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Contents lists available at ScienceDirect

Intensive and Critical Care Nursing

journal homepage: www.elsevier.com/iccn

Original article

The experience of intensive care nurses caring for patients with

delirium: A phenomenological study
Allana LeBlanc ∗ , Frances Fothergill Bourbonnais, Denise Harrison, Kelly Tousignant
University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada

a r t i c l e i n f o a b s t r a c t

Article history:
Received 5 January 2017 Objectives: The purpose of this research was to seek to understand the lived experience of intensive care
Received in revised form 31 August 2017 nurses caring for patients with delirium. The objectives of this inquiry were: 1) To examine intensive
Accepted 1 September 2017
care nurses’ experiences of caring for adult patients with delirium; 2) To identify factors that facilitate or
hinder intensive care nurses caring for these patients.
Keywords:
Research methodology: This study utilised an interpretive phenomenological approach as described by
Critical care
van Manen.
Critical care nursing
Delirium
Setting: Individual conversational interviews were conducted with eight intensive care nurses working
ICU delirium in a tertiary level, university-affiliated hospital in Canada.
Intensive care Findings: The essence of the experience of nurses caring for patients with delirium in intensive care was
Nursing revealed to be finding a way to help them come through it. Six main themes emerged: It’s Exhausting;
Phenomenology Making a Picture of the Patient’s Mental Status; Keeping Patients Safe: It’s aReally Big Job; Everyone Is Unique;
Riding It Out With Families and Taking Every Experience With You.
Conclusion: The findings contribute to an understanding of how intensive care nurses help patients and
their families through this complex and distressing experience.
© 2017 Elsevier Ltd. All rights reserved.

Implications for clinical practice

• The nurse-patient relationship is crucial and is reflected in the importance of moment by moment patient assessment.
• Building relationships with families is essential and contributes to both the assessment and management of these patients.
• Patient safety is an overarching concern as well as a challenge that is impacted by workload issues and teamwork.
• Experiential learning is essential in educating nurses about delirium.

Introduction
Ely, 2015). Delirium may affect greater than 80% of adult patients
Delirium is a temporary disturbance of attention and awareness in intensive care units (ICU) and is associated with longer ICU
that is associated with a change in cognition. It develops over a short and hospital length of stay, as well as increased mortality (Pisani
period of time and tends to fluctuate in severity throughout the et al., 2009; Shehabi et al., 2010). Other impacts of delirium in
day (Adamis et al., 2015; American Psychiatric Association, 2013). ICU patients include increased risk for long-term cognitive impair-
Symptoms include disorientation, hallucinations or delusions, psy- ments, greater functional dependency following hospital discharge,
chomotor agitation and/or hypoactivity and lethargy (Page and increased frequency of patient safety events, decreased quality of
life, short- and long-term emotional and psychological distress and
increased hospital and health system costs (Awissi et al., 2012; Barr
∗ Corresponding author. Present address: Permanent address: Intensive Care Unit,
et al., 2013; Girard et al., 2010; Pandharipande et al., 2013; Salluh
Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia,
et al., 2015). Patients who have experienced delirium in the ICU
V5Z 1M9, Canada. describe feelings of fear and struggling to make meaning or to find
E-mail address: Allana.LeBlanc@vch.ca (A. LeBlanc). human connection (Whitehorne et al., 2015). The emotional and

http://dx.doi.org/10.1016/j.iccn.2017.09.002
0964-3397/© 2017 Elsevier Ltd. All rights reserved.

