Risk of delirium as a diagnosis proposal: An integrative review

Authors

DOI:

https://doi.org/10.12957/reuerj.2025.93984

Keywords:

Nursing, Delirium, Nursing Process, Nursing Diagnosis, Risk Factors

Abstract

Objective: to identify risk factors for developing delirium and to present them as human response elements. Method: an integrative literature review presenting the risk factors as human response elements according to the NANDA International Diagnosis Classification taxonomy. The search strategy was applied in six databases, yielding 31 articles. Results: the concept of susceptibility to delirium as a human response was identified, as well as its 34 risk factors, classified into 12 risk factors related to independent actions by nurses, three at-risk populations and 19 associated conditions, configuring the presentation of this susceptibility as a risk Nursing diagnosis. Conclusion: the risk factors identified were presented as elements inherent to the patients' susceptibility to developing delirium, creating the “Risk of delirium” Nursing diagnosis proposal. This study may contribute to accuracy in nurses diagnosing such human response, collaborating to care quality.

Author Biographies

Luciana Aparecida Costa Carvalho, Universidade Estadual de Campinas

Nurse. PhD student. Universidade Estadual de Campinas. Campinas, SP, Brazil.

Marisa Dibbern Lopes Correia, Universidade Federal de Viçosa

Nurse. PhD. Associate Professor at Universidade Federal de Viçosa, Viçosa, MG, Brazil.

Gabrielle Martins da Silva, Universidade de São Paulo

Nurse. Obstetric Nursing resident. Universidade de São Paulo, São Paulo, Brazil.

Raisa Camilo Ferreira, Universidade Estadual de Campinas

Nurse. Post-PhD researcher. Universidade Estadual de Campinas, Campinas, SP, Brazil.

Micnéias Lacerda Botelho, Universidade Federal do Mato Grosso

Nurse. PhD in Nursing. Universidade Federal do Mato Grosso, Sinop, MT, Brazil.

Érika Christiane Marocco Duran, Universidade Estadual de Campinas

Nurse. Full Professor. Universidade Estadual de Campinas, Campinas, SP, Brazil.

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental dispordes: DSM-5-TR. 5th ed. text rev. Washington (DC): American Psychiatric Association; 2022.

2. Dalgalarrondo P. Psicopatologia e semiologia dos transtornos mentais. 3rd ed. Porto Alegre: Artmed; 2018. 520 p.

3. Smith CJ, Hodge D, Harrison FE, Williams Roberson S. The pathophysiology and biomarkers of delirium. Semin Neurol. 2024 [cited 2025 Aug 19]; 44(6):720-31. DOI: https://doi.org/10.1055/s-0044-1791666.

4. Igwe EO, Nealon J, O'Shaughnessy P, Bowden A, Chang HR, Ho MH, et al. Incidence of postoperative delirium in older adults undergoing surgical procedures: a systematic literature review and meta-analysis. Worldviews Evid Based Nurs. 2023 [cited 2025 Aug 19]; 20(3):220-37. DOI: https://doi.org/10.1111/wvn.12649.

5. Williams EC, Estime S, Kuza CM. Delirium in trauma ICUs: a review of incidence, risk factors, outcomes, and management. Curr Opin Anaesthesiol. 2023 [cited 2025 Aug 19]; 36(2):137-46. DOI: https://doi.org/10.1097/ACO.0000000000001233.

6. Contreras CCT, Páez-Esteban AN, Rincon-Romero MK, Carvajal RR, Herrera MM, Castillo AHDD. Nursing intervention to prevent delirium in critically ill adults. Rev Esc Enferm USP. 2021 [cited 2025 Aug 19]; 55:e03685. DOI: https://doi.org/10.1590/S1980-220X2019035003685.

7. Conselho Federal de Enfermagem. Resolução COFEN n. 736, de 17 de janeiro de 2024. Dispõe sobre a implementação do processo de enfermagem em todo contexto socioambiental onde ocorre o cuidado de enfermagem. Brasília (DF): COFEN; 2024 [cited 2025 Aug 19]. Available from: https://www.cofen.gov.br/resolucao-cofen-no-736-de-17-de-janeiro-de-2024.

8. Herdman HT, et al. NANDA International, Inc. Nursing diagnoses: definitions and classification 2024-2026. 13th ed. Harrisburg: NANDA International; 2024.

9. Pompeo DA, Rossi LA, Galvão CM. Integrative literature review: the initial step in the validation process of nursing diagnoses. Acta Paul Enferm. 2009 [cited 2025 Aug 19]; 22(4):434-38. DOI: https://doi.org/10.1590/S0103-21002009000400014.

