Les infections néonatales tardives (INT, survenant après 3 jours de vie) sont fréquentes et sont associées à une mortalité et une morbidité importantes chez les nouveau-nés prématurés. Dans ce contexte, il a été récemment décrit un clone de Staphylococcus capitis, appelé NRCS-A, impliqué spécifiquement dans ces INT dans différents services de réanimation néonatale (RN) à travers la France, et présentant un profil multirésistant atypique chez cette espèce, incluant notamment une sensibilité diminuée à la vancomycine, qui est pourtant l'antibiotique de première ligne en cas de suspicion d'INT. Dans le cadre de ce travail, nous avons démontré la distribution endémique du clone NRCS-A dans au moins 17 pays à travers le monde, spécifiquement dans les services de RN. De plus des données épidémiologiques issues des services de RN français ont identifié une prévalence élevée du clone dans certains services, illustrant sa capacité à s'implanter puis à persister dans ces services. Une caractérisation génétique du clone NRCS-A a été réalisée afin de mettre en évidence d'éventuels facteurs génétiques pouvant favoriser son implantation dans les services de RN. Cette analyse a démontré le rôle des éléments génétiques mobiles dans l'émergence du phénotype multirésistant du clone NRCS-A. En revanche aucun gène de virulence spécifique du clone n'a pu être mis en évidence. L'analyse des gènes spécifiques du clone a toutefois permis d'identifier le gène nsr codant pour la résistance à la nisine, bactériocine active sur de nombreuses bactéries à Gram positif et sécrétée par les bactéries de la flore commensale digestive. Ce gène pourrait donc conférer un avantage sélectif au clone NRCS-A pour s'implanter dans le microbiote des nouveau-nés prématurés. La persistance du clone dans les services de RN évoque la présence de réservoirs inertes ou humains au sein de ces services. Grâce à la mise au point d'une technique d'identification de S. capitis par gélose chromogénique sélective, nous avons pu démontrer la diffusion et la persistance de S. capitis dans un service de RN, sans toutefois identifier un réservoir unique responsable de cette colonisation. Nous avons également observé une inefficacité partielle des mesures de décontamination. Il n'existe en revanche pas de portage chronique chez le personnel soignant, ni de colonisation vaginale chez les femmes enceintes. Par ailleurs, nous avons pu mettre en évidence par repiquages successifs in vitro une capacité particulière du clone NRCS-A à acquérir de façon rapide et stable une résistance à la vancomycine sous pression de sélection par cet antibiotique. Cette capacité constitue un avantage sélectif majeur pour ce clone et pourrait avoir favorisé son implantation et sa persistance dans les services de RN où la pression de sélection par la vancomycine est élevée. Pour compléter ces résultats, une étude de cohorte prospective menée en RN a permis de démontrer que l'administration de vancomycine constituait un facteur de risque indépendant de survenue d'INT à S. capitis. Au-delà de la problématique spécifique des INT à S. capitis en RN, nos travaux illustrent plus largement un des enjeux majeurs de santé publique qui est l'impact écologique potentiel de l'utilisation des antibiothérapies probabilistes à large spectre sur l'émergence et la sélection de bactéries multirésistantes impliquées secondairement dans des infections nosocomiales. Ces travaux ouvrent de nouveaux axes de recherche concernant d'une part la meilleure compréhension de la physiopathologie des INT à S. capitis, et d'autre part plus largement les modalités de prévention des INT en RN et d'amélioration du diagnostic précoce des INT / Pas de résumé en anglais

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The field of early detection and intervention of hearing loss in neonates and infants has been marked by a growing international body of research investigating hearing screening programmes, protocols and outcomes of early detection for hearing loss. In South Africa, screening for neonates and infants in general and particularly for hearing loss is not common practice and is not meeting the needs of the South African population, with very few infants identified with hearing loss early in life. The Year 2002 Hearing Screening Position Statement recommends an intermediate step toward universal screening in the form of Targeted Newborn Hearing Screening (TNHS) as an option for developing countries with limited resources. The Neonatal Intensive Care Unit (NICU) provides a starting point for TNHS because it encompasses a number of risk factors for hearing loss. A combined descriptive and exploratory research methodology was followed to provide a