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Abstract(s)
Apesar de os termos “delirium” e “confusão aguda” serem utilizados na prática clínica há muitos anos e terem definições diferentes, continuam a ser utilizados de forma indiscriminada para se referirem à mesma síndrome. A ausência de diagnóstico de delirium pode comprometer a segurança do doente e ter implicações diretas nos cuidados de saúde prestados, tendo consequências que podem mesmo manifestar-se após a alta hospitalar. As unidades de cuidados intensivos estão normalmente associadas a um ambiente hostil para doentes e famílias, com muito ruído, pouco convidativas a visitas demoradas e com horários pouco flexíveis. Os doentes estão habitualmente com limitação da mobilidade, medicados e dependentes de equipamentos muitos deles invasivos e dos quais depende a sua vida. A perturbação do sono é uma constante, e a perceção de quando é dia ou noite nem sempre é fácil. A relação entre o ambiente e a saúde é mesmo uma das primeiras reflexões atribuídas a Florence Nightingale, considerada a primeira teórica de enfermagem e cujo objeto de estudo se focou nas implicações que o ambiente tinha na saúde dos doentes. O aparecimento de delirium está relacionado com diversos fatores, sendo importante considerar aqueles que são modificáveis, e sobre quais o enfermeiro especialista pode intervir. Da revisão integrativa da literatura, identificam-se algumas intervenções de enfermagem com impacto positivo na prevenção de delirium, como sejam a orientação dos doentes, a mobilização precoce, a criação de um ambiente mais agradável e a promoção do ciclo do sono. Urge aprofundar e consolidar este conhecimento na linguagem e nas práticas de enfermagem. Considera-se, por isso, que o maior desafio é a formação das equipas, começando pelas unidades de cuidados intensivos, onde a incidência de delirium é mais significativa.
Despite the terms "delirium" and "acute confusion" being used in clinical practice for many years and having different definitions, they continue to be used indiscriminately to refer to the same syndrome. Failure to diagnose delirium can compromise patient safety and have direct implications for health care delivery, with consequences that may occur even after hospital discharge. Intensive care units are usually associated with a hostile environment for patients and families, being noisy and uninviting for lengthy visits and with restricted visiting times. Patients are usually limited in mobility, medicated, and dependent on equipment that is, in many cases, invasive and on which the patient’s life depends. Sleep disturbance is a constant, and being able to tell whether it is day or night is not always easy. The relationship between the environment and health is one of the first reflections attributed to Florence Nightingale; considered the earliest nursing theory, its object of study focused on the implications that the environment has on patients' health. Delirium is related to several factors and it is important to understand which of those factors are modifiable so the specialist nurse can intervene. Through an integrative literature review we can identify some nursing interventions that have a positive impact on the prevention of delirium, such as patient guidance, early mobilisation, creating a more pleasant environment and promoting the sleep cycle. It is urgent to deepen and consolidate this knowledge in nursing language and practices. It is, therefore, considered that the greatest challenge is the training of teams, starting with intensive care units, where the incidence of delirium is more significant.
Despite the terms "delirium" and "acute confusion" being used in clinical practice for many years and having different definitions, they continue to be used indiscriminately to refer to the same syndrome. Failure to diagnose delirium can compromise patient safety and have direct implications for health care delivery, with consequences that may occur even after hospital discharge. Intensive care units are usually associated with a hostile environment for patients and families, being noisy and uninviting for lengthy visits and with restricted visiting times. Patients are usually limited in mobility, medicated, and dependent on equipment that is, in many cases, invasive and on which the patient’s life depends. Sleep disturbance is a constant, and being able to tell whether it is day or night is not always easy. The relationship between the environment and health is one of the first reflections attributed to Florence Nightingale; considered the earliest nursing theory, its object of study focused on the implications that the environment has on patients' health. Delirium is related to several factors and it is important to understand which of those factors are modifiable so the specialist nurse can intervene. Through an integrative literature review we can identify some nursing interventions that have a positive impact on the prevention of delirium, such as patient guidance, early mobilisation, creating a more pleasant environment and promoting the sleep cycle. It is urgent to deepen and consolidate this knowledge in nursing language and practices. It is, therefore, considered that the greatest challenge is the training of teams, starting with intensive care units, where the incidence of delirium is more significant.
Description
Keywords
Delirium Confusão aguda Doente crítico Cuidados de enfermagem Unidade cuidados intensivos Acute confusion Critically ill Nursing care Intensive care unit