Effect of psychoeducational program and relaxation training on critical care nurses’ stress regarding care of patients with delirium

Abstract

Background:

Critical care nurses (CCNs) face difficulties and stress when caring for patients with delirium, and the level of delirium-related stress may be related to gaps in their knowledge and skills.

Aim:

This study aimed to assess the impact of a psychoeducational and relaxation program on reducing the stress of CCNs caring for patients with delirium in intensive care units (ICUs) in Taiz city, Yemen.

Methods:

From June to the end of December 2022, a quasi-experimental study was conducted among 60 CCNs from two ICUs of Al-Thawra Hospital in Taiz. Demographic characteristics were collected using a pre-designed data collection sheet, and the levels of CCNs’ stress were measured using the Delirium Nursing Stress Scale (DNSS). To assess the impact of the developed psychoeducational and relaxation program, stress levels were measured before and after the program, as well as at a 3-month follow-up for long-term impact. The association of demographic characteristics with delirium-related stress was also studied. Data were then analyzed using appropriate statistical tests at a significance level of <0.05.

Results:

Before the program, the mean score of CCNs’ stress was 60.48 ± 9.51, corresponding to a moderate stress level of 86.7%. However, this score was significantly reduced to 30.98 ± 4.35 immediately after the program and was sustained at 33.13 ± 5.31 3 months after the program, corresponding to a mild stress level. The highest mean score of CCNs’ stress related to caring for patients with delirium was observed before the program for all causes of stress on the DNSS, being 4.95 ± 1.77 for the nursing environment, 9.37 ± 2.16 for relationships with peers, 14.40 ± 4.02 for knowledge about delirium, and 31.77 ± 5.78 for nursing practice and work. However, the mean stress scores related to all these causes showed a significant reduction after the program (2.85 ± 0.95, 4.70 ± 1.33, 7.20 ± 1.67, and 16.23 ± 2.80, respectively) and at the 3-month follow-up (3.15 ± 1.05, 4.95 ± 1.23, 7.67 ± 1.66 and 17.37 ± 3.57, respectively). On the other hand, the mean score of total stress for all DNSS items showed a significant reduction from 60.48 ± 9.51 before the program to 30.98 ± 4.35 after the program and 33.13 ± 5.31 at the 3-month follow-up. There were no statistically significant differences in the mean scores of delirium-related stress before and after the program, or at the 3-month follow-up for any of the demographic characteristics of CCNs.

Conclusion:

Psychoeducational and relaxation programs have a positive impact on stress reduction in CCNs caring for patients with delirium, improving the standard of care provided to these patients. Regular assessment of CCNs for delirium-related stress and educating them to acquire knowledge and skills are recommended to reduce this stress when caring for delirious patients.

Keywords

Delirium critical care nurses psychoeducational program relaxation stress

Introduction

Delirium is characterized by an abrupt alteration in the baseline neurocognitive functions of patients, resulting in acute impairment of attention, consciousness, and cognition. According to the American Psychiatric Association, this condition is caused by an underlying medical problem rather than an established or emerging neurocognitive disorder.¹ Delirium incidence in patients admitted to intensive care units (ICUs) can vary widely depending on the study population, study design, and diagnostic criteria used. However, delirium is a common problem in ICUs and can have a significant negative impact on patient outcomes. Several studies have reported delirium incidence rates ranging from 60% to 80% in ICU patients.^2–5

Critically ill patients and those with life-threatening conditions admitted to hospitals receive continuous and comprehensive care in ICUs.⁶ Critical care nurses (CCNs) face several challenges when working in ICUs, including overwhelming workloads, dealing with dying patients, a negative social environment, and insufficient resources.⁷ Other factors that contribute to their stress include difficult family relationships, conflicts with physicians, unskilled nursing personnel, time constraints, staff shortages, and violence.⁸ The constant stress in the work environment and the demanding nature of critical care make CCNs highly susceptible to burnout.⁹

The nursing role is widely perceived to be challenging, and stress can negatively impact nurses’ health and job satisfaction, ultimately affecting the quality of care provided to patients. Job-related stress has been linked to poor quality healthcare services, low productivity, decreased initiative, lack of motivation, enhanced resistance of thought, less interest in colleagues and facilities, and a lower sense of responsibility.¹⁰ Caring for patients with delirium increases CCNs’ effort and frustration and raises their stress levels. Delirious patients are functionally worse than those without delirium and are therefore more dependent on CCNs for their care. Some patients may become hostile and combative during nursing care, interfering with the achievement of care goals and putting staff at risk of harm. As a result, delivery of nursing care takes longer and usually requires more CCNs.^11,12

