Construction And Application Of Non-pharmacological Intervention Program Based On 4E Model For Elderly Patients With Subsyndromal Delirium In ICU

Objective:To construct a non-pharmacological intervention program for ICU elderly patients with subsyndromal delirium(SSD)based on 4E model,and to evaluate its clinical application effect,so as to provide reference for the standardized management of SSD in critically ill patients.Methods:This study is divided into two parts.The first part:The research group used the 4E model as the theoretical framework,used the literature analysis method to construct the first draft of the non-pharmacological intervention program,and used the Delphi expert consultation method to modify,supplement or delete the items of the non-pharmacological intervention program,and finally determined the non-pharmacological intervention program for elderly SSD patients in ICU.The second part:Using the convenience sampling method,130 elderly SSD patients admitted to the ICU of a tertiary general hospital in Guangxi Zhuang Autonomous Region from March 2022 to December 2022 were selected as the research objects.The 65 elderly SSD patients admitted from March 2022 to July 2022were used as the control group,and the 65 elderly SSD patients admitted from August 2022 to December 2022 were used as the experimental group.The control group was given routine ICU nursing,while the experimental group was given non-pharmacological intervention based on 4E model on the basis of routine ICU nursing.The incidence of delirium,duration of delirium,SSD negative rate,SSD duration,cognitive function,sleep quality,anxiety and depression,daily living ability,mechanical ventilation time and ICU hospitalization time were compared between the two groups,and the application effect of non-pharmacological intervention program was evaluated.The heart rate,respiration,mean arterial pressure,blood oxygen saturation of the experimental group were collected 5 mins before the early activity,at the 15th min of the activity and 5 mins after the activity.Adverse events such as unplanned extubation,falls,and falling out of bed during non-pharmacological intervention were collected to evaluate the safety of non-pharmacological intervention programs.Results:The first part:20 experts participated in two rounds of Delphi expert consultation.The effective recovery rate of the questionnaire was 100.00%.The expert authority coefficient of the two rounds of consultation were 0.868and 0.883 respectively.The Kendall’s coefficients of concordance of the item importance scores of the two rounds of experts were 0.341 and 0.444(P<0.001),and the Kendall’s coefficients of concordance of the item operability scores were 0.337 and 0.434(P<0.001).The mean value of importance score of each item was 3.80～5.00,the coefficient of variation was0～0.15,the mean value of operability score was 3.65～5.00,and the coefficient of variation was 0～0.13.The final non-pharmacological intervention program based on 4E model included 4 first-level items,11second-level items,and 37 third-level items.The second part:1.In the experimental group,the incidence of delirium was lower than that in the control group,the negative conversion rate of SSD was higher than that in the control group,and the duration of delirium and SSD was less than that in the control group,the differences were statistically significant(P<0.05).2.The delirium-free survival rate during ICU hospitalization in the experimental group was higher than that in the control group(Log Rank test,χ~2=5.240,P=0.022).3.The cognitive function score,sleep quality score and daily living ability score of the experimental group on the day of transferring out of ICU were higher than those of the control group,the differences were statistically significant(P<0.001),and the anxiety and depression score was lower than that of the control group,the difference was statistically significant(P<0.05).4.The mechanical ventilation time and ICU hospitalization time in the experimental group were less than those in the control group,and the differences were statistically significant(P<0.05).5.There were no statistically significant differences in heart rate,respiration and blood oxygen saturation of the experimental groups at 5 mins before the early activity,at the15th min of the activity and 5 mins after the activity(P>0.05),while there were statistically significant differences in mean arterial pressure(P<0.001).6.No adverse events such as unplanned extubation,falls and falling out of bed occurred during non-pharmacological intervention.Conclusion:1.The non-pharmacological intervention program for elderly patients with SSD in ICU based on 4E model constructed in this study has strong scientificity,reliability and clinical practicability,which can provide reference for the standardized management of SSD in critically ill patients.2.The non-pharmacological intervention program based on 4E model constructed in this study is safe and feasible,which can effectively improve the SSD outcome and clinical prognosis of patients,promote early rehabilitation of patients,and has good clinical application value.It is worth further clinical application.