Dynamic delirium - Nursing intervention to reduce delirium in patients critically Ill, a randomized control trial.

OBJECTIVE: To determine the effectiveness of a nursing intervention based on the Dynamic Symptom Model (DSM) and scientific evidence versus daily care in reducing the incidence and duration of delirium in intensive care patients. METHOD: We designed the intervention named "DyDel" (By Dynamic Delirium) based on the theoretical approach of the DSM and from scientific evidence. A double-masked clinical trial of parallel groups was developed to test DyDel, with 213 patients older than 18 admitted to the intensive care unit (ICU) randomized to the study groups. The intervention group received DyDel each shift from day 0 until discharged from the ICU, while the control group received daily care in the ICU. At the same time, all participants were followed to measure primary (incidence and duration of delirium) and secondary outcomes (level of sedation and pain, days of mechanical ventilation, stay in ICU, and physical restriction). RESULTS: Overall, the study population were older than 60 years (60.3 ± 15.2 years), the male gender (59.6 %), and the diagnosis of acute myocardial infarction (73.7 %) were predominant. Comparing groups of study, the incidence of delirium was lower in the intervention group (5.6 %) than in the control group (14.8 %) (p = 0.037). The intervention group had lower days with delirium (0.07 ± 0.308) than the control group (0.34 ± 1.28) (p = 0.016), lower pain intensity (p = 0.002) and lower days of physical restraints (p = 0.06). CONCLUSION: Non-pharmacological care, like the DyDel intervention, includes the family and focuses on the different patient's needs, which can help to reduce the incidence and duration of delirium in patients admitted to adult ICUs. IMPLICATIONS FOR CLINICAL PRACTICE: DyDel was non-pharmacological and included the family. The DyDel's activities were focused on physiological, psychological, spiritual, and social needs and the experience and trajectory of delirium. The nurse can give humanized care in the ICU by applying DyDel.

Factores relacionados a flebitis química en personas con quimioterapia, revisión sistemática de la literatura / Factors related to chemical phlebitis in patients treated with chemotherapy, a systematic literature review

Objetivo: Describir los factores asociados a la flebitis química en personas con diagnóstico de cáncer que reciben quimioterapia, evidenciados en la literatura. Metodología: Se realizó una revisión sistemática de la literatura, según recomendaciones de Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Resultados: Los factores que aumentaron el riesgo de flebitis química hallados en la evidencia fueron la edad mayor de 57 años, sexo femenino, antecedentes de cáncer, enfermedad metastásica, hipertensión arterial, neutropenia, tabaquismo, vaciamiento ganglionar, hipoalbuminemia, uso de medicamentos citotóxicos, epirrubicina, fosaprepitant, antraciclina y vinorelbina, presentación premezclada de los fármacos, dilución en 50 cc de solución salina normal, tiempo de administración mayor a 60 minutos, catéteres de calibres grandes como 18 G o 20 G y ubicación anatómica del catéter en antebrazo o fosa antecubital. Conclusión: los factores relacionados a la flebitis química hallados en la literatura fueron principalmente elementos inherentes al paciente y a su tratamiento, algunos de estos no son modificables.

Objective: To describe the factors related to chemical phlebitis in patients diagnosed with cancer undergoing chemotherapeutic treatment. Methodology: A systematic review of the literature was carried out, according to recommendations of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Results: The factors that increase the risk of chemical phlebitis were: age older than 57 years, female sex, history of cancer, metastatic disease, arterial hypertension, neutropenia, smoking, lymph node emptying, hypoalbuminemia, use of cytotoxic drugs, epirubicin, fosaprepitant, anthracycline and vinorelbine, premixed presentation, dilution in 50 cc of Normal Saline Solution, administration time greater than 60 minutes, catheters of large gauges such as 18 G or 20 G and anatomical location of the catheter in the forearm or antecubital fossa. Conclusion: Factors related to chemical phlebitis found in the literature were features inherent to the patient and their treatment. Therefore, some of these are not modifiable.