comprehensive perspective on longitudinal hearing screening for NICU neonates and infants at a provincial hospital in South Africa. The quantitative methods included a structured interview to compile risk factor information. Immittance measurements used included acoustic reflex measurements, 226 Hz and 1000 Hz tympanometry. Automated Otoacoustic Emission (AOAE) as well as Automated Auditory Brainstem Response (AABR) screening was conducted. Routine follow-up visits at three month intervals were booked if a subject passed the screen and a follow-up screening for further testing was booked if a subject referred the screening. A total of 49 neonates and infants as well as mothers were enrolled in the first year and followed up for the second year of data collection period. The results indicated that the NICU had potential as platform for TNHS in South Africa. The high incidence of risk factors reported is more when compared with developed countries and highlights the importance of hearing screening in the at risk population for a developing country. The results confirmed reports that 226 Hz probe tone tympanometry produces erroneous responses in young infants. A high correspondence between high frequency tympanometry and AOAE results was found and underlines the need for differential diagnosis to accurately detect middle ear effusion and/or sensorineural hearing loss in neonates and infants. The unilateral AOAE refer rate (7%) was within range of the reported values for initial screening at discharge from the NICU. AABR results indicated a relatively high unilateral refer result (24%) and may be attributed to irritability and restlessness. The highest referral rates in the current study were recorded during the second and third visit and may be attributed to the presence of middle-ear pathology in older infants. The perceptions of mothers emphasized the lack of awareness regarding hearing and hearing loss in South Africa. Lack of knowledge may be a contributing actor to poor compliance with screening follow-up. Despite prevailing challenges, such as a low follow-up return rate, lack of awareness regarding the benefits of early detection of hearing loss, the effect of middle ear effusion on screening results, the cost of hearing screening and different priorities of the national healthcare system, such as Human Immunodeficiency Virus, demonstrated the NICU promise as platform for TNHS in South Africa. TNHS programmes may serve as starting point to direct universal neonatal hearing screening programmes in South Africa. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / MComm Path / unrestricted

Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

Malgré les avancées en matière de prévention, Pseudomonas aeruginosa reste un pathogène fréquent et délétère en réanimation. Des facteurs de risque d’acquisition de ce micro-organisme ont déjà pu être identifiés, mais jamais dans un contexte multicentrique et rarement en ajustant sur des caractéristiques du service. Si l’analyse de la littérature était jusqu’alors en faveur d’une forte origine individuelle, la part du contexte d’hospitalisation et des caractéristiques de la réanimation paraît de moins en moins négligeable. Notre travail a permis non seulement de faire un état des lieux concernant les connaissances actuelles sur Pseudomonas aeruginosa en réanimation mais également d’identifier des profils type de patients et services de réanimation plus à risque vis à vis de ce micro-organisme. L’intérêt majeur est non seulement de pouvoir ainsi orienter les cliniciens face à une conjonction d’éléments mais surtout, là où les facteurs patients restent souvent peu modifiables, d’identifier des éléments contextuels d’acquisition sur lesquels il serait possible d’agir afin de réduire le risque infectieux. / Despite major advance in techniques and reinforcement of infection control measures, Pseudomonas aeruginosa remains frequent in intensive care unit (ICU) and is responsible for severe hospital-acquired infections. Several patient and pathogen-specific risk factors have been associated with acquisition of P. aeruginosa in ICUs Nevertheless those risk factors were identified in monocentric studies which rarely took in account the context of cares. If individual risk factors for P. aeruginosa acquisition have appeared to be predominant since then, the role of contextual variables seems to have been underestimated. This thesis provides insight into the epidemiology of P. aeruginosa in ICU, identifies individual and contextual risk factors for P. aeruginosa infection and P. aeruginosa acquisition and emphasizes the interest of contextual variables which gives new perspectives to P. aeruginosa prevention.

