Effectiveness of nurse-implemented nonpharmacologic interventions on delirium incidence in cardiac surgical ICU patients: A systematic review and meta-analysis
,
Abstract
Background & Aim: Delirium is a common, serious postoperative complication in cardiac surgery. This study evaluated the impact of nurse-implemented multimodal nonpharmacologic bundles on delirium incidence and severity in adult cardiac surgery ICU patients.
Methods & Materials: A systematic review and meta-analysis were conducted. A systematic literature search was performed across PubMed, Scopus, ScienceDirect, and Cochrane Library from inception to September 15, 2025. Data from eligible studies were extracted for narrative synthesis and meta-analysis. Pooled Odds_Ratios and 95% Confidence Intervals were calculated to evaluate delirium incidence, and statistical heterogeneity was assessed using the I2 statistic.
Results: Thirteen studies were included, with eight studies (N=3,831) suitable for meta-analysis. Nurse-implemented bundles were associated with a reduced incidence of delirium (OR 0.56; 95% CI: 0.41–0.75; I2=14%). Narrative synthesis of five additional studies indicated that interventions such as early mobilization and sensory-based bundles (eye masks/earplugs) may mitigate delirium severity. Furthermore, physical frailty was identified as a significant risk factor (Adj. OR 1.61), and Scenario-Based Learning was found to be a viable approach for enhancing nurse competency.
Conclusion: Nurse-implemented multimodal non-pharmacological bundles contribute to reducing delirium incidence in cardiac surgery ICUs. These findings suggest that such protocols serve as a relevant secondary prevention strategy. However, given the diversity of intervention components and geographical settings, these results should be interpreted with caution. Clinical protocols should consider integrating frailty screening and environmental modifications, while future research should prioritize standardized continuous outcomes like Delirium-Free Days.
Mattimore D, Fischl A, Christophides A, Cuenca J, Davidson S, Jin Z, et al. Delirium after Cardiac Surgery—A Narrative Review. Brain Sciences. 2023;13(12). doi:10.3390/brainsci13121682
2. Fu M, Yuan Q, Yang Q, Song W, Yu Y, Luo Y, et al. Risk factors and incidence of postoperative delirium after cardiac surgery in children: a systematic review and meta-analysis. Italian Journal of Pediatrics. 2024;50(1):1–16. doi:10.1186/s13052-024-01603-2 PubMed PMID: 38331831.
3. Ordóñez-Velasco L, Hernández-Leiva E. Factors associated with delirium after cardiac surgery: A prospective cohort study. Annals of Cardiac Anaesthesia. 2021;24(2):183–9. doi:10.4103/aca.ACA_43_20 PubMed PMID: 33884974.
4. Wang Y, Wang B. Risk factors of delirium after cardiac surgery: a systematic review and meta-analysis. Journal of Cardiothoracic Surgery. 2024;19(1):1–9. doi:10.1186/s13019-024-03156-1 PubMed PMID: 39707458.
5. Staicu RE, Vernic C, Ciurescu S, Lascu A, Aburel OM, Deutsch P, et al. Postoperative Delirium and Cognitive Dysfunction After Cardiac Surgery: The Role of Inflammation and Clinical Risk Factors. Diagnostics. 2025;15(7):1–20. doi:10.3390/diagnostics15070844
6. Echeverría M de LR, Schoo C, Paul M. Delirium. NCBI Bookshelf. A service of the National Library of Medicine, National Institute of Health. 2022. 3–5 p.
7. Chen H, Mo L, Hu H, Ou Y, Luo J. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. Journal of Cardiothoracic Surgery. 2021;16(1):1–11. doi:10.1186/s13019-021-01496-w PubMed PMID: 33902644.
8. Diao Y, Yu X, Zhang Q, Chen X. The predictive value of confusion assessment method‐intensive care unit and intensive care delirium screening checklist for delirium in critically ill patients in the intensive care unit: A systematic review and meta‐analysis. Nursing in Critical Care. 2024 Nov 27;29(6):1224–35. doi:10.1111/nicc.13064
9. Sahawneh F, Boss L. Non‐pharmacologic interventions for the prevention of delirium in the intensive care unit: An integrative review. Nursing in Critical Care. 2021 May 20;26(3):166–75. doi:10.1111/nicc.12594 PubMed PMID: 33474830.
