Artificial intelligence (AI), now an integral part of healthcare services and presents numerous opportunities. Customized treatment plans, clinical decision support systems, predictive analysis for disease prevention, patient engagement and education, quality improvement, and error reduction are some of these opportunities. In the context of delirium prevention, risk assessment, and treatment planning, the AI-supported system AI-AntiDelirium is designed to standardize the approach to delirium management in alignment with the PADIS guidelines. A randomized controlled trial evaluating the effectiveness of this system found that the workload of nurses decreased, facilitated early diagnosis and prevention of delirium, and recommended evidence-based and individualized delirium interventions. A systematic review concluded that AI applications did not significantly impact the length of hospital stay and emphasized the need for further research. Also, AI platforms contributed to positive results in reducing anxiety and depression in patients. Furthermore, systematic reviews have demonstrated that AI-based chatbots are effective in alleviating symptoms of depression and anxiety. However, the literature includes a limited number of patient education programs specifically designed to prevent or manage delirium through AI-based approaches. Notably, there is a lack of studies comparing the effectiveness of AI-supported educational interventions with those delivered directly by nurses.
The goal of this clinical trial is to develop a structured AINurse and Human Nurse orientation training program for intensive care unit (ICU) patients and compare the effects of these training programs on ICU patients' delirium-free days, level of anxiety and depression, and length of stay in the ICU. Hypotheses of the study:
H1: Patients who receive the structured AINurse patient orientation training program will have longer delirium-free days than patients who receive Human Nurse orientation training.
H2: Patients who receive the structured AINurse patient orientation training program will have lower levels of anxiety and depression than patients who receive the Human Nurse orientation training.
H3: Patients who receive the structured AINurse patient orientation training program will have shorter lengths of stay in the intensive care unit than patients who receive the Human Nurse orientation training.
Researchers will compare the AINurse patient orientation training program and the orientation training program provided by human nurses in terms of patients' delirium-free days, level of anxiety and depression, and length of stay in the ICU.
* Those in the intervention group will receive the AINurse orientation training program twice daily for 3 days. * Participants in the control group will receive face-to-face structured orientation training from researchers twice daily for 3 days. * Delirium-free day assessment, anxiety and depression will be evaluated for patients in both groups over 3 days. * The length of stay in the intensive care unit will be monitored for patients in both groups.
Intensive care unit confusion assessment scale (CAM-ICU scale) score of 0-2
Age 18 years or older
Hospitalized in the intensive care unit for at least 24 hours
Glasgow coma scale score of 13-14-15 points
Intensive care unit confusion assessment scale (CAM-ICU scale) score of 6-7
Any psychiatric illness or impaired brain function
Defined hearing loss
Advanced dementia
Parallel
Structured orientation program
BehavioralArtificial intelligence technology will be incorporated into the orientation training program developed for patients in the intensive care unit who are assigned to the intervention group. The program will be administered twice daily over a three-day period. In this group, delirium-free days will be tracked, changes in anxiety and depression levels will be evaluated, and the length of intensive care unit stay among patients who remain free of delirium through this intervention will be examined.
Human Nurse
BehavioralResearchers will administer a structured orientation training program lasting approximately 10 minutes face-to-face to participants in the control group. This training program will be administered twice daily for 3 days. Following the training program, delirium-free days, anxiety and depression scores, and length of stay in the intensive care unit will be evaluated.
Delirium-free days
The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale will be used to assess delirium-free days. CAM-ICU is utilized to assess the presence of delirium in critically ill patients. The CAM-ICU evaluates four key features in critically ill patients: (1) acute onset or fluctuating course of mental status, (2) inattention, (3) altered level of consciousness, and (4) disorganized thinking. A positive diagnosis of delirium is made when the first two criteria are present, along with either the third or fourth. The scale yields a total score ranging from 0 to 7, with interpretive cut-off points as follows: 0-2 indicating no delirium, 3-5 suggesting mild to moderate delirium, and 6-7 indicating severe delirium.
Level of anxiety and depression
Anxiety and depression, which can trigger delirium in patients, are assessed using the Hospital Anxiety and Depression Scale (HADS). HADS assesses the severity and risk of anxiety and depression in hospitalized patients. The scale consists of 14 items in a 4-point Likert format.Items 1, 3, 5, 6, 8, 10, 11, and 13 are reverse scored (3, 2, 1, 0), while items 2, 4, 7, 9, 12, and 14 are scored progressively (0, 1, 2, 3). Subscale scores are obtained by summing the relevant items: questions 1, 3, 5, 7, 9, 11, and 13 for the anxiety subscale (HAD-A), and questions 2, 4, 6, 8, 10, 12, and 14 for the depression subscale (HAD-D). In the Turkish adaptation, the cut-off scores were identified as 10/11 for the anxiety subscale and 7/8 for the depression subscale. Scores exceeding these thresholds indicate a risk of clinically significant anxiety or depression.
Length of stay in the intensive care unit
Patients will be followed up until discharge after the application to examine the effect of the planned Human Nurse and AINurse training on the length of stay in the intensive care unit.
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