This paper presents an evidence review and synthesis examining delirium identification, screening, and management in intensive care units (ICUs). Drawing on four studies ranging from Level II to Level VI evidence, the review evaluates the implementation rates of validated delirium screening tools, barriers to their adoption, and the comparative utility of instruments such as the Confusion Assessment Method (CAM). Based on the synthesized evidence, the paper recommends CAM as the primary intervention for enhancing delirium detection among adult ICU patients. Synthesis tables organizing studies by evidence level, intervention type, design, sample, and outcomes are also provided.
This paper demonstrates evidence synthesis for clinical practice improvement — a cornerstone technique in nursing and healthcare graduate work. Rather than simply summarizing individual studies, the author assigns evidence levels, maps interventions across studies, and uses converging findings to support a concrete, practice-based recommendation. This moves the work from descriptive literature review toward applied evidence-based decision-making.
The paper opens with a narrative evidence review of four studies, each assessed for relevance and evidence level. A brief intervention section then uses those findings to justify the selection of CAM. The synthesis tables that follow reorganize the same studies by evidence level, intervention type, and study design/outcome — reinforcing the narrative argument with structured visual evidence. References conclude the paper in APA format.
Luetz et al. (2014) conducted a study examining how delirium management is an important aspect of intensive care treatment alongside analgesia and sedation management. The main objective was to examine the implementation rate of delirium screening by healthcare professionals in the intensive care unit. To achieve this, the researchers utilized a multinational, two-part survey in which hospital, ICU, and patient data were collected and analyzed. The study found that even though 44% of hospitals and ICUs reported using a validated screening assessment, only 27% of patients had been monitored using the instrument. Additionally, the researchers found that a validated screening instrument enhances the ability of healthcare professionals to identify ICU delirium. The study provides Level III evidence, which is essential for promoting the use of a validated ICU delirium assessment tool. The article is relevant to this research because it demonstrates the reasons for failure to identify ICU delirium in many ICUs.
Ista et al. (2014) conducted a study to examine how to improve care for ICU patients with delirium through the use of an early screening tool and treatment approach. The study found that rates of delirium occurrence increase among ICU patients following the implementation of early screening, due to the detection of hypoactive delirium. However, ICU delirium prevention and management can lessen these incidences. Therefore, screening should be carried out and followed by prevention and management. The study provides Level II evidence, as it was a randomized controlled trial carried out in six intensive care units. Its significance to this project lies in its provision of a specific validated assessment tool for ICU delirium screening and its identification of barriers and facilitators of screening implementation. The barriers and facilitators identified in the study will be utilized as guidelines for implementing the ICU delirium assessment tool in this project.
Filinson et al. (2016) conducted a study to examine the adoption of ICU delirium assessment tools in intensive care units, based on a review of acute care settings in two hospitals. The study found that educational programs enhance the use of delirium screening tools by healthcare providers in acute care settings. The researchers also found that delirium screening tools such as the Confusion Assessment Method (CAM) enhance the detection of this condition among patients in intensive care units. The study provides Level VI evidence, as the researcher carried out a project based on the Plan-Do-Study-Act model proposed by the Institute for Healthcare Improvement. The significance of this study is its proposal of CAM adoption in ICUs as a means of enhancing delirium detection, which will be considered as a probable intervention for this project.
Friedman et al. (2014) conducted research examining delirium assessment among cancer patients admitted to an inpatient hospice unit. The researchers found that delirium is a common condition among patients with advanced cancer, and that the Confusion Assessment Method appears to be the most suitable delirium assessment instrument for detecting the condition. The study provides Level IV evidence, as it was conducted on advanced cancer patients within 72 hours of admission to a hospice unit. Its significance lies in its recommendation of a delirium assessment tool to enhance delirium management in intensive care units, a recommendation that will be considered when selecting an intervention for this project.
Based on the review of evidence and expert opinion regarding delirium prevention and management, the intervention chosen for implementation in this project is the Confusion Assessment Method (CAM) delirium assessment tool. The project will entail examining whether the use of CAM enhances delirium detection among adults in the intensive care unit. CAM will act as a validated delirium assessment instrument focused on enhancing delirium detection, and its efficacy will be determined by comparing its use with other multicomponent interventions.
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