Dans le secteur de la santé et particulièrement en unité des soins intensifs, diverses situations cliniques sont rencontrées et l'interprétation d'une grande quantité de données, y compris celles fournies par les équipements tels que moniteurs et ventilateurs, est exigée pour une prise de décision appropriée. La disparité entre cette quantité importante d'information et la capacité humaine limitée crée une variabilité inutile à la décision clinique. Pour faire face au problème, les experts médicaux ont défini des stratégies en vue de promouvoir une pratique fondée sur les données probantes. Cette méthode est devenue un standard pour la pratique clinique et a montré beaucoup d'avantages en menant à la définition de directives spécifiques ou des protocoles précis à appliquer dans certaines situations. Cependant, l'utilisation de directives/protocoles, particulièrement dans les soins intensifs, exige une participation continue des professionnels au chevet du malade et est ainsi difficile à appliquer en pratique clinique. La définition d'assistants informatisés est une solution technologique intéressante à explorer pour faciliter l'introduction des protocoles dans la routine clinique. En ventilation mécanique, on assiste à une prise de conscience croissante sur le potentiel de l'informatisation et son applicabilité au-delà de la recherche et plus concrètement dans le soutien du clinicien dans sa prise de décision quotidienne. Ceci à travers la prise en charge des tâches répétitives et la proposition de suggestions. Ce domaine constitue un environnement idéal pour de telles applications surtout que les ventilateurs de réanimation son aujourd'hui des équipements électroniques sophistiqués qui peuvent embarquer des protocoles informatisés. L'objectif de cette thèse était d'explorer les aspects de développement, déploiement et d'efficacité des « contrôleurs intelligents » en ventilation mécanique afin d'accélérer leur création et leur adoption. Pour examiner les phases de développement et de déploiement, nous nous sommes concentrés sur l'utilisation et l'extension du SmartCare®, une plateforme logicielle qui facilite l'automatisation des procédures thérapeutiques en ventilation mécanique à partir de la modélisation des connaissances expertes jusqu'à leur exécution en temps réel dans un équipement médical. A travers une approche ascendante, en se basant particulièrement sur notre expérience pratique dans le design de contrôleurs intelligents et après l'examen de divers contrôleurs existants, l'objectif était de définir un catalogue de pièces maitresses pour la représentation des protocoles en ventilation mécanique. L'utilisation d'une ontologie du domaine assure une formalisation saine de ces pièces.Sur base de cette approche, nous avons développé un contrôleur pour l'oxygénation testé au chevet du malade. Nous rapportons ses performances comparées à la pratique standard / In healthcare, especially in critical care, various clinical situations are encountered and a huge amount of data, including those provided by equipment such as monitors and ventilators, are required for an appropriate decision-making. The mismatch between this vast amount of information and the human capability creates unnecessary variability in clinical decision. To cope with this problem, medical experts have defined specific strategy called evidence based medicine. This method has become the standard of practice and showed many benefits by leading to the definition of specific guidelines or precise protocols to follow in specific situations. However, the use of guidelines/protocols, especially in critical care, requires the continuous involvement of professionals at the patient's bedside strongly limiting their application in practice. The introduction of computerized assistants for implementing such guidelines/protocols may be an interesting technological solution. In mechanical ventilation where various protocols are available there is a growing acceptance that such computerization might be useful beyond research, in assisting clinicians in their daily decision making by taking over some routine tasks or providing suggestions. Moreover, this domain constitutes an ideal environment because mechanical ventilators are presently powerful electronic equipments in which computerized protocols can be efficiently embedded. The objective of this thesis was to explore several aspects of the development, deployment, and effectiveness of computerized protocols or smart controllers in mechanical ventilation in order to accelerate their creation and adoption. For this purpose, we focused on the use and the extension of