American Journal of Nursing Research
ISSN (Print): 2378-5594 ISSN (Online): 2378-5586 Website: https://www.sciepub.com/journal/ajnr Editor-in-chief: Apply for this position
Open Access
Journal Browser
Go
American Journal of Nursing Research. 2026, 14(1), 10-19
DOI: 10.12691/ajnr-14-1-2
Open AccessArticle

Sensory Stimulation to Reduce Delirium Post Liver Transplantation

Nabawia S. Safan1, Naglaa M. El Mokadem2, , Essam M. Salah El Deen3 and Amal N. Abboud4

1Clinical Instructor of Critical Care and Emergency Nursing, Faculty of Nursing - Menoufia University, Egypt

2Professor at Critical Care and Emergency Nursing Department, Faculty of Nursing- Galala University, Suez, Egypt

3Professor of Hepatopancreatobiliary Surgery, National Liver Institute - Menoufia University, Egypt

4Lecturer of Critical Care and Emergency Nursing, Faculty of Nursing - Menoufia University, Egypt

Pub. Date: March 25, 2026

Cite this paper:
Nabawia S. Safan, Naglaa M. El Mokadem, Essam M. Salah El Deen and Amal N. Abboud. Sensory Stimulation to Reduce Delirium Post Liver Transplantation. American Journal of Nursing Research. 2026; 14(1):10-19. doi: 10.12691/ajnr-14-1-2

Abstract

Background: Post-operative delirium is a frequent complication after surgery especially liver transplantation, occurring in 15–20% of general patients admitted to ICU, and it has been associated with prolonged ICU and hospital length of stay, increased costs of care, and higher mortality rate. Sensory stimulation is a non-invasive, safe, inexpensive and straight forward approach widely used in caring for people post transplantation to reduce incidence of neurocognitive disorders, such as dementia and delirium. Purpose: to evaluate the effect of sensory stimulation to reduce delirium post liver transplantation. Design: A quasi-experimental design was utilized. Setting: Surgical Intensive Care Units of the National Liver Institute in Menoufia, Menoufia Governorate, Egypt. Sample: A convenient sample of 40 post liver transplant patients who were admitted to the ICU. Instruments: (1) A Semi Structured Demographic and Medical Data Sheet, (2) Simplified Acute Physiology Score II (SAPSII), (3) Richmond Agitation Sedation Scale (RASS), (4) Confusion Assessment Method in the ICU (CAM-ICU). Results: There was a highly statistically significant decrease in the mean score of delirium in the study group (0.30 ±0.10) compared to (4.15 ± 2.30) in the control group post intervention (p<0.001). Additionally, there was a highly statistically significant improvement in the incidence rate of delirium in the study group compared to the control group post intervention with the majority of participants in the study group (90%) compared to (20%) in the control group had no delirium. Also, there was a highly statistically significant reduction in the mean score of the ICU length of stay in the study group (6.70 ± 0.57) compared with the control group (8.50 ± 1.73) post intervention with (P< 0.001). Conclusion: sensory stimulation interventions had a significant impact on reducing the incidence rate, severity of delirium and ICU length of stay following liver transplantation. Recommendation: Sensory stimulation should be considered a standard practice post-operative for liver transplant patients, as it has been shown to reduce the incidence of delirium and promote better recovery outcomes.

Keywords:
Liver Transplantation Post-operative Delirium Sensory Stimulation

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Fuochi, E., Anastasio, L., Lynch, E. N., Campani, C., Dragoni, G., Milani, S., ... & Innocenti, T. (2023). Main factors influencing long-term outcomes of liver transplantation in 2022. World Journal of Hepatology, 15(3), 321.‏
 
[2]  Elflein, J., (2024). Total global liver transplants by region 2023.feb 5,2025. available at https:// www.statista.com/ statistics/ 398685/liver-transplants-by-world-region/. retrieved on 5/12/2024.
 
[3]  Abdel Ghaffar, H. (2024). Liver and kidney transplantation available at https://www.youm7.com/story/December 11, 2024 retrieved on 15/1/2025.
 
[4]  Rhaiem, R., Brustia, R., Rached, L., Sommacale, D. (2023). Liver Transplant Complications Management. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham (p.1581-1612).
 