Please cite this article in press as: LeBlanc, A., et al., The experience of intensive care nurses caring for patients with delirium: A
phenomenological study. Intensive Crit Care Nurs (2017), http://dx.doi.org/10.1016/j.iccn.2017.09.002
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psychological impacts can have consequences for patients after the assessment by the bedside nurse each shift using the CAM-ICU and
delirium has resolved (Brummel et al., 2014; Pandharipande et al., a delirium protocol was available to use for patients who screened
2013). positive. The delirium protocol consisted of a physician’s order set
Clinicians must be knowledgeable about delirium in ICU for pharmacologic and non-pharmacologic interventions for delir-
patients in order to identify it early and implement care and treat- ium.
ment strategies. Identifying delirium in an ICU setting can be Participants. Prior to data collection, meetings were held with
challenging because patients are frequently unable to communi- the nursing managers and educators to explain the study. Nursing
cate due to their severe illness and/or endotracheal intubation. staff were then notified about the study by informational posters
Key recommendations for delirium prevention and management and emails. A purposive sample of eight intensive care registered
include regular assessment for delirium with a valid and reliable nurses was recruited. Inclusion criteria were: 1) Registered nurse
tool, such as the Confusion Assessment Method for ICU (CAM-ICU), (RN) who has cared for intensive care unit patient(s) with delirium
early mobilisation, targeting light levels of sedation, promoting in the last 12 months; 2) employed full or part-time in the unit, with
sleep and using an interprofessional team approach to patient care greater than one year of intensive care experience. The participants’
(Barr et al., 2013). ages ranged from 21 to 60 years, years of nursing experience was
Increasingly, ICUs are implementing protocols aimed at pre- from one to >35 years and ICU experience varied from one year to
venting delirium and minimizing its impact on patient outcomes >25 years. Therefore, the sample consisted of less experienced as
(Balas et al., 2013; Barr et al., 2013; Barr and Pandharipande, 2013; well as very experienced nurses. Five participants were male and
Reade and Finfer, 2014). Intensive care nurses typically coordinate three were female.
and participate in implementing these protocols for the patients Data collection. One-to-one interviews of approximately one
under their care (Balas et al., 2012; Balas et al., 2014). However, the hour were held in a conversational style using open-ended ques-
successful use of such protocols can be challenging in daily prac- tions. Participants were invited to share personal stories or
tice due to a variety of organisational and human factors (Balas anecdotes to stimulate their recollections and to provide rich data.
et al., 2013; Barr et al., 2013; Basset et al., 2015; Carrothers et al., A reflexive journal was maintained to record methodological deci-
2013; Zamoscik et al., 2017). Additionally, Belanger and Ducharme sions, initial assumptions and impressions throughout the data
(2011) have pointed out that such protocols rarely provide guid- collection process. Having eight participants with varied experi-
ance on establishing therapeutic relationships with patients with ence levels describe caring for patients with delirium facilitated
delirium, or techniques that might reduce the negative emotional obtaining thick and rich descriptions (Morse, 2015). Overlapping of
consequences of the experience for patients and their families. key issues occurred in the transcribed data by the eighth interview.
Studies on the nursing care of critically ill patients with delirium Data analysis. The researchers analysed the interview tran-
have tended to focus on the accuracy and use of assessment tools, scripts (text) to reveal the essence of the lived experience of
risk factors, prevention, pharmacological and non-pharmacological intensive care nurses caring for patients with delirium. The pro-
