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Ayanaw Eyayu R, Gudayu Zeleke T, Chekol WB, Yaregal Melesse D, Enyew Ashagrie H. Assessment of level of knowledge, attitude, and associated factors toward delirium among health professionals working in intensive care unit multicenter, cross-sectional study, Amhara region comprehensive specialized hospitals, Northwest Ethiopia, 2023. Front Public Health 2024; 12:1338760. [PMID: 38510361 PMCID: PMC10951067 DOI: 10.3389/fpubh.2024.1338760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/30/2024] [Indexed: 03/22/2024] Open
Abstract
Background Patients in Intensive Care Unit (ICU) are at high risk of developing delirium. Lack of early detection and the inability to provide prompt management of delirium remain challenges of ICU patient care. This study aimed to assess the level of knowledge, attitude, and associated factors toward delirium among healthcare providers working in ICU. Methods A multicenter, cross-sectional survey was conducted in comprehensive specialized hospitals from 15 April to 5 June 2023. Data were collected using a pretested, self-administered questionnaire. Ordinal logistic regression analysis was performed at p < 0.05 with a 95% confidence interval (CI). The odds ratio with 95% CI was calculated to determine the strength of the association between independent and outcome variables. Results A total of 202 health professionals were included in this study, with a response rate of 87%. The proportions of good, moderate, and poor knowledge about delirium in ICU were 29.21 (95% CI: 23-36), 52.48 (95% CI: 45.3-59.5) and 18.32 (95% CI:13.2-24.4), respectively. The overall proportion of negative, neutral and positive attitude were 13.9 (95% CI: 9.4-19.4), 65.8 (95% CI: 58.9-72.4) and 20.3 (95% CI: 15-26.5) respectively. Being an anesthetist and exposure to training were positively associated with a good knowledge while belief in screening tool to change care and reading, and using guidelines were positively associated with a positive attitude. However, believing the impossibility of changing the practice of delirium care, and negative attitudes were delaying factors for a good knowledge. Also, workload and poor knowledge were hindering factors for a positive attitude. Conclusion More than half of health professionals had moderate knowledge and neutral attitude toward delirium. However, some of them had poor knowledge and a negative attitude. We recommend stakeholders prepare regular training for delirium care. Also, we urge health professionals to update themselves by reading guidelines and to use screening protocols for delirium.
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Affiliation(s)
| | | | | | | | - Henos Enyew Ashagrie
- Department of Anaesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Zhao Y, Missbrenner N, Xu HD, Josephson J. Enhancing delirium assessment and management through nursing education interventions: A scoping review. Nurse Educ Pract 2024; 75:103887. [PMID: 38245939 DOI: 10.1016/j.nepr.2024.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Abstract
AIM/OBJECTIVE The purpose of this scoping review was to explore the characteristics and outcomes of education interventions for nurses focused on delirium assessment and management. BACKGROUND Delirium is a prevalent acute and reversible neuropsychiatric syndrome in hospitalized patients. Delirium can cause cognitive, psychiatric and physical impairments and result in prolonged hospital stay, increased risk of readmission and elevated morbidity and mortality rates. Nurses play an essential role in managing delirium. There is a lack of understanding of the existing nursing educational interventions on delirium management. DESIGN The study was a scoping review. METHODS In this scoping review, we used Arksey and O'Malley's (2005) scoping review framework. We searched articles published between 2019 and 2023 in Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE using the following CINAHL/MeSH suggested subject terms: "delirium" in conjunction with "education" "intervention" and "nurse", "nurses" or "nursing." Studies on improving nursing knowledge and practices regarding delirium were included while those focusing on nursing students were excluded. Initial screening involved evaluating article titles and abstracts for relevance from 164 identified articles, followed by a full-text review of 42 articles. Finally, 17 articles were selected for comprehensive analysis. We extracted relevant information from each article and charted the findings in an evidence table. RESULTS The 17 selected articles showcased a variety of interventions used to educate nursing staff, such as workshops, simulations, group discussions, online modules and one-on-one coaching. Educational interventions primarily focused on delirium definition, risk factors, assessment and management. These educational interventions enhanced nurses' perception of delirium, boosting their confidence and knowledge in managing delirium. These interventions also led to increased compliance with delirium assessment and management protocols, which ultimately resulted in improved documentation accuracy and patient outcomes. CONCLUSIONS Findings from this scoping review suggest that nursing administration need to provide support and education for delirium prevention and management to enhance nursing staff confidence and competence in assessing and managing delirium. The use of interactive educational techniques has demonstrated profound benefits in schema development, expertize promotion and critical thinking. These findings have significant implications for future research, including the identification of essential nursing competencies for educational interventions and the assessment of long-term knowledge retention and its application in nursing practice.