It has long been thought that dealing with behavior that challenges is time consuming and discouraging, making CCNs feel anxious about restraining agitated patients. Moreover, they are frequent targets of physical and verbal aggression by hyperactive delirium patients. Caring for delirious patients presents a psychological challenge for CCNs when determining the appropriate approaches to deal with such patients. As a result, CCNs either spend too much time planning what to do or react too quickly with worry, which makes care less efficient. CCNs usually complain of the unsupportive environment and managers when addressing patient care problems.^13,14

Several studies have revealed the importance of educating and supporting CCNs caring for delirium to alleviate the stress they face that can negatively affect their care and practices. Therefore, support from a multidisciplinary critical care team is critical. This support can take the form of multidisciplinary team meetings, nursing team meetings, and meetings with management.^15
–17 Without measures to modulate the stress response, the consequences of stress on CCNs’ physical health can be deleterious, as manifested by symptoms such as headache, fatigue, skin rashes, somatic disturbance, lower back pain, stomach aches, gastrointestinal disorders, hypertension, coronary artery disease, sleep disorders, and weight fluctuations.^18,19

Earlier research on stress in nursing has found an association between occupational stress and personal judgment of emotional distress, as well as high rates of stress-related burnout and emotional illnesses.^20
–22 Occupational stress can directly or indirectly affect the quality and quantity of critical care provided to patients and their families, compromising patient care.^23,24 Although nurses are at high risk of job stress and burnout, they can benefit from the same stress management strategies they use to educate their clients. Nurses need to identify and manage workplace stressors and seek social support from colleagues to maintain a caring attitude toward patients. Stress management entails employing adaptive coping strategies in response to different situations.^25
–27

Ideally, stress can be reduced to an acceptable level, allowing nurses to work optimally and comfortably. Accordingly, the first step is to assess the environment for the necessary changes, followed by implementing appropriate coping strategies. Different physical, mental, emotional/spiritual, and organizational strategies can be used individually or in combination.^28,29 Implementation of various strategies to address stress issues has been suggested, including managing workload, promoting work-life balance, enhancing communication and teamwork through training and technology, and fostering a supportive and inclusive work culture. Furthermore, the need for collaboration between the healthcare professionals, the hospitals’ administrators and the healthcare policymakers to create an improved and sustainable working environment in the ICU has been emphasized. Addressing the above challenges and implementing the recommended strategies can improve the quality of patient care and the well-being of ICU staff.³⁰ Nurse satisfaction has been shown to be positively influenced by ICU design features such as lighting, privacy, layout, and equipment accessibility.³¹ In Saudi Arabia, a study identified inadequate staffing and resources, high workload, and limited organizational support as the challenges facing ICU nurses, emphasizing the need for improvement. These findings underscore the importance of improving the work environment in the ICU for the well-being of nurses and the quality of patient care.³² Therefore, this study aimed to assess the impact of a psychoeducational and relaxation program on reducing the stress of CCNs caring for patients with delirium in ICUs in Taiz city, Yemen.

Methods

Design: This study used a quasi-experimental design.

Setting: The study was conducted in two ICUs, a 10-bed unit for cardiac care and a 20-bed unit for general care, in Al-Thawra Hospital in Taiz. The units were staffed with a team of dedicated healthcare professionals, including nurses, intensive care specialists, anesthetists, respiratory specialists, nutritionists, and clinical pharmacists. There were 75 nurses on the nursing staff of the units.

Participants: This study included CCNs with a 3-year diploma or a bachelor’s degree in nursing, 20 nurses from cardiac care and 40 from general care who met the criteria for duty nurses and were caring for patients with delirium in the ICUs from June to the end of December 2022. The sample also included nurses with at least 1 year of ICU experience, while nurses who declined to participate and had less than 1 year of ICU experience were excluded. So that from the total number or 75 nurses, 8 nurses had less than 1 year of experience and 7 nurses hadn’t the desire to participate in the study. Informed consent was obtained from all study participants after the purpose of the study was explained to them.

Data collection and tools

Demographic characteristics of CCNs, including age, sex, level of education, marital status, duration of work in the ICU and participation in previous training on delirium, were collected using a pre-designed data collection sheet.