interventions, physical restraints, nurses’ beliefs and protocol com- cess of data analysis was based on three approaches to textual
pliance and implementation, (Balas et al., 2014; Bassett et al., analysis as described by van Manen (1997): (1) Holistic approach:
2015; Carrothers et al., 2013; Freeman et al., 2015; Gesin et al., The researcher read the transcript (text) as a whole to try to cap-
2012; Oosterhouse et al., 2016; Oxenbøll-Collet et al., 2016; van ture a sense of its overall significance; (2) Selective or highlighting
Eijk et al., 2011; Vasilevskis et al., 2011). Implementing best prac- approach: The researcher returned to the text regularly in order to
tices for patients with delirium depends largely on the knowledge underline within the participants’ statements those phrases that
and skill of nurses and their ability to communicate and coordi- were revealing to the experience under study. Revealing state-
nate effectively with the interprofessional team (Balas et al., 2013; ments were collected and sorted into folders and re-examined
Bassett et al., 2015; Oxenbøll-Collett et al., 2016). Despite the fre- until themes and subthemes emerged. (3) Detailed line- by- line
quency with which intensive care nurses encounter these patients, approach: The researcher read every line of the text and asked
inquiries into nurses’ experiences in the ICU setting are limited. what it revealed about the phenomenon. Quotations which sup-
The purpose of this research was to seek to understand the lived ported themes were extracted from the data. The relationship both
experience of intensive care nurses caring for patients with delir- within and between themes was analysed until a comprehensive
ium. The objectives of this inquiry were: 1) to examine intensive description of the experience of participants was uncovered.
care nurses’ experiences of caring for adult patients with delirium; Ethical approval. Ethical approval was obtained from the affili-
and 2) to identify factors that facilitated or hindered intensive care ated university’s and the participating institution’s research ethics
nurses caring for these patients. boards, approval number 20140066-01H. Informed consent was
obtained from participants prior to each interview.
Methods to ensure rigor. Trustworthiness of the findings was
Methods established using the criteria outlined by Lincoln and Guba (1985):
credibility, transferability, confirmability and dependability. To
Design. Van Manen’s approach, based in the hermeneutic phe- ensure credibility (truth value), the first author (an MScN student
nomenological tradition, provided the methodological lens for this at that time) had consistent consultation with the members of her
study (van Manen, 1997). He describes hermeneutic phenomeno- thesis committee who had expertise in nursing, delirium, criti-
logical research as the study of a person’s lived experience (the cal care and qualitative research. Member check interviews were
person’s reality as it is immediately experienced in the world). The employed for participants to comment on the research findings
findings of phenomenological research reveal an ‘understanding’ and themes (Noble and Smith, 2015). To enhance transferability,
of the moment (van Manen et al., 2016) so that persons who have detailed descriptions of the setting have been presented, as well
had, or could have had that experience, can recognize it. as descriptions of participants. Confirmability refers to the extent
Setting. Participants in this study were recruited from two ICUs to which the study findings originate from the experiences of the
in a university- affiliated, tertiary care academic health care centre participants and not as a result of researcher supposition or bias
in Canada. One ICU had 27 beds for patients with neurosurgical, (Lincoln and Guba, 1985). Quotes from the participants were used
trauma, vascular and general medical-surgical conditions while to explicate each theme to ensure confirmability. In addition, the
the other ICU had 26 beds with primarily oncology, pulmonary second author read all the transcripts and assisted in developing
and medical-surgical patients. Both units had a policy of delirium themes which were then verified by the remaining authors. To