10. Bulechek GM, Butcher HK, Dochterman J, Wagner CM. Classificação das intervenções de enfermagem - NIC. 7th ed. Rio de Janeiro: GEN Guanabara Koogan; 2020. 440 p.

11. Ursi ES, Galvão CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura. Rev Lat Am Enfermagem. 2006 [cited 2025 Aug 19]; 14(1):124-31. DOI: https://doi.org/10.1590/S0104-11692006000100017.

12. Stillwell SB, Overholt EF, Melnyk BM, Williamson KM. Evidence-based practice, step by step: searching for the evidence. Am J Nurs. 2010 [cited 2025 Aug 19]; 110(5):41-47. DOI: https://doi.org/10.1097/01.NAJ.0000372071.24134.7e.

13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 [cited 2025 Aug 19]; 372:n71. DOI: https://doi.org/10.1186/s13643-021-01626-4.

14. Bulut A, Yilmaz BE, Yurksel A. evaluating the risk of delirium in elderly inpatients in COVID-19 intensive care: a prospective and observational study. Turk J Geriatr. 2024 [cited 2025 Nov 1]; 27(1):68-78. DOI: https://doi.org/10.29400/tjgeri.2024.380.

15. Kim MS, Kim SH. Risk factors for postoperative delirium in patients with cardiac surgery. Sci Prog. 2024 [cited 2025 Nov 1]; 107(3):368504241266362. DOI: https://doi.org/10.1177/00368504241266362.

16. Cheng J, Lao Y, Chen X, Qiao X, Sui W, Gong X, et al Dynamic nomogram for subsyndromal delirium in adult intensive care unit: a prospective cohort study. Neuropsychiatr Dis Treat. 2023 Nov 22; 19:2535-48. DOI: https://doi.org/10.2147/ndt.s432776. Erratum in: Neuropsychiatr Dis Treat. 2023 [cited 2025 Nov 1]; 19:2755-2756. DOI: https://doi.org/10.2147/NDT.S453349.

17. Igwe EO, Ding P, Charlton KE, Nealon J, Traynor V. Association between Malnutrition and delirium in older chronic kidney disease patients admitted to intensive care units: a data linkage study. J Nutr Health Aging. 2023 [cited 2025 Nov 1]; 27(7):571-7. DOI: https://doi.org/10.1007/s12603-023-1938-5 .

18. Lee JH, Han WH, Chun JY, Choi YJ, Han MR, Kim JH. Delirium in patients with COVID-19 treated in the intensive care unit. PLoS One. 2023 [cited 2025 Nov 1]; 18(11):e0289662. DOI: https://doi.org/10.1371/journal.pone.0289662.

19. Wilson LD, Maiga AW, Lombardo S, Nordness MF, Haddad DN, Rakhit S, Smith LF, et al. Prevalence and Risk Factors for Intensive Care Unit Delirium After Traumatic Brain Injury: A Retrospective Cohort Study. Neurocrit Care. 2023 [cited 2025 Nov 1]; 38(3):752-60. DOI: https://doi.org/10.1007/s12028-022-01666-1.

20. Carvalho LAC, Correia MDL, Ferreira RC, Botelho ML, Ribeiro E, Duran ECM. Accuracy of delirium risk factors in adult intensive care unit patients. Rev Esc Enferm USP. 2022 [cited 2025 Nov 1]; 56:e20210222. DOI: https://doi.org/10.1590/1980-220X-REEUSP-2021-0222.

21. Pinheiro FGMS, Santos ES, Barreto DC, Weiss C, Oliveira JC, Vaez AC, Silva FA. Prevalência e fatores de risco associados ao delirium em uma unidade de terapia intensiva. Acta Paul Enferm 2022 [cited 2025 Nov 1]; 35:eAPE00646. DOI: https://doi.org/10.37689/acta-ape/2022AO006466.

22. Gholi Z, Yadegarynia D, Eini-Zinab H, Vahdat Shariatpanahi Z. Vitamin D deficiency is associated with increased risk of delirium and mortality among critically ill, elderly Covid-19 patients. Complement Ther Med. 2022 Nov [cited 2025 Nov 1]; 70:102855. DOI: https://doi.org/10.1016/j.ctim.2022.102855.

23. Hulde N, Zittermann A, Tigges-Limmer K, Koster A, Weinrautner N, Gummert J, et al. preoperative risk factors and early outcomes of delirium in valvular open-heart surgery. Thorac Cardiovasc Surg. 2022 Oct [cited 2025 Nov 1]; 70(7):558-65. DOI: https://doi.org/10.1055/s-0041-1740984

24. Abraham MP, Hinds M, Tayidi I, Jeffcoach DR, Corder JM, Hamilton LA, et al. Quetiapine for delirium prophylaxis in high-risk critically ill patients. Surgeon. 2021 [cited 2025 Nov 1]; 19(2):65-71. DOI: https://doi.org/10.1016/j.surge.2020.02.002.

