Research paper|Articles in Press

Psychological stress and associated factors in caring for patients with delirium among intensive care unit nurses: A cross-sectional study

Published:November 09, 2022DOI:



      Caring for patients with delirium is challenging and overwhelming for intensive care unit (ICU) nurses. Investigating the psychological impact of delirium care on ICU nurses is crucial to maintaining their psychological health and improving the quality of care.


      The objective of this study was to investigate the psychological stress of ICU nurses in caring for patients with delirium and potential factors.


      A total of 355 nurses from three tertiary care hospitals in Hunan Province, China, participated in this cross-sectional survey. Data were collected using the demographic sheet, Impact of Event Scale-Revised, Connor-Davidson Resilience Scale, and Occupational Coping Self-Efficacy Scale for Nurses. Descriptive and multiple linear regression analyses were used to examine the factors associated with psychological stress.


      ICU nurses suffered moderate psychological stress related to delirium care. The recent time to care for patients with delirium (P < 0.001), familiarity with delirium-related knowledge (P = 0.002), satisfaction with delirium-related support (P = 0.046), psychological resilience (P < 0.001), and occupational coping self-efficacy (P < 0.001) were significant contributors to psychological stress.


      Nurse managers and researchers need to focus on the psychological well-being of ICU nurses in caring for patients with delirium, especially those who are currently caring for patients with delirium, and provide tailored support, increase their knowledge of delirium, and also boost psychological resilience and coping skills.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Australian Critical Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Psychiatric Association DSM-Task Force
        Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.).
        Codas. 2013; 25: 191
        • Oh E.S.
        • Fong T.G.
        • Hshieh T.T.
        • Inouye S.K.
        Delirium in older persons: advances in diagnosis and treatment.
        JAMA. 2017; 318: 1161-1174
        • Wilson J.E.
        • Mart M.F.
        • Cunningham C.
        • Shehabi Y.
        • Girard T.D.
        • MacLullich A.M.J.
        • et al.
        Nat Rev Dis Primers. 2020; 6: 90
        • Witlox J.
        • Eurelings L.S.
        • de Jonghe J.F.
        • Kalisvaart K.J.
        • Eikelenboom P.
        • van Gool W.A.
        Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis.
        JAMA. 2010; 304: 443-451
        • Qi Z.
        • Yang S.
        • Qu J.
        • Li M.
        • Zheng J.
        • Huang R.
        • et al.
        Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: a systematic review and meta-analysis.
        Aust Crit Care. 2021; 34: 278-286
        • Unal N.
        • Guvenc G.
        • Naharci M.
        Evaluation of the effectiveness of delirium prevention care protocol for the patients with hip fracture: a randomised controlled study.
        J Clin Nurs. 2022; 31: 1082-1094
        • Tan C.M.
        • Camargo M.
        • Miller F.
        • Ross K.
        • Maximous R.
        • Yung P.
        • et al.
        Impact of a nurse engagement intervention on pain, agitation and delirium assessment in a community intensive care unit.
        BMJ Open Qual. 2019; 8e000421
        • Thomas N.
        • Coleman M.
        • Terry D.
        Nurses' experience of caring for patients with delirium: systematic review and qualitative evidence synthesis.
        Nurs Rep. 2021; 11: 164-174
        • LeBlanc A.
        • Bourbonnais F.F.
        • Harrison D.
        • Tousignant K.
        The experience of intensive care nurses caring for patients with delirium: a phenomenological study.
        Intensive Crit Care Nurs. 2018; 44: 92-98
        • Yue P.
        • Wang L.
        • Liu C.
        • Wu Y.
        A qualitative study on experience of nurses caring for patients with delirium in ICUs in China: barriers, burdens and decision making dilemmas.
        Int J Nurs Sci. 2015; 2: 2-8
        • Boehm L.M.
        • Jones A.C.
        • Selim A.A.
        • Virdun C.
        • Garrard C.F.
        • Walden R.L.
        • et al.
        Delirium-related distress in the ICU: a qualitative meta-synthesis of patient and family perspectives and experiences.
        Int J Nurs Stud. 2021; 122104030
        • Williams S.T.
        • Dhesi J.K.
        • Partridge J.S.L.
        Distress in delirium: causes, assessment and management.
        Eur Geriatr Med. 2020; 11: 63-70
        • Folkman S.
        • Lazarus R.S.
        • Gruen R.J.
        • DeLongis A.
        Appraisal, coping, health status, and psychological symptoms.
        J Pers Soc Psychol. 1986; 50: 571-579
        • Weiss D.S.
        The impact of event scale: revised.
        in: Wilson J.P. Tang C.Sk Cross-cultural assessment of psychological trauma and PTSD. International and cultural psychology series. Springer, Boston, MA2007