The Delirium Nursing Stress Scale (DNSS), a self-report tool developed by Suh and Yoo³³ and modified by Kim and Lee,³⁴ was used to measure stress levels in nurses caring for patients with delirium. This scale included 20 items across 4 sections: stress related to knowledge about delirium, nursing work environment, relationships with peers, and nursing practice and work. Each item was rated on a 5-point Likert scale from “not at all” to “extremely,” with a total score ranging from 20 to 100. Accordingly, stress was categorized into four levels: no stress (score 20), mild stress (score 21–46), moderate stress (score 47–73), and severe stress (score ⩾74). An Arabic-translated version of the scale (Supplemental File 1) The tool was validated by two psychiatrists and three professors of psychiatric nursing from the Faculty of Medicine and Health Sciences, Taiz University. The reliability of the DNSS tool was 0.89 as measured by Cronbach’s alpha.

Psychoeducational and relaxation program

Overview of the program

The psychoeducational and relaxation program was developed by the researchers after a three-month review of relevant materials and resources by two psychiatrists from Medicine department and five professors of psychiatric nursing and critical care nursing from Nursing department, the Faculty of Medicine and Health Sciences, Taiz University. The program had two components. One component involved the educating CCNs on the definition, causes, clinical manifestations, assessment, and nursing care plan for patients with delirium. The other component involved training CCNs in relaxation techniques, including problem-solving, deep breathing exercises, progressive muscle relaxation exercises, and meditation exercises and techniques.

The program was delivered over 11 h, five of which were theoretical and six practical hours. It consisted of 11 one-h sessions (one pre-assessment and 10 instructional) for 15 participants 3 days a week. Each session included an interactive lecture with videos and PowerPoint presentations, group discussions and practical training.

Program phases

The following phases were conducted to develop, implement and assess the impact of the program:

Stress assessment phase

In this phase, the stress of CCNs caring of patients with delirium was assessed over 1 month.

Program development phase

In this phase, the content and implementation strategy of the program, including the time and number of sessions and teaching methods, were discussed and developed over 2 months. In addition, the suitability of teaching location and facilities was assessed. The psychoeducational and relaxation program included 10 instructional sessions to educate CCNs about different aspects related to delirium and train them in relaxation strategies to reduce stress. These sessions included:

Session 1: Introduction, definition, subtypes, and incidence of the delirium

Session 2: Risk factors and causes of delirium

Session 3: Clinical manifestations and differential diagnosis of delirium from dementia and depression

Session 4: Screening tools used to assess delirium

Session 5: Prevention, treatment and nursing care plan for patients with delirium

Session 6: Identifying stress and methods for facing and managing it

Session 7: Problem-solving

Session 8: Deep breathing exercises

Session 9: Progressive muscle relaxation exercises

Session 10: Meditation exercises and techniques

Program implementation

Before implementing the 10 instructional sessions of the program, the researchers conducted a pre-assessment session to assess the stress levels of CCNs caring for patients with delirium using the DNSS tool and to collect demographic data. The CCNs were assessed at the end of each instructional session, and a report on the assessment results was presented at the next session to determine how well they understood the topics from the previous session. The researchers provided the participants with constructive feedback and guidance on areas for improvement.

Assessment of program impact

CCNs were assessed for stress reduction using the DNSS tool immediately after the completion of the program. A follow-up assessment was performed 3 months later to assess the long-term impact of the program on reducing stress.

Statistical analysis

Data were analyzed using the IBM SPSS Statistics software, version 26.0 (IBM Corp., Armonk, NY, USA). The normality of quantitative data distribution was verified by the Kolmogorov-Smirnov test. Categorical variables were expressed as frequencies and percentages, and continuous variables were expressed as mean and standard deviation (SD). The chi-square test was used to compare between categorical variables, and the repeated measures analysis of variance (ANOVA) was used to compare between the means of three related groups (before program, after program and follow-up). The independent-samples t-test for two groups and ANOVA for more than two groups were used to compare the mean score of stress level between different groups. Statistical significance was considered at a p-value < 0.05.

Ethical considerations

This study was ethically approved by the Institutional Review Board of the Faculty of Nursing, Assiut University, Assiut, Egypt (approval No. 3460022). In addition, permission to conduct the study was obtained from the Director General of Al-Thawra Hospital after explaining its purpose. Written informed consent was obtained from the CCNs after being informed of its purpose. The CCNs were also advised that the privacy and confidentiality of their data would be ensured. This study was conducted in accordance with the latest version of the Declaration of Helsinki.

