Nurses’ experiences of managing cognitive problems in intensive care unit patients: A qualitative study

Ann Louise Bødker Hanifa; Anette Bjerregaard Alrø; Anna Holm; Pia Dreyer

doi:10.1016/j.iccn.2023.103508

Nurses’ experiences of managing cognitive problems in intensive care unit patients: A qualitative study

Ann Louise Bødker Hanifa^*, Anette Bjerregaard Alrø, Anna Holm, Pia Dreyer

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

6 Citations (Scopus)

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Abstract

Objectives: Nurses hold a key position in identifying symptoms and initiating preventive strategies for cognitive impairment in delirious and non-delirious intensive care unit patients. However, it remains unclear whether nurses consider cognitive impairment as a distinct concern from delirium. By understanding nurses’ perspectives, we may identify barriers and facilitators in caring for patients with cognitive challenges in the intensive care unit. The objective of this study was to explore nurses’ experiences of cognitive problems in patients admitted to an intensive care unit. Research methodology: A phenomenological-hermeneutic study of interviews with ten nurses from intensive care units. Data were collected in March-April 2022 and analysed using a Ricœur-inspired method of interpretation. Findings: Three themes related to nurses’ experiences of cognitive problems emerged through analysis; 1) Cognitive problems and delirium are seen as two sides of the same coin, 2) Searching for the person behind the patient, and 3) Maintaining a sense of normality in a confusing environment. Conclusions: The interconnected concept of cognitive impairment and delirium syndrome meant that nurses assessed and managed cognitive problems in intensive care unit patients by focusing on preventing delirium. Apart from delirium screening, nurses relied on relatives’ knowledge to assess patients’ cognition. Most significantly, our study revealed a previously unexplored approach by nurses to manage patients’ cognition, which involved “shielding” patients from the noisy and disruptive intensive care unit environment. Implications for clinical practice: Effective communication methods, coupled with family involvement may aid nurses in identifying patients’ cognitive problems. In the acute phase of critical illness, distinguishing between delirium and cognitive problems may not be clinically relevant, as delirium protocols may protect patients’ cognition. Further investigating the concept of shielding may reveal previously unexplored nursing approaches to manage cognitive problems.

Original language	English
Article number	103508
Journal	Intensive and Critical Care Nursing
Volume	79
Number of pages	7
ISSN	0964-3397
DOIs	https://doi.org/10.1016/j.iccn.2023.103508
Publication status	Published - Dec 2023

Keywords

Cognition
Cognitive impairment
Critical care nursing
Delirium
Intensive care unit
Nurses’ perspective
Qualitative research
Intensive Care Units
Humans
Nurses
Qualitative Research
Delirium/diagnosis

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Cite this

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title = "Nurses{\textquoteright} experiences of managing cognitive problems in intensive care unit patients: A qualitative study",

abstract = "Objectives: Nurses hold a key position in identifying symptoms and initiating preventive strategies for cognitive impairment in delirious and non-delirious intensive care unit patients. However, it remains unclear whether nurses consider cognitive impairment as a distinct concern from delirium. By understanding nurses{\textquoteright} perspectives, we may identify barriers and facilitators in caring for patients with cognitive challenges in the intensive care unit. The objective of this study was to explore nurses{\textquoteright} experiences of cognitive problems in patients admitted to an intensive care unit. Research methodology: A phenomenological-hermeneutic study of interviews with ten nurses from intensive care units. Data were collected in March-April 2022 and analysed using a Ric{\oe}ur-inspired method of interpretation. Findings: Three themes related to nurses{\textquoteright} experiences of cognitive problems emerged through analysis; 1) Cognitive problems and delirium are seen as two sides of the same coin, 2) Searching for the person behind the patient, and 3) Maintaining a sense of normality in a confusing environment. Conclusions: The interconnected concept of cognitive impairment and delirium syndrome meant that nurses assessed and managed cognitive problems in intensive care unit patients by focusing on preventing delirium. Apart from delirium screening, nurses relied on relatives{\textquoteright} knowledge to assess patients{\textquoteright} cognition. Most significantly, our study revealed a previously unexplored approach by nurses to manage patients{\textquoteright} cognition, which involved “shielding” patients from the noisy and disruptive intensive care unit environment. Implications for clinical practice: Effective communication methods, coupled with family involvement may aid nurses in identifying patients{\textquoteright} cognitive problems. In the acute phase of critical illness, distinguishing between delirium and cognitive problems may not be clinically relevant, as delirium protocols may protect patients{\textquoteright} cognition. Further investigating the concept of shielding may reveal previously unexplored nursing approaches to manage cognitive problems.",

keywords = "Cognition, Cognitive impairment, Critical care nursing, Delirium, Intensive care unit, Nurses{\textquoteright} perspective, Qualitative research, Intensive Care Units, Humans, Nurses, Qualitative Research, Delirium/diagnosis",

author = "Hanifa, {Ann Louise B{\o}dker} and Alr{\o}, {Anette Bjerregaard} and Anna Holm and Pia Dreyer",

year = "2023",

month = dec,

doi = "10.1016/j.iccn.2023.103508",

language = "English",

volume = "79",

journal = "Intensive and Critical Care Nursing",

issn = "0964-3397",

publisher = "Churchill Livingstone",

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Nurses’ experiences of managing cognitive problems in intensive care unit patients: A qualitative study. / Hanifa, Ann Louise Bødker ; Alrø, Anette Bjerregaard; Holm, Anna et al.
In: Intensive and Critical Care Nursing, Vol. 79, 103508, 12.2023.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Nurses’ experiences of managing cognitive problems in intensive care unit patients

