Volume 4, Issue 2 (Spring 2018 -- 2018)                   JCCNC 2018, 4(2): 104-111 | Back to browse issues page

XML Print

1- Department of Nursing, Vasei Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran. , a.dehnabi95@gmail.com
2- Department of Psychiatry, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
3- Department of Statistics and Epidemiology, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
4- Department of Nursing, Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Abstract:   (2783 Views)
Background: Electrolyte imbalance, fear of death and illness, and homesickness are among the factors that may susceptible the patients hospitalized at Coronary Care Units (CCUs) to delirium. This study aimed to investigate the effect of modification of sensory stimulations on the reduction of delirium occurrence rate in patients admitted to CCU.
Methods: The present clinical trial was performed on 80 patients hospitalized at the CCU of Vasei Hospital affiliated to Sabzevar Medical University, Iran. The subjects were randomly assigned to the control and experimental groups (40 subjects in each). The control group received no intervention, while some environmental modifications like putting a clock and a calendar at the patient’s bedside were provided for the patients in the experimental group. Neecham Confusion Scale was used to collect the necessary data concerning the occurrence of delirium in both groups, twice a day (morning and afternoon) for 3 consecutive days. The obtained data were analyzed by Independent t-test, Mann Whitney U Test, and logarithmic link for the model fit using SAS. 
Results: The results showed 14 (35%) cases of delirium in the control group, and 3 (7.5%) cases in the experimental group. Moreover, the results of the analyses indicated no statistically significant difference between the 2 groups, on the first day (P=0.74). However, the 2 groups were significantly different in terms of delirium occurrence, on the second (P=0.03) and the third (P=0.003) days. 
Conclusion: The results confirmed that modification of the sensory stimulations can lead to a significant reduction of the delirium rate among the patients hospitalized at CCUs.
Full-Text [PDF 564 kb]   (1229 Downloads) |   |   Full-Text (HTML)  (828 Views)  
● Delirium in patients hospitalized in coronary care units are common.
● Delirium can be decreased in these patients by providing suitable environmental modifications.
● These modification include more cooperation of the medical staff, describing the environmental conditions, and allowing relatives to see the patient.
Plain Language Summary
Delirium is one of the oldest known medical disorders, characterized by acute and swirling start (several hours to several days) disturbances in consciousness, orientation, memory, thinking, perception, and behavior. The patients hospitalized at coronary care units are susceptible to delirium which is responsible for an increased death rate among these patients. The results obtained in the present study confirmed that the modification of the sensory stimulations can significantly reduce the delirium rate among the patients hospitalized at coronary care units.

Type of Study: Research | Subject: Special
Received: 2017/12/2 | Accepted: 2018/02/25 | Published: 2018/05/1