Result

Demographic characteristics of CCNs

The mean age of CCNs was 29.2 ± 4.2 years, with the majority (46.7%) being in the 25–30 age group. Most CCNs were females (61.7%), and more than half were unmarried (55%) and had a nursing diploma (55%). Most of the nurses (66.7%) working in general care, 61.7% had 5 years of ICU experience or less, with a mean ICU experience of 5.2 ± 2.5 years. On the other hand, more than half of the nurses (55%) worked >8 h per day, with a mean working duration of 9.8 ± 2.8 h per day (Table 1).

Table 1.

Demographic characteristics of the ICU nurses (N = 60).

Demographic characteristics	ICU nurses (N = 60)
Demographic characteristics	No	%
Age (mean ± SD)	29.18 ± 4.25
<25 years	13	21.7
25–30 years	28	46.7
>30 years	19	31.7
Sex
Female	37	61.7
Male	23	38.3
Educational qualifications
Diploma	33	55.0
Bachelor of nursing	27	45.0
Marital status
Married	27	45.0
Unmarried	33	55.0
Type ICUs
Cardiac care	20	33.3
General care	40	66.7
Years’ experience in ICU (mean ± SD)	5.18 ± 2.54
⩽5 years	37	61.7
>5 years	23	38.3
Working hours/day (mean ± SD)	9.82 ± 2.76
6–8 h	27	45.0
>8 h	33	55.0

Impact of the psychoeducational and relaxation program on CCNs’ stress

The mean score of CCNs’ stress before the program was 60.48 ± 9.51, corresponding to a moderate stress level of 86.7%. However, the mean score of stress was significantly reduced to 30.98 ± 4.35 and was sustained at a mean score of 33.13 ± 5.31 3 months post-program, corresponding to a mild stress level (Figure 1).

Figure 1.

Comparison of levels of stress among CCNs about delirium at pre, post-implementation and follow up evaluation of the educational program (N = 60).

The highest mean score of CCNs’ stress related to caring for patients with delirium was observed before the program for all causes of stress on the DNSS, being 4.95 ± 1.77 for nursing environment, 9.37 ± 2.16 for relationships with peers, 14.40 ± 4.02 for knowledge about delirium, and 31.77 ± 5.78 for nursing practice and work (Table 2). However, the mean scores of stress related to all these causes showed a significant reduction after the program (2.85 ± 0.95, 4.70 ± 1.33, 7.20 ± 1.67, and 16.23 ± 2.80, respectively) and at the 3-month follow-up (3.15 ± 1.05, 4.95 ± 1.23, 7.67 ± 1.66, and 17.37 ± 3.57, respectively). On the other hand, the mean score of total stress for all DNSS items showed a significant reduction from 60.48 ± 9.51 before the program to 30.98 ± 4.35 after the program and 33.13 ± 5.31 at the 3-month follow-up (Table 2).

Table 2.

The average scores of nurses on the Delirium Nursing Stress Scale (DNSS) were measured before, after, and during follow-up evaluations of psychoeducational program (N = 60).

Stress-related to	Total Score	Before intervention	After intervention	Follow up	p ¹	p ²	p ³	p⁴ value
					Comparison
Knowledge about delirium
Mean ± SD	25	14.40 ± 4.02	7.20 ± 1.67	7.67 ± 1.66	<.001*	<.001*	.109	<.001*
Range	25	5.0–23.0	5.0–11.0	5.0–12.0	<.001*	<.001*	.109	<.001*
Nursing environment
Mean ± SD	10	4.95 ± 1.77	2.85 ± 0.95	3.15 ± 1.05	<.001*	<.001*	.112	<.001*
Range	10	2.0–10.0	2.0–6.0	2.0–6.0	<.001*	<.001*	.112	<.001*
Relationship with peers
Mean ± SD	15	9.37 ± 2.16	4.70 ± 1.33	4.95 ± 1.23	<.001*	<.001*	.260	<.001*
Range	15	5.0–13.0	3.0–9.0	3.0–9.0	<.001*	<.001*	.260	<.001*
Nursing practice and work
Mean ± SD	50	31.77 ± 5.78	16.23 ± 2.80	17.37 ± 3.57	<.001*	<.001*	.068	<.001*
Range	50	17.0–43.0	10.0–21.0	10.0–25.0	<.001*	<.001*	.068	<.001*
Total stress score
Mean ± SD	100	60.48 ± 9.51	30.98 ± 4.35	33.13 ± 5.31	<.001*	<.001*	.069	<.001*
Range	100	29.0–75.0	21.0–41.0	21.0–47.0	<.001*	<.001*	.069	<.001*

Repeated measure ANOVA.

p¹: before versus after; p²: before versus follow up; p³: after versus follow up; p⁴ value: before versus after versus follow up.

