The Design and validation of a Nursing Plan for Elderly Patients with Postoperative Delirium.

Estela Melguizo-Herrera,César Hueso-Montoro,Yolima Manrique-Anaya,Ana Acosta-López,Isabel Patricia Gómez-Palencia

doi:10.3390/ijerph16224504

Abstract

Delirium is the sudden alteration of the state of consciousness and perception, fluctuating over hours or days. It predominates in older adults and is associated with the aging process. The incidence of delirium increases between 10% and 15% in surgical interventions. The objective of this study was the design and validation of a nursing care plan for elderly patients with postoperative delirium. This study was based on the Delphi method and applied to nursing professionals at the Hospital Universitario del Caribe, Cartagena. The sample consisted of 36 nurses with knowledge of the taxonomy of nursing diagnoses. The care plan was applied in two rounds. For the analysis, measures of central tendency and dispersion were used, as well as frequency and percentages. The participants were women (90.9%) from the hospitalization service (51.5%), with training in Nursing Diagnosis (NANDA), Nursing interventions classification (NIC) and Nursing Outcome Classifications (NOC) (78.8%). The validated care plan has eight diagnostic features. Highlights include “Risk for Ineffective Cerebral Tissue Perfusion” and “Disturbed Sleep Pattern” (in 98.1%; 11 results), with the highest score in the first round being “Vital Signs” (with 100%) and “Sleep” (100%) and “Mobility” (100%) in the second round. Forty-four interventions and 18 suggested activities were identified. This care plan offers the nursing professionals reliable and pertinent tools in clinical practice for the management of patients with postoperative delirium.

Highlights

Delirium is known to cause sudden alterations in attention and state of consciousness
Universitario del Caribe (HUC) (Cartagena, Colombia), in charge of elderly patients, we identified a lack of diagnosis and timely management of delirium
The first instrument was modified by the experts in the three care lines according to the degree of dispersion of the responses between 25, 50, and 75, which showed changes in the Nursing Outcome Classifications (NOC) results, Nursing interventions classification (NIC) interventions, and in the suggested interventions, producing the second plan of care as a result

Summary

Introduction

Delirium is known to cause sudden alterations in attention and state of consciousness. Delirium’s severity tends to fluctuate over hours or days [1] and can occur at any age, but it is more frequent in older adults due to its association with the aging process, recurrent medical illnesses, polypharmacy, and surgical procedures [2,3]. Studies show that the incidence of delirium increases between 10% and 15% in surgically treated patients and for every 48 h with delirium, mortality increases by 11% [5]. Previous studies show that an increase in delirium partly occurs because it goes unnoticed by more than 67% of non-psychiatric doctors, and only 22% of nursing staff can define delirium and its diagnostic criteria [6,7]. The detection and treatment of delirium create an additional workload for the nursing team [8]

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Conclusion