Validation to Spanish of nursing assessment scale for early diagnosis of delirium - Nu-DESC / Validación al español de la escala de valoración de enfermería para diagnóstico temprano de delirium - Nu-DESC / Validação para o espanhol da escala de avaliação de enfermagem para diagnóstico precoce de delirium - Nu - DESC

Objective. This work aimed to determine the validity and reliability of the Colombian Spanish version of the Nursing Delirium Screening Scale (Nu-DESC). Methods.A psychometric study was conducted to achieve the goal of this study, which measured face validity, content validity, sensitivity, specificity and predictive values of the Nu-DESC. Results. Face validity obtained a total Aiken V of 0.89, and content validity showed a modified Lawshe index of 0.92. When Nu-DESC was applied to 210 adult patients hospitalized in the Intensive Care Unit, it was found that 14.2% had suspected delirium. The instrument showed a sensitivity of 91.6%, specificity of 95.6%, positive predictive value of 73.3%, negative predictive value of 98.8%, good internal consistency with Cronbach's α of 0.8 and good concordance according to Cohen's Kappa index of 0.788. Conclusion. The Spanish version of the Nu-DESC scale for Colombia has appropriate psychometric values for assessing delirium risk. In addition, this scale is easy to apply, so the adaptation of nursing personnel for its employability favors routine monitoring and timely detection of delirium.

Objetivo. Determinar la validez y confiabilidad en su versión al español de Colombia de la escala de detección de delirium por enfermería (Nu-DESC, por sus siglas en inglés Nursing Delirium Screening Scale). Métodos. Estudio psicométrico, el cual midió la validez facial, de contenido, sensibilidad, especificidad y valores predictivos de la escala Nu-DESC. Resultados. La validez facial obtuvo un V de Aiken total de 0.89 y la validez de contenido mostró un índice Lawshe modificado de 0.92. Al aplicar Nu-DESC en 210 pacientes adultos hospitalizados en Unidad de Cuidados Intensivos se halló que 14.2% tuvo sospecha de delirium. El instrumento mostró una sensibilidad del 91.6%, especificidad de 95.6%, valor predictivo positivo de 73.3%, valor predictivo negativo de 98.8%, buena consistencia interna con α de Cronbach de 0.8 y buena concordancia según índice de Kappa de Cohen de 0.788. Conclusión.La versión en español para Colombia de la escala Nu-DESC tiene adecuados valores psicométricos para la valoración del riesgo de delirium. Además, esta escala es de fácil aplicación por lo que la adaptación del personal de enfermería para su empleabilidad favorece una rutinaria monitorización y detección oportuna del delirium.

Objetivo. Determinar a validade e a confiabilidade da versão colombiana em espanhol da escala de detecção de delirium em enfermagem (Nu-DESC, por sua sigla em inglês Nursing Delirium Screening Scale). Métodos. Estudo psicométrico, que mediu a validade facial, validade de conteúdo, sensibilidade, especificidade e valores preditivos da escala Nu -DESC. Resultados. A validade facial obteve um V de Aiken total de 0.89 e a validade de conteúdo mostrou um índice de Lawshe modificado de 0.92. Ao aplicar o Nu-DESC em 210 pacientes adultos internados na Unidade de Terapia Intensiva, constatou-se que 14.2% apresentavam suspeita de delirium. O instrumento apresentou sensibilidade de 91.6%, especificidade de 95.6%, valor preditivo positivo de 73.3%, valor preditivo negativo de 98.8%, boa consistência interna com α de Cronbach de 0.8 e boa concordância segundo o índice Kappa de Cohen de 0.788. Conclusão.A versão em espanhol para a Colômbia da escala Nu-DESC possui valores psicométricos adequados para avaliação do risco de delirium.

Effectiveness of nursing intervention to reduce delirium in adult critically ill - A protocol for a randomized trial.

