นักศึกษา (Student):
6610420002 นางสาว ฮาดีน่า พิศแลงาม
Nurses’ Experiences of Caring for Critically Ill Older Adults with Delirium in the Medical Intensive Care Unit:
ปีผลงานวิจัย (Research Year):
2025
อาจารย์ที่ปรึกษา (Advisor):
ผศ.ดร. ทิพมาส ชิณวงศ์
คำสำคัญ (Keywords):
#อาการไม่จำเพาะเจาะจง
วัตถุประสงค์ (Objectives)
Objective: To explore and describe the experiences of nurses caring for critically ill older adults with delirium in the Medical Intensive Care Unit (MICU) of a tertiary hospital in southern Thailand.
วิธีการดำเนินการวิจัย (Methodology)
Method: A descriptive phenomenological qualitative study was grounded in Husserl’s philosophy. Ten registered ICU nurses who had more than one year of experience in caring for critically ill older adults with delirium were purposively recruited from the Medical Intensive Care Unit (MICU). Data were collected between April and August 2025 through in-depth, semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Data analysis followed Colaizzi’s seven-step method to identify significant statements, formulate meanings, and derive thematic structures. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability, including member checking and peer debriefing.
ผลการวิจัย (Research Results)
Results: Ten registered ICU nurses who participated in this study were nine females (90%), age ranged from 24–50 years (mean 34 years). Most of them were single (80%), and the main religion was Buddhism (90%). Their work experience ranged from 2 to 26 years (mean 11.5 years). Based on Benner’s levels of nursing expertise, there was one novice, one advanced beginner, one competent, two proficient, and five experts. Only one participant (10%) had received formal training related to delirium care. There were five major themes emerged from the findings, which were: (1) providing humanized care within a safety-focused environment, (2) enhancing recovery, (3) facing and overcoming physical, psychological burdens and ethical dilemmas, (4) encountering multifaceted barriers, and (5) being transformed while advocating for better delirium care.
สรุปและข้อเสนอแนะ (Conclusion and Recommendations)
Recommendations
Based on the findings, the following recommendations are proposed for nursing practice, education, management, and future research.
1. Nursing Practice
1.1 Nurse should continue integrating individualized approaches by exploring patients’ backgrounds, routines, and preferences to guide non-pharmacological strategies. Safety protocols should explicitly support person-centered practices, particularly in decision-making related to restraint use
1.2 Prioritize non-pharmacological interventions as core care strategies
Environmental adjustments, orientation, therapeutic communication, sleep promotion, and family involvement should be consistently incorporated into routine ICU delirium care when clinically feasible.
1.3 Support ethical reflection and careful restraint use
Given the ethical tension described by participants, restraint decisions should include thorough assessment, clear documentation, frequent reassessment, and transparent communication with patients and families to balance safety with dignity.
1.4 Encourage reflective practice and peer support
Regular debriefing opportunities and peer discussions may help nurses process emotional stress, reduce moral distress, and sustain compassionate care in high-acuity environments.
2. Nursing Education
2.1 Incorporate delirium care training modules into undergraduate and graduate curricula, emphasizing both clinical knowledge and emotional intelligence.
2.2 Provide simulation-based learning and reflective practice workshops to improve nurses’ confidence and decision-making in complex delirium cases.
3. Nursing Management and Policy
3.1 Develop institutional guidelines and standardized assessment protocols tailored to the ICU context for early identification and management of delirium.
3.2 Ensure adequate staffing ratios and workload management to allow nurses sufficient time to deliver humanized, patient-centered care.
3.3 Support interdisciplinary collaboration among nurses, physicians, psychologists, and families to provide integrated delirium care.
3.4 Establish supportive systems, such as regular staff conferences and emotional well-being programs, to reduce occupational stress.
3.5 Encourage innovation and digital tools (e.g., applications to interpret intubated patients’ communication) to enhance safety and understanding.