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Affiliation(s)
- Yunchuan Zhao
- School of Nursing, Boise State University, 1910 University Drive, Mail Stop 1840, Boise, ID 83725, United States.
| | - Nicolette Missbrenner
- School of Nursing, Boise State University, 1910 University Drive, Mail Stop 1840, Boise, ID 83725, United States
| | - H Daniel Xu
- Department of Political Science, East Carolina University, 1000 E 5th Street, Mail Stop 564, Greenville, NC 27858, United States
| | - Jayne Josephson
- School of Nursing, Boise State University, 1910 University Drive, Mail Stop 1840, Boise, ID 83725, United States
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Garrido M, Álvarez E, Salech F, Rojas V, Jara N, Farías JI, de la Vega DP, Tobar E. Software-guided (PREVEDEL) cognitive stimulation to prevent delirium in hospitalised older adults: study protocol. BMC Geriatr 2023; 23:472. [PMID: 37543590 PMCID: PMC10403832 DOI: 10.1186/s12877-023-04189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/20/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Delirium is a clinical condition characterised by acute and fluctuating deterioration of the cognitive state, generally secondary to an acute pathology. Delirium is associated with negative outcomes in older adults, such as longer hospitalisations, higher mortality, and short and medium-term institutionalisation. Randomised clinical trials have shown that delirium is preventable through non-pharmacological prevention measures, decreasing its incidence by 30-50%. These interventions include promoting physical activity, facilitating the use of glasses and hearing aids, cognitive stimulation, and providing frequent reorientation of time and space, among others. These measures are currently seldom applied in hospitals in Chile and around the world for reasons including the heavy workload of clinical staff, the lack of trained personnel, and in general the absence of a systematic implementation processes. We developed a software called PREVEDEL, which includes non-pharmacological strategies such as cognitive stimulation, early mobilisation, orientation, and pain assessment. We propose a randomised clinical trial to evaluate whether cognitive stimulation guided by PREVEDEL software prevents delirium status (full/subsyndromal delirium) in hospitalised older adults. METHOD A randomised controlled trial, with parallel, multicentre groups. We will recruite patients 65 years or older who have been hospitalised for less than 48 h in the general ward or the intermediate care units of four hospitals in Santiago, Chile. The participants in the intervention group will use a tablet with cognitive stimulation software for delirium prevention for five continuous days versus the control group who will use the tablet without the software. We will evaluate the incidence, duration, density of delirium, subsyndromal delirium with the Confusion Assessment Method, cognitive with the Montreal Cognitive Assessment, and functional status with the Functional Independence Measure at discharge. Moreover, we will evaluate the adherence to prevention measures, as well as demographic variables of interest. DISCUSSION The use of cognitive PREVEDEL software could increase and improve the implementation of non-pharmacological prevention measures for delirium in hospitalised older adults, thus reducing its incidence and contributing to patients and health professionals. TRIAL REGISTRATION NCT05108207 ClinicalTrials.gov. Registered 4 November 2021.
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Affiliation(s)
- Maricel Garrido
- Departamento de Medicina, Servicio de Medicina Física y Rehabilitación, Hospital Clínico de La Universidad de Chile, Dr. Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
| | - Evelyn Álvarez
- Departamento de Terapia Ocupacional y Ciencia de La Ocupación, Facultad de Medicina, Universidad de Chile, Av. Independencia #1027, 8380453, Independencia-Santiago, Chile
- Centro de Estudios en Neurociencia Humana y Neuropsicología, Facultad de Psicología, Universidad Diego Portales, Vergara #275, 8320000, Santiago-Santiago, Chile
| | - Felipe Salech
- Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico de La Universidad de Chile, Dr. Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
- Sección de Geriatría, Hospital Clínico de La Universidad de Chile, Dr. Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
- Centro de Gerociencia, Salud Mental y Metabolismo, GERO, Las Palmeras #3425, 7800003, Ñuñoa, Santiago, Chile
| | - Verónica Rojas
- Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico de La Universidad de Chile, Dr. Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
- Departamento de Medicina, Unidad de Pacientes Críticos, Hospital Clínico de La Universidad de Chile, Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
- International Research Project for the Humanization of Intensive Care Units (HU-CI Project), Calle Cerceda #11, Collado -Villalba, 28400, Madrid, Spain
| | - Nicole Jara
- Departamento de Medicina, Servicio de Medicina Física y Rehabilitación, Hospital Clínico de La Universidad de Chile, Dr. Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
| | - José Ignacio Farías
- Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico de La Universidad de Chile, Dr. Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
- Departamento de Medicina, Unidad de Pacientes Críticos, Hospital Clínico de La Universidad de Chile, Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
| | - Daniela Ponce de la Vega
- Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico de La Universidad de Chile, Dr. Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile
| | - Eduardo Tobar
- Departamento de Medicina, Unidad de Pacientes Críticos, Hospital Clínico de La Universidad de Chile, Carlos Lorca Tobar #999, 8380456, Independencia-Santiago, Chile.
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Mohd Yosli HN, Hong W, Kazura K, Abdul Salim NH, Md Pauzi AL, Mat Din H, Sallehuddin H, Zohari Z, Minhat HS. Knowledge, Attitude, Perception and Current Practices of Health Personnel in Managing Post-Stroke Delirium in a New Stroke Centre in Malaysia. Malays J Med Sci 2023; 30:157-174. [PMID: 37655142 PMCID: PMC10467594 DOI: 10.21315/mjms2023.30.4.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/30/2022] [Indexed: 09/02/2023] Open
Abstract
Introduction Despite the high prevalence of post-stroke delirium in Malaysia, there are no studies on good practices related to its management. This study aimed to analyse the knowledge, attitude, perception, and factors associated with current practices related to delirium in acute stroke patients among health personnel at Hospital Sultan Abdul Aziz Shah (HSAAS) (formerly known as Hospital Pengajar Universiti Putra Malaysia). Methods This cross-sectional study was conducted from 26 April 2021 to 9 May 2021 (17 weeks). All health personnel from various departments managing patients with acute stroke in our centre were invited to participate. An online questionnaire was disseminated to assess their knowledge, attitude, perception, and current practices concerning delirium. Multiple logistic regression was used to examine the association between the independent and dependent variables. The level of significance was set at P < 0.05. Results The response rate was 22.49% (47 of 209 participants). More than half (61.7%, n = 29) had good current practices towards delirium in acute stroke patients. A significant association was found between knowledge and current practices related to delirium (P = 0.024). However, there was no significant association between current practices and sociodemographic factors (age, ethnicity, gender and job position), attitude, perceptions, screening barriers, or health service organisation. Conclusion Most respondents had good current practices and knowledge in managing post-stroke delirium. Therefore, upskilling health personnel for managing this illness is essential to ensure good post-stroke care and improve prognosis related to delirium.
