ABSTRACT
Background
Delirium is a common and serious postoperative complication in intensive care units, associated with increased morbidity, mortality and long‐term cognitive impairment, and despite the pivotal role of nurses in its assessment and management, variations in prevalence and gaps in intervention‐focused nursing research persist, underscoring the need for a bibliometric evaluation of the literature.
Aim
The aim of the study was to quantitatively analyse and visually map trends, citations, key terms and country contributions in nursing research on postoperative delirium in intensive care as well as to characterize the overall structure of the literature.
Study Design
This study was conducted as a retrospective and descriptive research using the bibliometric analysis method on December 1, 2025. No time restrictions were imposed on the literature. Data analysis was performed using R Studio software.
Results
The earliest study on postoperative delirium in intensive care units within the field of nursing was published in 2001, and the analysed publications covered the period from 2001 to December 2025. In addition, 55.96% of all publications have been released in the past 7 years. The journal with the highest number of publications is Nursing in Critical Care, while the United States stands out as the country with the highest research output. It can be suggested that topics such as ‘cardiac surgery’, ‘nursing care’, ‘postoperative delirium’, ‘postoperative care’ and the ‘Confusion Assessment Method for the Intensive Care Unit’ represent areas that warrant further investigation and development in future research.
Conclusions
The analysis showed a marked increase in publications on postoperative delirium in intensive care nursing in recent years. The United States and the Journal Nursing in Critical Care were identified as the leading contributors to the literature. Thematic mapping indicated that the literature primarily focused on delirium assessment and intensive care nursing, with several interconnected research areas.
Relevance to Clinical Practice
The findings emphasize the critical role of nurses in delirium screening and management in intensive care units. While assessment tools are well represented in the literature, further research is needed to develop and evaluate nurse‐led interventions aimed at delirium prevention and care. Enhancing nursing education and institutional support may contribute to improved patient outcomes and quality of postoperative intensive care.
Keywords: bibliometric, delirium, intensive care unit, nursing
Impact Statements
- What is known about this topic
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○Postoperative delirium is a common and serious complication among patients in intensive care units, associated with increased mortality, prolonged mechanical ventilation and long‐term cognitive impairment.
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○Nurses play a central role in the assessment and management of delirium in intensive care units, primarily through the use of validated screening tools such as the Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU).
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○Previous studies have extensively examined the prevalence, risk factors and clinical outcomes of postoperative delirium; however, nursing‐focused research is dispersed across multiple journals and lacks a consolidated overview of research trends.
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- What this paper adds
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○This study provides the first comprehensive bibliometric mapping of nursing research on postoperative delirium in intensive care units, revealing publication trends, influential journals, authors and countries.
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○The findings identify core and emerging research themes such as delirium assessment, nursing care, postoperative care and the use of CAM‐ICU, highlighting areas that remain underdeveloped in intervention‐based nursing research.
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○By visualizing collaboration patterns and thematic structures, this analysis offers a framework to guide future nursing research, education and policy development aimed at improving delirium prevention and management in intensive care settings.
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1. Introduction
Delirium is defined as an acute disturbance in attention and awareness, accompanied by additional cognitive abnormalities, that occur over a short period of time and varies throughout the day [1, 2]. Postoperative delirium is a prevalent syndrome among patients hospitalized to intensive care units (ICUs) and the prevalence/incidence has been reported in varying ranges [3, 4]. In a systematic review and meta‐analysis that evaluated 51 studies including a total of 39,076 patients, the delirium prevalence among ICU patients was reported as 33% [3]. The incidence rates of postoperative delirium were reported to be between 4.1% and 54.9% for patients undergoing cardiac surgery [4]. The variations in rates appear to be mainly caused by various contributing factors, including immobility, pain, prolonged mechanical ventilation, length of stay in the ICU and unfavourable environmental conditions that influence vision, lights of monitors, noise and sleep [5, 6]. It has been reported that delirium is associated with increased mortality rates, longer mechanical ventilation durations and long‐term cognitive impairments after discharge among ICU patients [7, 8]. Thus, early identification of delirium in ICUs could prevent many complications, improve patients' outcomes and reduce morbidity [9, 10]. Critical care nurses play a pivotal role in the prevention, early identification and assessment of delirium as well as providing appropriate care interventions to manage this condition [11, 12]. Their responsibilities include clinical routine screening and identification of delirium using validated tools such as Confusion Assessment Method for the CAM‐ICU (Confusion Assessment Method for the Intensive Care Unit), Nursing Delirium Scale, Delirium Rating Scale‐R‐98, implementation of early non‐pharmacological interventions—such as early mobilization, hydration, sleep promotion and management of delirium with coordinated multidisciplinary actions [13, 14]. The recent systematic reviews and meta‐analyses focusing on surgical ICUs emphasize that nurses use many delirium assessment tools; there are some new available prediction models for delirium—such as Prediction Model Risk of Bias Assessment Tool and Nurses' Delirium Screening Checklist—that need to be improved [15, 16, 17].