Please cite this article in press as: LeBlanc, A., et al., The experience of intensive care nurses caring for patients with delirium: A
phenomenological study. Intensive Crit Care Nurs (2017), http://dx.doi.org/10.1016/j.iccn.2017.09.002
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can be frustrating for the nurse and the patient, participants described
trying to meet patient’s needs for safety and for delivering care:
“Most of the stories are all the same. The worst one is when they
have no idea of where they are and their main goal is getting home.
It doesn’t matter what you tell them or what they’re hooked up
to, they’re climbing out of bed. . . .it could be dangerous. So you’re
constantly going back to the bedside.” (Steven)
Participants described in the subtheme Not being able to give
optimal care, how difficult it was to provide care when patients
were uncooperative or unable to communicate:
“There may be some hidden needs that are very necessary that I
can’t identify. I would not be able to give them the best care that I
could so I find this is quite hard.” (Jessica)
This left participants feeling dissatisfied. Participants experi-
enced frustration when there was lack of agreement among the
health care team about how to manage patients’ agitation. The
subtheme Being on guard o described the experience of caring for
disorientated, agitated patients. Being on guard meant maintaining
personal safety as well as the patients’ safety:
“If you get report that this patient is going to be fighting you and
aggressive. You just get this feeling, ‘Oh this is going to be a long
day.”’ (Steven)
Conversely, the subtheme Feeling challenged revealed how
working with these patients could be a positive experience when
participants felt they were able to nurse them effectively (Alan,
Steven, Donald, Ben, Joann) even if the patients’ symptoms did not
fully resolve:
“I find it is a challenge but I like that challenge because I find it very
rewarding and I can just calm my patient with talking.” (Alan)
Taking on the challenge was easier when the participants felt
they had support and ‘a plan’ for managing the patient.
Making a picture of the patients’ mental status. Participants
drew upon professional knowledge, previous experiences with
patients, as well as information from family members to fill in
this picture. They noted behaviours, monitored for changes and
sometimes used the CAM-ICU. Considered together, all of this infor-
mation helped participants to make a picture of the patients’ mental
status in the moment. This picture was continually revised:
“We have our tools in the ICU like our CAM score...But also by just
Fig. 1. Overview of themes and subthemes. A diagram of themes and subthemes observing the patient. See how he is responding. (. . .) and you sort
that emerged from the analysis. The essence of the experience was finding a way to of start making a picture of how their mental status is.” (Alan)
help them come through it.
The subtheme Assessing the patient as a whole described the
participants’ holistic assessments which included baseline level of
enhance dependability, the researcher maintained a decision trail function, medical history, current status and treatment plan, past
to record methodological decisions as well as decisions related to and present interventions and “getting a sense of what is normal for
data analysis (Noble and Smith, 2015). him” (Gary) from family. Participants made note of small changes
and continuously assessed for altered mental status as described in
Findings the subtheme Filling in the picture: moment by moment:
“He was calmer. Things seem to start to come back as to why he
The essence of the experience of intensive care nurses caring for
was in the hospital. Start to recall the surgery that he had whereas
adult patients with delirium can be described as finding a way to help
before he didn’t know what he had, where he was.” (Steven)
them come through it. Participants were challenged to find ways to
provide safe, person-centred care in order to help patients come Some participants stated that moment by moment assessments
through the temporary state of delirium. Six themes emerged: It’s were not “believed” by the medical team and that they needed other
Exhausting; Making a Picture of the Patient’s Mental Status; Keep- strategies to communicate. Some would call the physician to the
ing Patients Safe: It’s a Really Big Job; Everyone is Unique; Riding it bedside to “capture the moment” (Gail), others used the CAM-ICU
Out with Families; and Taking Every Experience With You. (See Fig. 1. findings to be “believed”:
Overview of Themes and Subthemes.)
“I get people to believe me by objective evidence [emphatic tone-
It’s exhausting. Participants described feeling mentally and
laughs]. So, using your CAM tool.” (Ben)
emotionally exhausted by their efforts to care for patients with
symptoms of disorientation and/or agitation. In the subtheme It