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Affiliation(s)
| | - Wei Hong
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Khairunnisa Kazura
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Noor Hafizah Abdul Salim
- Department of Emergency, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Selangor, Malaysia
| | - Ahmad Luqman Md Pauzi
- Department of Emergency, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Selangor, Malaysia
| | - Hazwan Mat Din
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Selangor, Malaysia
| | - Hakimah Sallehuddin
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Selangor, Malaysia
- Geriatric Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Zahira Zohari
- Geriatric Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Halimatus Sakdiah Minhat
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Liu X, Long J, Chang Y, Gao H, Zhang X, Chen J, Hu R. Application of the whole-course care model (IWF/C Care) for postintensive care syndrome based on an early warning system in critically ill patients: a randomised controlled trial study protocol. BMJ Open 2023; 13:e073035. [PMID: 37479509 PMCID: PMC10364161 DOI: 10.1136/bmjopen-2023-073035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Critically ill patients are at risk of developing postintensive care syndrome (PICS), which is manifested by physical, psychological and cognitive impairment. Currently, there are no programmes that combine early warning systems with interventions for PICS. We hypothesise that a comprehensive care model for PICS based on an early warning system would reduce medical costs and the incidence of PICS. METHODS AND ANALYSIS The Intensive Care Unit (ICU) -Ward-Family/Community whole-course care (IWF/C Care) trial will be a unicentric, randomised, controlled trial. A total of 138 ICU patients from two ICUs at a university hospital in Guizhou province, China, will be enrolled in February 2023. The inclusion criteria are an age of 18 years or older, an ICU stay of more than 48 hours, provide informed consent and the ability to communicate normally. Patients will be followed for 12 months and randomised in a 1:1:1 ratio to three groups. INTERVENTIONS Patients in intervention group 1 will be assessed by the PICS early warning system within 24 hours of ICU discharge, and precise interventions will be carried out according to the results; that is, high-risk patients will receive care based on the IWF/C Care model and low-risk patients will receive routine care. All patients in intervention group 2 will receive care based on the IWF/C Care model. The control group will receive routine care. The primary endpoints are the incidence of PICS and quality of life. The secondary endpoints include the incidence of adverse events: the unplanned readmission rate, cost-effectiveness, and the experiences and feelings of patients receiving care based on the IWF/C Care model. The incidence of PICS will be measured at ICU discharge, general ward discharge, the home/community stage and 1 month and 3, 6, 9, and 12 months after discharge. ETHICS AND DISSEMINATION Ethics approval was obtained from Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University (approval number: KLL-2022-780). The results of this study will be distributed through peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2300068135.
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Affiliation(s)
- Xiaohui Liu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jianmei Long
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yonghu Chang
- School of Information Engineering, Zunyi Medical University, Zunyi, Guizhou, China
| | - Huiming Gao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xia Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Junxi Chen
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Rujun Hu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Zhou C, Qu X, Wang L, Wu Q, Zhou Y. Knowledge, attitude, and practice regarding postoperative delirium among cardiac surgery nurses: A cross-sectional multi-centre study. J Clin Nurs 2023. [PMID: 37173828 DOI: 10.1111/jocn.16751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/23/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
AIMS AND OBJECTIVES To examine knowledge, attitude, and practice regarding postoperative delirium and the relationships among cardiac surgery nurses in China. BACKGROUND Postoperative delirium is a prevalent and devastating complication following cardiac surgery. Nurses play a part in multi-disciplinary collaboration for preventing and managing postoperative delirium, of whom knowledge, attitude, and practice are essential. DESIGN A cross-sectional multi-centre study. METHODS Nurses from cardiac surgery wards and intensive care units of five tertiary hospitals in Wuhan, Hubei Province, China were enrolled. Data were gathered online using a self-administered questionnaire. Student's t-test, or analysis of variance, or non-parametric tests were performed to compare differences across groups. Bootstrapping mediation analysis was conducted to examine the relationship between knowledge, attitude, and practice. The STROBE checklist was used for the reporting of this study. RESULTS Of 429 nurses, a moderate level of knowledge and high levels of attitude and practice regarding postoperative delirium were revealed. Nurses with higher education, higher academic title, 5-10 years of practice in nursing and cardiac surgery nursing exhibited increased knowledge. With advanced age, practice in a specialised hospital, and training experience, nurses reported a better degree of practice. Attitude played a full mediating effect in the relationship between knowledge and practice, accounting for 81.82% of the total effects. CONCLUSIONS Knowledge, attitude, and practice regarding postoperative delirium are promising among Chinese cardiac surgery nurses, with knowledge of screening tools and perioperative nonpharmacological interventions and practice of screening in need of enhancement. Attitudes act as an intermediary between knowledge and practice regarding postoperative delirium. RELEVANCE TO CLINICAL PRACTICE Innovative and stratified in-service education is warranted to address knowledge enhancement. Meanwhile, organisations are suggested to make efforts to foster nurses' positive attitudes, particularly in creating a favourable culture and developing institutional protocols for postoperative delirium management to improve practice. NO PATIENT OR PUBLIC CONTRIBUTION This study is focused on cardiac surgery nurses' knowledge, attitude, and practice regarding postoperative delirium, and the research questions and design are from clinical nursing practice, literature review, and expert panel review, in which the patient or public is temporarily not involved.