10. Söylemez GK, Bulut H. The effectiveness of postoperative delirium prevention, diagnosis, and intervention protocol in patients monitored in the intensive care unit after cardiac surgery: a quasi-experimental study. BMC Nursing. 2024 Dec 18;23(1):904. doi:10.1186/s12912-024-02547-y
11. Zhang S, Han Y, Xiao Q, Li H, Wu Y. Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis*. Critical Care Medicine. 2021 Feb 16;49(2):335–46. doi:10.1097/CCM.0000000000004773 PubMed PMID: 33332818.
12. Askarkafi F, Rayyani M, Dehghan M. The Effect of Massage With and Without Aromatic Oil on Delirium After Open-Heart Surgery: A Randomized Controlled Trial. Journal of Chiropractic Medicine. 2020 Mar 1;19(1):49–57. doi:10.1016/j.jcm.2019.08.001
13. Cheng H, Ling Y, Li Q, Li X, Tang Y, Guo J, et al. Association between modified frailty index and postoperative delirium in patients after cardiac surgery: A cohort study of 2080 older adults. CNS Neuroscience & Therapeutics. 2024 Jun 1;30(6). doi:10.1111/cns.14762 PubMed PMID: 38924691.
14. Deeken F, Sánchez A, Rapp MA, Denkinger M, Brefka S, Spank J, et al. Outcomes of a Delirium Prevention Program in Older Persons after Elective Surgery: A Stepped-Wedge Cluster Randomized Clinical Trial. JAMA Surgery. 2022 Feb 1;157(2):E216370. doi:10.1001/jamasurg.2021.6370 PubMed PMID: 34910080.
15. Fazlollah A, Babatabar Darzi H, Heidaranlu E, Moradian ST. The effect of foot reflexology massage on delirium and sleep quality following cardiac surgery: A randomized clinical trial. Complementary Therapies in Medicine. 2021 Aug 1;60. doi:10.1016/j.ctim.2021.102738 PubMed PMID: 34029674.
16. Gómez Tovar LO, Henao Castaño AM. Dynamic delirium – Nursing intervention to reduce delirium in patients critically Ill, a randomized control trial. Intensive and Critical Care Nursing. 2024 Aug 1;83. doi:10.1016/j.iccn.2024.103691 PubMed PMID: 38518455.
17. Jahanbazi A, Jokar F, Kheirollahi N. The Effect of Scenario-Based Learning on the Performance of Nurses Regarding Delirium in Cardiac Surgery Intensive Care Units. Iranian Journal of Nursing and Midwifery Research. 2022 Jul;27(4):260–5. doi:10.4103/ijnmr.ijnmr_28_21
18. Milz S, Holaubek C, Siebel J, Hulde N, Wefer F, Fruend A, et al. Implementation of Evidence-Based International Recommendations Reduces Postoperative Delirium Rate in Patients Undergoing Cardiac Surgery or Interventions: A System-Based Quality Improvement Study. Reviews in Cardiovascular Medicine. 2024;25(10). doi:10.31083/j.rcm2510369
19. Shorofi SA, Dadashian P, Arbon P, Moosazadeh M. The efficacy of earplugs and eye masks for delirium severity and sleep quality in patients undergoing coronary artery bypass grafting in cardiac intensive care units: A single-blind, randomised controlled trial. Australian Critical Care. 2024 Jan 1;37(1):74–83. doi:10.1016/j.aucc.2023.08.003 PubMed PMID: 37802695.
20. Söylemez GK, Bulut H. The effectiveness of postoperative delirium prevention, diagnosis, and intervention protocol in patients monitored in the intensive care unit after cardiac surgery: a quasi-experimental study. BMC Nursing. 2024 Dec 1;23(1). doi:10.1186/s12912-024-02547-y
21. Zhang H, Wang Q, Feng P. Significance Analysis of the Improvement in Postoperative Recovery of Cardiac Surgery Patients Based on the Graded Management Established Using the Delirium Prediction Model. Alternative Therapies in Health and Medicine. 2025 Jan;31(1):338–42. PubMed PMID: 38607204.