SmartCare®, a computer framework for the automation of respiratory therapy starting from clinical knowledge modelling to execution in real time of specific routines embedded into medical products [1]. Through a reengineering approach, from practical experience in smart controller design and investigation of existing controllers, the objective was to define a catalogue of building blocks to facilitate the creation of new controllers. The modeling of such blocks using dedicated domain ontology ensures a sound formalization. To prove the effectiveness of such a generic approach, we built a smart controller for oxygenation tested on the patient's bedside. We reported its performance compared to standard therapy

Introdução: As complicações decorrentes da permanência prolongada na ventilação mecânica invasiva (VMI) contribuem negativamente na funcionalidade do paciente crítico. A intervenção fisioterapêutica busca diminuir este impacto negativo, promovendo a recuperação e preservação funcional. Geralmente suas condutas são baseadas em julgamentos clínicos, estilos individualizados e sem padronização, gerando questionamentos sobre o real impacto da sua inserção no manejo destes pacientes. Objetivos: Avaliar a eficácia da intervenção fisioterapêutica no centro de terapia intensiva (CTI) em pacientes críticos que foram submetidos a um protocolo de extubação da VMI e também a efetividade da fisioterapia nos seguintes itens: percentual de sucesso no protocolo de extubação, tempo de permanência na VMI, permanência no CTI, tempo de internação hospitalar e taxa de mortalidade; através da comparação entre os grupos (com e sem intervenção fisioterapêutica). Material e Métodos: Foram incluídos neste trabalho pacientes que necessitaram de VMI por um período maior que 48 horas e que foram considerados aptos para extubação pela equipe médica assistente. Foram excluídos pacientes que não fossem extubados em até 6 horas após ventilação espontânea em tubo T, paciente com traqueostomia e com doença neuromuscular periférica. Após, o paciente foi colocado em ventilação espontânea com tubo T, e em seguida foi registrado o índice de respiração rápida e superficial (IRRS) através da relação freqüência respiratória/volume corrente, sendo este calculado no 1º (IRRS 1) e 30o (IRRS 2) minuto do teste. Os dados foram expressos em freqüência e percentual, média e desvio padrão e mediana (percentil 25-percentil 75), a variável sucesso foi corrigida por análise de covariância (ANCOVA), com nível de significância p<0,05. Resultados: Foram incluídos 265 pacientes neste estudo, divididos em dois grupos: grupo 1 (sem intervenção fisioterapêutica) possuindo 149 pacientes e o grupo 2 (com intervenção fisioterapêutica) possuindo 116 pacientes. Na comparação entre o grupo 1 e 2 encontramos os seguintes resultados: média de idade 58,3 versus 57,7 (p = 0,79), média de APACHE II (Acute Physiology Chronic Health Evaluation) 18,9 versus 22,3 (p=0,003), sucesso de extubação 80,5% versus 88,8% (p=0,05), IRRS 1 58,2 versus 50,5 (p=0,11), IRRS 2 56,0 versus 45,0 (p=0,01), dias de intubação 7,0 versus 7,0 (p=0,34), dias de internação no CTI 13,0 versus 10,0 (p<0,05), dias de internação hospitalar 33,0 versus 35,0 (p=0,25), óbito 21 versus 25 (p=0,13). Conclusão: O grupo com intervenção fisioterapêutica demonstrou um aumento no sucesso da extubação orotraqueal e diminuição nos dias de internação no CTI. Também apresentou maior tempo de internação hospitalar e taxa de mortalidade, podendo ser justificado pela maior gravidade demonstrada no grupo pelo APACHE II. / Introduction: Complications arising from prolonged invasive mechanical ventilation (IMV) contribute negatively to the functionality of the critically ill patient. The physiotherapy intervention seeks to reduce this negative impact, promoting the recovery and functional preservation of the patient. Generally the physiotherapist’s conducts are based on clinical trials and individualized styles without standardization, raising questions about the real impact of their insertion in the management of these patients. Objectives: To evaluate the efficacy of physical therapy intervention in the intensive care unit (ICU) in critically ill patients who were submitted to a protocol of extubation from IMV and also the effectiveness of physiotherapy in the following items: percentage of success in the extubation protocol implementation, length of stay at IMV, length of stay in ICU, length of hospital stay and mortality rate; by comparing the groups (with and without physical therapy intervention). Material e Methods: This study enrolled patients who required IMV for a period longer than 48 