Please cite this article in press as: LeBlanc, A., et al., The experience of intensive care nurses caring for patients with delirium: A
phenomenological study. Intensive Crit Care Nurs (2017), http://dx.doi.org/10.1016/j.iccn.2017.09.002
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Not all participants considered the CAM-ICU helpful for assess- important, participants described needing to be ‘patient’, or ‘accept’
ing patients. The subtheme Using tools but using judgment described who the patient was at that moment in time (Gail, Ben Alan, Donald,
how participants used, or did not use, the CAM-ICU and other scales, Steven). Taking the time involved:
such as the Richmond Agitation Sedation Scale and the delirium
“being a willing participant to the care that you give to your patient.
protocol into their daily practice.
Instead of rushing and getting through everything you might have
“We have to fill out forms, we have to sign here we have to sign to take extra time to do things with the patient. . . and be calm and
there. It becomes sort of a cookie cutter nursing. Where is my pro- be kind to patients too.” (Gail)
fessional autonomy here?” (Alan)
In the subtheme, Finding the proper way, the participants
Participants who did use the CAM-ICU varied in how they described using trial and error to find effective strategies. For exam-
applied it with patients and some mistrusted the results: ple, manipulating the environment by modifying noise and light, or
providing comfort by bathing or repositioning, ‘just open the cur-
“I guess there are patients that’ll be fine on the CAM . . . but they
tains so they can see it’s daylight’ (Joann). They used knowledge and
could get all the questions right but still be seeing things every-
clinical judgment to tailor practices to patients’ individual needs.
where, confused.” (Steven)
Riding it out with families. This theme captured the experi-
All of the participants who used the CAM-ICU in any way sup- ences that were shared with families. Two subthemes emerged:
plemented their findings with other assessments to make a picture Partnering with the family to work together to care for the patient
of the patient’s mental status. Few participants had used the delir- more effectively and Caring for the family in which participants pro-
ium protocol. Those who did found it helpful to obtain drug orders vided direct emotional and educational interventions. Participants
from physicians. None of the participants considered it helpful to described moving back and forth between these roles:
guide non-pharmacologic interventions.
“It was him and his wife. (. . .) I explained to her that he would
Keeping patient’s safe: it’s a really big job. This theme reflected
come through this. She calmed down. She was able to talk with him
the challenges participants faced when patients were disoriented,
a little more. (. . .) And for the next two days − me and her − we
agitated, or unable to protect themselves from harm:
just rode it out (. . .) and it worked out fine.” (Steven)
“When he started to get really agitated and restless. He totally could
Taking every experience with you. This theme involved build-
not recognize any person now and [he was] just agitated and just
ing up personal resources, skills and knowledge to effectively care
kept climbing out of the bed. . . and just keeping him safe is a really
for these challenging patients:
big job.” (Jessica)
“I think you’ve got to take every experience with you. That’s
These patients required the continuous presence of the nurse
what nursing’s all about and you learn something new every
to ensure that they did not harm themselves (e.g. by accidentally
day.” (Gail)
removing a life-supporting device). The subtheme Keeping an eye
on the patient reflected the vigilance required which was difficult They built up a store of strategies they could try with patients to
in a busy environment and sometimes impossible to do alone: find out “what works well and what doesn’t” (Donald) and developed
expertise over time.
“the fridge is in the middle of the unit. So it takes us about a minute
Factors facilitating and inhibiting caring for patients with
to go and get the [medication] and come back. . .and with those
delirium. Participants’ experiences were influenced by contextual
kinds of patients, a minute, everything could happen in a minute.”
factors that helped or hindered. These were grouped into: the envi-
(Gary)
ronment of care, patient-related factors and nurse-related factors.
The subtheme Knowing when and how to respond revealed that Environmental factors such as high acuity, medical technology and
participants prioritized when to intervene and how to manage devices, high workload made caring for these patients more dif-
patient care: ficult. It was easier to care for patients when interprofessional
communication was good and when a culture of safety aided team
“It means putting other things aside and treating the immediate
cooperation. Individual nurse factors that were helpful included
needs. . . I have to divert my attention to helping them with what-
knowledge of and experience with delirium, being able to be calm
ever is happening right now.” (Ben)
and accepting with the patients and relationships with other nurses
This subtheme contained participants’ thoughts about chemical and the interprofessional team. Caring for these patients was more
and physical restraint which were considered last resort: difficult when they were physiologically unstable, when the treat-
ment for delirium or the need to maintain safety conflicted with
“Sometimes you just have to physically restrain them. . . to make it
the treatment for other clinical goals and when the patients were
safe for him and for you. . . It’s not nice but sometimes you have to.
unsafe due to agitation. Family involvement was at times difficult,
We’ll give medications for it. . . hopefully calm it down.” (Steven)
but was helpful when a partnership could be achieved. Fig. 2 illus-
They expressed concerns about adverse effects of sedation, such trates the researchers’ interpretation of the factors contributing to
as prolonged ICU stay. the complexity of caring for patients. The participants navigated
Everyone is unique. This theme captured the efforts taken to through these factors in order to find a way to help them come
provide person-centred care. The participants used their knowl- through it. The intersection of the circles indicates that these fac-
edge of each patient to tailor their interventions and drew upon tors interacted within the circle and could also interact with factors
past experiences: present in the surrounding circles. In this view, the nurse interacted
with the complexities of the patient and family as well as those of
“I find that everyone is unique and every patient is unique in how
the ICU environment.
you care for them. As long as you have the support behind you.
We’re there to help them and we’re there to support them and when
Discussion
you have a great team behind you, you can do it.” (Gail)
Additional nursing time was needed to care for these patients. Caring for patients with delirium in the ICU is a complex process
The subtheme Taking the time also revealed that mind set was and the participants in this study focused on: Finding a way to help