22. Zhao Y, Guo S, Wang Z, Dong Y, Wei W, Su Z. Clinical investigation into risk factors for delirium post-cardiac surgery and its implications for nursing intervention guided by behavior change theory. Journal of Cardiothoracic Surgery. 2024 Dec 1;19(1). doi:10.1186/s13019-024-03021-1 PubMed PMID: 39420396.
23. Lin L, Peng Y, Huang X, Li S, Chen L, Lin Y. A family intervention to prevent postoperative delirium in patients undergoing cardiac valve surgery: A randomized controlled study. Heart & Lung. 2024 Jan;63:1–8. doi:10.1016/j.hrtlng.2023.09.002
24. Shirvani F, Naji SA, Davari E, Sedighi M. Early mobilization reduces delirium after coronary artery bypass graft surgery. Asian Cardiovascular and Thoracic Annals. 2020 Nov 5;28(9):566–71. doi:10.1177/0218492320947230
25. Zhao Q, Liu S, Zhao H, Dong L, Zhu X, Liu J. Non-pharmacological interventions to prevent and treat delirium in older people: An overview of systematic reviews. International Journal of Nursing Studies. 2023;148. doi:10.1016/j.ijnurstu.2023.104584
26. Abraha I, Trotta F, Rimland JM, Cruz-Jentoft A, Lozano-Montoya I, Soiza RL, et al. Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: A systematic overview. The SENATOR project ONTOP series. PLoS One. 2015;10(6). doi:10.1371/journal.pone.0123090
27. Vos CF, van Diem-Zaal IJ, Pop-Purceleanu M, van den Boogaard M. Prevention of delirium in the Intensive Care Unit. Nederlands Tijdschrift voor Geneeskunde [Internet]. 2023;167(28). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85165629141&partnerID=40&md5=80bb29f0bda36411f45dd4950bc9945d
28. Wang J, Lu Y, Chen X, Wu Y. Effectiveness of nurse-led non-pharmacological interventions on outcomes of delirium in adults: A meta-analysis of randomized controlled trials. Worldviews on Evidence-Based Nursing. 2024;21(5):514–27. doi:10.1111/wvn.12739
29. Bannon L, McGaughey J, Verghis R, Clarke M, McAuley DF, Blackwood B. The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis. Intensive Care Medicine. 2019;45(1). doi:10.1007/s00134-018-5452-x
30. Oliveira C, Garnacho Martins Nobre CF, Dourado Marques RM, Madureira Lebre Mendes MM, Cruz Pontífice Sousa P. O papel do enfermeiro na prevenção do delirium no paciente adulto/idoso crítico. Revista Cuidarte. 2022 Jun 23. doi:10.15649/cuidarte.1983
31. Vallés-Fructuoso O, Rodríguez-Mondéjar JJ, Alonso-Crespo D, Robleda-Font G, López-López C, Gil-Castillejos D, et al. Diez puntos clave para la prevención, monitorización y tratamiento no farmacológico del delirio en el paciente crítico. Enfermería Intensiva. 2025 Apr;36(2):100499. doi:10.1016/j.enfi.2024.05.004
32. Hirsch C. Prevention of delirium in the medical wards. In: Delirium: Prevention, Symptoms and Treatment [Internet]. 2017. p. 49–69. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85034960325&partnerID=40&md5=8925914815ff031ae1a923f023e6d38a
33. Lu L, Phua QS, Bacchi S, Goh R, Gupta AK, Kovoor JG, et al. Small Study Effects in Diagnostic Imaging Accuracy: A Meta-Analysis. JAMA Network Open. 2022;5(8):E2228776. doi:10.1001/jamanetworkopen.2022.28776
34. Evans DK, Yuan F. How Big Are Effect Sizes in International Education Studies? Educational Evaluation and Policy Analysis. 2022;44(3):532–40. doi:10.3102/01623737221079646
35. Hutchins SS, Brown C, Mayberry R, Sollecito W. Value of a small control group for estimating intervention effectiveness: Results from simulations of immunization effectiveness studies. Journal of Comparative Effectiveness Research. 2015;4(3):227–38. doi:10.2217/cer.15.11
