Delirium prevention and management in an adult intensive care unit through evidence-based nonpharmacological interventions: a scoping review

Abstract

Objective: to map and review current literature to describe evidence-based nonpharmacological interventions for delirium prevention and management in adult critically ill patients. 

Introduction: previous research has demonstrated the efficacy of nonpharmacological interventions for intensive care unit (ICU) delirium; however, the heterogeneity and complexity of these interventions make it challenging to disseminate and integrate into clinical practice. 

Design: this scoping review follows the Joanna Briggs Institute (JBI) Protocol Guidelines. 

Data sources: cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsycINFO, JBI, ProQuest, and Excerpta Medica databases were searched until August 2023. 

Review methods: double screening, extraction, and data coding using thematic analysis and frequency counts. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using the extension for scoping reviews. 

Results: thirty-three primary research articles were included; thirty-one were quantitative, and two were qualitative. Four categories of interventions were identified: instrument-based therapeutic interventions (n = 10) consisting of the use of music, light, mirror, and occupational therapy; nurse-led interventions (n = 5) consisting of interventions directly delivered by the nurses with mobilisation, orientation, and cognitive stimulation being the most common types of intervention. Family-delivered interventions (n = 5) are delivered directly by family members, with extended visitation and orientation being the most utilised. Multicomponent interventions (n = 13) combine different aspects of single interventions into care bundles and programs. 

Conclusion: this review identified a lack of consistency in applying nonpharmacologic interventions to prevent and manage delirium in adult ICUs. Standardised evidence-based guidelines addressing all aspects of single-component or multicomponent nonpharmacological delirium interventions, along with support for ICU staff utilising these interventions and family member education and support, are required. Without consistent involvement from the healthcare team and patient families, opportunities may have been lost to optimise family-centred care practices in critical care settings. 

Patient or public contribution: no patient or public contribution was necessary for this review. 

Protocol registration: the protocol registration for this review can be accessed via Open Science Framework at https://doi.org/10.17605/OSF.IO/CMQWG.

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