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Falk A, Stenman M, Kåhlin J, Hultgren R, Nymark C. Suffering in silence - Cardiac surgery patients recalling hypoactive delirium a qualitative descriptive study. Intensive Crit Care Nurs 2023; 79:103493. [PMID: 37480700 DOI: 10.1016/j.iccn.2023.103493] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES Postoperative delirium affects up to 50% of patients undergoing cardiac surgery. Delirium phenotypes are commonly divided into hyperactive and hypoactive, with hypoactive symptoms (reduced motor activity and withdrawal) often being overlooked due to their discreet character. Although the consequences of hypoactive delirium are severe, studies focusing on patients' experiences of hypoactive delirium are scarce. The aim of the study was to describe cardiac surgery patients' experiences of hypoactive delirium. RESEARCH METHODOLOGY/DESIGN We used qualitative descriptive semi-structured interviews with an inductive, latent approach. Twelve patients with hypoactive symptoms of delirium after cardiac surgery were purposefully selected. Interview data were analysed by qualitative content analysis. FINDINGS Two themes based on eight sub-themes emerged. "Dream or reality in parallel worlds" included disturbing experiences of existing in parallel realities with cognitive effects, residual nightmares, and illusions that occasionally persisted after hospital discharge. "Managing the state of hypoactive delirium" included experiences of intellectually dealing with hypoactive delirium with assumptions of causes and cures, and through interactions like communicating with others. CONCLUSION Participants experienced hypoactive delirium as extensive and long-lasting with perceptions of existing in parallel realities. The findings emphasize the need for healthcare professionals to have expertise in hypoactive delirium and its fluctuating course, as the delirium of many patients may be undetected and undiagnosed. Improving the use of screening tools for clinical practice is essential for the detection of hypoactive delirium, and a person-centred approach is needed to properly care for this group of patients. IMPLICATIONS FOR CLINICAL PRACTICE The challenges in the recognition of hypoactive delirium need to be emphasized because the syndrome is still overlooked. The use of screening tools in clinical practice is essential. A person-centred approach supports relationships between delirious patients and healthcare professionals.
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Affiliation(s)
- Anna Falk
- Department of Molecular Medicine and Surgery, Karolinska Institutet, L1:00, Anna Steckséns gata 53, SE-171 76 Stockholm, Sweden; Perioperative Medicine and Intensive Care Function E7:67, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
| | - Malin Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, L1:00, Anna Steckséns gata 53, SE-171 76 Stockholm, Sweden; Perioperative Medicine and Intensive Care Function E7:67, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Jessica Kåhlin
- Perioperative Medicine and Intensive Care Function E7:67, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Biomedicum, Solnavägen 9, SE-171 65 Solna, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, L1:00, Anna Steckséns gata 53, SE-171 76 Stockholm, Sweden; Department of Vascular Surgery, C9:27, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Carolin Nymark
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, SE-141 52 Huddinge, Sweden; Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Gill C, Griffiths M, Easton A, Solomon T. Challenges for nurses in caring for patients with acute encephalitis: lack of knowledge, time and rehabilitation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:40-45. [PMID: 35019745 DOI: 10.12968/bjon.2022.31.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM To explore the experiences of registered nurses providing care to adult patients affected by encephalitis, from admission into hospital through to discharge. STUDY DESIGN A qualitative phenomenological methodology was used. Sample and setting: Eight registered nurses in a city centre teaching hospital. METHODS Data collection took place using in-depth, semi-structured interviews. Data were analysed and themes identified using framework analysis. FINDINGS Three key findings were identified: nurses felt that they lacked knowledge of encephalitis, lacked time to give these patients the care they needed, and they lacked access to rehabilitation for patients with encephalitis. CONCLUSION This study provides the first evidence on nurses' experiences of providing care to patients affected by encephalitis. It has shown that they often lack the knowledge and time to give adequate support to patients. They also lack access to rehabilitation for these patients.
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Affiliation(s)
- Claire Gill
- PhD Candidate, Department of Health Sciences, University of York
| | - Mike Griffiths
- Clinical Lecturer, Institute of Infection and Global Heath, University of Liverpool
| | - Ava Easton
- CEO Encephalitis Society, Encephalitis Society, Malton, North Yorkshire
| | - Tom Solomon
- Professor, Encephalitis Society, Malton, North Yorkshire
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Kim H, Lee SM. Effect on Quality of Care of a Delirium Prevention Campaign for Surgical Intensive Care Nurses. J Nurs Care Qual 2021; 36:361-368. [PMID: 33394874 DOI: 10.1097/ncq.0000000000000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delirium is an important issue related to mortality in patients treated in intensive care units. LOCAL PROBLEM Although there are guidelines for preventing delirium, its importance may be overlooked compared with the treatment of physical illness. METHODS A 2-step delirium prevention campaign (DPC) was implemented and its effects compared (before and after the DPC). INTERVENTIONS The DPC comprised the Confusion Assessment Method for the Intensive Care Unit and a checklist for delirium prevention. RESULTS Hospital mortality declined after the DPC, but there were no significant changes in the incidence and duration of delirium. CONCLUSIONS Nurses led the delirium preventive care intervention. Delirium prevention care may be more effective with policy approaches to progress the DPC.