36. Vasques C, Magalhães P, Cortinhas A, Mota P, Leitão J, Lopes VP. Effects of intervention programs on child and adolescent bmi: A meta-analysis study. Journal of Physical Activity and Health. 2014;11(2):426–44. doi:10.1123/jpah.2012-0035
37. Cordero CP, Dans AL. Key concepts in clinical epidemiology: detecting and dealing with heterogeneity in meta-analyses. Journal of Clinical Epidemiology. 2021;130:149–51. doi:10.1016/j.jclinepi.2020.09.045
38. Kanters S. Fixed- and Random-Effects Models. In: Methods in Molecular Biology [Internet]. 2022. p. 41–65. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85116115951&doi=10.1007%2f978-1-0716-1566-9_3&partnerID=40&md5=98d4c865e662807df33ce893a55b77f8 doi:10.1007/978-1-0716-1566-9_3
39. Moss W, Zhang R, Carter GC, Kwok AC. A Case for the Use of the 5-Item Modified Frailty Index in Preoperative Risk Assessment for Tissue Expander Placement in Breast Reconstruction. Annals of Plastic Surgery. 2022;89(1):23–7. doi:10.1097/SAP.0000000000002771
40. Connolly MJ, Ahmed A, Worrall A, Williams N, Sheehan S, Dowdall J, et al. Reliability of the modified Frailty Index (mFI) for intervention and continued surveillance in elective infrarenal abdominal aortic aneurysm (AAA). The Surgeon. 2023;21(4):250–5. doi:10.1016/j.surge.2022.10.002
41. Byrnes T, Woodward J. Implementing a Delirium Risk Stratification Tool and Rounds to Identify and Prevent Delirium in Hospitalized Older Adults. Journal of Nursing Care Quality. 2023;38(2):158–63. doi:10.1097/NCQ.0000000000000676
42. Ku YL, Tang MH, Chen SM, Kuo WY, Huang KT. Delirium Care by Intensive Care Unit Nurses: Focus Group Studies in a Medical Center of Southern Taiwan. Dimensions of Critical Care Nursing. 2023;42(5):255–62. doi:10.1097/DCC.0000000000000568
43. Hustad J, Johannesen B, Fossum M, Hovland OJ. Nursing students’ transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study. BMC Nursing. 2019 Dec 8;18(1):53. doi:10.1186/s12912-019-0376-5
44. Abbasinia M, Babaii A, Nadali Z, Pakzaban S, Abbasi M, Shamali M. The effects of a tailored postoperative delirium prevention intervention after coronary artery bypass graft: A randomized controlled trial. Nursing Practice Today. 2021;8(3):226-33.
https://doi.org/10.18502/npt.v8i3.5937.
2. Fu M, Yuan Q, Yang Q, Song W, Yu Y, Luo Y, et al. Risk factors and incidence of postoperative delirium after cardiac surgery in children: a systematic review and meta-analysis. Italian Journal of Pediatrics. 2024;50(1):1–16. doi:10.1186/s13052-024-01603-2 PubMed PMID: 38331831.
3. Ordóñez-Velasco L, Hernández-Leiva E. Factors associated with delirium after cardiac surgery: A prospective cohort study. Annals of Cardiac Anaesthesia. 2021;24(2):183–9. doi:10.4103/aca.ACA_43_20 PubMed PMID: 33884974.
4. Wang Y, Wang B. Risk factors of delirium after cardiac surgery: a systematic review and meta-analysis. Journal of Cardiothoracic Surgery. 2024;19(1):1–9. doi:10.1186/s13019-024-03156-1 PubMed PMID: 39707458.
5. Staicu RE, Vernic C, Ciurescu S, Lascu A, Aburel OM, Deutsch P, et al. Postoperative Delirium and Cognitive Dysfunction After Cardiac Surgery: The Role of Inflammation and Clinical Risk Factors. Diagnostics. 2025;15(7):1–20. doi:10.3390/diagnostics15070844
6. Echeverría M de LR, Schoo C, Paul M. Delirium. NCBI Bookshelf. A service of the National Library of Medicine, National Institute of Health. 2022. 3–5 p.