Please cite this article in press as: LeBlanc, A., et al., The experience of intensive care nurses caring for patients with delirium: A
phenomenological study. Intensive Crit Care Nurs (2017), http://dx.doi.org/10.1016/j.iccn.2017.09.002
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Fig. 2. Factors contributing to the complexity of caring for patients in ICU with delirium. A diagram of the researchers’ interpretation of the factors contributing to complexity
of care that the nurses must navigate in order to find a way to help them come through it. Factors are grouped into patient-related, nurse-related, and environment-related
factors. Intersecting circles indicate that these factors interact within the circle, and can also interact with factors present in the surrounding circles.

them come through it to provide person-centred care. The partici- participants’ differing perceptions of the CAM-ICU suggest that its
pants’ interpretation of their experience was bound by the nature use in daily clinical practice is complicated. Oxenbøll-Collet et al.
of the ICU as a highly technological and interventionist space, the (2016) detailed similar concerns about the CAM-ICU from Danish
resources available and their relationships with team members, nurses and physicians including that it should not replace nursing
patients and families. These descriptions underscore the significant judgment and clinical assessment. Acknowledging the contribu-
work that is required to manage these patients within the con- tion of both moment by moment assessments and CAM-ICU results
text of life threatening illness, high technology, family distress and places the use of this tool within the realm of nursing judgment and
interprofessional team care. not in opposition to it.
Surveillance required to protect patients and themselves was Maintaining the patient’s safety was viewed as optimal and
unremitting throughout the workday and contributed to feeling professional care. Interventions for safety included constant obser-
exhausted. Increased strain and workload when caring for these vation, verbal reorientation, a calm approach and using physical
patients has been reported in numerous studies (Jung et al., 2013; and/or chemical restraints as a last resort. Other studies have
Mc Donnell and Timmins, 2012; Yue et al., 2015; Zamoscik et al., emphasized the need to keep an eye on patients (Dahlke and
2017). Significantly, the examples shared focused on descriptions of Phinney, 2008; Schmidt, 2010). Participants considered restraints
agitated behaviours. The participants appeared to equate delirium necessary at times to maintain safety but were concerned about
with agitation which could indicate an incomplete understanding adverse effects such as over-sedation. Chemical restraints have
of delirium. been associated with increased length of ICU stay and delayed
Current recommendations include that patients be assessed for weaning from mechanical ventilation and therefore, their use
delirium using tools such as the CAM-ICU at least once per nursing should be minimized whenever possible (Barr et al., 2013). When
shift (Barr et al., 2013). However, many participants in this study adverse events did occur, such as an unplanned extubation, the par-
did not trust the CAM-ICU results, or found it difficult to use in ticipants in this current study felt personally at fault. As Schofield
everyday practice. This is supported by findings from Oosterhouse et al. (2012) noted, safety is one of the major discourses influencing
et al. (2016) who observed that even when tools for identifying nurses’ practice.
delirium were available, they were inconsistently used and that The time required to assess and care for patients’ unique needs
simply having a tool did not necessarily warrant its use. The partici- was stressed by the participants. Trying to connect with patients
pants in this current study assessed patients’ mental status moment could be seen as a process of ‘getting to know’ the patient in the
by moment in order to plan and evaluate nursing care regard- midst of delirium. The participants described tailoring their inter-
less of whether the patient was CAM-ICU positive or negative. The ventions, such as modifying noise and light, to meet the unique
dichotomous categorisation of the CAM-ICU results clashed with needs of each patient. Zolnierek defined knowing the patient as
the way the participants experienced these patients as changing “in-depth knowledge of the patient’s patterns of responses and
moment by moment. However, they were expected to communi- knowing the patient as a person” (2013, p. 3). Knowing the patient
cate with the interprofessional team using the CAM-ICU results. The