[5]  Ma, Y., Li, C., Peng, W., & Wan, Q. (2023). The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation. Frontiers in Neurology, 14, 1229990,1-10.‏
 
[6]  Patrono, D., Rigo, F., Bormida, S., Berchialla, P., Giordanengo, L., Skurzak, S., ... & Romagnoli, R. (2020). Graft factors as determinants of postoperative delirium after liver transplantation. Updates in surgery, 72(4), 1053-1063.‏
 
[7]  Tarasova, N., Kulikov, A., & Bilotta, F. (2021). Postoperative delirium. Current Anesthesiology Reports, 11(3), 195-201.‏
 
[8]  Kukolja, J., & Kuhn, J. (2021). SOP: treatment of delirium. Neurological Research and Practice, 3(1), 12.‏
 
[9]  Liang, S., Chau, J. P. C., Lo, S. H. S., Choi, K. C., Bai, L., & Cai, W. (2023). The effects of a sensory stimulation intervention for preventing delirium in a surgical intensive care unit: A randomized controlled trial. Nursing in Critical Care, 28(5), 709-717.‏
 
[10]  Duning, T., Ilting-Reuke, K., Beckhuis, M., & Oswald, D. (2021). Postoperative delirium–treatment and prevention. Current Opinion in Anesthesiology, 34(1), 27-32.‏
 
[11]  Thomas, N., Coleman, M., & Terry, D. (2021). Nurses’ experience of caring for patients with delirium: systematic review and qualitative evidence synthesis. Nursing Reports, 11(1), 164-174
 
[12]  American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. In Diagnostic and statistical manual of mental disorders,49(2),335-346.
 
[13]  Marie, T. (2017). Mosby's Pocket Dictionary of Medicine, Nursing & Health Professions. 8th Edition, Elesevier company, USA. 10(1), 65-86.
 
[14]  Cheng, L., Cortese, D., Monti, M. M., Wang, F., Riganello, F., Arcuri, F., ... & Schnakers, C. (2018). Do sensory stimulation programs have an impact on consciousness recovery?. Frontiers in neurology, 9, 826,1-9.‏
 
[15]  Le Gall, J. R., Lemeshow, S., & Saulnier, F. (1993). A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. Jama, 270(24), 2957-2963.‏
 
[16]  Hyam, J., Welch, C., Harrison, D., & Menon, D. (2006). Case mix, outcomes, and comparison of risk prediction models for admissions to adult, general and specialist critical care units for head injury: a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care, 10(2), 1-11.‏
 
[17]  Strand, K., Strand, L. I., & Flaatten, H. (2010). The interrater reliability of SAPS II and SAPS 3. Intensive care medicine, 36, 850-853.‏
 
[18]  Sessler, C. N., Gosnell, M. S., Grap, M. J., Brophy, G. M., O'Neal, P. V., Keane, K. A., ... & Elswick, R. K. (2002). The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. American journal of respiratory and critical care medicine, 166(10), 1338-1344.‏
 
[19]  Ely, E., Truman, B., Shintani, A., Thomason, J., Wheeler, A., Gordon S Francis J, Speroff, T., Gautam, S., Margolin, R., Sessler, C., Dittus, R., & Bernard, G. (2003). Monitoring sedation status over time in ICU patients: the reliability and validity of the Richmond Agitation Sedation Scale (RASS). JAMA; 289:2983-2991.
 
[20]  Ely, E., Inouye, S., Bernard, G., Gordon, S., Francis, J., May, L., Truman, B., Speroff, T., Gautam, S., Margolin, R., Hart, R., & Dittus, R. (2001). Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA; 286(21):2703-10.
 
[21]  Liang, S., Chau, J. P. C., Lo, S. H. S., Zhao, J., & Choi, K. C. (2021). Effects of nonpharmacological delirium-prevention interventions on critically ill patients' clinical, psychological, and family outcomes: A systematic review and meta-analysis. Australian Critical Care, 34(4), 378-387.‏
 
[22]  Xu, C., Zhang, Y., Yuan, D., Wang, C., Wang, X., Liang, X., ... & Duan, J. (2025). Effects of Sensory‐Based Interventions on Delirium Prevention in Critically Ill Patients: A Systematic Review and Meta‐Analysis. International Journal of Nursing Practice, 31(1), e13321.‏
 
[23]  Adineh, M., Elahi, N., Molavynejad, S., Jahani, S., & Savaie, M. (2023). Investigating the effect of implementing a sensory stimulation program by family members on delirium status of brain injury patients hospitalized in the intensive care unit: A randomized clinical trial. Journal of Education and Health Promotion,12(1),187.‏
 
[24]  Contreras, C. C. T., Esteban, A. N. P., Parra, M. D., Romero, M. K. R., Silva, C. G. D., & Buitrago, N. P. D. (2021). Multicomponent nursing program to prevent delirium in critically ill patients: a randomized clinical trial. Revista gaucha de enfermagem, 42, e20200278,1-10.
 