7. Chen H, Mo L, Hu H, Ou Y, Luo J. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. Journal of Cardiothoracic Surgery. 2021;16(1):1–11. doi:10.1186/s13019-021-01496-w PubMed PMID: 33902644.
8. Diao Y, Yu X, Zhang Q, Chen X. The predictive value of confusion assessment method‐intensive care unit and intensive care delirium screening checklist for delirium in critically ill patients in the intensive care unit: A systematic review and meta‐analysis. Nursing in Critical Care. 2024 Nov 27;29(6):1224–35. doi:10.1111/nicc.13064
9. Sahawneh F, Boss L. Non‐pharmacologic interventions for the prevention of delirium in the intensive care unit: An integrative review. Nursing in Critical Care. 2021 May 20;26(3):166–75. doi:10.1111/nicc.12594 PubMed PMID: 33474830.
10. Söylemez GK, Bulut H. The effectiveness of postoperative delirium prevention, diagnosis, and intervention protocol in patients monitored in the intensive care unit after cardiac surgery: a quasi-experimental study. BMC Nursing. 2024 Dec 18;23(1):904. doi:10.1186/s12912-024-02547-y
11. Zhang S, Han Y, Xiao Q, Li H, Wu Y. Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis*. Critical Care Medicine. 2021 Feb 16;49(2):335–46. doi:10.1097/CCM.0000000000004773 PubMed PMID: 33332818.
12. Askarkafi F, Rayyani M, Dehghan M. The Effect of Massage With and Without Aromatic Oil on Delirium After Open-Heart Surgery: A Randomized Controlled Trial. Journal of Chiropractic Medicine. 2020 Mar 1;19(1):49–57. doi:10.1016/j.jcm.2019.08.001
13. Cheng H, Ling Y, Li Q, Li X, Tang Y, Guo J, et al. Association between modified frailty index and postoperative delirium in patients after cardiac surgery: A cohort study of 2080 older adults. CNS Neuroscience & Therapeutics. 2024 Jun 1;30(6). doi:10.1111/cns.14762 PubMed PMID: 38924691.
14. Deeken F, Sánchez A, Rapp MA, Denkinger M, Brefka S, Spank J, et al. Outcomes of a Delirium Prevention Program in Older Persons after Elective Surgery: A Stepped-Wedge Cluster Randomized Clinical Trial. JAMA Surgery. 2022 Feb 1;157(2):E216370. doi:10.1001/jamasurg.2021.6370 PubMed PMID: 34910080.
15. Fazlollah A, Babatabar Darzi H, Heidaranlu E, Moradian ST. The effect of foot reflexology massage on delirium and sleep quality following cardiac surgery: A randomized clinical trial. Complementary Therapies in Medicine. 2021 Aug 1;60. doi:10.1016/j.ctim.2021.102738 PubMed PMID: 34029674.
16. Gómez Tovar LO, Henao Castaño AM. Dynamic delirium – Nursing intervention to reduce delirium in patients critically Ill, a randomized control trial. Intensive and Critical Care Nursing. 2024 Aug 1;83. doi:10.1016/j.iccn.2024.103691 PubMed PMID: 38518455.
17. Jahanbazi A, Jokar F, Kheirollahi N. The Effect of Scenario-Based Learning on the Performance of Nurses Regarding Delirium in Cardiac Surgery Intensive Care Units. Iranian Journal of Nursing and Midwifery Research. 2022 Jul;27(4):260–5. doi:10.4103/ijnmr.ijnmr_28_21
18. Milz S, Holaubek C, Siebel J, Hulde N, Wefer F, Fruend A, et al. Implementation of Evidence-Based International Recommendations Reduces Postoperative Delirium Rate in Patients Undergoing Cardiac Surgery or Interventions: A System-Based Quality Improvement Study. Reviews in Cardiovascular Medicine. 2024;25(10). doi:10.31083/j.rcm2510369
19. Shorofi SA, Dadashian P, Arbon P, Moosazadeh M. The efficacy of earplugs and eye masks for delirium severity and sleep quality in patients undergoing coronary artery bypass grafting in cardiac intensive care units: A single-blind, randomised controlled trial. Australian Critical Care. 2024 Jan 1;37(1):74–83. doi:10.1016/j.aucc.2023.08.003 PubMed PMID: 37802695.