1. Barr, J., et al., 2013. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine, 41(1), pp. 263-306. [DOI:10.1097/CCM.0b013e3182783b72] [PMID] [DOI:10.1097/CCM.0b013e3182783b72]
2. Clary, G. L., & Krishnan, K. R., 2001. Delirium: Diagnosis, neuropathogenesis, and treatment. Journal of Psychiatric Practice, 7(5), pp. 310-23. [DOI:10.1097/00131746-200109000-00004] [PMID] [DOI:10.1097/00131746-200109000-00004]
3. Inouye, S. K., 2006. Delirium in older persons. New England Journal of Medicine, 354(11), pp. 1157-65. [DOI:10.1056/NEJMra052321] [PMID] [DOI:10.1056/NEJMra052321]
4. Kalani, Z., Tavangar, H. & Rahimi, A., 2013. [Effectiveness of nursing interventions on incidence of delirium in patients hospitalized to intensive cardiac care units, Shiraz hospitals, 2012 (Persian)]. Medical-Surgical Nursing Journal, 2(3-4), pp. 93-100.
5. Kiely, D. K., Jones, R. N., Bergmann, M. A. & Marcantonio, E. R., 2007. Association between psychomotor activity delirium subtypes and mortality among newly admitted postacute facility patients. The Journals of Gerontology, 62(2), pp. 174-9. [DOI:10.1093/gerona/62.2.174] [DOI:10.1093/gerona/62.2.174]
6. Leslie, D. L., et al., 2005. Premature death associated with delirium at 1-year follow-up. Archives of Internal Medicine, 165(14), pp. 1657-62. [DOI:10.1001/archinte.165.14.1657] [PMID] [DOI:10.1001/archinte.165.14.1657]
7. Marcantonio, E., et al., 2002. Delirium severity and psychomotor types: Their relationship with outcomes after hip fracture repair. Journal of the American Geriatrics Society, 50(5), pp. 850-7. [DOI:10.1046/j.1532-5415.2002.50210.x] [PMID] [DOI:10.1046/j.1532-5415.2002.50210.x]
8. Martinez, F. T., et al., 2012. Preventing delirium in an acute hospital using a non-pharmacological intervention. Age and Ageing, 41(5), pp. 629-34. [DOI:10.1093/ageing/afs060] [PMID] [DOI:10.1093/ageing/afs060]
9. McPherson J. A., et al., 2013. Delirium in the cardiovascular intensive care unit: Exploring modifiable risk factors. Critcal Care Medicine, 41(2), pp. 405-13. [DOI:10.1097/CCM.0b013e31826ab49b] [PMID] [PMCID] [DOI:10.1097/CCM.0b013e31826ab49b]
10. Modabernia, M. J., Khalkhali, S. M. R. & Najafi, K., 2002. [Delirium in CCU (Persian)]. Journal of Guilan University of Medical Sciences, 11(41), pp. 1-6.
11. Naughton, B. J., et al., 2005. A multifactorial intervention to reduce prevalence of delirium and shorten hospital length of stay. Journal of the American Geriatrics Society, 53(1), pp. 18-23. [DOI:10.1111/j.1532-5415.2005.53005.x] [PMID] [DOI:10.1111/j.1532-5415.2005.53005.x]
12. Pisani, M. A., et al., 2009. Days of delirium are associated with 1-year mortality in an older intensive care unit population. American Journal of Respiratory and Critical Care Medicine, 180(11), pp. 1092-7. [DOI:10.1164/rccm.200904-0537OC] [PMID] [PMCID] [DOI:10.1164/rccm.200904-0537OC]
13. Tabet, N., et al., 2005. An educational intervention can prevent delirium on acute medical wards. Age and Ageing, 34(2), pp. 152-6. [DOI:10.1093/ageing/afi031] [PMID] [DOI:10.1093/ageing/afi031]
14. Tadrisi, S. et al., 2009. Richmond agitation¨Csedation scale validity and reliability in intensive care unit adult patients Persian version. Journal of Critical Care Nursing, 2(1), pp. 15-21.
15. Tsios, A. & Alichanidou, E., 2009. Coronary Care Unit (CCU) psychosis syndrome. Hospital Chronicles, 4(3), pp. 32-4.
16. Uguz, F., et al., 2010. Delirium following acute myocardial infarction: Incidence, clinical profiles, and predictors. Perspectives in Psychiatric Care, 46(2), pp. 135-42. [DOI:10.1111/j.1744-6163.2010.00249.x] [PMID] [DOI:10.1111/j.1744-6163.2010.00249.x]
17. Van Rompaey, B., et al., 2012. The effect of earplugs during the night on the onset of delirium and sleep perception: A randomized controlled trial in intensive care patients. Critical Care, 16(3), p. R73. [DOI:10.1186/cc11330] [PMID] [PMCID] [DOI:10.1186/cc11330]
18. Yamaguchi, T., Tsukioka, E. & Kishi, Y., 2014. Outcomes after delirium in a Japanese intensive care unit. General Hospital Psychiatry, 36(6), pp. 634-6. [DOI:10.1016/j.genhosppsych.2014.09.006] [PMID] [DOI:10.1016/j.genhosppsych.2014.09.006]
19. Zolfaghari, M., et al., 2012. [Effectiveness of a multifactor educational intervention on delirium incidence and length of stay in patients with cardiac surgery (Persian)]. Journal of Hayat, 18(1), pp. 67-78.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.