• Evidence Based Nursing Strategies for the Prevention and Management of Delirium in Intensive Care Unit Patients
  • Mohammad Reza Shabani,1 Mohammad Nouri,2,* Nastaran Riyahi,3
    1. Instructor of Operating Room,Department of Operating Room, kerman University of Medical Sciences, kerman, iran
    2. Department of Nursing, Urmia Branch, Islamic Azad University, Urmia, Iran.
    3. Department of Anesthesia, Abadan University of Medical Sciences, Abadan, Iran


  • Introduction: Delirium is a frequent and severe complication among intensive care unit (ICU) patients, associated with increased morbidity, prolonged hospitalization, and higher mortality rates. As an acute neuropsychiatric disorder, it compromises cognitive function, impairs recovery, and escalates healthcare costs. Despite advances in pharmacological interventions, evidence strongly supports the critical role of nursing led, non pharmacological strategies in preventing and managing delirium. This systematic review aims to synthesize current evidence on nursing strategies informed by high-quality research, focusing on their effectiveness in ICU delirium prevention and management.
  • Methods: A systematic literature search was conducted in PubMed, CINAHL, Scopus, and Cochrane Library for studies published between January 2014 and August 2024. Eligible studies evaluated nursing specific interventions targeting delirium prevention or reduction among adult ICU patients. Inclusion criteria encompassed randomized controlled trials, quasi-experimental studies, cohort analyses, and qualitative research with reported outcomes on delirium incidence, duration, or severity. Studies that solely assessed pharmacological interventions without direct nursing application were excluded. The review process adhered to PRISMA guidelines, with independent dual review for study selection and thematic synthesis.
  • Results: Thirty-two studies met the inclusion criteria, highlighting a range of evidence based nursing strategies. Interventions such as early mobilization, multimodal sensory stimulation optimization, maintenance of circadian rhythms through structured sleep protocols, effective pain management, and cognitive orientation activities demonstrated consistent reductions in delirium incidence and severity. Family participation programs, delivery of familiar sensory cues, and individualized environmental modifications further contributed to improved patient orientation and decreased agitation episodes. Qualitative findings emphasized the importance of nurse–patient communication, continual observation, and interprofessional collaboration in reinforcing intervention adherence. Across diverse ICU populations, the integration of multiple strategies proved more effective than singular approaches.
  • Conclusion: Evidence based nursing strategies play a pivotal role in mitigating the onset and progression of delirium in ICU patients. Incorporating structured, multifaceted nursing protocols into standard ICU care can significantly enhance patient outcomes, reduce complications, and promote recovery. Future implementation studies should address training standardization, feasibility in resource limited settings, and long term follow up on cognitive and functional outcomes.
  • Keywords: Critical care nursing; Delirium prevention; Intensive care unit; Evidence based practice