Statistically significant difference (p < .05).

Comparison of mean scores of CCNs’ stress related to delirium according to demographic characteristics

There were no statistically significant differences in the mean scores of CCNs’ stress before and after the program, or at the 3-month follow-up for any of the demographic characteristics (Table 3).

Table 3.

The relationship between demographic characteristics and the average stress score of nurses was examined at the pre, post-implementation, and follow-up evaluations of psychoeducational program (N = 60).

Demographic characteristics		Before intervention	After intervention	Follow up
		Mean ± SD	Mean ± SD	Mean ± SD
Age groups	<25 years	57.31 ± 13.74	30.08 ± 3.90	32.46 ± 3.89
	25–30 years	61.93 ± 6.57	31.43 ± 4.70	33.43 ± 5.32
	>30 years	60.53 ± 9.78	30.95 ± 4.21	33.16 ± 6.28
	F	1.049	0.422	0.143
	p value	.357	.658	.867
Sex	Female	60.86 ± 9.28	30.92 ± 4.83	33.76 ± 5.96
	Male	59.87 ± 10.06	31.09 ± 3.54	32.13 ± 3.98
	t	−0.391	0.144	−1.156
	p value	.697	.886	.252
Educational qualifications	Diploma	58.48 ± 9.64	31.12 ± 4.46	32.70 ± 4.95
	Bachelor of nursing	62.93 ± 8.93	30.81 ± 4.28	33.67 ± 5.78
	t	1.834	−0.269	0.700
	p value	.072	.789	.486
Marital status	Married	60.81 ± 10.67	31.63 ± 3.19	32.59 ± 5.37
	Un Married	60.21 ± 8.61	30.45 ± 5.09	33.58 ± 5.31
	t	0.242	1.042	−0.710
	p value	0.810	0.302	0.480
Type ICUs	Cardiac care	60.60 ± 6.63	31.8 ± 4.62	33.55 ± 5.79
	General care	60.43 ± 10.75	30.58 ± 4.21	32.93 ± 5.12
	t	0.067	1.029	0.427
	p value	.947	.308	.671
Years’ experience in ICU	⩽5 years	60.73 ± 9.52	31.14 ± 4.24	33.32 ± 5.12
	>5 years	60.09 ± 9.70	30.74 ± 4.60	32.83 ± 5.72
	t	0.252	0.340	0.351
	p value	.802	.735	.727
Working hours/day	6–8	61.04 ± 7.85	31.07 ± 4.36	33.37 ± 5.70
	>8	60.03 ± 10.79	30.91 ± 4.4	32.94 ± 5.06
	t	0.405	0.145	0.472
	p value	.687	.885	.757

Discussion

The present study showed moderate stress in the majority of CCNs caring for patients with delirium in Taiz, as reflected by a high mean score of total stress before implementing a psychoeducational and relaxation program. This finding may be attributed to the need for self-protection felt by the majority of nurses and the perceived threat that dealing with delirious patients may jeopardize their personal safety. Nurses believe that delirious patients are entirely dependent on them because they often need more support to perform their daily activities due to their major physical and cognitive deficits. This finding is supported by several earlier studies,^33
–37 showing that the majority of ICU nurses had moderate stress with high mean scores of total stress when caring for patients with delirium. Furthermore, the physical restraints of patients with delirium are mostly managed by nurses in various healthcare settings, adding to their stress.³⁸ The use of physical restraints was found to induce feelings of sadness and guilt in nurses.³⁹

The present study revealed high levels of stress experienced by the majority of CCNs prior to implementing the psychoeducational and relaxation program in terms of knowledge about delirium, nursing environment, relationship with peers, and nursing practice and work. These findings are consistent with those reported in previous studies conducted elsewhere,^34,40
–44 which found significantly high mean scores of stress among CCNs caring for patients with delirium due to insufficient information on delirium prevention and management. In addition, there are several factors that may contribute to CCNs’ stress while caring for patients with delirium, including a lack of awareness of delirium causes, unfamiliarity with the delirium consequences and facing numerous barriers such as ICU regulations, quality of relationships at work, and end-of-life concerns in the ICU. The most common stress-related cause reported by CCNs caring for patients with delirium in the present study was the lack of appropriate screening tools in the ICU, followed by lack of contact with patients due to heavy workload, time-consuming use of delirium-screening techniques, and insufficient knowledge of delirium in the ICU.