hours and who were considered suitable for extubation by medical assistant staff. We excluded patients who were not extubated within 6 hours after spontaneous breathing in T-tube, tracheostomy and patients with peripheral neuromuscular disease. After, the patient was placed on spontaneous ventilation with T-tube and then it was recorded the rapid shallow breathing index (RSBI) using the ratio of respiratory rate / tidal volume, which is calculated on the 1st (RSBI 1) and 30th (RSBI 2) minutes of the test. The data were expressed as frequency and percentage, mean and standard deviation and median (25th percentile – 75th percentile), the variable ‘success’ was adjusted by analysis of covariance (ANCOVA), with significance level p < 0.05. Results: 265 patients were included in this study, divided into two groups: group 1 (no physiotherapy intervention) with 149 patients and group 2 (physical therapy) with 116 patients. In the comparison between groups 1 and 2, we found the following results: mean age 58.3 versus 57.7 (p = 0.79), mean APACHE II (Acute Physiology Chronic Health Evaluation) 18.9 versus 22.3 (p = 0.003) , successful extubation 80.5 % versus 88.8 % (p = 0.05) , RSBI 1 58.2 versus 50.5 (p = 0.11) , RSBI 2 56.0 versus 45, 0 (p = 0.01) , days of intubation 7.0 versus 7.0 (p = 0.34) , days of ICU stay 13.0 versus 10.0 (p < 0.05) , days of hospitalization 33.0 versus 35.0 (p = 0.25) , deaths 21 versus 25 (p = 0.13). Conclusion: The group with physiotherapy intervention showed an increased success in performing orotracheal extubation and a decrease in ICU stay. Also, it resulted in longer hospital stay and higher mortality rate, which can be explained by the greater severity demonstrated in the group by APACHE II.

Bakgrund: Att vårdas på en barnintensivvårdsavdelning (BIVA) är en stressande miljö för både barn och föräldrar. Detta kan hindra föräldrar från att vara delaktiga i vården och nära sitt barn som är kritiskt sjuk. Barnets upplevelse av trygghet påverkas av förälderns mående och delaktighet i vården. Syfte: Studiens syfte var att undersöka föräldrars upplevelse av delaktighet i vården och förekomst av symptom på posttraumatisk stress (PTS) efter att deras barn vårdats på BIVA.  Metod: En retrospektiv deskriptiv design med kvantitativ och kvalitativ ansats användes, där 40 föräldrar besvarade två enkäter om upplevelse av delaktighet på BIVA och symptom på PTS. Resultat: Åttio procent av föräldrarna upplevde sig i stor utsträckning ha varit delaktiga i vården och i de beslut som rörde barnets vård. Föräldrarnas upplevelse av delaktighet resulterade i två huvudteman: Främjande och Hindrande faktorer för delaktighet. Det var en större andel mammor (41%) som visade symptom på PTS jämfört med pappor (12%) (p=0,038). Det var en större andel föräldrar som inte hade högskoleutbildning som visade symptom på PTS jämfört med föräldrar som hade högskoleutbildning (64% versus 14%). Slutsats: Föräldrar upplevde sig i stor grad vara delaktiga i beslut och barnets vård. Identifierade faktorer bland föräldrar med ökad förekomst att utveckla symptom på PTS var att vara mamma, yngre ålder och att inte ha en högskoleutbildning. / Background: Parents whose child was admitted to the pediatric intensive care unit (PICU) found it to be a stressful environment for both child and parent. This can restrict parents from being close and involved in their child's care. The child's sense of security is affected by the parents' feelings and involvement in care. Purpose: The aim of the study was to investigate parents' experiences of participation in the care and parents' symptoms of post-traumatic stress (PTS) after their child was discharged from the PICU. Method: A retrospective descriptive design was used with a quantitative and qualitative approach, where 40 parents answered two surveys about the experience of participation in PICU and symptoms of PTS. Result: Eighty percent of the parents felt that they had been involved in the care and in the decisions concerning the child's care. The parents’ experience of participation resulted in two main themes: promoting and inhibiting factors for participation. There was a higher proportion of mothers (41%) who showed symptoms of PTS compared to fathers (12%) (p=0,038). A higher percentage of parents who didn't have post-secondary education showed PTS symptoms, compared to those who did have post-secondary education (64% versus 14%). Conclusion: Parents reported that they had been involved in the care and in the decisions concerning the child's care. Symptoms of PTS among parents correlated with being a mother, younger age and lower educational level.

