Intensivsykepleieres erfaring med deliriumskartlegging i intensivavdelinger – en scoping review

Abstract

Background: Patients in intensive care units are at risk of delirium. Regular use of a delirium assessment tool is recommended. CAM-ICU is a validated assessment tool, developed for intensive care patients. Research shows that delirium assessment occurs less often than recommended.

Objectives: The aim of this study is to collect existing literature on nurses' experience using CAM-ICU. The research question is: What experiences do intensive care nurses have with the use of CAM-ICU.

Method: This is a scoping review based on Arksey and O'Malley's five-step model. Qualitative and quantitative research has been collected. This has been done through systematic searches in the databases Embase, MEDLINE, CINAHL and Academic Search Elite. The searches resulted in 13 articles that were included in the study. The findings were processed in a numerical and a thematic analysis. The thematic analysis was based on Aveyard's method for literature studies.

Results: The findings show both positive and negative experiences with the use of CAM-ICU. Several studies showed that CAM-ICU was de-prioritised, while some of the nurses felt that CAM-ICU contributed to a better patient assessment. CAM-ICU can improve communication and collaboration when both nurses and doctors use it. There is no clear consensus that CAM-ICU is easy to administer, confidence in the tool is also variable. The nurses experienced that CAM-ICU was challenging when dealing with mechanically ventilated and sedated patients, lack of time is also highlighted, in addition to the need for increased knowledge.

Conclusion:  This study shows varied experience with the utility of, and trust in, CAM-ICU. In particular, the implementation of CAM-ICU in sedated and mechanically ventilated patients is experienced as challenging. The findings point to the fact that interdisciplinary collaboration appears to be important for the use of CAM-ICU. More knowledge and training are requested. This study can be useful when drawing up implementation strategies for new mapping tools.