The incidence of delirium in intensive care patients remains high, and its consequences have a high negative impact on patients, their families, health care teams, and society in general. Because delirium can lead to increased hospital stay, increased days on mechanical ventilation, increased risk of adverse events, increased memory loss and even increased mortality. However, some factors that precipitate delirium can be modified to reduce its presence and duration through non-pharmacological measures. Thus, the present protocol seeks to establish the theoretical and methodological background to develop and test nursing interventions to reduce delirium in adult patients hospitalized in the intensive care unit. For this reason, it is based on the theoretical elements of delirium and a nursing theory, called the Dynamic Symptoms Model (DSM), to understand the phenomenon and how nursing knowledge can be used to intervene. Thus, a nursing intervention proposal is proposed based on the DSM and scientific evidence, and a methodological design of a randomized controlled clinical trial type with parallel groups, which allows measuring the effectiveness of the designed interventions, following methodological and ethical rigor and with adequate control of biases.

Validation to Spanish of nursing assessment scale for early diagnosis of delirium - Nu-DESC.

Objective: This work aimed to determine the validity and reliability of the Colombian Spanish version of the Nursing Delirium Screening Scale (Nu-DESC). Methods: A psychometric study was conducted to achieve the goal of this study, which measured face validity, content validity, sensitivity, specificity and predictive values of the Nu-DESC. Results: . Face validity obtained a total Aiken V of 0.89, and content validity showed a modified Lawshe index of 0.92. When Nu-DESC was applied to 210 adult patients hospitalized in the Intensive Care Unit, it was found that 14.2% had suspected delirium. The instrument showed a sensitivity of 91.6%, specificity of 95.6%, positive predictive value of 73.3%, negative predictive value of 98.8%, good internal consistency with Cronbach's α of 0.8 and good concordance according to Cohen's Kappa index of 0.788. Conclusion: The Spanish version of the Nu-DESC scale for Colombia has appropriate psychometric values for assessing delirium risk. In addition, this scale is easy to apply, so the adaptation of nursing personnel for its employability favors routine monitoring and timely detection of delirium.

Scales to measure post intensive care syndrome, a scoping review.

INTRODUCTION: Post Intensive Care Syndrome is a recently studied syndrome that affects between 50% and 70% of patients admitted to the ICU, its detection is complex due to the great variety of affected components. OBJECTIVE: To determine the most widely used assessment instruments for the detection of post-intensive care syndrome, according to the evidence in the last 5 years. METHODOLOGY: A scoping review was carried out in the databases: Academic Search, ScienceDirect, Scielo, Biblioteca Virtual en Salud, Medline, and Springer Link, with terms «Postintensive care syndrome¼ and «Post-intensive care syndrome¼. This review included 22 articles that met the criteria of: research or review typology, English, Spanish or Portuguese language, with access to the full text and published between 2015 and 2020. CONCLUSIONS: Most of the instruments used to measure post-intensive care syndrome are divided according to the components of physical affectation (the Medical Research Council scale, the Katz index and the Barthel index); cognitive (Repeatable Battery for the Assessment of Neuropsychological Status, and the Montreal Cognitive Assessment test); and mental (Hospital Anxiety and Depression Scale, Beck's anxiety test, Depression Inventory Second Edition scale and Post Traumatic Stress Syndrome-14 scale). In addition, two tools were found that measure the event in its entirety with its three components, such as the Healthy Aging Brain Care Monitor and the Post-Intensive Care Syndrome Questionnaire.

Sospecha de delirium y posibles factores relacionados en el adulto mayor hospitalizado / Suspeita de delírio e possíveis fatores relacionados em idosos internados / Suspected delirium and possible related factors in hospitalized older adults

Objetivo: describir la sospecha de delirium en adultos mayores hospitalizados en medicina interna y sus posibles factores relacionados. Materiales y método: estudio correlacional de corte transversal y muestreo por conveniencia, con 49 adultos mayores de 70 años hospitalizados en medicina interna que aceptaron participar de forma voluntaria. Se aplicó la Escala de Detección de Delirium por Enfermería, la cual mide la sospecha de delirium, y se empleó análisis descriptivo y bivariado. Resultados: la prevalencia de sospecha de delirium en los pacientes del estudio fue de 20,4 %. La edad fue significativamente menor en los pacientes que no presentaron delirium en comparación con aquellos que mostraron sospecha (73 vs. 82 años, respectivamente, p = 0,05). Otras variables que evidenciaron un comportamiento similar son el número de comorbilidades (1 sin delirium vs. 2 sospecha, p = 0,037), haber padecido delirium al menos una vez antes de la actual hospitalización (1 sin delirium vs. 6 sospecha, p = 0,000) y no reportar antecedentes psicoactivos (17 sin delirium vs. 3 sospecha p = 0,009). El análisis bivariado evidenció una posible asociación significativa entre el delirium y los antecedentes de diabetes (or 6,8; ic 95 % 1,43-32,19 [p = 0,020]), el consumo de alcohol (or 5,2; ic 95 % 1,15-23,85 [p = 0,029]) y antecedentes de delirium en hospitalización previa (or 6,3; ic 95 % 1,02-38,9 [p = 0,000]). Conclusiones: el delirium es un problema que continúa impactando a los adultos, particularmente a los adultos mayores, quienes por los factores fisiológicos propios de la edad son más vulnerables a padecer este evento.