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Affiliation(s)
- Heejeong Kim
- Seoul St. Mary's Hospital (Ms Kim), and Department of Nursing, College of Nursing (Dr Lee), The Catholic University of Korea, Seoul, Republic of Korea
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Qiu Y, Sessler DI, Chen L, Halvorson S, Cohen B, Bravo M, Ince I, Maheshwari K, Kurz A. Preoperative Vitamin D Deficiency Is Associated With Postoperative Delirium in Critically Ill Patients. J Intensive Care Med 2021; 37:655-662. [PMID: 34196246 DOI: 10.1177/08850666211021330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Postoperative delirium is common, with a reported incidence of 11% to 80% in critically ill patients. Delirium is an independent prognostic factor for poor hospital outcomes. Low vitamin D concentrations are associated with a decline in cognitive function. We therefore tested the hypothesis that low preoperative serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with postoperative delirium in critically ill patients. METHOD We conducted a retrospective analysis of adults in a surgical intensive care unit for at least 48 hours immediately after non-cardiac and non-neurosurgical operations at Cleveland Clinic between 2013 and 2018. Delirium was assessed by trained nurses using CAM-ICU twice daily for the initial 5 postoperative days. Any positive value was considered evidence of delirium. We assessed the association between 25(OH)D concentrations within a year before surgery and the incidence of postoperative delirium using logistic regression, adjusted for potential confounders. A linear spline term with a knot at 30 ng/ml, the threshold for normal 25(OH)D concentration, was added to accommodate a nonlinear relationship between 25(OH)D concentrations and delirium. RESULTS We included 632 patients, who had a mean (SD) 25(OH)D concentration of 25 (15) ng/ml; 55% (346/632) experienced delirium. We observed an adjusted odds ratio of 1.4 (95% CI: [1.1, 1.8], P = 0.01) for delirium per 10 ng/ml decrease in 25(OH)D concentrations when patients' 25(OH)D concentrations were less than 30 ng/ml. In patients whose 25(OH)D concentrations were at least 30 ng/ml, the adjusted odds ratio was 0.9 (95% CI: [0.7, 1.1], P = 0.36). CONCLUSION Preoperative 25(OH)D concentrations are associated with postoperative delirium in patients whose concentrations are below the normal threshold, but not at concentrations ≥30 ng/ml. A trial will be needed to determine whether the relationship is causal, and whether vitamin D supplementation before surgery might reduce the incidence of delirium.
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Affiliation(s)
- Yuwei Qiu
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | | | - Liang Chen
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Sven Halvorson
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Barak Cohen
- Department of Outcomes Research, Cleveland Clinic, OH, USA
| | - Mauro Bravo
- Department of Outcomes Research, Cleveland Clinic, OH, USA
| | - Ilker Ince
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - Andrea Kurz
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH, USA
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Contreras CCT, Páez-Esteban AN, Rincon-Romero MK, Carvajal RR, Herrera MM, Castillo AHDD. Nursing intervention to prevent delirium in critically ill adults. Rev Esc Enferm USP 2021; 55:e03685. [PMID: 33886913 DOI: 10.1590/s1980-220x2019035003685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of a nursing intervention for delirium prevention in critically ill patients. METHOD A quasi-experimental study was conducted with a non-equivalent control group and with evaluation before and after the intervention. 157 Patients were part of the intervention group and 134 of the control group. Patients were followed-up until they were discharged from the ICU or died. The incidence of delirium in both groups was compared. Additionally, the effect measures were adjusted for the propensity score. RESULTS The incidence and incidence rate of delirium in the control group were 20.1% and 33.1 per 1000 person-days (CI 95% 22.7 to 48.3) and in the intervention group was 0.6% and 0.64 per 1000 person-days (CI 95% 0.22 to 11.09), respectively. The crude Hazard Ratio was 0.06 (CI 95% 0,008 to 0,45) and adjusted 0.07 (CI 95% 0,009 to 0,60). The number needed to be treated was six. CONCLUSION Low incidence of delirium in critically ill patients intervened demonstrated the effectiveness of interventions. The average intervention time was 4 days with a 15-minutes dedication for each patient.
