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Martínez-García M, Sánchez-López E, Fernández-Trinidad M. Managing delirium in acute inpatient units: A cross-sectional study of nursing teams' knowledge and perceived limitations. Nurs Open 2023; 10:2213-2221. [PMID: 36379912 PMCID: PMC10006588 DOI: 10.1002/nop2.1471] [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: 11/08/2021] [Revised: 10/05/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022] Open
Abstract
AIM The aim of the study was to describe nursing teams' theoretical knowledge of delirium and their perceptions of the way in which it is handled in acute inpatient units. DESIGN This is a descriptive cross-sectional study using a questionnaire comprising ten questions on knowledge and seven on perception. METHODS The sample consisted of 216 professionals working at a hospital complex in Madrid, Spain. Descriptive and non-parametric bivariate analyses were performed for a p < .05. RESULTS Fifty-three point two per cent of staff possessed sufficient theoretical knowledge, and this figure rose significantly among professionals with more years of experience. Areas for improvement in theoretical knowledge included the use of therapeutic immobilization, screening scale, subtypes of delirium and precipitating factors. Sixty-eight point five per cent of staff perceived their knowledge as fair, 50% agreed that delirium was underdiagnosed and 48.1% agreed that preventive measures were only occasionally taken. Perceived barriers included lack of training, work overload, ineffective coordination and lack of standardized protocols.
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Affiliation(s)
- Marta Martínez-García
- Hospital Universitario Infanta Leonor, Madrid, Spain.,Facultad de Enfermería Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Miriam Fernández-Trinidad
- Hospital Universitario Infanta Leonor, Madrid, Spain.,Facultad de Enfermería Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
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Porritt K, McArthur A, Lockwood C, Munn Z. JBI's approach to evidence implementation: a 7-phase process model to support and guide getting evidence into practice. JBI Evid Implement 2023; 21:3-13. [PMID: 36545902 DOI: 10.1097/xeb.0000000000000361] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT In this paper, we provide an overview of JBI's approach to evidence implementation and describe the supporting process model that aligns with this approach. The central tenets of JBI's approach to implementing evidence into practice include the use of evidence-based audit and feedback, identification of the context in which evidence is being implemented, facilitation of any change, and an evaluation process. A pragmatic and practical seven-phased approach is outlined to assist with the 'planning' and 'doing' of getting evidence into practice, focusing on clinicians as change agents for implementing evidence in clinical and policy settings. Further research and development is required to formally evaluate the robustness of the approach to better understand the complex nature of evidence implementation.
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Affiliation(s)
- Kylie Porritt
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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Cohen C, Pereira F, Kampel T, Bélanger L. Integration of family caregivers in delirium prevention care for hospitalized older adults: A case study analysis. J Adv Nurs 2020; 77:318-330. [PMID: 33078872 DOI: 10.1111/jan.14593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 07/16/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
AIM To understand how family caregivers of older adults hospitalized for orthopaedic surgery are integrated by nurses in delirium prevention care. DESIGN Multiple case study. METHODS The sample consisted of eight cases. Each case comprised an older adult, a family caregiver, and a nurse. Data were collected from September 2017 - April 2018 through various instruments, including semi-structured interviews and family caregiver logs. Within- and across-case analyses were conducted, based on the model of The Care Partner Engagement developed by Hill, Yevchak, Gilmore-Bykovskyi, & Kolanowski (Geriatric Nursing, 35, 2014, 272). RESULTS Two themes emerged: (a) family caregivers were engaged in caring for the older adults during their hospital stay, though they had differences in terms of views and needs; and (b) family caregivers communicated with nurses but nurses did not recognize their role and did not integrate them much in care. CONCLUSION The presence and availability of family caregivers, their sense of responsibility towards the hospitalized older adults, and their positive effects on them suggest that family caregivers could be integrated more systematically in a care partnership with nurses. Poor integration of family caregivers in delirium prevention care shows that nurse delirium prevention competencies and their relational skills for communicating effectively with family caregivers need to be developed further. IMPACT Integrating family caregivers in delirium prevention care for older adults is a challenge for nurses. Family caregivers are engaged during the hospitalization of older adults, though differences and problems exist between the two groups. While there is communication between patients, family caregivers, and nurses, nurses do not recognize the role of family caregivers and hardly integrated them in the delirium prevention care of hospitalized older adults. Nurses must adopt a patient- and family-centred approach. Care and training facilities must make resources available to implement this approach in nursing practice.