Objective: To describe the suspicion of delirium in older adults hospitalized in internal medicine and the possible risk factors associated to this event. Materials and method: Cross-sectional and correlational study through convenience sampling. Forty-nine adults over 70 years hospitalized in internal medicine agreed to participate by signing an informed consent form. We adopted the Nursing Delirium Screening Scale, which measures suspicion of delirium. Descriptive and bivariate analysis was also used.Results: The prevalence of suspected delirium among participants was 20.4%. Age was significantly lower in patients who did not present delirium compared to those who showed suspicion (73 vs. 82 years, respectively, p = 0.05). Other variables that showed a similar behavior were the number of comorbidities (1 no delirium vs. 2 suspected, p = 0.037), having suffered from delirium at least once before current hospitalization (1 no delirium vs. 6 suspected, p = 0.000), and no psychoactive history (17 no delirium vs. 3 suspected, p = 0.009). Bivariate analysis reported a possible significant association between delirium and history of diabetes (or 6.8; ci 95% 1.43-32.19 [p = 0.020]), alcohol consumption (or 5.2; ci 95% 1.15-23.85 [p = 0.029]), and history of delirium during previous hospitalization (or 6.3; ci 95% 1.02 - 38.9 [p = 0.000]). Conclusions: Delirium is an issue that continues to affect adults, particularly the elderly, who are more vulnerable to suffering this event due to age-related physi-ological factors.

Objetivo: descrever suspeitas de delírio em idosos internados em medicina interna e os seus possíveis fatores de risco. Materiais e método: estudo correlacional de corte transversal com amostragem por conveniência. Participaram 49 pessoas com mais de 70 anos de idade internadas em medicina interna que concordaram em participar de forma voluntária. Foi utilizada a Escala de Detecção do Delírio para Enfermagem, que mede as suspeitas de delírio. Foi utilizada uma análise descritiva e bivariada. Resultados: a prevalência de suspeita de delírio no estudo foi de 20,4%. A idade era significativamente mais baixa naqueles que não apresentavam delírio em comparação com aqueles que apresentavam suspeitas (73 vs 82 anos, respectivamente, p = 0,05). Outras variáveis mostraram comportamento semelhante, tais como número de comorbilidades (1 sem delírio vs 2 suspeitas, p = 0,037), tendo sofrido de delírio pelo menos uma vez antes da internação atual (1 sem delírio vs 6 suspeitas, p = 0,000) e nenhum histórico psicoativo (17 sem delírio vs 3 suspeitas, p = 0,009). A análise bivariada evidenciou uma possível associação significativa entre delírio e histórico de diabetes (or 6,8 ci 95% 1,43-32,19 [p = 0,020]), consumo de álcool (or 5,2 ci 95% 1,15-23,85 [p = 0,029]) e histórico de delírio em internação anterior (or 6,3 ci 95% 1,02-38,9 [p = 0,000]). Conclusões: o delírio é um problema que continua a ter impacto nos adultos, mais ainda na população idosa, que, devido a fatores fisiológicos relacionados com a idade, são mais vulneráveis a sofrer com esse evento.

