NURSING APPROACHES OF SOCIAL TYPE HAVE A POSITIVE IMPACT ON THE TREATMENT OF POSTOPERATIVE DELIRIUM

Abstract

Acute postoperative organic psychosyndrome (delirium) is a common complication after cardiac surgery. It is characterized by disorientation of the patient in terms of space and time, most often in the Intensive Care Unit, often accompanied by aggressive or self-destructive behaviour.

Purpose: The purpose of this study is to investigate the effectiveness of specific nursing interventions in the treatment of delirium.

Materials and methods: We included in the study 47 patients who developed delirium out of a total 184 patients undergoing major cardiac surgery (CABG, AVR, MVR, combined interventions, aneurysm and dissection thoracic aorta ) in the same period, lasting 18 months. Patients were tested for the syndrome with valid instrument scales, more specifically CAM -ICU (Confusement Assessment Method for Intensive Care Unit) and Nu DeSc (Nursing Delirium Screening Scale). They were then divided into four groups, a control group without any additional intervention, a group in which patients were given option for listening to music for 20 minutes twice a day, one group that followed an additional physiotherapy program and, finally, a group with two extra visits by friends or relatives, lasting twenty minutes daily.

Results: The study included 152 (83%) men and 32 (17%) women. The average age of both sexes without delirium was 61.55± 7.9 years and with delirium 68.97±8.1. Patients supportive interventions implemented have improved behavior in delirium, based on the results of measurement scales. More specifically, patients within the music group had an average score of 4.8±0.7 prior to the intervention and an average score of 3.2±0.4 (p<0.01) after the intervention. The physical therapy group had an average pre-intervention score of 4.7±0.6 and a score of 3.6±0.4 after the intervention (p<0.05). Finally, the group with the additional visits had a pre-score of 5.0±0.7 and a score after the intervention of 4.0±0.5 (p<0.05). Duration of delirium has been much shorter in the intervention groups compared to the control group not receiving intervention (32±3, 36±4 and 38±4 vs 48±9 hours respectively).

Conclusion: The supportive, non-pharmaceutical interventions can improve the image of patients with delirium after cardiac surgery.