The significant clinical issue I have chosen to further research is Intensive Care Unit (ICU) delirium. Working in an ICU, I have witnessed ICU delirium first hand. It is quite common in the Trauma ICU in my hospital, because it has no windows. ICU delirium is a significant issue, because it has been linked to negative patient outcomes such as longer hospital stays and higher risk of mortality. It is a serious issue, because it can be hard to assess until it has already become full blown. There are suggested tools and preventive measures, but no solid treatment.
Every patient in the ICU is at risk for developing ICU delirium. On my floor I would say at least 25% of the patients have ICU delirium. Standard practice at my hospital is to use the CAM-ICU scale once per shift to assess for delirium. It is common to look through a patient’s chart and see “unable to assess” in the comments. This is related to the patient being intubated, sedated, and/or the nurse not knowing the patient’s baseline. Another gap in knowledge is in relation to the fact that there are subtypes of ICU delirium. According to Jun Gwon (2013) “Physicians and other caregivers in the ICU usually notice agitation as a consequence whereas patient with hypoactive delirium, which is a more frequent subtype . . . remain unnoticed” (p. 195). Noticing that a patient has become aggressive and irritated comes easily, but noticing a patient is not as talkative or less engaged can easily get missed.
Chamberlain School of Nursing (2015). Reading research literature – The research process – Lesson. [Online lecture, Week 2]. Retrieved from nursingonline.chamberlain.edu
Houser, J. (2015). Nursing research: Reading, using, and creating evidence (3rd ed.). Sudbury, MA: Jones & Bartlett.
Jun Gwon, C. (2013). Delirium in the intensive care unit. Korean Journal of Anesthesiology, 65(3), 195-202. doi: 10.4097/kjae/2013.65.3.195