What is Delirium?
Delirium is the most common complication associated with hospitalization of older adults with an incidence of 25% to 60%. Delirium is responsible for approximately 17.5 million hospital days annually, yet nurses fail to recognize it as much as 70% of the time. The negative impact of delirium-related consequences has been linked to the failure to recognize delirium early Many factors have been attributed to failure to detect the delirium, such as lack of knowledge about cognitive disorders and assessment methods; failure to detect quietly delirious patients; failure to correctly interpret signs and symptoms; failure to recognize delirium superimposed on dementia; the atypical presentation of delirium in the older adult; and nurses’ philosophical perspective towards aging.
Patients’ Risk Factors
Still others have suggested that certain patients’ risk factors, such as dementia, advanced age, visual impairment, and hypoactive delirium, are associated with a 20-fold chance of nurses’ failing to recognize delirium (Inouye et al.), Despite all of these investigations, reasons for nurses’ under the recognition of delirium and the clinical decision making processes they use remain speculative and poorly understood. Factors such as the fluctuating nature of symptoms and varied clinical presentations make delirium difficult to diagnose. Because nurses spend a considerable amount of time at the bedside, they are in the best position to identify the subtle changes associated with early delirium.
However, nurses are more likely to under-recognize delirium than physicians and nurse recognition of delirium requires a clear understanding of the clinical manifestations and potential causes, particularly in high-risk groups such as very old people. Patients who suffer from delirium in the hospital often have poor outcomes compared to other patients. The mortality rate for persistent delirium is substantially higher than the one-year mortality rates of acute conditions such as heart disease, influenza, and pneumonia. An estimated twenty-five percent of patients who develop delirium while hospitalized will die within six months.
This will to critically appraise early recognition of delirium in ICU addressing implementation of the tools formulating conclusions about the interventions that could be provided to ICU patients with delirium and recommendations to practice. To evaluate the findings of prior researchers in the context of delirium in ICU and form conclusions keeping into view the discussions and reflections of the researches, to reflect on the effectiveness of some elements of tools in the early recognition of delirium. To critically appraise the review literature on intervention that could help in reduction of delirium occurrence and to formulate conclusions and establish further recommendations to clinical practice in delirium management within ICU.