The effect of non-pharmacological interventions on the severity and duration of hypoactive delirium in post-operative cardio-thoracic surgery patients

Abstract

The prevalence of Hypoactive delirium and delirium in Intensive Care Units (ICU) can be as high as 80% and is characterized by decreased cognitive function, inattentive thinking, and fluctuation of consciousness, disorientation and confusion which could result in an increase of 6 months mortality and cognitive impairment. If no screening tool for detection for hypoactive delirium and delirium is utilized, it will be undetected and the outcome will be worse if no non-pharmacological interventions are in place. The aim and objective of the study was to assess the effect of non-pharmacological interventions on the severity and duration of hypoactive delirium and delirium in ICU patients following cardio-thoracic surgery. The Quasi experimental non-equivalent control group design was used. The setting was a private hospital of 138 beds with 18 ICU beds based in Gauteng. The population was chosen by convenient sampling and consisted of post-operative Cardio-thoracic surgery participants who met the inclusion criteria and gave informed consent pre-operatively. The control group of 30 participants enrolled firstly. If the participants screened positive for hypoactive delirium or delirium on day 1 at 8:00 with screening utilizing the Intensive care delirium screen checklist (ICDSC), they were enrolled into the study and received standard nursing care. They were screened again at 16:00 with the ICDSC to assess the prevalence and duration of delirium or hypoactive delirium if no intervention was implemented. The intervention group was enrolled in the same manner and screened with the ICDSC at 8:00 and 16:00. They received non-pharmacological interventions instead together with standard nursing care. The difference in the ICDSC checklist scores was utilized for data analysis. The results showed that the duration in hours from hypoactive delirium and delirium to no delirium in the intervention group (62,4 hours to no delirium) was significantly shorter than in the control group (72,3 hours to no delirium) thus therefore supported the hypothesis. Limitations to this study were that only one ICU unit in a private hospital was used with a small sample size consisting out of cardio-thoracic patients.