The present study found delirium-related stress was significantly reduced from moderate to mild stress in the majority of CCNs following the psychoeducational and relaxation program. This finding indicates that increasing awareness of delirium and its management through psychoeducational and relaxation techniques can reduce stress levels in CCNs caring for patients with delirium. This finding is in agreement with that reported by Park and Gu,³⁷ who found that overall delirium-related stress became milder as reported by the majority of CCNs who participated in an educational program. It was found that higher knowledge and good practice of nurses in dealing with delirium significantly reduce their levels of stress.^36,45 Therefore, it is possible to reduce the work stress of nurses by providing them with the necessary knowledge, practices, and stress management tools. Meanwhile, interactive E-learning has been shown to lower the mean scores of nurses’ delirium-related strain of care. The advantage of E-learning in lowering the strain of care may be attributed to its effectiveness in enhancing nurses’ capacity to detect and manage delirium.⁴⁶ Overall, the mild stress reported by all CCNs after the program in the present study should be interpreted with caution because they might have overestimated their stress levels during the initial assessment prior to the program. In order to address this issue, further studies involving interviews with nurses are needed. Furthermore, nursing school curricula should be regularly reviewed and modified to ensure that theoretical knowledge aligns with current hospital practices, including topics related to recognizing delirium, stress, and stress management techniques.

In the present study, immediate reductions in CCNs’ delirium-related stress on the key components of the DNSS tool after the program were sustained 3 months later at follow-up. Similarly, a study among CCNs in Korea reported a significant reduction in delirium-related stress for these key components after receiving a psychoeducational program.³⁷ The less stressful work with delirious patients observed after the program in the present study may be due to standardized basic knowledge, effective communication of nurses when dealing with delirious patients, and improved communication of nurses with relatives of the patients. Moreover, improvement of knowledge can increase nurses’ self-confidence and ability to deal with emergency situations.

The present study did not find a statistically significant association between delirium-related stress and any of the demographic characteristics of CCNs, either before or after the program, or at the 3-month follow-up. This finding is in the line with that by Kim and Eun,⁴⁷ who found no significant association between the demographic characteristics of CCNs and average delirium-related stress. Likewise, Suh and Yoo³³ found no significant association between CCNs’ demographic characteristics and average stress, except for a statistically significant association with their age and level of education. Younger nurses are more likely to assume more job obligations and feel underprepared. They are thus subject to pressure and stress in the workplace, which may result in uncontrollable feelings of dissatisfaction.

The present study has some limitations as it was conducted in a single hospital. However, the present psychoeducational and relaxation program was the first to address the training gap among CCNs in Taiz city so as to reduce their delirium-related stress. Importantly, there was a remarkable lack of knowledge and skills to care for patients with delirium among CCNs in the city, particularly with deteriorated healthcare services and health systems as a result of the country’s armed conflicts. Although the present findings cannot be generalized to the critical care of patients with delirium in the whole country, the developed program may still have benefits in educating and training CCNs in the care and management of delirious patients. Another limitation might be introduced by measuring stress based on a self-report tool. Therefore, further studies are required to address this self-assessment issue and explore the program’s sustainability and potential for development of the program.

Conclusion

There is a positive impact of psychoeducational and relaxation program on reducing the stress levels in CCNs caring for patients with delirium in the ICUs in Taiz city, improve the standard of care provided to these patients. Demographic characteristics of CCNs have no association with the levels of stress before or after the program, either immediately or 3 months later. It is recommended that CCNs be regularly assessed for delirium-related stress and educated to acquire knowledge and skills necessary to reduce this stress when caring for delirious patients.

Supplemental Material

sj-doc-1-inc-10.1177_17511437241275307 – Supplemental material for Effect of psychoeducational program and relaxation training on critical care nurses’ stress regarding care of patients with delirium

Supplemental material, sj-doc-1-inc-10.1177_17511437241275307 for Effect of psychoeducational program and relaxation training on critical care nurses’ stress regarding care of patients with delirium by Saleh O Abdullah, Alaa El Din M Darweesh, Naglaa A Mohammed, Sameer A Alkubati and Awatif M Alrasheeday in Journal of the Intensive Care Society

Footnotes

Acknowledgements

Grateful acknowledgment to every nursing staff working at Intensive Care Units in the Al-Thawra Hospital.