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Affiliation(s)
| | | | | | - Raquel Rivera Carvajal
- Universidad de Santander, Facultad de Ciencias de la Salud, Bucaramanga, Santander, Colombia
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Henao Castaño ÁM, Baquero Lizarazo AC, Gonzalez Pabon N, Burgos Tulcán GF, Lozano Gonzalez L. Enfermería en la monitorización del delirium en cuidado intensivo adulto: una revisión de alcance. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2021. [DOI: 10.11144/javeriana.ie22.emdc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introducción. El delirium es una alteración cognitiva secundaria a una situación clínica aguda que puede estar presente en el paciente crítico, y la enfermería juega un rol protagónico en la prevención, monitoreo y tratamiento no farmacológico del delirium en el paciente en unidad de cuidado intensivo. Objetivo. Identificar las investigaciones actuales que describen las estrategias que utilizan las enfermeras para la monitorización del delirium en la unidad de cuidado intensivo adulto. Método. Revisión de alcance, utilizando la pregunta orientadora ¿qué estrategias utiliza enfermería en la monitorización del delirium en la unidad de cuidado intensivo?, estudios obtenidos en las bases de datos PubMed, Biblioteca Virtual en Salud, Science Direct y Cochrane. Se realizó una revisión crítica con el instrumento CASPe, los datos se extrajeron, y se llevaron a cabo registros en tablas de gráficos elaboradas para condensar la información. Resultados. Trece estudios se consideraron relevantes y fueron analizados. Las estrategias de monitorización del delirium empleadas por enfermería son, principalmente, el juicio clínico, la observación de la agitación y, en menor medida, el empleo de instrumentos validados para la detección. Conclusión. La enfermería requiere comprender mejor el delirium, y para esto la educación es vital para mejorar su conocimiento, y aumentar la autoconfianza y competencia en la evaluación a través del uso correcto de instrumentos.
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FitzGerald JM, Price A. Delirium in the acute hospital setting: the role of psychiatry. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2020.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
SUMMARYIn this overview we discuss the role of psychiatry in managing delirium in acute hospital admissions. We briefly discuss the role psychiatry can offer in four main domains: (a) assessment; (b) management; (c) recovery; and (d) paradigm, education and research. In the assessment section we discuss accurately detecting delirium in the context of comorbid mixed neuropsychiatric syndromes, including depression and dementia, and the clinical importance of delirium subtyping. The management section briefly outlines pharmacological and non-pharmacological approaches to delirium and their evidence-based rationale. The recovery section focuses on the effect delirium can have on cognitive decline, mental health and long-term health, including functional outcome and need for institutional care after hospital discharge. Finally, we outline the role of psychiatry in delirium research and education. We hope that this article will encourage clinicians to reflect on their current practice and consider holistic and evidence-based care for this vulnerable population in the acute hospital setting.
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Al-Qadheeb NS, Nazer LH, Aisa TM, Osman HO, Rugaan AS, Alzahrani AS, Ghonimat IM, Mohammed AM, Maghrabi K, Alrowaished AA, Hussein NH, Maslamani YA, Falatah S, Skrobik Y. Arabic intensive care delirium screening checklist's validity and reliability: A multicenter study. J Crit Care 2019; 54:170-174. [PMID: 31476652 DOI: 10.1016/j.jcrc.2019.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/19/2019] [Accepted: 08/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop an Arabic version of Intensive Care Delirium Screening Checklist (ICDSC) and assess its validity and reliability among critically ill patients. MATERIALS AND METHODS Multicentered study of convenience sample of adult ICU patients. Arabic translation was performed with rigorous back-to-back translation methods. Concurrent validity was established by calculating the sensitivity and specificity of two examiner assessments compared to a psychiatric evaluation. Kappa coefficients describe interrater reliability, whereas Cronbach α and composite reliability depict internal consistency. RESULTS Three hundred critically ill patients were enrolled. Of these, validity testing was assessed in 180 patients. ICDSC screening was positive for delirium in 11% of enrolled patients. The area under the receiver operator characteristic (ROC) curve is 0.9413, with predicted sensitivity 70% (95% confidence interval [CI]: 60-81%) and specificity 99% (95% CI: 98-100%). The Arabic ICDSC showed acceptable internal consistency (Cronbach α = 0.63 and composite reliability = 0.64). Interrater agreement was excellent (Kappa coefficient [ҡ] = 0.85). CONCLUSIONS Arabic ICDSC is a valid and reliable delirium-screening tool among Arabic-speaking ICU population. Future studies could address whether these findings are generalizable to a higher proportion of mechanically ventilated patients, and address acceptability and reliability in other Arabic language critical care settings.
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Affiliation(s)
- Nada S Al-Qadheeb
- Department of Critical Care, Hafer Albatin Central Hospital, Hafer Albatin, Saudi Arabia.
| | - Lama H Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Tharwat M Aisa
- Department of Critical Care, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Hassan O Osman
- Department of Critical Care, Hafer Albatin Central Hospital, Hafer Albatin, Saudi Arabia
| | - Asia S Rugaan
- Department of Critical Care, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ahmad S Alzahrani
- Department of Psychiatry, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Iyad M Ghonimat
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
| | - Alaaldin M Mohammed
- Department of Critical Care, Hafer Albatin Central Hospital, Hafer Albatin, Saudi Arabia
| | - Khalid Maghrabi
- Department of Critical Care, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abdulellah A Alrowaished
- Department of Psychiatry, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Najah H Hussein
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
| | - Yahya A Maslamani
- Department of Critical Care, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Sawsan Falatah
- Department of Nursing, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Yoanna Skrobik
- McGill University, Department of Medicine, Regroupement de Soins Critiques Respiratoires, Réseau de Santé Respiratoire FRQS, Montreal, QC, Canada
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