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Affiliation(s)
- Chenxi Zhou
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Qu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiansheng Wu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanrong Zhou
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Baluku Murungi E, Niyonzima V, Atuhaire E, Nantume S, Beebwa E. Improving Nurses Knowledge and Practices of Delirium Assessment at Mbarara Regional Referral Hospital: A Quasi Experimental Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:313-322. [PMID: 37020902 PMCID: PMC10069436 DOI: 10.2147/amep.s398606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Despite the recommendations for delirium assessment in clinical settings, it stills remain a serious clinical problem associated with prolonged mechanical ventilation, stress on the patient and family, and mortality. There is paucity of data regarding delirium assessment and prevention in developing world. The Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was developed to aid in the assessment of delirium. There is no documented assessment of delirium and prevention in Uganda. This study evaluated the effect of an educational intervention on nurses' knowledge and practices of delirium assessment using the CAM-ICU tool. METHODS We used a quasi-experimental and recruited a convenience sample of 29 nurses from ICU and ER. The assessment before and after the interventions was conducted using a self-completed questionnaire from October 2020 to January 2021. The interventions were delivered through face-to-face presentations, demonstrations, watching videos, and hands on practice. Data were entered into excel, cleaned and exported to Stata version 14. Median and interquartile ranges were used for continuous variables, and frequencies and percentages for categorical variables. The mean knowledge score was calculated before and after the intervention. A paired t-test was used to compare Pre- and Post-test knowledge and practice scores at P <0.05. RESULTS Majority (62%) were female, 48% were Diploma holders, median age was 30 (IQR = 28-32) years and median years of experience 3.5 (IQR = 3-4). The Mean knowledge scores was 10.7 (SD = 2.36) pretest and 19 (0.94) posttest. The mean practice score was 2 (SD = 0.83) pretest and 6 (0.35) posttest. There were significant differences in mean knowledge and practice scores before and after intervention mean of (t (28) =17.32, p < 0.001) and (t (28) = 25.04, p<0.001), respectively. CONCLUSION Educational intervention Improved nurses' knowledge and practice of delirium assessment. Continuous nursing education could improve nurses' knowledge of delirium assessment and thus quality of patient care.
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Affiliation(s)
- Eric Baluku Murungi
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Vallence Niyonzima
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Evas Atuhaire
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Susan Nantume
- Masaka School of Comprehensive Nursing, Masaka City, Uganda
| | - Esther Beebwa
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda
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Vreeswijk R, Maier AB, Kalisvaart KJ. Recipe for primary prevention of delirium in hospitalized older patients. Aging Clin Exp Res 2022; 34:2927-2944. [PMID: 36131074 DOI: 10.1007/s40520-022-02249-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022]
Abstract
Delirium is an acute fluctuating syndrome characterized by a change in consciousness, perception, orientation, cognition, sleep-wake rhythm, psychomotor skills, and the mood and feelings of a patient. Delirium and delirium prevention remain a challenge for healthcare professionals, especially nurses who form the basis of patient care. It also causes distress for patients, their caregivers and healthcare professionals. However, delirium is preventable in 30-40% of cases. The aim of this article is to summarize the delirium risk models, delirium screening tools, and (non-pharmacological) delirium prevention strategies. A literature search of review articles supplemented by original articles published in PubMed, Cinahl, and Cochrane between 1 January 2000 and 31 December 2020 was carried out. Among the older patients, delirium is a common condition with major consequences in terms of mortality and morbidity, but prevention is possible. Despite the fact that delirium risk models, delirium screening scales and non-pharmacological prevention are available for the development of a hospital delirium prevention programme, such a programme is still not commonly used on a daily basis.
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Affiliation(s)
- Ralph Vreeswijk
- Department of Geriatric Medicine, Spaarne Gasthuis Haarlem, Boerhavelaan 22, 2035 RC, Haarlem, The Netherlands.
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.,Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
| | - Kees J Kalisvaart
- Department of Geriatric Medicine, Spaarne Gasthuis Haarlem, Boerhavelaan 22, 2035 RC, Haarlem, The Netherlands
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Development of a scale measuring the difficulties faced by nurses who care for patients with delirium in intensive care units. Aust Crit Care 2022:S1036-7314(22)00043-1. [PMID: 35595665 DOI: 10.1016/j.aucc.2022.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/02/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Delirium in patients in the intensive care unit is associated with adverse outcomes. Nurses experience many difficulties in caring for those with delirium, which can lead to nurse burnout, prevent effective care for patients, and negatively impact the patient. The identification of factors creating challenges for nurses is, therefore, important to enable intervention. OBJECTIVES The aim of this study was to develop a new scale to assess the difficulties faced by nurses caring for patients with delirium in the intensive care unit and to examine its reliability and validity. METHODS We based our draft scale items on literature reviews and interviews. Four experts evaluated the collected items. After a pilot study, 211 nurses working in intensive care units in Japan completed the questionnaire. Subsequent statistical analysis of results included factor validity, construct validity, known-group validity, internal consistency, and test-retest reliability. RESULTS Exploratory factor analysis extracted a scale of 33 items with eight factors and an additional scale of four items with one factor. The analysis of construct validity suggested a possible association with the Strain of Care for Delirium Index. In the known-group validity, a comparison with two groups based on experience in the intensive care unit found significant differences among the five factors. Internal consistency (Cronbach's α = 0.68-.87) and test-retest reliability (intraclass correlation coefficients = .46-.62) were confirmed. CONCLUSION We developed a difficulty scale for nurses caring for patients with delirium in the intensive care unit and confirmed its reliability and validity. The difficulty factors were developed with the intention to identify educational interventions for nurses and the introduction of new organisational resources, such as manpower and providing emotional support and feedback to nurses.
