Abstract
<title>Abstract</title> <p>Background Delirium prevention depends on timely risk assessment, routine monitoring, and consistent implementation of non-pharmacological preventive practices. Guidelines emphasize recognition of at-risk patients and multicomponent prevention, but implementation at the bedside may vary across clinical settings. Aim This study characterized nurse-reported delirium-risk assessment, routine monitoring, reported barriers, and non-pharmacological prevention practices, with particular attention to differences between intensive care units and general wards. Methods This multicentre cross-sectional analysis included 234 nurses from five training and research hospitals in Istanbul, Türkiye. Nurses had at least one year of nursing experience and worked in prespecified intensive care units or general wards. Descriptive analyses summarized screening, monitoring, barriers, and preventive-practice frequencies. Eighteen preventive practices shared across settings were evaluated. Pooled outcome distributions were screened before modelling; 14 outcomes were retained for primary proportional-odds ordinal logistic-regression models. Models compared ICU with ward nurses and adjusted for hospital fixed effects, current-unit experience per five-year increase, and education. Benjamini–Hochberg false-discovery-rate correction was applied across the 14 primary ICU–ward comparisons. Sensitivity analyses excluded 14 facility-metadata-flagged records, replaced current-unit experience with a derived total-experience proxy, and omitted hospital fixed effects. Results No nurse reported routine delirium-risk assessment for every newly admitted patient. Routine monitoring of patients considered at high risk of delirium was reported by 44 nurses (18.80%); monitoring relied on observation of command-following or agitation-related behaviour rather than a formal delirium instrument. Eight of 14 adjusted ICU–ward practice comparisons remained significant after false-discovery-rate correction. ICU nurses reported more frequent pain relief and avoidance of unnecessary room or unit changes. ICU nurses reported less frequent sleep support, noise reduction, facilitation of family or friend visits, adequate lighting, avoidance of unnecessary catheterization, and avoidance of physical restraints. All 14 primary ordinal models were stable, no binary primary fallback was required, and the directional consistency check supported the ICU–ward effect interpretation. Sensitivity analyses excluding facility-flagged records and replacing the experience covariate left all conclusions unchanged. Omitting hospital fixed effects produced larger magnitude shifts for five estimates but no direction reversals among the false-discovery-rate-significant primary findings and no change in the number of significant findings. Conclusion The findings identify major gaps in routine delirium-risk assessment and high-risk monitoring and show clinically meaningful ICU–ward differences in reported non-pharmacological prevention practices. The pattern suggests setting-specific strengths and implementation gaps: ICU nurses reported stronger implementation of pain relief and avoidance of unnecessary transfers, whereas ward nurses reported more frequent implementation of several environmental, family-contact, sleep-support, catheter-related, and restraint-related practices.</p>