El concepto del confort en el cuidado de enfermería / The Concept of Comfort in Nursing Care

Introducción: Para enfermería, el confort es un objetivo de cuidado en los múltiples escenarios del actuar disciplinario, lleva a la formulación de teorías con perspectiva holística y logra aplicar el confort desde una mirada física, psicoespiritual, ambiental y social. Objetivo: Identificar los atributos del concepto confort entendido por enfermería en los diferentes escenarios de cuidado. Métodos: Revisión integrativa, con estrategia de búsqueda: "Confort" AND "Nursing", en las bases de datos Scopus, Google Académico, BVS, EBSCO, Cochrane, Ovid y Medline. Los criterios de elegibilidad fueron: estudios primarios, a texto completo, publicados entre 2009-2019, en español, inglés y portugués. Se utilizó el diagrama prisma para el análisis crítico de diseños experimentales, revisiones y cualitativos, se emplearon las plantillas del Critical Appraisal Skills Programme (Caspe). Para los demás diseños se aplicaron las listas de chequeo del Joanna Briggs Institute, quedaron incluidos 16 artículos. Conclusión: El confort está ligado a temas que enmarcan la realidad física, social, psíquica y ambiental de la persona, determinado por los atributos: 1. Alivio físico del dolor mediante intervenciones farmacológicas y de elementos externos en contacto con el cuerpo. 2. Soporte social con cercanía de los familiares, lo que facilita la adaptación al ambiente hospitalario y reduce la ansiedad. 3. Relaciones con el personal sanitario de acompañamiento y acceso a información sobre la condición del paciente. 4. Ambiente adaptado para favorecer la recuperación y alivio. 5. Descanso que incluye reposo y sueño, generando alivio; y 6. Salud mental con alivio de ansiedad, estrés y adecuada recuperación mental(AU)

Introduction: For nursing, comfort is a care-related objective in the multiple settings of professional performance; it leads to the formulation of theories with a holistic perspective and manages to be applied from a physical, psychospiritual, environmental and social point of view. Objective: To identify the attributes of the concept of comfort understood by nursing in different care settings. Methods: Integrative review carried out in the Scopus, Google Scholar, VHL, EBSCO, Cochrane, Ovid and Medline databases, using the following search strategy: "Comfort" AND "Nursing". The eligibility criteria considered primary studies, full texts, published between 2009 and 2019, in Spanish, English or Portuguese. The PRISMA diagram was used for the critical analysis of experimental, review and qualitative studies, using the templates of the Critical Appraisal Skills Program (Caspe). For the other designs, the checklists of the Joanna Briggs Institute were applied and sixteen articles were included. Conclusion: Comfort is related to issues that enclose the physical, social, psychic and environmental reality of a person, determined by the following attributes: physical relief of pain through pharmacological interventions and external elements in contact with the body; social support with the closeness of family members, which facilitates adaptation to the hospital environment and reduces anxiety; relationships with the accompanying health personnel and access to information on the patient's condition; an adapted environment to favor recovery and relief; rest including sleep and generating relief; and mental health with relief of anxiety, stress and adequate mental recovery(AU)

Cuidar personas con dolor e insuficiencia cardíaca desde la teoría de adaptación a condiciones crónicas de salud / Caring People with Pain and Heart Failure, from theory of Adapting to Chronic Health Conditions / Cuidar de pessoas com dor e insuficiência cardíaca, da teoria da adaptação às condições crônicas de saúde

Introducción: cerca de 85 % de los pacientes con insuficiencia cardiaca reportan dolor, esto genera preocupación debido a que, según tipología del dolor, esta experiencia puede afectar la calidad de vida de los pacientes y sus cuidadores. Objetivo: diseñar una estrategia de cuidados de enfermería basada en la teoría de adaptación a condiciones crónicas de la salud de Callista Roy, para reducir la experiencia de dolor en personas con insuficiencia cardíaca. Metodología: se elaboró la estructura conceptual teórico empírica (CTE) de la teoría de mediano rango seleccionada, para consolidar los conceptos y proposiciones que generaron los componentes o dominios de la estrategia. Posteriormente, para construir los cuidados de la estrategia se realizó una revisión sistemática de la literatura con búsqueda en las bases de datos: ScienceDirect, Scopus y Medline, con los términos "pain", "heart failure" y "nursing care", y se organizó la evidencia según los dominios emergidos del CTE para este fenómeno. Resultados: se diseñó una estrategia con cuidados que abordan los dominios: 1) fisiológico, con valoración del síntoma, ejercicio, control de peso y sitios dolorosos; 2) autoconcepto y rol con reducción de ansiedad, estrés, depresión, entrenamiento en cambio de pensamientos, actitudes y comportamientos; y 3) de interdependencia mediante compartir experiencias de autocuidado, apoyo espiritual y diarios de salud. Conclusión: la evidencia y el conocimiento teórico de enfermería aportan múltiples cuidados que pueden aplicarse en los pacientes con dolor e insuficiencia cardíaca, para reducir dicha experiencia a través de cuidados enfocados en confort, estimulación cognitiva y apoyo familiar, social y espiritual.