List of abbreviations

CCNs: Critical Care Nurses, ICU: Intensive Care Unit, DNSS: Delirium Nursing Stress Scale

Authors contributions

Saleh Abdullah designed the study; Saleh Abdullah conducted the survey and data collection; Alaa El Din M Darweesh analyzed the data; Alaa El Din M Darweesh and Sameer A Alkubati interpreted the results. Saleh O Abdullah, Alaa El Din M Darweesh, Naglaa A Mohammed, Sameer A Alkubati, and Awatif M Alrasheeday wrote the first draft of the paper and contributed to the revision of the whole paper. All authors read and approved the final manuscript.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Saleh O Abdullah

Sameer A Alkubati

Data availability statement

The data presented in this study are available on request from the corresponding author.

Supplemental material

Supplemental material for this article is available online.

References

American Psychiatric Association, D. S. M. T. F., & American Psychiatric Association, D. S. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American psychiatric association.

Barr

Fraser

Puntillo

, et al.; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41: 263–306.

Ely

Gautam

Margolin

, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27: 1892–1900.

Pisani

MA.

Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007; 167: 1629.

Page

Ely

Gates

, et al. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med 2013; 1: 515–523.

Marshall

Bosco

Adhikari

, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of intensive and Critical Care Medicine. J Crit Care 2017; 37: 270–276.

Adams

AMN

Chamberlain

Giles

TM.

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: an integrative literature review. Aust Crit Care 2019; 32: 319–329.

Moss

Good

Gozal

, et al. A critical care societies collaborative statement: burnout syndrome in critical care health-care professionals. A call for action. Am J Respir Crit Care Med 2016; 194: 106–113.

Alzailai

Barriball

Alkhatib

, et al. Factors that contributed to burnout among intensive care nurses during the COVID-19 pandemic in Saudi Arabia: a constructivist grounded theory. Aust Crit Care 2023; 36: 19–27.

10.

Rabei

Mourad

Hamed

AED

. Work stress and sleep disturbances among internship nursing students. Middle East Curr Psychiatry 2020; 27: 1–6. DOI: 10.1186/s43045-020-00032-1

11.

Awad

Critical care nurses’ knowledge, perception and barriers regarding delirium in adult critical care units. BMJ 2019; 7: 193–198.

12.

Rosen

Connors

Clark

, et al. Assessment and management of delirium in older adults in the emergency department: Literature review to inform development of a novel clinical protocol. Adv Emerg Nurs J 2015; 37: 183–196.

13.

Hagerling

Nurse attitudes toward caring for older patients with delirium. Sci J Heal Sci 2019; 1: 622–624.

14.

Kristiansen

Konradsen

Beck

Nurses’ experiences of caring for older patients afflicted by delirium in a neurological department. J Clin Nurs 2019; 28: 920–930.

15.

Goldsworthy

Mechanical ventilation in the critically ill patient: international nursing perspectives. Crit Care Nurs Clin North Am 2016; 28: i.

16.

Roh

YS.

The training needs of Korean intensive care unit nurses regarding delirium. Intensive Crit Care Nurs 2021; 62: 102954.

17.

Touhy

Jett

(eds.). Ebersole and hess’ toward healthy aging: human needs and nursing response. 10th ed. St. Louis: Mosby, 2020.

18.

Johnson

Vanderhoef

Center

NK.

(eds.). Psychiatric-mental health nurse practitioner review and resource manual. 4th ed. Philadelphia: Nursing Knowledge Center, American Nurses Association, 2016. https://books.google.com.eg/books?id=ZT2UjwEACAAJ

19.

Swearingen

Wright

(eds.). All-in-one nursing care planning resource-E-book: medical-surgical, pediatric, maternity, and psychiatric-mental health. 5th ed. St. Louis: Elsevier Health Sciences, 2019.

20.

de Wijn

van der Doef

. Patient-related stressful situations and stress-related outcomes in emergency nurses: a cross-sectional study on the role of work factors and recovery during leisure time. Int J Nurs Stud 2020; 107: 1–11.

21.

Ilić

Arandjelović

MŽ

Jovanović

, et al. Relationships of work-related psychosocial risks, stress, individual factors and burnout - questionnaire survey among emergency physicians and nurses. Med Pr 2017; 68: 167–178.

22.

Potter

Dollard

O’Keeffe

, et al. Australian work health and safety policy for psychosocial hazards and risks: evaluation of the context, content, and implementation. Australia: University of South Australia, 2019. https://core.ac.uk/reader/189917800

23.

Aitken

Marshall

Chaboyer

(eds.). Critical care nursing. 4th ed. Australia: Elsevier, 2019. https://books.google.com.eg/books?id=ey2hwwEACAAJ

24.