Despite this progress, perceived barriers in effective delirium management remain evident. Recent systematic and integrative reviews reported some barriers including lack of documentation, lack of time, knowledge deficit, impaired communication that delay the implementation of nurse‐led delirium management [18, 19, 20]. These barriers highlight the need for further studies on nurses' beliefs and practices, as well as the development of specific educational and institutional solutions. Moreover, while the prevalence and risk factors for postoperative delirium—such as pain, longer duration of stay in the ICU, use of physical restraints—have been widely investigated, further research is needed to determine effective nursing care interventions that address these factors and improve patient outcomes [3, 21].
Although bibliometric studies on postoperative delirium have been conducted in broader surgical contexts [22], bibliometric analyses specifically focusing on postoperative delirium within intensive care nursing remain limited. Given the expanding body of literature, a bibliometric mapping of publications in the nursing field is warranted to systematically evaluate research trends, identify influential works and highlight areas requiring further investigation. The purpose of this article is to map the focus and thematic trends of research on postoperative delirium and nursing care in intensive care units. The findings are expected to provide valuable insights into the evolution of nursing knowledge on postoperative delirium in ICUs and inform future directions for clinical practice, nursing knowledge, and policy.
2. Aims and Research Questions
The aim of this study was to quantitatively analyse and visually map publication trends, citation patterns, key terms and country contributions in nursing research on postoperative delirium in intensive care units and to describe the overall characteristics of the literature.
The research questions are presented below:
How are studies on the subject distributed by country, journal, institution and author?
What are the trends, most productive topics and existing gaps in the literature on studies related to the subject?
3. Methods
3.1. Design
This study was conducted as a retrospective and descriptive research using bibliometric analysis methods. Bibliometric analyses can be made more comprehensive with scientific maps that reveal interactions between authors, institutions, countries and similar variables. Such maps examine the structure of a discipline or research field and the collaborations between articles, researchers, and expertise through visualized networks [23]. Thematic reviews have a structure that differs from traditional manual literature search methods. This study is presented in accordance with the methodological and reporting principles recommended by the EQUATOR network for bibliometric studies [24].
3.2. Setting
In bibliometric analysis, the method relies on tools and techniques specific to this field; it is examined more comprehensively using technology‐supported quantitative and statistical indicators [25]. These studies generally employ two fundamental analytical approaches: (a) performance analysis, which reveals the quantity and impact of research outputs and (b) scientific mapping, which makes visible the knowledge clusters, themes and research communities within a field [26, 27].