Introduction: About 85 % of patients with heart failure report pain. This pathology can affect the quality of life of patients and their caregivers because it causes pain and limits the physical functionality of patients. Objective: Develop a nursing care strategy to reduce pain in patients with heart failure, based on middle range theory of Callista Roy (Adaptation to chronic health conditions theory). Methodology: Conceptual-Theoretical-Empirical (C-T-E) structure of the selected medium-range theory was elaborated to consolidate the concepts and propositions that provided the components or domains and of the strategy. Subsequently, to construct the interventions of the strategy, a systematic review of literature was carried out in the following databases: ScienceDirect, Scopus and Medline, with the terms "pain", "heart failure" and "nursing care". The evidence was organized according to the components emerging from the CTE for this phenomenon. Results: Evidence and theoretical concepts show various interventions applicable in patients with heart failure. These interventions address the following domains: 1) physiological, with symptom assessment, exercise, weight control, and painful sites; 2) self-concept and role with reduction of anxiety, stress, depression, training to change thoughts, attitudes, and behaviors; and 3) interdependence, with sharing experiences of self-care, spiritual support and health journals, among others. Conclusion: Evidence and theoretical nursing knowledge provide multiple interventions that can be applied in patients with heart failure to reduce the experience of pain, mainly through care focused on comfort, cognitive stimulation and family, social and spiritual support.

Introdução: cerca de 85 % dos pacientes com insuficiência cardíaca relatam dor, o que suscita preocupação considerando que dependendo do tipo de dor, essa experiência pode afetar a qualidade de vida do paciente e de seus cuidadores. Objetivo: desenvolver uma estratégia de cuidado de enfermagem baseada em na teoria de adaptação às condições crônicas de saúde de Callista Roy, para reduzir a experiência de dor em pessoas com insuficiência cardíaca. Metodologia: a estrutura conceitual teórica empírica (CTE) da teoria de médio alcance selecionada foi elaborada para consolidar os conceitos e proposições que forneceram os componentes ou domínios para a estratégia. Posteriormente, para construir as intervenções da estratégia, foi realizada uma revisão sistemática da literatura com uma pesquisa nas seguintes bases de dados: ScienceDirect, Scopus e Medline, com os termos "pain", "heart failure" e "nursing care", e as evidências foram organizadas de acordo com os dominios emergentes do CTE para este fenômeno. Resultados: foi elaborada uma estratégia com intervenções que abordam os seguintes domínios: 1) fisiológico, com avaliação dos sintomas, exercícios, controle de peso e locais dolorosos; 2) autoconceito e papel com redução da ansiedade, estresse, depressão, treinamento para mudar pensamentos, atitudes e comportamentos; e 3) interdependência, com o compartilhamento de experiências de autocuidado, apoio espiritual e diários de saúde, entre outros. Conclusão: As evidências e o conhecimento teórico de enfermagem fornecem múltiplas intervenções que podem ser aplicadas em pacientes com insuficiência cardíaca para reduzir a experiência de dor, principalmente por meio de cuidados voltados para o conforto, estimulação cognitiva e suporte familiar, social e espiritual.