[25]  Elcokany, N. M., & Ahmed, F. R. (2019). Effect of family reorientation messages on delirium prevention among critically ill patients. J Nurs Educ Pract, 9, 50-58.‏
 
[26]  Brennan, K., Sanchez, D., Hedges, S., Lynch, J., Hou, Y. C., Al Sayfe, M., ... & Frost, S. A. (2023). A nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to intensive care: a stepped-wedge cluster randomised trial. Australian Critical Care, 36(4), 441-448.‏
 
[27]  Kruger, A. (2017). The Effect of Non-Pharmacological Interventions on the Severity and Duration of Hypoactive Delirium in Post-Operative Cardio-Thoracic Surgery Patients. University of Pretoria (South Africa) ,1-24. available at https:// search.proquest.com/ openview/ 01238e2e633f5f 0eaf0df 0ace9479b9f/1? pq-origsite= gscholar& cbl= 2026366 &diss=y retrieved on 3/2/2025.
 
[28]  Chan, L., & Corso, G. (2024). Pharmacological and non-pharmacological prevention and management of delirium in critically ill and palliative patients in the inpatient setting: a review. Frontiers in Medicine, 11, 1403842,1-15.‏
 
[29]  Sayed, Z. A., Abd-Elraziek, E. M. E., & Sayed, I. G. (2020). Application of Multicomponent Nursing Intervention to Controlling Delirium and Duration of ICU Stay among Critically Ill Older Adult Patient. Egyptian Journal of Health Care, 11(4), 121-137.‏
 
[30]  Bannon, L., McGaughey, J., Verghis, R., Clarke, M., McAuley, D. F., & Blackwood, B. (2019). The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis. Intensive Care Medicine, 45, 1-12.‏
 
[31]  Ying, M. A., Wei-ting, P. E. N. G., & Qi-quan, W. A. N. (2023). Risk Factors and Prognosis of Delirium After Liver Transplantation. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCES), 54(3), 642-647.‏
 
[32]  Zhou, S., Deng, F., Zhang, J., & Chen, G. (2021). Incidence and risk factors for postoperative delirium after liver transplantation: a systematic review and meta-analysis. Eur. Rev. Med. Pharmacol. Sci, 25, 3246-3253.‏
 
[33]  Chen, J., Wang, H., He, Z., & Li, T. (2020). Analysis of risk factors for postoperative delirium after liver transplantation. Neuropsychiatric Disease and Treatment, 16,1645-1652.‏
 
[34]  Park, K. H., Son, H. J., Choi, Y. J., Park, G. H., Lee, Y. S., Park, J. Y., ... & Shim, J. R. (2020). Liver transplant patients with high preoperative serum bilirubin levels are at increased risk of postoperative delirium: a retrospective study. Journal of clinical medicine, 9(5), 1591.
 
[35]  Franz, N. D., Alaniz, C., Miller, J. T., & Farina, N. (2023). Association between sedative medication administration and delirium development in a medical intensive care unit. Journal of Pharmacy Practice, 36(5), 1164-1169.‏
 
[36]  Li, H., Liu, C., Yang, Y., Wu, Q. P., Xu, J. M., Wang, D. F., ... & Mi, W. D. (2024). Effect of intraoperative midazolam on postoperative delirium in older surgical patients: A prospective, multicenter cohort study. Anesthesiology, 142(2), 268.‏
 
[37]  Casamento, A., Neto, A. S., Lawrence, M., Chudleigh, L., Browne, E., Taplin, C., ... & Bellomo, R. (2023). Delirium in ventilated patients receiving fentanyl and morphine for Analgosedation: findings from the ANALGESIC trial. Journal of Critical Care, 77, 154343,1-8.‏
 
[38]  Casault, C., Soo, A., Lee, C. H., Couillard, P., Niven, D., Stelfox, T., & Fiest, K. (2021). Sedation strategy and ICU delirium: a multicentre, population-based propensity score-matched cohort study. BMJ open, 11(7), 1-10.‏
 
[39]  Wang, C. T., Mao, Y., Zhao, L., & Ma, B. (2019). The impact of analgosedation on mortality and delirium in critically ill patients: a systematic review and meta-analysis. Intensive and Critical Care Nursing, 54, 7-14.‏
 
[40]  Liu, Y., Li, X. J., Liang, Y., & Kang, Y. (2019). Pharmacological prevention of postoperative delirium: a systematic review and meta‐analysis of randomized controlled trials. Evidence‐Based Complementary and Alternative Medicine, 2019(1), 9607129.‏
 
[41]  Strøm, T., Martinussen, T., & Toft, P. (2010). A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. The Lancet, 375(9713), 475-480.‏