Assessment of Delirium in the Intensive Care Unit Using the CAM-ICU Tool: The Role of Nurses in Recognition and Care Provision

Assessment of Delirium in the Intensive Care Unit Using the CAM-ICU Tool: The Role of Nurses in Recognition and Care Provision

1,2 Valentina Ješić
2,3 Dafina Binaj
1 Sabina Babić
1 Nikolina Vratan

1 Sestre milosrdnice University Hospital Center, Zagreb, Croatia, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy
² University of Novo mesto, Faculty of Health Sciences, Slovenia
³ Secondary School of Medicine ”Dr Ali Sokoli”, Pristina, Kosovo

Abstract
Introduction: Delirium is a common neuropsychiatric syndrome in intensive care units, with a prevalence ranging from 20% to 80%. It is associated with prolonged hospital stay, increased mortality, and long-term cognitive impairment. Due to its fluctuating clinical presentation, early recognition remains challenging, which makes the use of validated assessment tools essential. The Confusion Assessment Method for the Intensive Care Unit, CAM-ICU, is one of the most widely used instruments. Nurses, due to their continuous presence at the bedside, play a key role in screening and initiating timely interventions.

Methods: A systematic literature review was conducted using PubMed, Web of Science, and Scopus in September 2025, covering studies published between 2015 and 2025. In accordance with PRISMA guidelines, randomized controlled trials, clinical and observational studies, educational interventions, quality improvement projects, and review articles were included. Due to heterogeneity in study designs, results were synthesized narratively.

Results: Ten studies met the inclusion criteria. The CAMICU tool demonstrated high diagnostic accuracy, with sensitivity ranging from 74% to 90% and specificity from 92% to 98%, along with good feasibility in routine nursing practice. Educational interventions improved nurses’ knowledge, confidence, and documentation rates, while quality improvement projects reported increased screening frequency and reduced benzodiazepine use. The most commonly reported barriers included lack of formal education, challenges in differential diagnosis, limited assessment in sedated and mechanically ventilated patients, and lower assessment frequency during night shifts.

Conclusion: CAM-ICU is a reliable and practical instrument for the early detection of delirium in intensive care units. Regular use supported by structured education and institutional protocols improves assessment consistency and contributes to safer clinical practice. Further development of national guidelines and systematic implementation within the Croatian healthcare system may improve patient safety and clinical outcomes.

Keywords: delirium, intensive care unit, CAM-ICU, nurses
Article received: 03.09.2025.
Article accepted: 31.01.2026.
https://doi.org/10.24141/1/12/2/6