Intervención de enfermería para reducir incidencia y duración del delirium en personas en cuidados intensivos  / Nursing Intervention to Reduce Incidence and Duration of Delirium in Patients in Intensive Care

Objetivo: determinar la efectividad de la intervención de enfermería basada en el Modelo de Síntomas Dinámicos (MSD) y en evidencia científica, frente al cuidado cotidiano, para la reducción de la incidencia y duración del delirium en personas en cuidados intensivos. Método: se emplearon dos fases, diseño y evaluación de la intervención. El diseño siguió las recomendaciones de Sidani desde el enfoque teórico con aplicación del MSD y desde el enfoque empírico con una revisión sistemática. La evaluación de la intervención se realizó con un ensayo clínico aleatorizado de grupos paralelos doble ciego. La muestra fueron 213 personas en UCI. El análisis empleó estadística analítica, paramétrica y no paramétrica. Resultados: se diseñó la intervención denominada Dynamic Delirium (DyDel) con 10 cuidados y 33 actividades. Los cuidados partieron de los componentes fisiológico, psicológico, spiritual y social, ambiental, experiencia y trayectoria del MSD. Las actividades de cada cuidado surgieron de la evidencia científica. Al probar la intervención se halló que la incidencia y duración del delirium fueron significativamente menor en el grupo intervención frente al grupo control (incidencia 5,6% Vs. 14,8%, respectivamente, (p=0.037)) (duración 0.07±0.308 Vs. 0.34±1.28, respectivamente (p=0.016)). El grupo intervención también logró más cantidad de días con dolor leve y sin uso de inmovilizaciones físicas. Conclusión: la intervención DyDel, basada en el MSD y en evidencia científica, fue multicomponente, no farmacológica y vincula a la familia, y fue efectiva para reducir el delirium en personas en UCI. Se comprobó que el conocimiento propio de enfermería mejora la práctica. (AU)

Objective: to determine the effectiveness of a nursing intervention based on the Dynamic Symptom Model (DSM) and scientific evidence, versus daily care, in reducing the incidence and duration of delirium in intensive care patients. Method: two phases were used, design and evaluation of the intervention. The design followed Sidani's recommendations from the theoretical approach with the application of the DSM and the empirical approach with a systematic review. The evaluation of the intervention was carried out with a randomized clinical trial of parallel groups, double-blind. The sample consisted of 213 ICU patients. The analysis used analytical, parametric and nonparametric statistics. Results: the intervention called Dynamic Delirium (Dydel) was designed with ten care and 33 activities. Care was based on the physiological, psychological, spiritual and social, environmental, experience and MSD trajectory components. The activities for each care were derived from scientific evidence. When testing the intervention, it was found that the incidence and duration of delirium were significantly lower in the intervention group versus the control group (incidence 5.6% vs 14.8%, respectively, (p=0.037)) (duration 0.07±0.308 vs 0.34±1.28, respectively (p=0.016)). The intervention group also achieved more days with mild pain and without the use of physical immobilizations. Conclusion: the DyDel intervention, based on the DSM and scientific evidence, was multicomponent, non-pharmacological and linked to the family, and was effective in reducing delirium in ICU patients. It was proven that nursing knowledge improves practice. (AU)

Intervenciones y efectividad del Paquete ABCDEF en el tratamiento de delirium: revisión de alcance / Intervenções e efetividade do pacote ABCDEF no delirium: revisão de escopo / Interventions and effectiveness of the ABCDEF Bundle for treating delirium: A scoping review

Objetivo: describir las intervenciones de cada componente del paquete ABCDEF y su efectividad para prevenir y tratar el delirium en pacientes hospitalizados en cuidados intensivos. Síntesis de contenido: se realizó una revisión de alcance empleando los términos MeSH delirium e intensive care units, agregando ABCDEF con el operador AND, en las bases de datos Medline, Science Direct, Biblioteca Virtual de Salud y Scopus. Se seleccionó un total de 23 artículos según los criterios de inclusión establecidos. Entre estos, se logró identificar intervenciones para el control del dolor (A), el despertar y la respiración espontánea (B), sedación de la analgesia y sedación (c), monitorización del delirium (d), movilidad temprana (E) y el empoderamiento de la familia (F). Todo el paquete ABCDEF y sus componentes mostraron efectividad en la reducción de la incidencia y duración del delirium, así como de los días de ventilación mecánica y de la mortalidad. Conclusiones: las intervenciones del paquete ABCDEF identificadas fueron la monitorización del dolor y su control con fármacos y relajación; la implementación del protocolo de despertar y respiración espontánea, según criterios de seguridad; la administración de analgesia antes de la sedación ­siendo esta última nula o mínima­, monitorizando el estado de conciencia y profundidad de la sedación con escalas validadas y monitorizando el delirium al menos una vez al día; movilización temprana, progresiva y al máximo potencial que se pueda lograr; y la vinculación de la familia en las rondas, en el cuidado básico y en la prevención del delirium.

