1. Domenico, Giusti Gian MSN, RN
  2. Federica, Piergentili RN

Article Content

The Importance of Staff Training in the Prevention of Delirium

Dear Editor:


I read with interest your journal, and I am writing about intensive care unit (ICU) delirium. It is a well-known problem in ICUs, but sometimes undervalued by staff. Delirium in the ICU is a syndrome occurring in a lot of critically ill patients. Its underestimation can lead to increased time of mechanical ventilation, morbidity, and mortality.1


A recent study shows that the delirium prevalence of 32% in ICU patients proves the significance of the problem, and data confirm the importance of students about this syndrome. It is necessary to become active because delirium has a significant impact about mortality, morbidity, and the length of stay of patients.2 One of the main problems about this topic is operator behavior. In an observational study conducted in Iniarti by the Italian Nurses Critical Care Association,3 56% of Italian ICU nurses maintain that only 25% of ICU patients show signs of delirium, and they consider only patients with hyperactive delirium.


This is a very difficult kind of assessment, because only 12% of the units use an evaluation scale tool, and from other studies, it follows that less than half of nurses assess this symptom.4 Even realizing the seriousness of this matter, nurses cannot modify nursing attitudes that can lead patients to show delirium symptoms. In conclusion, there is a need to invest in personnel training, especially for nurses who spend a lot of time at the patient's bedside, so they recognize delirium in time and understand the importance of the use of an evaluation scale. Moreover, it is necessary to invest in the efficiency of nonpharmacological actions by improving the presence of a patient's family in the ICU.5


Piergentili Federica, RN


Nurse Researcher


Evidence-Based Nursing


Emergency Department


Passignano S. T. Hospital, Italy


Submitted by: Giusti Gian Domenico, MSN, RN


A. O. "S. Maria della Misericordia" Perugia


ACUTI (Intensive Care Unit)


S. Andrea delle Fratte (PG) 06156




1. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients. JAMA. 2004;32:955-962. [Context Link]


2. Salluh JI, Soares M, Teles MJ, et al. Delirium epidemiology in critical care (DECCA): an international study. Critical Care. 2010;14:R210. [Context Link]


3. Giusti GD, Scelsi S, Piegentili F, Sansolino S. ICU delirium: Italian intensive care nurse perceptions: a nationwide survey (Italian). Scenario. 2010;27(3):5-10. [Context Link]


4. Devlin JW, Fong JJ, Howard EP, et al. Assessment of delirium in the intensive care units: nursing practice and perceptions. Am J Crit Care. 2008;17(6):555-566. [Context Link]


5. Giannini A. Open intensive care units: the case in favour. Minerva Anestesiol. 2007;73:299-305. [Context Link]