Improving the Accuracy of Delirium Assessments in Neuroscience Patients: Scaling a Quality Improvement Program to Improve Nurses' Skill, Compliance, and Accuracy in the Use of the Confusion Assessment Method in the Intensive Care Unit Tool

Risk factors for delirium after surgery for craniocerebral injury in the neurosurgical intensive care unit

BACKGROUND

Postoperative delirium is common in patients who undergo neurosurgery for craniocerebral injury. However, there is no specific medical test to predict postoperative delirium to date.

AIM

To explore risk factors for postoperative delirium in patients with craniocerebral injury in the neurosurgery intensive care unit (ICU).

METHODS

A retrospective analysis was performed in 120 patients with craniocerebral injury admitted to Hainan People’s Hospital/Hainan Hospital Affiliated to Hainan Medical University, The First Affiliated Hospital of Hainan Medical University, and The Second Affiliated Hospital of Hainan Medical University between January 2018 and January 2020. The patients were categorized into groups based on whether delirium occurred. Of them, 25 patients with delirium were included in the delirium group, and 95 patients without delirium were included in the observation group. Logistic regression analysis was used to explore the association between sex, age, educational level, Glasgow coma scale (GCS), complications (with or without concussion, cerebral contusion, hypoxemia and ventricular compression) and site of injury and delirium.

RESULTS

The GCS score above 8 and concomitant disease of cerebral concussion, cerebral contusion, hypoxemia and ventricular compression, and damage to the frontal lobe were associated with delirium in patients admitted to neurosurgical intensive care unit (ICU) (all P < 0.05). However, age, sex, administration more than three medicines, and educational level were not significantly associated with the onset of delirium in patients with craniocerebral injury in the neurosurgical ICU (P < 0.05). Multivariate logistic regression analysis showed that GCS score above 8, cerebral concussion, cerebral contusion, hypoxemia, ventricle compression, and frontal lobe disorders were independent risk factors for delirium in patients with craniocerebral injury in the neurosurgical ICU (P < 0.05).

CONCLUSION

GCS score, concussive concussion, cerebral contusion, hypoxemia, ventricle compression, and damage to frontal lobe are risk factors of postoperative delirium.

Implementation Science Training and Resources for Nurses and Nurse Scientists

PURPOSE

The purpose of this article is to describe the differences between quality improvement and implementation science, the urgency for nurses and nurse scientists to engage in implementation science, and international educational opportunities and resources for implementation science.

ORGANIZING CONSTRUCT

There is a push for providing safe, effective, patient-centered, timely, efficient, and equitable health care. Implementation science plays a key role in adoption and integration of evidence-based practices to improve quality of care.

METHODS

We reviewed implementation science programs, organizations, and literature to analyze the roles of nurses and nurse scientists in translating evidence into routine practice.

FINDINGS

Implementation-trained nurses and nurse scientists are needed as part of multidisciplinary teams to advance implementation science because of their unique understanding of contextual barriers within nursing practice. Likewise, nurses are uniquely qualified for recognizing what implementation strategies are needed to improve nursing care across practice settings.

CONCLUSIONS

Many international clinical and training resources exist and are supplied to aid interested readers in learning more about implementation science.

CLINICAL RELEVANCE

Half of research evidence never reaches the clinical setting, and the other half takes 20 years to translate into clinical practice. Implementation science-trained nurses are in a position to be excellent improvers for meaningful change in practice.