Prioritizing delirium risk factors in nursing: a cross-sectional study using the analytic hierarchy process

Delirium is a complex neuropsychiatric syndrome characterized by acute and fluctuating disturbances in attention, cognition, and consciousness. Despite its significant impact on patient outcomes, a gap persists between clinical practice and evidence-based approaches for delirium prevention and management. This study aims to systematically explore nurses' perceptions of delirium risk factors, identify which factors they prioritize, and examine the reasoning behind their prioritization using the Analytic Hierarchy Process (AHP). By addressing these objectives, this study identified potential knowledge gaps in delirium prevention while examining the contributions and challenges of applying the AHP method in prioritizing delirium risk factors.

A cross-sectional study was conducted with 234 nurses from five academic hospitals in Türkiye. Delirium risk factors were categorized into four main categories through the consensus of a panel of six experts with experience in delirium care and research. These finalized categories were used to develop an Analytic Hierarchy Process (AHP) questionnaire, enabling nurses to perform pairwise comparisons of the risk factors. Data collected through the AHP questionnaire were analysed using MATLAB software, and Consistency Ratios (CR) were calculated to ensure the reliability of the responses.

Nurses identified age > 65 (GW = 0.161), noisy hospital environment where patient stays (GW = 0.077), patient living alone (GW = 0.064), insufficient interaction with patient's relatives or caregivers (GW = 0.046), admission to intensive care unit following emergency surgery or physical trauma (GW = 0.041) and admission due to surgery (GW = 0.041) as significant risk factors. Other factors such as anemia (GW = 0.006), vision and/or hearing impairment (GW = 0.009), existing cardiovascular disorder (e.g., hypertension) (GW = 0.01) and patient being in a coma or medically induced coma (GW = 0.01) ranked lower. Over half of the nurses prioritized psychological causes, citing fear, anxiety, and stress as significant contributors to delirium.

The study reveals significant discrepancies between nurses' prioritization of delirium risk factors and established evidence. Psychological causes were emphasized over organic factors, highlighting potential knowledge gaps and challenges in delirium recognition. By applying the AHP methodology, this study provides reliable insights into nurses' perspectives on delirium risk factors. These findings can guide future educational programs and policy interventions to bridge gaps between evidence-based practices and clinical application, ultimately improving delirium prevention strategies in healthcare settings. Furthermore, this study underscores the contributions and challenges of employing the AHP method to prioritize delirium risk factors, providing valuable insights and methodological guidance for researchers seeking to adopt this approach in nursing studies.

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