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Affiliation(s)
- Christine Cohen
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts, Western Switzerland, Sion, Switzerland
| | - Thomas Kampel
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Louise Bélanger
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
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Cohen C, Pereira F, Kampel T, Bélanger L. Understanding the integration of family caregivers in delirium prevention care for hospitalized older adults: A case study protocol. J Adv Nurs 2019; 75:1782-1791. [PMID: 30937929 DOI: 10.1111/jan.14009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/07/2019] [Accepted: 01/25/2019] [Indexed: 01/20/2023]
Abstract
AIM To understand family caregiver involvement in delirium prevention care for older adults hospitalized for orthopaedic surgery hospitals and family caregiver integration by nurses. DESIGN Multiple-case study. METHODS The model of Care Partner Engagement was selected as theoretical framework. Eight cases will comprise an older adult hospitalized a family caregiver and a ward nurse. They will be recruited with a non-probability sampling on two orthopaedic surgery wards in two hospitals. Semi-structured interviews with participants will be audiotaped. Sociodemographic data will be collected. These data, researcher field notes and interview transcripts will be subjected to within- and across-case thematic analysis. Regional ethics committee approved the study protocol in August 2018. DISCUSSION The study will allow surgical nursing teams to gain a better understanding of the issues and possibilities regarding family caregiver integration in delirium prevention care for older adults.
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Affiliation(s)
- Christine Cohen
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Sion, Switzerland
| | - Thomas Kampel
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Louise Bélanger
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
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Loftus CA, Wiesenfeld LA. Geriatric Delirium Care: Using Chart Audits to Target Improvement Strategies. Can Geriatr J 2017; 20:246-252. [PMID: 29296131 PMCID: PMC5740948 DOI: 10.5770/cgj.20.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Our hospital identified delirium care as a quality improvement target. Baseline characterization of our delirium care and deficits was needed to guide improvement efforts. Methods Two inpatient units were selected: 1) A general internal medicine unit with a focus on geriatrics, and 2) a surgical unit. Retrospective chart audits were conducted for all patients over age 50 admitted during a one-month period to compare delirium care with best practice guideline (BPG) recommendations, and to determine the incidence of missed cases of delirium and negative outcomes in patients with delirium. The aim was to gather local data to prioritize improvement efforts and mobilize stakeholders. Results 186 charts were reviewed: 17 patients had physician-diagnosed delirium, 21 patients had missed delirium, and 148 patients had no delirium. Compliance with delirium BPGs was variable, but generally poor. There was a trend towards missed delirium and physician-diagnosed delirium being associated with greater odds of having above-median length of stay and lower odds of discharge home compared to no delirium diagnosis. Conclusion Overall, the chart audits confirmed delirium underrecognition and poor adherence to best practices in delirium management. Granular analysis of this data was used to mobilize stakeholders and prioritize improvement plans.
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Affiliation(s)
- Carla A Loftus
- Department of Psychiatry, Mount Sinai Hospital, Sinai Health System, Toronto, ON
| | - Lesley A Wiesenfeld
- Department of Psychiatry, Mount Sinai Hospital, Sinai Health System, Toronto, ON.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON
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Evidence-Based Practice in Perianesthesia Nursing: Application of the American Geriatrics Society Clinical Practice Guideline for Postoperative Delirium in Older Adults. J Perianesth Nurs 2017; 33:253-264. [PMID: 29784254 DOI: 10.1016/j.jopan.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/22/2016] [Indexed: 01/24/2023]
Abstract
Delirium is a pervasive and dangerous syndrome for older adults in the perianesthesia setting, occurring in up to 60% of surgical cases. The American Geriatrics Society performed a systematic review to develop recommendations for the prevention and management of postoperative delirium in older adults. The recommendations emphasize nonpharmacologic interventions with a strong focus on reducing the use of psychoactive medication. Perianesthesia nurses can serve as leaders in translating these recommendations into evidence-based practice at the bedside for older adults.
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Bull MJ, Boaz L, Maadooliat M, Hagle ME, Gettrust L, Greene MT, Holmes SB, Saczynski JS. Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty. J Am Geriatr Soc 2016; 65:e13-e17. [PMID: 27861701 DOI: 10.1111/jgs.14535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. DESIGN Mixed-method, pre-post quasi-experimental design. SETTING A Midwest Veterans Affairs Medical Center and a nonprofit health system. PARTICIPANTS Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention. INTERVENTION Four telephone-based education modules using vignettes were completed during the 3 weeks before the older adult's hospital admission for elective hip or knee replacement. Each module required 20 to 30 minutes. MEASUREMENTS Interviews were conducted before the intervention and 2 weeks and 2 months after the older adult's hospitalization. A researcher completed the Confusion Assessment Method (CAM) and a family caregiver completed the Family Version of the Confusion Assessment Method (FAM-CAM) 2 days after surgery to assess the older adults for delirium symptoms. RESULTS Family caregivers' knowledge of delirium symptoms improved significantly from before the intervention to 2 weeks after the intervention and was maintained after the older adult's hospitalization. They also were able to recognize the presence and absence of delirium symptoms in the vignettes included in the intervention and in the older adult after surgery. In 94% of the cases, the family caregiver rating on the FAM-CAM approximately 2 days after the older adult's surgery agreed with the researcher rating on the CAM. Family caregivers expressed satisfaction with the intervention and stated that the information was helpful. CONCLUSION Delivery of a telephone-based intervention appears feasible. All family caregivers who began the program completed the four education modules. Future studies evaluating the effectiveness of the educational program should include a control group.