Bakgrund: Intensivvård är den högsta vårdinstansen på ett sjukhus, en av sjukvårdens mest resurskrävande behandlingsformer. När en patient blir kritiskt sjuk eller påvisar försämrade vitalparametrar kontaktar vårdpersonalen mobil intensivvårdsgrupp (MIG) som utgår ifrån intensivvårdsavdelningen (IVA). Problemformulering: De kritiskt sjuka patienterna vårdas inte längre bara på IVA men också på vårdavdelningar. I ett omvårdnads- och professionsperspektiv som intensivvårdssjuksköterska är det av betydelse och centralt att förstå orsakerna till kontakt med MIG. Syfte: Att kartlägga kontakter, orsaker och skillnader med mobil intensivvårdsgrupp på ett sjukhus i Västra Götalandsregionen. Metod: En icke-experimentell studie med ett konsekutivt urval och retrospektiv journalgranskning av 386 patientkontakter med MIG under åren 2017–2019. Resultat: Studiens resultat påvisar en hög medelålder. Ingen skillnad återfanns i patientgruppen ur ett könsperspektiv. Den framträdande gruppen är den geriatriska patienten ≥65år som är utsatt och en högriskgrupp vid kontakt med MIG. De utgör majoriteten av alla kontakter med MIG åren 2017–2019. Diskussion: Studiens kartläggning och resultat påvisar behov av kompetenshöjande utbildning och optimeringsteam. Geriatriska patientgruppen behöver vårdinsatser i rätt tid och med rätt kompetens för att minska antalet MIG kontakter och initiera insatser i förtid och motverka svikt av vitala parametrar.

Bakgrund: En vanligt förekommande företeelse är att en akut sjuk patient drabbas av delirium. Detta ställer stora krav på sjuksköterskan att vara lyhörd på symtomen. Det finns ett fåtal kvalitativa studier om sjuksköterskans erfarenhet av delirium, dessa studier visar att sjuksköterskor har kunskapsbrist om delirium. Det finns framtagna riktlinjer som endast används sporadiskt och sjuksköterskor upplever den ökade arbetsbördan, som delirium kan orsaka, som stressande. Syfte: Syftet var att belysa sjuksköterskans erfarenhet av att vårda en patient med delirium. Metod: Resultatet baseras på en litteraturstudie av artiklar som ej är äldre än tio år. Datainsamling gjordes från databaserna CINAHL och PsycINFO. 14 vetenskapliga artiklar inkluderades. Artiklarna analyserade med en kvalitativ innehållsanalys på manifest nivå. Resultat: I studiens resultat framkom sju underkategorier, som genererade tre kategorier: ”Vårdandets komplexitet”, ”Att identifiera och behandla delirium” och ”Sjuksköterskans behov av kompetens och stöd”. Slutsats: För att på bästa sätt tillgodose en patients behov, som drabbats av delirium, behöver sjuksköterskan ha en bra kommunikation. Vårdarbetet med en patient med delirium kan ge sjuksköterskan en känsla av otillräcklighet, som ofta beror på tidsbrist på grund av hög arbetsbelastning. Mycket tyder på att det idag saknas forskning och utbildning inom området. Genom att öka kunskapen om vården för patienter med delirium så skulle sjuksköterskans professionella roll stärkas. / Background: A common occurrence is that an acutely ill patient suffers from delirium. This places great demands on the nurse to be responsive to the symptoms. There are a few qualitative studies on the nurse's experience of delirium; these studies show that nurses have a lack of knowledge about delirium. There are guidelines that are only used sporadically, and nurses experience the increased workload, that delirium can cause as stressful. Aim: The purpose was to highlight the nurse´s experiences of caring for a patient with delirium. Method: The result is based on a literature review of articles no older than ten years. Data collection was done from the databases CINAHL and PsycINFO. 14 scientific articles were included and a qualitative content analysis at manifest level was used. Results: The results emerged in seven categories, which generated three themes: "The complexity of care", "Identifying and treating delirium" and "The nurse´s need of competence and support”. Conclusions: To meet the needs of a patient affected by delirium, the nurse needs good communication. Caring for a patient with delirium can give the nurse a feeling of inadequacy, which is often due to lack of time due to high workload. Much indicates that today there is a lack of research and education in this area. By increasing the knowledge about care for patients with delirium, the nurse´s professional role would be strengthened.