| Objective:To construct a non-drug nursing intervention program for critically ill children with delirium by literature review and expert letter inquiry,and to explore the clinical intervention effect of this scheme on early stage of delirium in critically ill children through preliminary clinical application,and to verify the implementation of the strategy.in order to reduce the incidence of delirium and disease mortality,improve the prognosis of the disease,shorten the length of stay in hospital,improve the quality of nursing service,and improve the satisfaction of children’s families.Methods:1.In this study,the related influencing factors of delirium in ICU children were clarified through literature review,and the non-drug intervention scheme for delirium in ICU children was initially constructed through group discussion and consultation with clinical experts.2.Delphi expert letter method was used to consult 16 experts.Through two rounds of expert letters,the indicators were screened,and the enthusiasm,authority and opinion coordination of experts were evaluated.Finally,the first-level items and the intervention dimensions and contents of each item in the non-drug intervention program for children with ICU were determined,and the non-drug intervention program for children with ICU delirium was formed.3.In a historical control study,141 children who were admitted to the PICU ward of a children’s hospital in Jiangxi Province from August 2022 to January 2023were randomly divided into control group(n=63)and experimental group(n=78).The children in the control group received routine nursing intervention and health education.On the basis of ICU routine nursing measures,the children in the experimental group received non-drug intervention of ICU delirium.The incidence of delirium,the duration of each delirium(hours),the time of mechanical ventilation,the days of hospitalization,the intervention rate of delirium,the protective restraint,the time of drug pump,the dose and frequency of sedative,and the accidental extubation rate(indwelling needle,gastric tube and endotracheal intubation)were observed in the two groups.the effect was evaluated by comparing the differences between the two groups.Results:1.Results of the items of non-drug intervention program:the non-drug intervention program for children with ICU delirium was formed,including 6first-level indicators,14 second-level indicators and 49 third-level indicators.2.The results of expert letter inquiry:the effective questionnaire recovery rates of the two rounds of expert consultation were 100%and 93.75%respectively,and the expert authority coefficients were 0.86 and 0.85,respectively,and the variance coefficients of the first,second and third grades of the non-drug intervention program for ICU delirium children in the first round were 0.12,0.13,0.21respectively.The variance coefficients of the first,second and third grades of the non-drug intervention program in the second round of ICU delirium were0.05,0.06,0.06 respectively,and the coordination coefficients of the first,second and third grades of the first round were 0.28,0.24,0.18 respectively(P<0.05),and The coordination coefficients of the first,second and third grade indicators are0.05,0.06,0.06 respectively.The final non-drug intervention program for children with ICU delirium included delirium assessment,pain management,sleep management,sedation management,parental participation and early activities.3.A total of 156 subjects were included in this study,because 2 cases died during the study period,3 cases were transferred to other hospitals for treatment,2cases of active withdrawal during midway,8 cases were excluded from incomplete data,and finally included 141 cases,including 78 cases in the experimental group and 63 cases in the control group.There was no significant difference in age,sex,body weight(kg),mental state and pain score between the two groups.The baseline of the study was the same and comparable(P>0.05).4.In this study,there were 26 cases of delirium in the test group,the incidence of delirium was 33.38%(26/78),and the incidence of delirium in the control group was 32 cases,and the incidence of delirium was 50.79%(32/63).The difference between the two groups was statistically significant(χ~2=-4.38,P<0.05).The accidental extubation rate of high-risk group was 20.22%in the control group and7.70%in the experimental group(χ~2=6.045,P<0.05).Non-drug intervention could reduce the accidental extubation rate of high-risk group in severe children.However,in terms of the average length of stay,the average length of stay in the control group was89.28(34.58,143.43)hours,and that in the test group was 49.16(31.25,99.84).There was no significant difference between the two groups(P>0.05).5.Among the children with delirium in the two groups,the average duration of delirium was 46.75(7.75,91.12)hours in the control group and 34.83(21.52,52.39)hours in the test group,and there was no significant difference between the two groups(P>0.05).There was no significant difference in the duration of medication during delirium between the two groups(P>0.05).6.At admission,the score of delusion was(11.79±4.05)in the control group and(10.59±3.46)in the test group.There was no significant difference between the two groups(P>0.05).The state of delirium was the same between the two groups on admission.Within 4 hours after ventilator withdrawal,the score of delusion was(10.62±2.55)in the control group and(7.68±3.20)in the test group.There was significant difference between the two groups(χ2=-3.996,P<0.05).At the time of transfer or discharge,the score of delusion was(9.08±3.50)in the control group and(7.56±2.57)in the test group.There was significant difference between the two groups(P<0.05).7.A total of 48 critical pediatric nurses participated in this study,47female and1 man,with an average age of(32.29±4.95)years and an average length of service of(10.62±5.63)years.The score of delirium-related knowledge of nurses before and after training was(75.13±8.75)and(84.21±4.71),respectively.There was significant difference in the score of related knowledge between pre-training and post-training(χ~2=10.27,P<0.05).Conclusion:1.The implementation of delirium non-drug intervention program can effectively reduce the level of delirium and improve the incidence of delirium in critically ill children.2.The implementation of delirium non-drug intervention program had little effect on the duration of delirium and the demand for sedative drugs in critically ill children.3.The implementation of delirium non-drug intervention program in children’s intensive care unit can reduce the rate of unplanned extubation of medium-and high-risk catheters.4.The implementation of delirium non-drug intervention program had little effect on the length of hospitalization of critically ill children.5.The implementation of ICU non-drug intervention program for delirium children in the children’s intensive care unit can effectively improve the relevant knowledge level of medical staff. |
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