Chamberlain

Pollock

Fulbrook

; ACCCN Workforce Standards Development Group. ACCCN workforce standards for intensive care nursing: systematic and evidence review, development, and appraisal. Aust Crit Care 2018; 31: 292–302.

25.

Crisp

Taylor

Douglas

, et al. (eds.). Potter & Perry’s fundamentals of nursing—Australian version. 5th ed. Chatswood: Elsevier Australia, 2016. https://books.google.com.eg/books?id=p9AwngAACAAJ

26.

Starc

Stress factors among nurses at the primary and secondary level of public sector health care: the case of Slovenia. Open Access Maced J Med Sci 2018; 6: 416–422.

27.

Yılmaz

EB.

Resilience as a strategy for struggling against challenges related to the nursing profession. Chin Nurs Res 2017; 4: 9–13.

28.

Barrera

Attard

Chaplin

Oxford textbook of inpatient psychiatry. Oxford University Press, 2019. https://books.google.com.eg/books?id=8AuXDwAAQBAJ

29.

Yoder-Wise

. (ed.). Leading and managing in nursing. 7th ed. Missouri: Elsevier—Health Sciences Division, 2019. https://books.google.com.eg/books?id=nKdWtAEACAAJ

30.

Alameddine

Dainty

Deber

, et al. The intensive care unit work environment: current challenges and recommendations for the future. J Crit Care 2009; 24: 243–248.

31.

Obeidat

Younis

Al-Shlool

, et al. A study of workspace design characteristics exemplified by nurses’ satisfaction within three intensive care units in a university hospital. HERD Heal Environ Res Des J 2022; 15: 63–78.

32.

Ageel

Shbeer

Assessment of the critical care work environment of intensive care unit nurses in Saudi Arabia. Risk Manag Healthc Policy 2022; 15: 2413–2420.

33.

Suh

Yoo

Intensive care unit nurse’s knowledge, nursing performance, and stress about delirium. J Korean Acad Adult Nurs 2007; 19: 55–65.

34.

Kim

Lee

Factors affecting nursing performance of delirium for general hospital clinical nurses. J Korean Clin Nurs Res 2016; 22: 183–193.

35.

Jung

Recovery room nurses’ knowledge and stress of emergence delirium. J Korean Clin Nurs Res 2014; 20: 256–266.

36.

Koo

Yang

Factors influencing performance of delirium care for postoperative delirium of elderly patients among recovery room nurses. J Korean Acad Soc Nurs Educ 2016; 22: 387–395.

37.

Park

MO.

The development and effects of evidence-based nursing practice guideline for cancer patients with Delirium. Korean Soc Évid Nurs 2013; 1: 4–15.

38.

Via-Clavero

Sanjuán-Naváis

Romero-García

, et al. Eliciting critical care nurses’ beliefs regarding physical restraint use. Nurs Ethics 2019; 26: 1458–1472.

39.

Chuang

Y-H

Huang

H-T.

Nurses? Feelings and thoughts about using physical restraints on hospitalized older patients. J Clin Nurs 2007; 16: 486–494.

40.

Helgesen

Adan

Dybvik Bjørglund

, et al. Nurses’ experiences of delirium and how to identify delirium—a qualitative study. Nurs Open 2021; 8: 844–849.

41.

Jokwiro

Rickard

Edvardsson

Factors associated with stress of conscience in caring for older people with delirium in a hospital setting: an exploratory cross-sectional study. Collegian 2021; 28: 296–302.

42.

Schmitt

Gallagher

Albuquerque

, et al. Perspectives on the delirium experience and its burden: common themes among older patients, their family caregivers, and nurses. Gerontologist 2019; 59: 327–337.

43.

Thomas

Coleman

Terry

Nurses’ experience of caring for patients with Delirium: systematic review and qualitative evidence synthesis. Nurs Rep 2021; 11: 164–174.

44.

Williams

Dhesi

Partridge

JSL

. Distress in delirium: causes, assessment and management. Eur Geriatr Med 2020; 11: 63–70.

45.

Kim

EH.

Relationship between knowledge, stress, and nursing performance about care for delirium in geriatric hospital nurses. J Korean Clin Health Sci 2016; 4: 593–602.

46.

Najafi Ghezeljeh

Rahnamaei

Omrani

, et al. The effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. J Intensive Care Soc 2022; 23: 44–52.

47.

Kim

Eun

Knowledge, performance and stress about care for delirium in orthopedic hospital nurses. J Muscle Jt Heal 2013; 20: 72–80.

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