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Yıldırım F, Türkleş S, Altundal Duru H. The effect of delirium information training given to intensive care nurses on patient care: quasi-experimental study. PeerJ 2022; 10:e13143. [PMID: 35419213 PMCID: PMC8997191 DOI: 10.7717/peerj.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/28/2022] [Indexed: 01/12/2023] Open
Abstract
Background Training programs aiming to improve delirium diagnosis and management skills increase nurses' care efficiency and improve patients' health outcomes. This study was conducted to examine the effect of delirium information training on patient care by intensive care nurses. Methods In the research, one group pretest-posttest quasi-experimental design was used. The study sample consisted of 30 nurses working in four intensive care units of a university hospital between November 05, 2018, and February 15, 2019. The Personal Information Form, the Checklist for the Care of the Patient in Delirium, and the Confusion Assessment Scale for the Intensive Care Unit were used to collect the data. Intensive care nurses were provided with information training supported by a training booklet in two sessions of 40 min each. Results In the study, according to the Checklist for the Care of the Patient in Delirium, while the pre-test point average of the nurses was 6.17 ± 2.29, the post-test point average had increased to 11.17 ± 1.51 (p < 0.001). After the training, it was determined that there was a significant increase in the percentage of nurses who stated that they evaluated and detected whether their patients had pain, hallucinations, and delusions (p < 0.001). As a result, it has been determined that providing delirium information training to intensive care nurses positively affects the care of patients with delirium. In addition, it has been determined that with the Confusion Assessment Scale for Intensive Care Unit, nurses can provide the care they need to patients at risk in terms of delirium by identifying delirium.
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Affiliation(s)
- Fulya Yıldırım
- Department of Pediatric Surgery Service, Mersin University Hospital, Mersin, Turkey
| | - Serpil Türkleş
- Department of Psychiatric and Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
| | - Hilal Altundal Duru
- Department of Psychiatric and Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
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Massachusetts Intensive Care Unit Nurses From Multiple Hospitals Develop a Collaborative to Improve Delirium Assessment Accuracy. Dimens Crit Care Nurs 2022; 41:76-82. [PMID: 35099153 DOI: 10.1097/dcc.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND RELEVANCE Early recognition of delirium mobilizes nurses to intervene in a timely manner to minimize cognitive, physical, and mental health burdens. The life-altering challenges of unrecognized delirium in intensive care unit (ICU) patients motivated a group of Massachusetts ICU nurse leaders to form a collaborative and improve delirium screening accuracy in 4 area hospitals. LOCAL PROBLEM Baseline audits confirmed a lack of delirium screening accuracy across multiple institutions. The purpose of this article is to describe how our collaborative was developed and to outline our delirium accuracy assessment program. METHODS In March of 2015, 2 graduates from the Clinical Scene Investigator Academy contacted members within the Boston cohort to form a regional collaborative to improve patient outcomes. The purpose of our project was to improve our delirium assessment accuracy to greater than 80% in patients across our ICUs. Using a successful project, we scaled this work based on the needs of each institution. A preaudit-postaudit design was used to evaluate the effectiveness of our programs. RESULTS Data showed an improved overall accuracy assessment of 88.3% (P < .01), whereas the patients with an altered Richmond Agitation Sedation Scale markedly improved to 87.7% (P < .01). CONCLUSIONS Every ICU in the United States is working on improving reportable quality metrics, but all too often, this work is being done in silos. When critical care nurses have the knowledge, skills, and time to work together, they can begin to transform health care.