        • Wu K.K.
        • Chan K.S.
        The development of the Chinese version of impact of event scale--revised (CIES-R).
        Soc Psychiatr Psychiatr Epidemiol. 2003; 38: 94-98
        • Li J.
        • Su Q.
        • Li X.
        • Peng Y.
        • Liu Y.
        COVID-19 negatively impacts on psychological and somatic status in frontline nurses.
        J Affect Disord. 2021; 294: 279-285
        • Ji Z.
        • Han W.
        • Deng Z.
        • Lu K.
        Distress, appraisal, and coping among the frontline healthcare provider redeployed to the epicenter in China during COVID-19 pandemic.
        Front Psychol. 2021; 12678369
        • Lai J.
        • Ma S.
        • Wang Y.
        • Cai Z.
        • Hu J.
        • Wei N.
        • et al.
        Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.
        JAMA Netw Open. 2020; 3e203976
        • Connor K.M.
        • Davidson J.R.
        Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC).
        Depress Anxiety. 2003; 18: 76-82
        • Yu X.
        • Zhang J.
        Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale (CD-RISC) with Chinese people.
        SBP (Soc Behav Pers). 2007; 35: 19-30
        • Pisanti R.
        • Lombardo C.
        • Lucidi F.
        • Lazzari D.
        • Bertini M.
        Development and validation of a brief occupational coping self-efficacy questionnaire for nurses.
        J Adv Nurs. 2008; 62: 238-247
        • Zhai Y.X.
        • Chai X.Y.
        • Liu K.
        • Meng L.D.
        The reliability and validity of the professional coping self-efficacy scale for nurses in Chinese[J].
        Mod Prev Med. 2021; 48 ([in Chinese]): 423-442
        • Krewulak K.D.
        • Stelfox H.T.
        • Leigh J.P.
        • Ely E.W.
        • Fiest K.M.
        Incidence and prevalence of delirium subtypes in an adult ICU: a systematic review and meta-analysis.
        Crit Care Med. 2018; 46: 2029-2035
        • Semple D.
        • Howlett M.M.
        • Strawbridge J.D.
        • Breatnach C.V.
        • Hayden J.C.
        A systematic review and pooled prevalence of delirium in critically ill children.
        Crit Care Med. 2022; 50: 317-328
        • Mattison M.L.P.
        Ann Intern Med. 2020; 173: ITC49-ITC64
        • Helms J.
        • Kremer S.
        • Merdji H.
        • Schenck M.
        • Severac F.
        • Clere-Jehl R.
        • et al.
        Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients.
        Crit Care. 2020; 24: 491
        • Pun B.T.
        • Badenes R.
        • Heras La Calle G.
        • Orun O.M.
        • Chen W.
        • Raman R.
        • et al.
        Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study.
        Lancet Respir Med. 2021; 9: 239-250
        • Zamoscik K.
        • Godbold R.
        • Freeman P.
        Intensive care nurses' experiences and perceptions of delirium and delirium care.
        Intensive Crit Care Nurs. 2017; 40: 94-100
        • Al Sabei S.D.
        • Al-Rawajfah O.
        • AbuAlRub R.
        • Labrague L.J.
        • Burney I.A.
        Nurses' job burnout and its association with work environment, empowerment and psychological stress during COVID-19 pandemic.
        Int J Nurs Pract. 2022; e13077
        • Labrague L.J.
        • De Los Santos J.A.A.
        • Falguera C.C.
        • Nwafor C.E.
        • Galabay J.R.
        • Rosales R.A.
        • et al.
        Predictors of nurses' turnover intention at one and five years' time.
        Int Nurs Rev. 2020; 67: 191-198
        • Roh Y.S.
        The training needs of Korean intensive care unit nurses regarding delirium.
        Intensive Crit Care Nurs. 2021; 62102954
        • Ho M.H.
        • Chang H.R.
        • Liu M.F.
        • Chen K.H.
        • Shen Hsiao S.T.
        • Traynor V.
        Recognizing intensive care unit delirium: are critical care nurses ready?.
        J Nurs Res. 2022; 30: e214
        • Lee G.
        • Roh Y.S.
        Knowledge, barriers, and training needs of nurses working in delirium care.
        Nurs Crit Care. 2021;
        • Trogrlić Z.
        • Ista E.
        • Ponssen H.H.
        • Schoonderbeek J.F.
        • Schreiner F.
        • Verbrugge S.J.
        • et al.
        Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals.
        Nurs Crit Care. 2017; 22: 133-140
        • Fletcher D.
        • Sarkar M.
        Psychological resilience: a review and critique of definitions, concepts, and theory.
        Eur Psychol. 2013; 18: 12-23
        • Guo Y.F.
        • Luo Y.H.
        • Lam L.
        • Cross W.
        • Plummer V.
        • Zhang J.P.
        Burnout and its association with resilience in nurses: a cross-sectional study.
        J Clin Nurs. 2018; 27: 441-449
        • Karabulak H.
        • Kaya F.
        The relationship between psychological resilience and stress perception in nurses in Turkey during the COVID-19 pandemic.
        J Nurs Res. 2021; 29: e175