3.3. Data Collection
The data were obtained from the Web of Science (WoS) database via the Akdeniz University online library. A search conducted in the WoS database using the keywords ‘postoperative delirium’, ‘intensive care unit’, ‘nursing’ or ‘nurse’ identified 211 publications. The inclusion criteria were (a) studies containing the keywords ‘postoperative delirium’, ‘intensive care unit’, ‘nursing’ or ‘nurse’ in the title, keywords or abstract. The exclusion criteria were (b) articles without keywords; (c) editorial material, book chapters, proceeding papers and retracted articles; (d) publications written in languages other than English. Along with 10 studies unrelated to the topic, three German and one Greek publications; one book chapter, one editorial material, one proceeding paper and one retracted article were excluded from the analysis. A bibliometric analysis was performed on a total of 193 publications, including 162 articles and 31 reviews (Figure 1). Since bibliometric studies mostly use large data sets, it is important to limit the analyses to a specific time frame and database, considering the efficiency and effectiveness of the search processes [28, 29]. For this reason, the study was conducted in the WoS database. The three best databases for bibliometric data are WoS, Scopus and Google Scholar. WoS is a comprehensive indexing system that includes over 21 000 high‐quality academic journals from around the world, including open access publications that have undergone a peer‐review process [30, 31]. Due to the ongoing scientific flow in the database, the search was conducted on December 1, 2025, for a single day. No time restrictions were imposed on the literature.
FIGURE 1.
Flow diagram of study selection.
3.4. Data Analysis
The analysis of the obtained data was performed using R Studio software and the ‘Biblioshiny’ application from the Bibliometrix R package [32]. Publications downloaded in BibTeX format and saved as Savedrecs.bib were processed in R Studio and classified according to data inclusion and exclusion criteria. In addition, the annual distribution of publications was visualized using Microsoft Excel.
3.5. Ethics Statement
Since the study involved a retrospective review of data obtained from the WoS database, ethics committee approval was not required.
4. Results
4.1. Basic Information and Number of Publications by Year
Between 2001 and 2025, a total of 193 documents on postoperative delirium in intensive care units were published in 115 sources. The annual growth rate of publications was 5.95%, the average age of articles was 7.06 years, and the average number of citations per article was 45.79. A total of 4711 references were made to the articles. There were 975 authors and six single‐authored studies. The average number of co‐authors per document was 5.77, while the international co‐authorship rate was 20.73% (Table 1).
TABLE 1.
Basic information.
| Descriptive | |
| Timespan | 2001–2025 |
| Sources | 115 |
| Documents | 193 |
| Annual growth rate % | 5.95 |
| Document average age | 7.06 |
| Average citations per doc | 45.79 |
| References | 4711 |
| Document contents | |
| Keywords plus | 413 |
| Author's keywords | 400 |
| Authors | |
| Authors | 975 |
| Authors of single‐authored docs | 6 |
| Authors collaboration | |
| Single‐authored docs | 6 |
| Co‐authors per doc | 5.77 |
| International co‐authorships % | 20.73 |
| Document types | |
| Article | 162 |
| Review | 31 |
When examining the distribution of publications for the 2001–2025 period, it was observed that the highest production, 55.96%, occurred between 2019 and 2025 (Figure 2).
FIGURE 2.
Annual trend in article production.
4.2. Top 10 Authors, Institutions and Journals That Contributed the Most to Field
The findings in Table S1 reveal the contribution levels of the ten most productive authors, the country, the institution, and the journal in the field. In this context, Ely Ew. (n = 9) is seen to be the most productive author. In terms of institutional contributions, Vanderbilt University (n = 47) stands out as the institution producing the most publications. The journal that published the most articles on the subject is ‘Nursing in Critical Care’ (n = 9) (Table S1).
4.3. Top Countries by Publications and Citations
Table S2 presents the top 10 most productive countries, determined by publication counts and citation analyses, as well as the relationships observed among these countries. According to this, the United States (freq = 257) stands out as having the highest productivity and citation count (n = 4292) (Table S2). When examining the scientific map of countries, those with the highest number of publications are shown in shades of blue, whereas grey indicates countries with no publications. The colour transition from dark blue to light blue indicates that countries are ranked from highest to lowest in terms of publication production levels (Figure S1).
