Tehran University of Medical Sciences Nursing Practice Today 2383-1154 0 0 2026 06 09 4550 4550 Dikki Saputra Department of Nursing, Faculty of Medicine, Universitas Tanjungpura, Indonesia Muhammad Luthfi Department of Nursing, Faculty of Medicine, Universitas Tanjungpura, Indonesia Hafizul Makruf Sekolah Tinggi Ilmu Kesehatan Medika Seramoe Barat, Meulaboh, Indonesia 2025 10 02 2026 04 13 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. https://npt.tums.ac.ir/index.php/npt/article/view/4550