25. Matioli KBB, Moraes Filho IM, Sousa TV, Pereira M, Silva RM, Sá ES, et al . Delirium: prevalence and factors associated with the postoperative period of cardiovascular surgery in the elderly. Rev. baiana enferm. 2021 [cited 2025 Nov 1]; 35:e42203. DOI: http://dx.doi.org/10.18471/rbe.v35.42203.

26. Jäckel M, Aicher N, Rilinger J, Bemtgen X, Widmeier E, Wengenmayer T, et al. Incidence and predictors of delirium on the intensive care unit in patients with acute kidney injury, insight from a retrospective registry. Sci Rep. 2021 [cited 2025 Nov 1]; 11(1):17260. DOI: https://doi.org/10.1038/s41598-021-96839-x.

27. Oh TK, Park HY, Song IA. Factors associated with delirium among survivors of acute respiratory distress syndrome: a nationwide cohort study. BMC Pulm Med. 2021 [cited 2025 Nov 1]; 21(1):341. DOI: https://doi.org/10.1186/s12890-021-01714-0.

28. Pun BT, Badenes R, Heras La Calle G, Orun OM, 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(3):239-50. DOI: https://doi.org/10.1016/s2213-2600(20)30552-x. Erratum in: Lancet Respir Med. 2021 [cited 2025 Nov 1]; 9(3):e29. DOI: https://doi.org/10.1016/S2213-2600(21)00047-3.

29. Wu Z, Li H, Liao K, Wang Y. Association between dexamethasone and delirium in critically ill patients: a retrospective cohort study of a large clinical database. J Surg Res. 2021 [cited 2025 Nov 1]; 263:89-101. DOI: https://doi.org/10.1016/j.jss.2021.01.027.

30. Abdelrahman I, Vieweg R, Irschik S, Steinvall I, Sjöberg F, Elmasry M. Development of delirium: association with old age, severe burns, and intensive care. Burns. 2020 [cited 2025 Nov 1]; 46(4):797-803. DOI: https://doi.org/10.1016/j.burns.2020.02.013.

31. Cai S, Zhang X, Pan W, Latour JM, Zheng J, Zhong J, et al. Prevalence, predictors, and early outcomes of post-operative delirium in patients with type a aortic dissection during intensive care unit stay. Front Med (Lausanne). 2020 [cited 2025 Nov 1]; 7:572581. DOI: https://doi.org/10.3389/fmed.2020.572581.

32. Yamamoto T, Mizobata Y, Kawazoe Y, Miyamoto K, Ohta Y, Morimoto T, Yamamura H. Incidence, risk factors, and outcomes for sepsis-associated delirium in patients with mechanical ventilation: a sub-analysis of a multicenter randomized controlled trial. J Crit Care. 2020 [cited 2025 Nov 1]; 56:140-44. DOI: https://doi.org/10.1016/j.jcrc.2019.12.018.

33. Green C, Bonavia W, Toh C, Tiruvoipati R. Prediction of ICU delirium: validation of current delirium predictive models in routine clinical practice. Crit Care Med. 2019 [cited 2025 Nov 1]; 47(3):428-435. DOI: https://doi.org/10.1097/CCM.0000000000003577.

34. Pan Y, Yan J, Jiang Z, Luo J, Zhang J, Yang K. Incidence, risk factors, and cumulative risk of delirium among ICU patients: a case-control study. Int J Nurs Sci. 2019 [cited 2025 Nov 1]; 6(3):247-51. DOI: https://doi.org/10.1016/j.ijnss.2019.05.008.

35. 34.Guo Z, Liu J, Li J, Wang X, Guo H, Ma P, Su X, Li P. Postoperative delirium in severely burned patients undergoing early escharotomy: incidence, risk factors, and outcomes. J Burn Care Res. 2017 [cited 2025 Nov 1]; 38(1):e370-6. DOI: https://doi.org/10.1097/BCR.0000000000000397.

36. Kumar AK, Jayant A, Arya VK, Magoon R, Sharma R. Delirium after cardiac surgery: a pilot study from a single tertiary referral center. Ann Card Anaesth. 2017; 20(1):76-82. DOI: https://doi.org/10.4103/0971-9784.197841. Erratum in: Ann Card Anaesth. 2017 [cited 2025 Nov 1]; 20(2):281. DOI: https://doi.org/10.4103/0971-9784.201631.