20. Söylemez GK, Bulut H. The effectiveness of postoperative delirium prevention, diagnosis, and intervention protocol in patients monitored in the intensive care unit after cardiac surgery: a quasi-experimental study. BMC Nursing. 2024 Dec 1;23(1). doi:10.1186/s12912-024-02547-y
21. Zhang H, Wang Q, Feng P. Significance Analysis of the Improvement in Postoperative Recovery of Cardiac Surgery Patients Based on the Graded Management Established Using the Delirium Prediction Model. Alternative Therapies in Health and Medicine. 2025 Jan;31(1):338–42. PubMed PMID: 38607204.
22. Zhao Y, Guo S, Wang Z, Dong Y, Wei W, Su Z. Clinical investigation into risk factors for delirium post-cardiac surgery and its implications for nursing intervention guided by behavior change theory. Journal of Cardiothoracic Surgery. 2024 Dec 1;19(1). doi:10.1186/s13019-024-03021-1 PubMed PMID: 39420396.
23. Lin L, Peng Y, Huang X, Li S, Chen L, Lin Y. A family intervention to prevent postoperative delirium in patients undergoing cardiac valve surgery: A randomized controlled study. Heart & Lung. 2024 Jan;63:1–8. doi:10.1016/j.hrtlng.2023.09.002
24. Shirvani F, Naji SA, Davari E, Sedighi M. Early mobilization reduces delirium after coronary artery bypass graft surgery. Asian Cardiovascular and Thoracic Annals. 2020 Nov 5;28(9):566–71. doi:10.1177/0218492320947230
25. Zhao Q, Liu S, Zhao H, Dong L, Zhu X, Liu J. Non-pharmacological interventions to prevent and treat delirium in older people: An overview of systematic reviews. International Journal of Nursing Studies. 2023;148. doi:10.1016/j.ijnurstu.2023.104584
26. Abraha I, Trotta F, Rimland JM, Cruz-Jentoft A, Lozano-Montoya I, Soiza RL, et al. Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: A systematic overview. The SENATOR project ONTOP series. PLoS One. 2015;10(6). doi:10.1371/journal.pone.0123090
27. Vos CF, van Diem-Zaal IJ, Pop-Purceleanu M, van den Boogaard M. Prevention of delirium in the Intensive Care Unit. Nederlands Tijdschrift voor Geneeskunde [Internet]. 2023;167(28). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85165629141&partnerID=40&md5=80bb29f0bda36411f45dd4950bc9945d
28. Wang J, Lu Y, Chen X, Wu Y. Effectiveness of nurse-led non-pharmacological interventions on outcomes of delirium in adults: A meta-analysis of randomized controlled trials. Worldviews on Evidence-Based Nursing. 2024;21(5):514–27. doi:10.1111/wvn.12739
29. Bannon L, McGaughey J, Verghis R, Clarke M, McAuley DF, Blackwood B. The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis. Intensive Care Medicine. 2019;45(1). doi:10.1007/s00134-018-5452-x
30. Oliveira C, Garnacho Martins Nobre CF, Dourado Marques RM, Madureira Lebre Mendes MM, Cruz Pontífice Sousa P. O papel do enfermeiro na prevenção do delirium no paciente adulto/idoso crítico. Revista Cuidarte. 2022 Jun 23. doi:10.15649/cuidarte.1983
31. Vallés-Fructuoso O, Rodríguez-Mondéjar JJ, Alonso-Crespo D, Robleda-Font G, López-López C, Gil-Castillejos D, et al. Diez puntos clave para la prevención, monitorización y tratamiento no farmacológico del delirio en el paciente crítico. Enfermería Intensiva. 2025 Apr;36(2):100499. doi:10.1016/j.enfi.2024.05.004
32. Hirsch C. Prevention of delirium in the medical wards. In: Delirium: Prevention, Symptoms and Treatment [Internet]. 2017. p. 49–69. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85034960325&partnerID=40&md5=8925914815ff031ae1a923f023e6d38a