T2 - A qualitative study

AU - Hanifa, Ann Louise Bødker

AU - Alrø, Anette Bjerregaard

AU - Holm, Anna

AU - Dreyer, Pia

PY - 2023/12

Y1 - 2023/12

N2 - Objectives: Nurses hold a key position in identifying symptoms and initiating preventive strategies for cognitive impairment in delirious and non-delirious intensive care unit patients. However, it remains unclear whether nurses consider cognitive impairment as a distinct concern from delirium. By understanding nurses’ perspectives, we may identify barriers and facilitators in caring for patients with cognitive challenges in the intensive care unit. The objective of this study was to explore nurses’ experiences of cognitive problems in patients admitted to an intensive care unit. Research methodology: A phenomenological-hermeneutic study of interviews with ten nurses from intensive care units. Data were collected in March-April 2022 and analysed using a Ricœur-inspired method of interpretation. Findings: Three themes related to nurses’ experiences of cognitive problems emerged through analysis; 1) Cognitive problems and delirium are seen as two sides of the same coin, 2) Searching for the person behind the patient, and 3) Maintaining a sense of normality in a confusing environment. Conclusions: The interconnected concept of cognitive impairment and delirium syndrome meant that nurses assessed and managed cognitive problems in intensive care unit patients by focusing on preventing delirium. Apart from delirium screening, nurses relied on relatives’ knowledge to assess patients’ cognition. Most significantly, our study revealed a previously unexplored approach by nurses to manage patients’ cognition, which involved “shielding” patients from the noisy and disruptive intensive care unit environment. Implications for clinical practice: Effective communication methods, coupled with family involvement may aid nurses in identifying patients’ cognitive problems. In the acute phase of critical illness, distinguishing between delirium and cognitive problems may not be clinically relevant, as delirium protocols may protect patients’ cognition. Further investigating the concept of shielding may reveal previously unexplored nursing approaches to manage cognitive problems.

AB - Objectives: Nurses hold a key position in identifying symptoms and initiating preventive strategies for cognitive impairment in delirious and non-delirious intensive care unit patients. However, it remains unclear whether nurses consider cognitive impairment as a distinct concern from delirium. By understanding nurses’ perspectives, we may identify barriers and facilitators in caring for patients with cognitive challenges in the intensive care unit. The objective of this study was to explore nurses’ experiences of cognitive problems in patients admitted to an intensive care unit. Research methodology: A phenomenological-hermeneutic study of interviews with ten nurses from intensive care units. Data were collected in March-April 2022 and analysed using a Ricœur-inspired method of interpretation. Findings: Three themes related to nurses’ experiences of cognitive problems emerged through analysis; 1) Cognitive problems and delirium are seen as two sides of the same coin, 2) Searching for the person behind the patient, and 3) Maintaining a sense of normality in a confusing environment. Conclusions: The interconnected concept of cognitive impairment and delirium syndrome meant that nurses assessed and managed cognitive problems in intensive care unit patients by focusing on preventing delirium. Apart from delirium screening, nurses relied on relatives’ knowledge to assess patients’ cognition. Most significantly, our study revealed a previously unexplored approach by nurses to manage patients’ cognition, which involved “shielding” patients from the noisy and disruptive intensive care unit environment. Implications for clinical practice: Effective communication methods, coupled with family involvement may aid nurses in identifying patients’ cognitive problems. In the acute phase of critical illness, distinguishing between delirium and cognitive problems may not be clinically relevant, as delirium protocols may protect patients’ cognition. Further investigating the concept of shielding may reveal previously unexplored nursing approaches to manage cognitive problems.

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KW - Critical care nursing

KW - Delirium

KW - Intensive care unit

KW - Nurses’ perspective

KW - Qualitative research

KW - Intensive Care Units

KW - Humans

KW - Nurses

KW - Qualitative Research

KW - Delirium/diagnosis

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DO - 10.1016/j.iccn.2023.103508

M3 - Journal article

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AN - SCOPUS:85169887403

SN - 0964-3397

VL - 79

JO - Intensive and Critical Care Nursing

JF - Intensive and Critical Care Nursing

M1 - 103508

ER -

Nurses’ experiences of managing cognitive problems in intensive care unit patients: A qualitative study

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Keywords

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