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Arachchi TMJ, Pinto V. Understanding the Barriers in Delirium Care in an Intensive Care Unit: A Survey of Knowledge, Attitudes, and Current Practices among Medical Professionals Working in Intensive Care Units in Teaching Hospitals of Central Province, Sri Lanka. Indian J Crit Care Med 2022; 25:1413-1420. [PMID: 35027803 PMCID: PMC8693102 DOI: 10.5005/jp-journals-10071-24040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Delirium is a common, underdiagnosed, and undertreated condition that increases morbidity and mortality in ICU patients which has an incidence up to 80%. Barriers that hinder optimum care of delirium include inadequate knowledge, poor attitudes, and low perceived importance of delirium care. Aim To assess attitudes, knowledge, and current practices related to delirium care among medical professionals working in intensive care units (ICUs) in all teaching hospitals in Central Province, Sri Lanka, as there are no Sri Lankan studies on this regard. Method A descriptive cross-sectional study was carried out among all medical professionals working in nine ICUs in all (n = 5) teaching hospitals in Central Province. Data were collected using a pretested self-administered questionnaire. Responses to questions were compared between postgraduate trainee medical officers (PG-MOs) and non-postgraduate-trainee medical officers (non-PG-MOs). Results Eighty-eight questionnaires were analyzed. More than 80% of PGs and non-PG-MOs regarded ICU delirium as significant problem that should be screened and prevented. Forty-one percent stated confidence in diagnosing delirium. However, more than 75% of non-PG-MOs failed to recognize features of hypoactive delirium. Only 30–50% subjects in incorporated preventive methods in usual practice and more than 60% non-PG-MOs had poor knowledge and experience on delirium screening. More than 80% of the participants did not routinely screen their patients. More than 90% non-PG-MOs (p <0.05) had no recent educational exposure. Conclusion A positive attitude toward the importance of management of delirium was observed. However, there is a discrepancy between the perceived importance and the current practice related to screening and prevention. Participants, especially non-PG-MOs, lacked knowledge on delirium screening, diagnosis, and identification of risk factors, probably related to a lack of educational exposure. How to cite this article Arachchi TMJ, Pinto V. Understanding the Barriers in Delirium Care in an Intensive Care Unit: A Survey of Knowledge, Attitudes, and Current Practices among Medical Professionals Working in Intensive Care Units in Teaching Hospitals of Central Province, Sri Lanka. Indian J Crit Care Med 2021;25(12):1413–1420.
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Affiliation(s)
- Tilani M Jayasinghe Arachchi
- Department of Anaesthesiology and Critical Care, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Vasanthi Pinto
- Department of Anaesthesiology and Critical Care, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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13
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Salameh B, Al Razeeni DM, Mansor K, Abdallah JM, Ayed A, Salem H. Delirium in Intensive Care Units: Perceptions of Physicians and Nurses. Crit Care Nurs Q 2021; 44:393-402. [PMID: 34437318 DOI: 10.1097/cnq.0000000000000376] [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: 11/25/2022]
Abstract
Delirium is an indicator of morbidity and mortality in intensive care unit (ICU) patients. It can lead to negative outcomes and longer hospital stays, thus increasing hospital costs. Despite national recommendations for daily assessment of delirium, it remains underdiagnosed. Many studies point to a lack of knowledge among health care professionals to accurately detect and manage ICU delirium. The aim of our study was to assess the knowledge, attitudes, and practices of Palestinian health care professionals regarding ICU delirium. The results of a cross-section observational study revealed that delirium appears to be often underrecognized or misdiagnosed in ICUs in Palestine. Therefore, it is critical to further educate the medical and nursing teams and to promote the use of validated tools that can aid in the assessment of this condition. In this way, the length of hospital stays and related health care costs can be reduced.
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Affiliation(s)
- Basma Salameh
- Department of Nursing, Arab American University, Jenin, Palestine (Drs Salameh and Ayed); Palestinian Ministry of Health-ICU Department, Rafedia Hospital, Nablus, Palestine (Dr Razeeni and Mr Mansor); An-najah National University, Nablus, Palestine (Dr Abdallah); and Kindred Hospital, Denver, Colorado (Ms Salem)
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14
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Chen X, Zhuang Y, Lao Y, Qiao L, Chen Y, Guo F. Development and implementation of a novel decision support tool on physical restraint use in critically ill adult patients. Int J Nurs Pract 2021; 28:e12961. [PMID: 34075650 DOI: 10.1111/ijn.12961] [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] [Received: 12/22/2019] [Revised: 03/20/2021] [Accepted: 04/24/2021] [Indexed: 01/22/2023]
Abstract
AIM To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients. DESIGN A nonequivalent quasi-experimental design combined with a descriptive qualitative approach was used. METHODS A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi-experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared. RESULTS The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision-making. CONCLUSIONS The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision-making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree.
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Affiliation(s)
- Xiangping Chen
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiyu Zhuang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuewen Lao
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijie Qiao
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yueliang Chen
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Guo
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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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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16
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Garrido MA, Alvarez EA, Ponce DP, Salech F, Tobar DI, Tobar EA. Consolidated framework for advancing implementation science for the implementation process and adherence assessment of a non-pharmacological delirium prevention program. Int J Geriatr Psychiatry 2021; 36:302-313. [PMID: 32892410 DOI: 10.1002/gps.5425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the contribution of applying the theoretical framework of implementation science for adherence to non-pharmacological interventions to prevent delirium. METHODS A quasi-experimental prospective design was conducted from March 2017 to October 2018 in a teaching hospital. Participants included 149 healthcare staff and 72 elderly inpatients. A non-pharmacological delirium prevention program was designed, applied and evaluated in accordance with the consolidated framework for advancing implementation research (CFIR). The primary outcome was the global adherence rate to 12 predefined indicators, comparing measurements at baseline (O1), after training (O2) and at a 6-month follow-up (O3) assessed by an external reviewer. Staff knowledge and beliefs about delirium were assessed using a validated tool, and delirium incidence was evaluated using the confusion assessment method. RESULTS Overall adherence increased from 58.2% (O1) to 77.9% (O2) and 75.6% (O3) (O2 vs. O1: p < 0.001 and O3 vs. O1: p < 0.001). Staff perceptions regarding implementation of non-pharmacological interventions increased from 74.8% to 81.9% (p = 0.004). Delirium incidence was non-significantly reduced from 20% (O1) to 16% (O3) (p = 0.99). CONCLUSIONS Implementation of a delirium prevention program using a CFIR model was useful in improving adherence to activities included in this program, as well as improving the knowledge and beliefs regarding delirium by healthcare workers. The impact of this implementation strategy on the incidence of delirium should be evaluated in a larger scale multicenter trial.