4.4. Co‐Occurrence Network, Word Cloud and Thematic Map
A network analysis method based on author keywords was used. This method shows how often keywords happen at the same time. The network analysis revealed that the keywords formed five distinct clusters. The cluster highlighted in red represents the most frequently co‐occurring keywords, whereas the purple and blue clusters indicate commonly used terms. In the purple cluster, the keywords ‘delirium’, ‘intensive care unit’, ‘nursing’, ‘critical care’, ‘intensive care’, ‘surgery’ and ‘critical illness’ stand out in terms of frequency of use (Figure 3).
FIGURE 3.
Co‐occurrence network.
It presents a word cloud of the most frequently used keywords related to the topic. In the word cloud, the size of each word increases with its frequency of use. The most frequently used author keywords were identified as ‘delirium (freq = 127)’, ‘intensive care unit (freq = 31)’, ‘nursing (freq = 27)’, ‘critical care (freq = 24)’, ‘postoperative delirium (freq = 20)’, ‘risk factors (freq = 19)’, ‘ICU (freq = 15)’ and ‘cardiac surgery, intensive care, and surgery (freq = 11)’ (Figure S2).
The thematic map of studies related to postoperative delirium in intensive care is presented in Figure 4. This analysis considered 50 author keywords. The minimum clustering reference value was set to one, and only one level was used for each cluster. The upper‐right quadrant of the map displays the ‘motor themes’, characterized by high centrality and density, with prominent keywords such as ‘knowledge’, ‘critically ill patients’ and ‘delirium’. The upper‐left quadrant contains themes with low centrality but high density—these are typically niche areas. In this region, terms like ‘eye masks’ and ‘postoperative complications’ appear, indicating limited external connections to the broader research topic. The lower‐left quadrant comprises themes with both low centrality and low density, suggesting limited impact in the field; this includes keywords like ‘machine learning’ and ‘risk factor’. The lower‐right quadrant features main themes with high centrality but low density. Here, the keywords ‘cardiac surgery’, ‘nursing care’, ‘postoperative delirium’, ‘postoperative care’ and ‘CAM‐ICU’ stand out. This indicates that these are central themes that still have room for further research development (Figure 4).
FIGURE 4.
Thematic map.
5. Discussion
This study provides the first systematic bibliometric mapping of research on postoperative delirium in intensive care units within the field of nursing. By analysing publication statistics and thematic trends of research, the findings strengthen the knowledge based on postoperative delirium in nursing care and provide the basis for further targeted investigations. The analysis examines 193 documents published between the years 2001 and 2025. The earliest publication identified from 2001 focused on nursing practice in postoperative delirium assessment in the ICU and introduced the Confusion Assessment Method (CAM) which is widely used by nurses for the rapid and reliable diagnosis of delirium [33].
A significant finding is the marked increase in scholarly activity, with more than half of all publications (55.96%) being published within the most recent 7‐year period (2019–2025). This sharp rise in publications reflects the recent and global recognition of postoperative delirium as an important patient safety and quality of care indicator within intensive care units. In this context, the expansion of research articles, meta‐analytic evidence and the development of standardized delirium screening tools highlight the intensified scholarly focus on postoperative delirium in recent years [4, 16].
Based on publications by countries, the United States emerged as the top prolific contributor to the literature on postoperative delirium in intensive care nursing. This is evidenced by the US ranking first in total publications as well as being the origin of both the most productive author and institution. In this context, the nation's large research facilities, high rates of specialized procedures and early adoption of protocols for managing complex critical care patients are frequently cited as reasons for this dominance [5]. In addition to publication volume, the collaboration patterns observed in this study provide further insight into the structure of the literature. The international collaboration rate was relatively limited, indicating that most studies were conducted within single‐country research teams rather than through multinational cooperation. From a bibliometric perspective, this finding suggests that research networks remain modest. The country‐level distribution also indicates that contributions from many regions remain comparatively limited.
