Date Available

8-5-2025

Year of Publication

2025

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice

College

Nursing

Department/School/Program

Nursing

Faculty

Dr. Holly Chitwood

Committee Member

Susan Webb

Faculty

Dr. Jill Clemmons

Abstract

Background: The pediatric intensive care unit (PICU) is a dynamic, fast-paced, and high-acuity unit where children are prone to the development of pediatric delirium (PD). PD is a condition of neurologic dysfunction increasing risk of morbidity and mortality among patients. Literature on PD is rapidly expanding, providing an opportunity for increased research on how to manage PD. Caregivers know their children, are often readily available at the bedside, and invested in being included in care. Additionally, literature shows that caregiver presence at the bedside is one non- pharmacological intervention that can aid in reducing PD. The development and implementation of a structured educational intervention aimed at enhancing caregiver engagement in the management of PD within the PICU, in order to increase caregiver knowledge and promote the use of evidence-based prevention strategies, may be beneficial to reduce the severity of PD, as measured by Cornell Assessment of Pediatric Delirium (CAPD) scores (Appendix A).

Purpose: The purpose of this study was to develop, implement, and evaluate a structured, evidence-based process for facilitating caregiver involvement in reducing delirium among critically ill children in the PICU.

Methods:This was a single-center quasi-experimental study with a retrospective and prospective chart reviews and posttest-only design to determine the efficacy of a novel process for involving caregivers in reducing PD in the PICU through the evaluation of caregiver knowledge and CAPD scores. The study took place at Norton Children’s Hospital, a Level 1 Pediatric Trauma Center in Louisville, Kentucky. Inclusion criteria were caregivers of patients classified as “critical” in the PICU, caregivers who primary language was English, caregivers without an active Child Protective Services case/security concern, caregivers whose child was not receiving end-of-life care, and caregivers whose child had been in the PICU for at least 72 hours. Statistical analysis was performed with the Wilcoxon signed-rank test. Data was reported as frequencies with percentages and standard deviations with means.

Results: Electronic post-survey results indicated that the educational session increased caregiver knowledge regarding PD. There was no statistically significant difference between CAPD scores before and after the educational session and survey (Z = -0.271, p = 0.786). The median pre- educational session score was 5.5 (IQR: 0.0-16.25) and the median post-educational session score was 9.0 (IQR: 0.0-12.0).

Discussion: This project found that the development and implementation of a structured, evidence-based process for facilitating caregiver involvement in reducing PD among critically ill children in the PICU may be a feasible method for engaging caregivers in preventing, identifying, and managing PD.

Conclusion: This project supports the value and feasibility of implementing a structured process for facilitating caregiver involvement in reducing PD in the PICU via evidence-based education and open conversation with caregivers for the timely management of PD. Further research is needed to determine whether involving caregivers in managing PD significantly affects CAPD scores and whether a standardized, evidence-based educational intervention may translate to a larger and more diverse sample.

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