Facilitators and Barriers for Nurses Implementing Delirium PADIS Guidelines in the Intensive Care Unit: An Integrative Review

Introduction: Delirium is a significantly prevalent condition within the Intensive Care Unit (ICU), reaching rates of up to 80% in mechanically ventilated patients. Further, delirium has significant detrimental effects on ICU patient mortality, recovery, and quality of life during and following hospitalization. Purpose: The purpose of this review is to identify facilitators and barriers for nurses implementing delirium PADIS guidelines in adult ICU settings. Methods: An integrative review was conducted following PRISMA and quality appraisal guidelines and included an analysis of studies published from 2013-2023. Inclusion criteria consisted of all types of quantitative study designs; qualitative studies; quality improvement projects; review studies; English; adult ICU patient study populations; ICU settings and focus on ICU delirium guidelines; studies with nurses implementing delirium guidelines; and studies that examined facilitators and barriers. Results: The 15 included studies were conducted in a variety of different countries and consisted of five cross-sectional studies, two mixed-methods, one cohort report, three qualitative studies, three quality improvement projects, and one systematic review. The most commonly reported barriers were lack of interdisciplinary collaboration and support, and barriers related to workload and knowledge deficits among nurses. The most commonly reported facilitators were related to interdisciplinary collaboration and education. Conclusion: Findings from this review provide insight on the important aspects of nurse's experiences and perspectives that have the ability to initiate interventions that will increase nurse’s implementation of PADIS guidelines, thus further improving quality of patient care.