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Affiliation(s)
- Maricel A Garrido
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Evelyn A Alvarez
- Escuela de Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile.,Departamento de Ciencias de la Ocupación y Terapia Ocupacional, Universidad de Chile, Santiago, Chile
| | - Daniela P Ponce
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Chile
| | - Felipe Salech
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Chile.,Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Chile.,Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Unidad de Cuidados Adulto Mayor, Clínica Las Condes, Santiago, Chile
| | - Daniel I Tobar
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Eduardo A Tobar
- Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Departamento de Medicina Interna Norte, Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santiago, Chile
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17
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Liang S, Chau JPC, Lo SHS, Li S, Gao M. Implementation of ABCDEF care bundle in intensive care units: A cross-sectional survey. Nurs Crit Care 2021; 26:386-396. [PMID: 33522036 DOI: 10.1111/nicc.12597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Delirium affects up to 80% of patients in intensive care units (ICUs) and is associated with higher mortality, physical dependence, and health care costs. The 2018 pain, agitation, delirium, immobility, and sleep guideline recommended ABCDEF care bundle for delirium prevention and management. However, limited information is available regarding the adoption of the care bundle in ICUs in Mainland China. AIMS AND OBJECTIVES To assess the current implementation of the ABCDEF care bundle for delirium prevention as reported by ICU nurses in Mainland China. DESIGN A cross-sectional study was conducted. METHODS A cross-sectional online survey using a validated questionnaire about the practices of the ABCDEF care bundle was conducted among 334 registered nurses in 167 ICUs of 65 cities in Mainland China. RESULTS Almost 50% of the sampled ICU nurses were unaware of the ABCDEF care bundle, though 86.83% of the surveyed ICUs implemented pain assessments and 95.51% implemented sedation assessments. Nearly half (46.41%) of the surveyed ICUs performed routine spontaneous awaking trials, with 21.26% performing them daily. Spontaneous breathing trials were performed in 38.32% of the surveyed ICUs. Only 47% of the surveyed ICUs routinely monitored patients for delirium. About one-third (38.35%) of the surveyed ICUs were supported by specialist teams that implemented the mobilization programmes. Most ICUs restricted the duration of family visits per day (<0.5 hour: 61.67%; 0.5-2 hours: 23.65%; >2 hours: 3.29%) and only 28.14% of the surveyed ICUs employed dedicated staff to support the families. CONCLUSIONS Although most of the surveyed ICUs implemented pain and sedation assessments, many of them did not implement structured delirium assessments. Early mobilization programmes and family participation should be encouraged. RELEVANCE TO CLINICAL PRACTICE Promoting the uses of a reliable delirium assessment tool such as Confusion Assessment Method for Intensive Care Unit patients, building an early mobilization team, and engaging family caregivers in the care plan may contribute to improved patients' clinical outcomes.
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Affiliation(s)
- Surui Liang
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Shunling Li
- The Surgical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Mingrong Gao
- The Surgical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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18
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Roh YS. The training needs of Korean intensive care unit nurses regarding delirium. Intensive Crit Care Nurs 2020; 62:102954. [PMID: 33139167 DOI: 10.1016/j.iccn.2020.102954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate high-priority training needs by analysing the perceived importance and self-reported performance of nurses' delirium care competency. DESIGN A cross-sectional survey with a convenience sample of 255 Korean intensive care units nurses. SETTING Intensive care units in the Republic of Korea. MAIN OUTCOME MEASURES Intensive care unit nurses' delirium care competency. RESULTS Exploratory factor analysis of the Nurse Delirium Care Competency Scale showed a six-factor structure, which accounted for 67.51% of the variance in nurses' delirium care competency: management algorithm, prevention, communication, nursing management, assessment, and collaboration. The self-reported performance scores of all six factors were significantly lower than their perceived importance scores. The delirium assessment factor was identified as a high training priority on the importance-performance matrix for new graduate nurses. CONCLUSION Training programmes should be developed considering the six delirium care competency factors identified in this study. Further, nurse educators must adopt active educational modalities such as case-based small group learning and simulation-based learning to improve nurse competency in recognising and managing delirium.
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Affiliation(s)
- Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of Korea.
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19
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Kim Y, Jin Y, Jin T, Lee SM. Risk factors and outcomes of sepsis-associated delirium in intensive care unit patients: A secondary data analysis. Intensive Crit Care Nurs 2020; 59:102844. [PMID: 32253122 DOI: 10.1016/j.iccn.2020.102844] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the risk factors of sepsis-associated delirium and determine their effect on intensive care unit adult patient outcomes. DESIGN A secondary analysis of data from system development studies. SETTING Korean intensive care unit patients in a university hospital who were diagnosed with sepsis. METHODS The risk factors for sepsis-associated delirium were classified into patient factors and sepsis clinical features and were analysed using hierarchical logistic regression analysis. Outcomes included in-hospital mortality, 30-day in-hospital mortality, duration of mechanical ventilation, length of stay in the intensive care unit, length of hospital stay, total medical expenses, discharge placement, re-hospitalisation and visits to the emergency department after discharge. RESULTS The risk factor for sepsis-associated delirium including patients aged 65 ≥years, dependent activity and high nursing needs (patient factors), low level of consciousness, tachypnoea, and thrombocytopaenia (clinical features of sepsis). Use of vasopressors/inotropes and albumin decreased the risk of sepsis-associated delirium. Mechanical ventilation duration was prolonged and discharge to skilled nursing facilities was increased by sepsis-associated delirium. CONCLUSIONS The risk factors for sepsis-associated delirium increased as the severity of condition for patients with sepsis increased. Early identification of risk factors associated with sepsis-associated delirium may improve patient outcomes.