Objetivo: descrever as intervenções de cada componente do pacote ABCDEF e sua eficácia na prevenção e no tratamento do delirium em pacientes internados em terapia intensiva. Síntese do conteúdo: foi realizada uma revisão de escopo, utilizando os termos MeSH delirium e intensive care units, e acrescentando ABCDEF com o operador AND, nas bases de dados Medline, Science Direct, Biblioteca Virtual de Saúde e Scopus, chegando a 23 artigos de acordo com os critérios de inclusão. Destes, foi possível identificar intervenções para controle da dor (A); despertar e respiração espontânea (B); sedação de analgesia e sedação (c); monitorar delirium (d); mobilidade precoce (E) e empoderamento familiar (F). O ABCDEF e seus componentes mostraram-se eficazes na redução da incidência e da duração do delirium, bem como dos dias de ventilação mecânica e mortalidade. Conclusões: as intervenções do pacote ABCDEF encontradas foram: monitoramento da dor e seu controle com medicamentos e relaxamento; implantação do protocolo de despertar e respiração espontânea segundo critérios de segurança; administração de analgesia antes da sedação, ­sendo esta última nula ou mínima­, monitorando o estado de consciência e profundidade da sedação com escalas validadas, monitorando delirium pelo menos uma vez ao dia; mobilização precoce, progressiva e ao máximo potencial que possa ser alcançado; e vinculação da família nas rondas, na atenção básica e na prevenção do delirium.

Objective: To describe the interventions of each component of the ABCDEF bundle and their effectiveness in the prevention and treatment of delirium in patients hospitalized in intensive care units. Content synthesis: Scoping review using the MeSH terms delirium and intensive care units, adding ABCDEF through the AND operator, in the databases Medline, Science Direct, Virtual Health Library, and Scopus. A total of 23 articles were identified based on the inclusion criteria. From these works, it was possible to identify interventions for pain control (A), awakening and spontaneous breathing (B), sedation from analgesia and sedation (c), monitoring of delirium (d), early mobility (E), and family empowerment (F). The ABCDEF bundle and its components showed effectiveness in reducing the incidence and duration of delirium, as well as the days of mechanical ventilation and mortality. Conclusions: The ABCDEF bundle interventions identified were pain monitoring and its control with drugs and relaxation; the implementation of the protocol of awakening and spontaneous breathing accord-ing to safety criteria; the administration of analgesia before sedation ­being this null or minimal­, monitoring the state of consciousness and depth of sedation with validated scales, as well as monitoring delirium at least once a day; early, progressive and maximum-potential mobilization; and engaging family members in the rounds, basic care, and prevention activities for treating delirium.

Analysis of Delirium From the Dynamic Symptoms Model: A Literature Review.

Delirium is a manifestation of brain injury or acute and generalized dysfunction of the upper cerebral cortical processes. In this way, it is important to analyze delirium more broadly as a symptom to understand and intervene taking into account that it is manifesting the presence of brain lesions whose consequences are deleterious to the neurological performance of patients. This article is intended to present a comprehensive approach of delirium analyzed from a symptom perspective and from theoretical and conceptual structure, such as the Dynamic Symptoms Model, specific to the nursing practice. A literature review related to delirium and components of Dynamic Symptoms Model was carried out. We searched the MEDLINE, ScienceDirect, SciELO, and Scopus databases using the terms Delirium, Intensive Care Units, Nursing, and Risk Factor. The existing literature provides evidence of the antecedents, experience, interventions, interactions, and consequences of delirium, which are components of the Model. Thus, the analysis from the Dynamic Symptoms Model perspective bears relevance and contributes to the understanding and approach of delirium.