Facilitators and Barriers for Nurses Implementing Delirium PADIS Guidelines in the Intensive Care Unit

Background Many barriers exist in the literature related to the implementation of the Clinical Practice Guidelines for the Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in the intensive care unit (ICU). Objectives The objective of this integrative review was to identify barriers to and facilitators of nurses’ PADIS delirium guideline implementation in adult ICU settings. Methods We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines as a framework for this review and the Joanna Briggs Institute quality appraisal guidelines. The inclusion criteria led to the identification of quantitative and qualitative studies, quality improvement projects, and review studies published in English between 2013 and 2023 that addressed adult ICU patients and explored facilitators and barriers regarding nurses’ delirium guideline implementation in a variety of countries. Results The 15 selected studies were 5 cross-sectional studies, 2 mixed-methods studies, 1 cohort report, 3 qualitative studies, 3 quality improvement projects, and 1 systematic review. The most commonly reported barriers concerned a lack of interdisciplinary collaboration and support, a workload burden, and knowledge deficits among nurses. The most commonly reported facilitators were related to interdisciplinary collaboration and education on delirium, PADIS guideline, and ABCDE bundle. Discussion Delirium is crucial to address in critically ill patients, and nurses’ implementation of PADIS guidelines is vital for better outcomes. This review identified barriers and facilitators at individual, educational, and institutional levels. The review findings emphasize the need for routine and structured education for nurses on delirium risk factors, prevalence, outcomes, complications, management, and assessment to combat the educational deficits that inhibit guideline implementation. The review findings also highlight the need for interdisciplinary collaboration and education to effectively support nurses. Hospitals and other institutions can leverage these insights to develop strategic interdisciplinary education planning, including delirium-focused rounds and routine interdisciplinary discussions about incorporating delirium guidelines into the care of ICU patients.