Patient confusion in intensive care units (ICU) is difficult to assess, mainly because the patients cannot talk, but UTS Associate Professor Jane Stein-Parbury's pioneering research has cast new light on the topic.

Professor Stein-Parbury from the Faculty of Nursing, Midwifery and Health has found that there are several types of ICU confusion, which have often been called ICU syndrome.

She is developing a clinical assessment schedule that nurses and doctors will be able to use to recognise and treat different types of confusion. If they can identify the cause, they can treat it because usually it is reversible, unless it's the confusion before death. Confused ICU patients are at great risk, as they may try to rip out tubes or get out of bed.

"Figuring out what's going on is very difficult," said Professor Stein-Parbury. "An ICU ward is full of equipment - it's the cutting edge of high-tech nursing. There are tubes coming out of every orifice imaginable. The patients are ventilated, which means they can't speak. The endotracheal tube goes down through their mouth and sits on their vocal chords. They are critically ill, it's touch and go. They are in a strange place with noise, machines and unfamiliar people, and on top of it they can't speak."

ICU patients are often admitted either anaesthetised or comatosed. The classic patient would be in a motor vehicle accident, be moved to ICU, open their eyes and say "where am I, what is this place?"

The confusion that ICU patients experience can range from mild disorientation to a full-blown delirium. In her original study, completed in 1998, Professor Stein-Parbury found that experienced nurses are able to differentiate types of confusion, although they are not consciously aware of doing so. This clinical wisdom is tacitly embedded in their everyday practice.

In a follow-on study, Professor Stein-Parbury, author of the textbook Patient and Person, interviewed 50 expert ICU nurses around the country for her research, concentrating on nurses with more than ten years experience. She found that the nurse at the bedside is the key to identifying and unlocking a patient's psychological state. Because confusion fluctuates and changes forms, the nurse is in the best position to assess it.

"The researcher in me is intrigued that so little is known about patient confusion in ICU, despite its noticeably high incidence since the inception of critical care in the 1960s," she said.

Professor Stein-Parbury will deliver a paper at the 8th World Intensive and Critical Care Medicine Congress to be held on 28 October at Darling Harbour.