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Affiliation(s)
- Yeunwoo Kim
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yinji Jin
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Taixian Jin
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun-Mi Lee
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea.
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20
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Alvarez EA, Garrido M, Ponce DP, Pizarro G, Córdova AA, Vera F, Ruiz R, Fernández R, Velásquez JD, Tobar E, Salech F. A software to prevent delirium in hospitalised older adults: development and feasibility assessment. Age Ageing 2020; 49:239-245. [PMID: 31957783 DOI: 10.1093/ageing/afz166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND non-pharmacological interventions to prevent delirium are useful in hospitalised older adults. However, they are poorly implemented in clinical practice. We aimed to develop a software for bedside use by hospitalised older adults and to improve their access to these interventions. METHODS a transdisciplinary team composed of healthcare professionals, designers, engineers and older adults participated in the development of the software. Scrum methodology was used to coordinate the work of the team, and the software was evaluated in a feasibility study. RESULTS a software for touchscreen mobile devices that supports Android 5.0 or later was produced, including modules for time-spatial re-orientation, cognitive stimulation, early mobilisation, sensorial support use promotion, sleep hygiene and pain management optimisation. Horizontal disposition, use of colour contrast and large interaction areas were used to improve accessibility. The software's usability and accessibility were evaluated in 34 older adults (average age 73.2 ± 9.1 years) showing that 91.1% of them got access to all the software functions without previous instructions. The clinical feasibility assessment showed that 83.3% of the 30 enrolled hospitalised patients (76 ± 8 years) completed the 5-day protocol of software usage during hospitalisation. Software use was associated with a decreased trend in delirium incidence of 5 of 32 (15.6%) at baseline to 2 of 30 (6.6%) after its implementation. CONCLUSION a highly accessible and implementable software, designed to improve access to non-pharmacological interventions to prevent delirium in hospitalised older adults, was developed. The effectiveness of the software will be evaluated in a randomised clinical trial.
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Affiliation(s)
- Evelyn A Alvarez
- Escuela de Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Metropolitana, Chile
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Maricel Garrido
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
| | - Daniela P Ponce
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Metropolitana, Chile
| | - Gaspar Pizarro
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Andres A Córdova
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Felipe Vera
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Rocio Ruiz
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Raul Fernández
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
| | - Juan D Velásquez
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
- Instituto Sistemas Complejos de Ingeniería (ISCI), Universidad de Chile, Santiago, Metropolitana, Chile
| | - Eduardo Tobar
- Departamento de Medicina Interna Norte, Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Felipe Salech
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Metropolitana, Chile
- Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
- Unidad de Cuidados Adulto Mayor, Clínica Las Condes, Santiago, Chile
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Xing J, Yuan Z, Jie Y, Liu Y, Wang M, Sun Y. Risk factors for delirium: are therapeutic interventions part of it? Neuropsychiatr Dis Treat 2019; 15:1321-1327. [PMID: 31190836 PMCID: PMC6529602 DOI: 10.2147/ndt.s192836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/08/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Delirium is associated with increased morbidity and mortality in critically ill patients. Research on risk factors for delirium allows clinicians to identify high-risk patients, which is the basis for early prevention and diagnosis. Besides the risk factors for delirium that are commonly studied, here we more focused on the less-studied therapeutic interventions for critically ill patients which are potentially modifiable. Materials and methods: A total of 320 non-comatose patients admitted to the ICU for more than 24 hrs during 9 months were eligible for the study. Delirium was screened once daily using the CAM-ICU. Demographics, admission clinical data, and daily interventions were collected. Results: Ninety-two patients (28.75%) experienced delirium at least once. Delirious patients were more likely to have longer duration of mechanical ventilation, ICU stay, and hospital stay. Most of the less-studied therapeutic interventions were linked to delirium in the univariate analysis, including gastric tube, artificial airway, deep intravenous catheter, arterial line, urinary catheter, use of vasoactive drugs, and sedative medication. After adjusting with age and ICU length of stay, mechanical ventilation (OR: 5.123; 95% CI: 2.501-10.494), Acute Physiology and Chronic Health Evaluation (APACHE) II score≥20 at admission (OR: 1.897; 95% CI: 1.045-3.441), and gastric tube (OR: 1.935, 95% CI: 1.012-3.698) were associated with increased risk of delirium in multivariate analysis. Conclusion: Delirium was associated with prolonged mechanical ventilation, ICU stay, and hospital stay. Multivariate risk factors were gastric tube, mechanical ventilation, and APACHE II score. Although being a preliminary study, this study suggests the necessity of earliest removal of tubes and catheters when no longer needed.
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Affiliation(s)
- Jinyan Xing
- Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Zhiyong Yuan
- Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Yaqi Jie
- School of Life Sciences, Qingdao University, Qingdao, 266071, People's Republic of China
| | - Ying Liu
- Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Mingxue Wang
- Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
| | - Yunbo Sun
- Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, People's Republic of China
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