33. Lu L, Phua QS, Bacchi S, Goh R, Gupta AK, Kovoor JG, et al. Small Study Effects in Diagnostic Imaging Accuracy: A Meta-Analysis. JAMA Network Open. 2022;5(8):E2228776. doi:10.1001/jamanetworkopen.2022.28776
34. Evans DK, Yuan F. How Big Are Effect Sizes in International Education Studies? Educational Evaluation and Policy Analysis. 2022;44(3):532–40. doi:10.3102/01623737221079646
35. Hutchins SS, Brown C, Mayberry R, Sollecito W. Value of a small control group for estimating intervention effectiveness: Results from simulations of immunization effectiveness studies. Journal of Comparative Effectiveness Research. 2015;4(3):227–38. doi:10.2217/cer.15.11
36. Vasques C, Magalhães P, Cortinhas A, Mota P, Leitão J, Lopes VP. Effects of intervention programs on child and adolescent bmi: A meta-analysis study. Journal of Physical Activity and Health. 2014;11(2):426–44. doi:10.1123/jpah.2012-0035
37. Cordero CP, Dans AL. Key concepts in clinical epidemiology: detecting and dealing with heterogeneity in meta-analyses. Journal of Clinical Epidemiology. 2021;130:149–51. doi:10.1016/j.jclinepi.2020.09.045
38. Kanters S. Fixed- and Random-Effects Models. In: Methods in Molecular Biology [Internet]. 2022. p. 41–65. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85116115951&doi=10.1007%2f978-1-0716-1566-9_3&partnerID=40&md5=98d4c865e662807df33ce893a55b77f8 doi:10.1007/978-1-0716-1566-9_3
39. Moss W, Zhang R, Carter GC, Kwok AC. A Case for the Use of the 5-Item Modified Frailty Index in Preoperative Risk Assessment for Tissue Expander Placement in Breast Reconstruction. Annals of Plastic Surgery. 2022;89(1):23–7. doi:10.1097/SAP.0000000000002771
40. Connolly MJ, Ahmed A, Worrall A, Williams N, Sheehan S, Dowdall J, et al. Reliability of the modified Frailty Index (mFI) for intervention and continued surveillance in elective infrarenal abdominal aortic aneurysm (AAA). The Surgeon. 2023;21(4):250–5. doi:10.1016/j.surge.2022.10.002
41. Byrnes T, Woodward J. Implementing a Delirium Risk Stratification Tool and Rounds to Identify and Prevent Delirium in Hospitalized Older Adults. Journal of Nursing Care Quality. 2023;38(2):158–63. doi:10.1097/NCQ.0000000000000676
42. Ku YL, Tang MH, Chen SM, Kuo WY, Huang KT. Delirium Care by Intensive Care Unit Nurses: Focus Group Studies in a Medical Center of Southern Taiwan. Dimensions of Critical Care Nursing. 2023;42(5):255–62. doi:10.1097/DCC.0000000000000568
43. Hustad J, Johannesen B, Fossum M, Hovland OJ. Nursing students’ transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study. BMC Nursing. 2019 Dec 8;18(1):53. doi:10.1186/s12912-019-0376-5
44. Abbasinia M, Babaii A, Nadali Z, Pakzaban S, Abbasi M, Shamali M. The effects of a tailored postoperative delirium prevention intervention after coronary artery bypass graft: A randomized controlled trial. Nursing Practice Today. 2021;8(3):226-33.
https://doi.org/10.18502/npt.v8i3.5937.
| Issue | Articles in Press | |
| Section | Review Article(s) | |
| Keywords | ||
| delirium; cardiac surgical procedures; nursing care; critical care; systematic review; meta-analysis | ||
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How to Cite
1.
Saputra D, Luthfi M, Makruf H. Effectiveness of nurse-implemented nonpharmacologic interventions on delirium incidence in cardiac surgical ICU patients: A systematic review and meta-analysis. Nurs. pract. today. 2026;:X-X.
