/10.1007/s00134-009-1466-8.
Devlin J, Brummel N, Al-Qadheeb N. Optimising the recognition of delirium in the intensive care unit. Best Pract Res Clin Anaesthesiol [Internet]. 2012;26(3):385-393. https://www.doi.org/10.1016/j.bpa.2012.08.002
Grover S, Natasha K. Assessment scales for delirium: A review. World J Psychiatry [Internet]. 2012;2(4):58-70. https://www.doi.org/10.5498/wjp.v2.i4.58
Andrews L, Silva SG, Kaplan S, Zimbro K. Delirium monitoring and patient outcomes in a general intensive care unit. Am J Crit Care [Internet]. 2015;24(1):48-56. https://www.doi.org/10.4037/ajcc2015740
Elliot SR. ICU delirium: a survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit. Intensive Crit Care Nurs [Internet]. 2014.;30(6):333-338. https://www.doi.org/10.1016/j.iccn.2014.06.004
Powell T, Nolan M, Yang G, Tam M, Metter D, Gibran N, et al. Nursing Understanding and Perceptions of Delirium: Assessing Current Knowledge, Attitudes, and Beliefs in a Burn ICU. J Burn Care Res [Internet]. 2019;40(4):471-477. https://www.doi.org/10.1093/jbcr/irz040
American Association of Critical-Care Nurses. Assessment and Management of Delirium Across the Life Span. Crit Care Nurse [Internet]. 2016;36(5):14-19. https://www.doi.org/10.4037/ccn2016242
Morandi A, Brummel N, Ely E. Sedation, delirium and mechanical ventilation: the ‘ABCDE’ approach. Curr Opin in Crit Care [Internet]. 2011;17(1):43-49. https://www.doi.org/10.1097/MCC.0b013e3283427243
Devlin J, Skrobik Y, Gélinas C, Needham D, Slooter A, Pandharipande P, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med [Internet]. 2018;46(9):825-873. https://www.doi.org/10.1097/CCM.0000000000003299
Martínez F, Donoso A, Márquez C, Labarca E. Implementing a Multicomponent Intervention to Prevent Delirium Among Critically Ill Patients. Crit Care Nurse [Internet]. 2017;37(6):36-46. https://www.doi.org/10.4037/ccn2017531
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Derechos de autor 2021 Investigación en Enfermería: Imagen y Desarrollo