37. 36.Mehta S, Cook D, Devlin JW, Skrobik Y, Meade M, Fergusson D. Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015 [cited 2025 Nov 1]; 43(3):557-66. DOI: https://doi.org/10.1097/CCM.0000000000000727.

38. Pipanmekaporn T, Chittawatanarat K, Chaiwat O, Thawitsri T, Wacharasint P, Kongsayreepong S; et al. Incidence and risk factors of delirium in multi-center Thai surgical intensive care units: a prospective cohort study. J Intensive Care. 2015 [cited 2025 Nov 1]; 3:53. DOI: https://doi.org/10.1186/s40560-015-0118-z.

39. Smith PJ, Rivelli SK, Waters AM, Hoyle A, Durheim MT, Reynolds JM, et al, Blumenthal JA. Delirium affects length of hospital stay after lung transplantation. J Crit Care. 2015 [cited 2025 Nov 1]; 30(1):126-9. DOI: https://doi.org/10.1016/j.jcrc.2014.09.010.

40. Limpawattana P, Panitchote A, Tangvoraphonkchai K, Suebsoh N, Eamma W, Chanthonglarng B, et al. Delirium in critical care: a study of incidence, prevalence, and associated factors in the tertiary care hospital of older Thai adults. Aging Ment Health. 2016 [cited 2025 Nov 1]; 20(1):74-80. DOI: https://doi.org/10.1080/13607863.2015.1035695.

41. Whitlock EL, Torres BA, Lin N, Helsten DL, Nadelson MR, Mashour GA, et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg. 2014 [cited 2025 Nov 1]; 118(4):809-17. DOI: https://doi.org/10.1213/ANE.0000000000000028.

42. Zhang Z, Pan L, Deng H, Ni H, Xu X. Prediction of delirium in critically ill patients with elevated C-reactive protein. J Crit Care. 2014 [cited 2025 Nov 1]; 29(1):88-92. DOI: https://doi.org/10.1016/j.jcrc.2013.09.002.

43. Guenther U, Theuerkauf N, Frommann I, Brimmers K, Malik R, Stori S, et al. Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study. Ann Surg. 2013 [cited 2025 Nov 1]; 257(6):1160-7. DOI: https://doi.org/10.1097/SLA.0b013e318281b01c.

44. Norkienė I, Ringaitienė D, Kuzminskaitė V, Šipylaitė J. Incidence and risk factors of early delirium after cardiac surgery. Biomed Res Int. 2013 [cited 2025 Nov 1]; 2013:323491. DOI: https://doi.org/10.1155/2013/323491.

45. Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and precipitating factors associated with delirium: a systematic review. JAMA Netw Open. 2023 [cited 2025 Aug 19]; 6(1):e2249950. DOI: https://doi.org/10.1001/jamanetworkopen.2022.49950

46. Stollings JL, Rumbaugh KA, Wang L, Hayhurst CJ, Ely EW, Hughes CG. Correlation of the critical care pain observation tool and numeric rating scale in intensive care unit patients. J Intensive Care Med. 2024 [cited 2025 Aug 19]; 39(1):12-20. DOI: https://doi.org/10.1177/08850666231187336.

47. Contreras CCT, Páez-Esteban AN, Rincon-Romero MK, Carvajal RR, Herrera MM, Díaz del Castillo AH. Nursing intervention to prevent delirium in critically ill adults. Rev Esc Enferm USP. 2021 [cited 2025 Aug 19]; 55:e03685. DOI: https://doi.org/10.1590/S1980-220X2019035003685.

48. Mart MF, Williams Roberson S, Salas B, Pandharipande PP, Ely EW. Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med. 2021 [cited 2025 Aug 19]; 42(1):112-26. DOI: https://doi.org/10.1055/s-0040-1710572.

49. Williams EC, Estime S, Kuza CM. Delirium in trauma ICUs: a review of incidence, risk factors, outcomes, and management. Curr Opin Anaesthesiol. 2023 [cited 2025 Aug 19]; 36(2):137-46. DOI: https://doi.org/10.1097/ACO.0000000000001233.

Published

2025-12-07

How to Cite

1.
Carvalho LAC, Correia MDL, Silva GM da, Ferreira RC, Botelho ML, Duran Érika CM. Risk of delirium as a diagnosis proposal: An integrative review. Rev. enferm. UERJ [Internet]. 2025 Dec. 7 [cited 2026 Feb. 4];33(1):e93984. Available from: https://www.e-publicacoes.uerj.br/enfermagemuerj/article/view/93984

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Section

Review Articles