Multicomponent nursing program to prevent delirium in critically ill patients: a randomized clinical trial

Contreras, Claudia Consuelo Torres; Esteban, Astrid Nathalia Páez; Parra, Myriam Durán; Romero, Mayerli Katherine Rincón; Silva, Carolina Giordani da; Buitrago, Nohora Paola Duarte

doi:10.1590/1983-1447.2021.20200278

Claudia Consuelo Torres Contreras

Universidad de Santander (UDES), School of Health Sciences, Nursing Investigation Group EVEREST. Bucaramanga, Santander, Colombia.

http://orcid.org/0000-0001-7064-9380

Astrid Nathalia Páez Esteban

Universidad de Santander (UDES), School of Health Sciences, Nursing Investigation Group in Public Health. Bucaramanga, Santander, Colombia.

http://orcid.org/0000-0003-0010-7564

Myriam Durán Parra

Universidad de Santander (UDES), School of Health Sciences, Nursing Investigation Group EVEREST. Bucaramanga, Santander, Colombia.

http://orcid.org/0000-0001-9960-8283

Mayerli Katherine Rincón Romero

Universidad de Santander (UDES), School of Health Sciences, Nursing Investigation Group EVEREST. Bucaramanga, Santander, Colombia.

http://orcid.org/0000-0002-4668-1070

Carolina Giordani da Silva

Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.

http://orcid.org/0000-0001-6035-7704

Nohora Paola Duarte Buitrago

Universidad de Santander (UDES), School of Health Sciences, Nursing Investigation Group EVEREST. Bucaramanga, Santander, Colombia.

http://orcid.org/0000-0001-7804-4247

Corresponding author:
Claudia Consuelo Torres Contreras E-mail: clau.torres@mail.udes.edu.co

Authorsip contribution

Concept - Claudia Consuelo Torres Contreras. Data selection - Astrid Nathalia Páez Esteban - Nohora Paola Duarte Buitrago. Formal analysis - Astrid Nathalia Páez Esteban. Investigation - Claudia Consuelo Torres Contreras - Astrid Nathalia Páez Esteban - Myriam Durán Parra - Mayerli Katherine Rincón Romero - Nohora Paola Duarte Buitrago. Methodology - Astrid Nathalia Páez Esteban. Project management - Claudia Consuelo Torres Contreras. Supervision - Claudia Consuelo Torres Contreras. Writing - original draft - Claudia Consuelo Torres Contreras - Astrid Nathalia Páez Esteban - Myriam Durán Parra - Mayerli Katherine Rincón Romero - Carolina Giordani da Silva - Nohora Paola Duarte Buitrago. Writing - review and editing - Claudia Consuelo Torres Contreras - Astrid Nathalia Páez Esteban - Mayerli Katherine Rincón Romero - Carolina Giordani da Silva.

The authors declare having no conflict of interest.

Associated editor

Graziella Aliti

Editor-in-chief

Maria da Graça Oliveira Crossetti

Control group (n=41)

Intervention group (n=40)

The control group received regular care, which consisted in standard hospital care: orientation and diminution of environmental stimuli, such as noise and lighting. This care was provided by general practitioners, specialized physicians, nurses, and support personnel. The members of the intervention team did not provide services to the patients who were in the control group and thus received regular care.
However, the same group of physicians and specialists, nurses and support personnel, and the resident physicians provided regular care to both groups.

The intervention group was also treated with the multicomponent nursing program. For the interventions, a calm and private environment was formed by closing the device to enter the cubicle (doors, curtains), thus providing privacy. Two previously trained nurses carried out the intervention daily, starting when the patient entered the study and ending when they left it. The intervention lasted for nearly 15 minutes. Below, there is a description of the activities carried out: COGNITIVE STIMULATION
-Time and space orientation: At first, the patient was daily complimented, called by their name, and was offered information about the space, with their location and why they were there.
Later, a watch and a calendar were shown to the patient. Then, there was a conversation about the events and news, to encourage and stimulate the person.
Discussions and an active listening were encouraged: the patient was asked about prior experiences, current activities, and there were attempts to connect the past and the present. Also, games of word search and crosswords were also made available.
- Visual and auditory stimuli: direct visual contact, frequent use of contact, the use of visual and auditory devices (glasses, hearing aids), active listening to the patient, allowing them to manifest their preoccupations and respond to questions. During contact with the patient, the voice was low, the tone of voice was medium, and the sentences were short and clear.
The communication was concrete and specific.
Photographs, letters, and drawings from magazines or made by their relatives were shown. They were asked about what personal items they would like to have at hand during their stay at the hospital, and they were helped to get these items. These could include: glasses, hearing aids, dental prosthesis, family photos, religious objects.
The use of matching games such as: marking from a list the objects that belong inside a fridge. FAMILY SUPPORT
The inclusion of family and caregivers in the self-care and in the reorientation of the patient was encouraged.
Education was provided about delirium and its complications. It was made easier for a relative or person of confidence of the patient to get closer and stay as long as possible.

Daily follow up using CAM-ICU and RASS: the intervention was carried out daily and the CAM-ICU scale was used to verify the effect of the intervention (whether or not delirium was developing). If the health state of the patient worsened or their sedation level did not allow for the intervention to be carried out, the intervention was resumed when the conditions needed to continue the activities of preventing delirium were present again. This was done within a limit of 8 days, that is, any patient who had still not recovered after this period was removed from the study.

Variable	Control n=41		Intervention n=40		P value^*
Variable	N	%	N	%	P value^*
Sex Male	26	63.4	25	62.5	0.93
Age ≥ 60 years	33	80.5	32	80	0.96
Origin
Emergency	26	63.4	19	47.5	0.50
Surgery	1	2.4	4	10.0
Hospitalization	4	9.8	6	15.0
External	10	24.4	11	27.5
Diagnostic group
Medical	34	82.9	26	65.0	0.17
Surgical	0	0.0	3	7.5
Trauma	1	2.4	2	5.0
Neurology/neurosurgery	6	14.6	9	22.5
Urgent admission	41	100.0	36	90.0	0.07
Morphine use	11	26.8	10	25	0.85
Sedative use	23	56.1	22	55	0.92
Infection	27	65.9	24	60	0.59
Metabolic acidosis	7	17.1	13	32.5	0.11
Mechanical ventilation	17	41.5	21	52.5	0.32
APACHE II >14	38	92.7	40	100	0.08
Hospital stay ≥5 days	29	70.7	27	67.5	0.75
Coma	6	14.6	11	27.5	0.15
PREDELIRIC > 50	32	78.0	35	87.5	0.26

Category	Control n=41	Intervention n=40	Measurement
Category	n %	n %	Measurement
Delirium	10 (24.4)	2 (5.0)	0.01^*
RR (95% CI)			0.20 (0.05 to 0.88)
ARR (95% CI)			19.39 (4.61 to 34.17)
NNT (95% CI)			5 (3 to 26)

[1] Corresponding author:
Claudia Consuelo Torres Contreras E-mail: clau.torres@mail.udes.edu.co

Brasil

Brasil

Multicomponent nursing program to prevent delirium in critically ill patients: a randomized clinical trial

Programa de enfermagem multicomponente para prevenção de delirium em pacientes críticos: ensaio clínico randomizado

ABSTRACT

Objectives

Methods

Results

Conclusion