The network and frequency analyses of author keywords identified ‘delirium’, ‘intensive care unit’, ‘nursing’, ‘critical care’ and ‘postoperative delirium’ as the most prominent concepts shaping the current literature. These keywords collectively define the primary focus of the field. Further analysis using the thematic map highlighted clusters of research themes that are currently developing and represent possible directions for further investigations. Within the basic themes, the keywords such as ‘cardiac surgery’, ‘nursing care’, ‘postoperative delirium’, ‘postoperative care’ and ‘CAM‐ICU’ suggest the need for more comprehensive studies and deeper exploration of their internal relationships. Despite the clear establishment of these core concepts, the thematic analysis suggests that some areas receive comparatively less emphasis within the mapped literature. Taken together, these findings indicate that while the core concepts of postoperative delirium in intensive care nursing are clearly established, the thematic structure of the literature remains distributed across multiple interconnected areas rather than consolidated within a single dominant research focus.
The distribution of publications across journals indicates that research on postoperative delirium in intensive care nursing is concentrated within a limited number of specialized nursing and critical care journals. Notably, ‘Nursing in Critical Care’ emerges as the most prominent publication venue for studies addressing postoperative delirium in intensive care settings. Although the literature spans a wide range of sources, a substantial proportion of publications are clustered within this journal, highlighting its central role in disseminating nursing research, including family‐oriented interventions on postoperative delirium in intensive care [34].
The literature contains numerous studies addressing nurses' roles, practices and approaches to delirium management in ICUs [10, 11]. However, investigations into postoperative complications and risk factors of delirium remain limited. Although the prevalence of delirium in ICUs has been widely investigated, further research is required to identify effective nursing care interventions that address these factors and improve patient outcomes [21, 35, 36].
6. Limitations
This study has strength and several limitations. One of the main strengths of this study is that it is the first bibliometric analysis to examine research focuses and thematic trends related to postoperative delirium in intensive care units. However, the study also has some methodological limitations. All publications included in the bibliometric analysis were retrieved solely from the Web of Science (WoS) database and only included studies published in English. Consequently, relevant studies indexed in other databases or published in different languages may have been excluded, potentially creating selection bias. Furthermore, the data were collected on December 1, 2025, meaning that studies published after this date were not included in the analysis, thus limiting the temporal scope of the findings. In addition, although the WOS is a widely used and high‐quality database for bibliometric analyses, the exclusion of other databases such as Scopus, PubMed and CINAHL may have limited the comprehensiveness of the retrieved literature, particularly in a nursing‐focused field.
7. Implications for Research
This bibliometric analysis highlights the need for future research to move beyond descriptive studies towards intervention‐focused and outcome‐oriented nursing research on postoperative delirium in intensive care units. Greater emphasis should be placed on evaluating nurse‐led, non‐pharmacological interventions and their impact on patient outcomes. Additionally, expanding bibliometric analyses to include multiple databases and non‐English publications may provide a more comprehensive understanding of global research trends and collaboration patterns.
8. Conclusions
This bibliometric analysis provides an overview of research trends and thematic structures related to postoperative delirium in intensive care units within the nursing field. The findings demonstrate a substantial increase in publications over the past 7 years, reflecting growing scholarly attention to postoperative delirium as an important issue in patient safety and quality of care. Research output has been predominantly driven by the United States and concentrated in a limited number of journals. Thematic analyses indicate that existing studies primarily focus on delirium assessment, intensive care nursing and postoperative outcomes, particularly in cardiac surgery patients. Core themes such as nursing care, postoperative delirium, postoperative care and the use of CAM‐ICU remain central yet insufficiently developed, suggesting important gaps in interventions‐based nursing research. Overall, this study summarises research trends in nursing literature on delirium in intensive care units and highlights potential directions for future research.
Funding
The authors have nothing to report.
Ethics Statement
The authors have nothing to report.
Consent
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Table S1: Top 10 authors, affiliation and journals contributing the most to the field.
Table S2: Top countries by publications and citations.
Figure S1: Country scientific production.
Figure S2: Word cloud.
Acknowledgements
The authors have nothing to report.
Data Availability Statement
Data available upon request from the authors.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Table S1: Top 10 authors, affiliation and journals contributing the most to the field.
Table S2: Top countries by publications and citations.
Figure S1: Country scientific production.
Figure S2: Word cloud.
Data Availability Statement
Data available upon request from the authors.