Effects of narrative nursing on delirium and outcomes in mechanically ventilated ICU patients: a randomized trial

To evaluate whether a structured narrative nursing intervention reduces the incidence and duration of delirium, improves clinical outcomes, and increases patient satisfaction in mechanically ventilated intensive care unit (ICU) patients.

In this single-center, randomized controlled trial, 88 mechanically ventilated ICU patients were randomly assigned, by a computer-generated sequence, to an intervention group (n = 44) or a control group (n = 44). The control group received standard ICU care. In addition to standard care, the intervention group received a daily 30-min structured narrative nursing session throughout the period of mechanical ventilation. The intervention comprised four components: externalization of problems, deconstruction, re-authoring, and witnessing. The primary outcome was delirium incidence, assessed with the Confusion Assessment Method for the ICU (CAM-ICU). Secondary outcomes included ICU length of stay, duration of mechanical ventilation, ICU mortality, patient satisfaction, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. As this study evaluated standard nursing care interventions without the use of investigational drugs or devices, prospective clinical trial registration was not required.

The overall incidence of delirium was significantly lower in the intervention group compared with the control group (34.1% vs. 63.6%, P < 0.001), with the most pronounced reduction observed in hypoactive delirium (20.5% vs. 40.9%, P = 0.02). Both the onset and duration of delirium were markedly shortened in the intervention group (P < 0.05). Compared with controls, patients receiving narrative nursing exhibited shorter ICU stays and fewer days on mechanical ventilation (P < 0.05), a reduced ICU mortality rate (6.8% vs. 22.7%, P = 0.035), lower SOFA scores (P = 0.019), and significantly higher nursing satisfaction (P < 0.001). Multivariable logistic regression identified narrative nursing as an independent protective factor against delirium (OR = 0.27, 95% CI: 0.10-0.70, P = 0.008). Subgroup analysis by age demonstrated that the protective effect was particularly evident in older patients (≥65 years), where the intervention markedly reduced the risk of delirium (OR = 0.13, 95% CI: 0.04-0.48, P = 0.002). In contrast, among younger patients, the main benefit was reflected in improved satisfaction with nursing care.

A structured narrative nursing intervention reduced the incidence and duration of delirium among mechanically ventilated ICU patients, improved selected clinical outcomes, and increased patient satisfaction. Limitations include the single-center design, modest sample size, and limited blinding, which may introduce bias. Multicenter, adequately powered, prospectively registered randomized trials are warranted to confirm these findings.