Please cite this article in press as: LeBlanc, A., et al., The experience of intensive care nurses caring for patients with delirium: A
phenomenological study. Intensive Crit Care Nurs (2017), http://dx.doi.org/10.1016/j.iccn.2017.09.002
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assists nurses to provide safe care, develop relationships and utilize Canadian hospital and may not reflect the experiences of nurses
expertise (Zolnierek, 2013). in smaller, non-academic ICUs, or ICUs in other countries or con-
The subthemes Partnering with the family and Caring for the fam- texts. The sample was non-random and therefore the participants
ily echoed the findings of a study about the roles of family members may have had a particular interest in the study topic. A strength of
of ICU patients (Frivold et al., 2015). They described the family this study is that the participants varied widely in age and years of
members’ experience of being cared for by nurses and physicians experience and both males and females were represented.
as “being in a participating role” and “being in a receiving role” (p. 1).
Family members who were able to participate in care activities and Conclusion
decision making, developed a sense of meaningfulness and those
whose psychosocial needs were met were more likely to express This study examined intensive care nurses’ experiences of car-
feelings of confidence in the health care system (Frivold et al., 2015). ing for patients with delirium. The essence of the experience was
Integrating family members into the routine care of ICU patients, revealed to be: finding a way to help them come through it. In spite of
irrespective of delirium, has been associated with improved com- the many challenges faced while caring for these patients, nurses
munication and relationships with the health care team, reduced found a way through the complexity to provide individualised,
anxiety and improved satisfaction, as well as the potential for person-centred care to patients and their families. Many of the
enhanced patient care (Al-Multair et al., 2013). Promising areas nurses who participated in this study found this care rewarding
of research on partnering with families involve inclusion during and felt privileged to do so.
rounds (Davidson et al., 2017), active involvement in care in adult
ICUs (Liput et al., 2016) and even family interventions to reduce Conflicts of interest
delirium (Mitchell et al., 2017). However, the extent to which fam-
ily should be involved and maintaining the balance with providing None.
adequate support remains unclear (Davidson et al., 2017; Olding
et al., 2016). Funding
This study demonstrated the central role of experience in learn-
ing to care for these patients and developing expertise over time. This research did not receive any specific grant from funding
When learning to care for patients with delirium attention must be agencies in the public, commercial, or not-for-profit sectors.
paid to the complexities of the patient and family as well as those
of the ICU environment. Combining an educational intervention for
Ethical statement
nurses with an intervention to promote discussion of delirium dur-
ing interprofessional rounds may have a greater effect than either
Ethical approval was obtained from the affiliated university’s
of the interventions alone. Further, integrating delirium into com-
and the participating institution’s research ethics boards (Ottawa
prehensive ICU care including management of pain, agitation, early
Health Science Network Research Ethics Board). Informed consent
mobility and family engagement is likely to be more beneficial than
was obtained from participants prior to each interview.
focusing on delirium in isolation (Barnes-Daly et al., 2017).
In this study, barriers and facilitators to caring for patients
Acknowledgements
were contextually bound. Previous studies have identified factors
that are important to consider when implementing new practices
We would like to thank the participants for sharing their time
or guidelines related to delirium (Bassett et al., 2015; Carrothers
and experiences.
et al., 2013; Oxenbøll-Collet et al., 2016). Improving care for these
patients requires careful consideration of the barriers and facili-
tators present in the local context to achieve sustainable practice References
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Zamoscik et al., 2017). of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98,
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phenomenological study. Intensive Crit Care Nurs (2017), http://dx.doi.org/10.1016/j.iccn.2017.09.002
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Please cite this article in press as: LeBlanc, A., et al., The experience of intensive care nurses caring for patients with delirium: A
phenomenological study. Intensive Crit Care Nurs (2017), http://dx.doi.org/10.1016/j.iccn.2017.09.002