Critical care nurses' prioritisation of patient care, including delirium prevention and management strategies: A mixed-method study

Sarah Crowe; A Fuchsia Howard

doi:10.1016/j.aucc.2024.101154

Critical care nurses' prioritisation of patient care, including delirium prevention and management strategies: A mixed-method study

Aust Crit Care. 2025 Jan 15;38(3):101154. doi: 10.1016/j.aucc.2024.101154. Online ahead of print.

Authors

Sarah Crowe¹, A Fuchsia Howard²

Affiliations

¹ Fraser Health Authority, 96th Avenue, Surrey, 13750, BC, Canada. Electronic address: sarah.crowe@fraserhealth.ca.
² University of British Columbia, School of Nursing, Vancouver, BC, Canada.

PMID: 39817934
DOI: 10.1016/j.aucc.2024.101154

Abstract

Background: Delirium is a common issue in critical care, yet its prevention and management strategies are often inconsistent. Understanding the factors that lead to the omission or delay in delirium-related care by critical care nurses is essential for enhancing patient outcomes.

Objectives: This study aimed to identify the specific delirium-related prevention and management strategies that are frequently missed or delayed by critical care nurses. It also explored factors influencing nurses' prioritisation of care, including delirium-related strategies.

Methods: A mixed-method approach was utilised, combining quantitative data from online surveys and qualitative insights from interviews with critical care nurses in a Canadian health authority. The Missed Nursing Care Survey identified instances of missed or delayed care, while interviews provided deeper insights into care prioritisation decisions.

Results: Quantitative findings indicated frequent delays in patient mobilisation and physical care that were attributed to staffing shortages, high patient volume, and increased admissions and discharges. Qualitative findings revealed that factors such as patient acuity, structured routines, knowledge gaps, limited support, unit culture, and resource inadequacies influenced the prioritisation of delirium-related care, often leading to its inadvertent deprioritisation.

Conclusion: This study underscores the need to integrate delirium care into patient acuity assessments and establish sustainable education programs to enhance the recognition and prioritisation of delirium by critical care nurses. Addressing these factors is critical for improving patient outcomes in critical care settings.

Implications for clinical practice: Strengthening critical care nurses' capacity to consistently recognise and prioritise delirium-related care through targeted education and system-level support could potentially contribute to better patient outcomes.

Keywords: Critical care; Delirium; Mixed-method; Nursing care; Prioritisation.