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Affiliation(s)
- Margaret J Bull
- College of Nursing, Marquette University, Milwaukee, Wisconsin
| | - Lesley Boaz
- College of Nursing, Marquette University, Milwaukee, Wisconsin
| | - Mehdi Maadooliat
- Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee, Wisconsin
| | - Mary E Hagle
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Lynn Gettrust
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | | | | | - Jane S Saczynski
- Department of Epidemiology, Northeastern University, Boston, Massachusetts
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Toye C, Kitchen S, Hill A, Edwards D, Sin M, Maher S. Piloting staff education in Australia to reduce falls in older hospital patients experiencing delirium. Nurs Health Sci 2016; 19:51-58. [DOI: 10.1111/nhs.12300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 04/29/2016] [Accepted: 05/24/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Christine Toye
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Su Kitchen
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Andrew Hill
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Deborah Edwards
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Michelle Sin
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Sean Maher
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
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A Smartphone-based Decision Support Tool Improves Test Performance Concerning Application of the Guidelines for Managing Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy. Anesthesiology 2016; 124:186-98. [PMID: 26513023 DOI: 10.1097/aln.0000000000000885] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Society of Regional Anesthesia and Pain Medicine (ASRA) consensus statement on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy is the standard for evaluation and management of these patients. The authors hypothesized that an electronic decision support tool (eDST) would improve test performance compared with native physician behavior concerning the application of this guideline. METHODS Anesthesiology trainees and faculty at 8 institutions participated in a prospective, randomized trial in which they completed a 20-question test involving clinical scenarios related to the ASRA guidelines. The eDST group completed the test using an iOS app programmed to contain decision logic and content of the ASRA guidelines. The control group completed the test by using any resource in addition to the app. A generalized linear mixed-effects model was used to examine the effect of the intervention. RESULTS After obtaining institutional review board's approval and informed consent, 259 participants were enrolled and randomized (eDST = 122; control = 137). The mean score was 92.4 ± 6.6% in the eDST group and 68.0 ± 15.8% in the control group (P < 0.001). eDST use increased the odds of selecting correct answers (7.8; 95% CI, 5.7 to 10.7). Most control group participants (63%) used some cognitive aid during the test, and they scored higher than those who tested from memory alone (76 ± 15% vs. 57 ± 18%, P < 0.001). There was no difference in time to completion of the test (P = 0.15) and no effect of training level (P = 0.56). CONCLUSIONS eDST use improved application of the ASRA guidelines compared with the native clinician behavior in a testing environment.
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Bull MJ, Boaz L, Jermé M. Educating Family Caregivers for Older Adults About Delirium: A Systematic Review. Worldviews Evid Based Nurs 2016; 13:232-40. [PMID: 26970229 DOI: 10.1111/wvn.12154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delirium in older adults is considered a medical emergency; it contributes to a cascade of functional decline and to increased mortality. Early recognition of delirium symptoms is critical to prevent these negative consequences. Family caregivers who are educated about delirium could partner with nurses and other healthcare professionals in early recognition of delirium symptoms. Before implementing such partnership models, it is important to examine the effectiveness of educating family caregivers about delirium. AIMS To examine whether providing education on delirium to family caregivers improved their knowledge, emotional state, or response in reducing the incidence of delirium in older adults. METHODS For this systematic review, we conducted literature searches in CINAHL, Cochrane Library, Medline, PsycINFO, Web of Science, Social Sciences in ProQuest, Dissertations and Theses, and the Virginia Henderson Global Nursing eRepository for studies published in the English language between January 2000 and June 2015. Criteria for inclusion were: (a) primary focus on educating family caregivers for older adults about delirium; (b) use of experimental, quasi-experimental, or comparative design; (c) measured family caregiver outcomes of delirium knowledge, emotional state, or response in reducing delirium incidence in older adults; and (d) published in the English language. Articles were appraised using Melnyk's rapid critical appraisal guides. RESULTS Seven studies met the review criteria. Four studies found that family caregivers' delirium knowledge increased; two noted that delirium incidence in older adults declined; and one study reported less distress following receipt of education. LINKING EVIDENCE TO ACTION Providing family caregivers with information about delirium can be beneficial for both family caregivers and older adults. However, rigorous evaluation of education programs for family caregivers about delirium is needed.
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Affiliation(s)
- Margaret J Bull
- Professor, Marquette University College of Nursing, Milwaukee, WI
| | - Lesley Boaz
- Assistant Professor, Marquette University College of Nursing, Milwaukee, WI
| | - Martha Jermé
- Health Sciences Librarian, Marquette University, Milwaukee, WI
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Kim MY, Park UJ, Kim HT, Cho WH. DELirium Prediction Based on Hospital Information (Delphi) in General Surgery Patients. Medicine (Baltimore) 2016; 95:e3072. [PMID: 27015177 PMCID: PMC4998372 DOI: 10.1097/md.0000000000003072] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To develop a simple and accurate delirium prediction score that would allow identification of individuals with a high probability of postoperative delirium on the basis of preoperative and immediate postoperative data.Postoperative delirium, although transient, is associated with adverse outcomes after surgery. However, there has been no appropriate tool to predict postoperative delirium.This was a prospective observational single-center study, which consisted of the development of the DELirium Prediction based on Hospital Information (Delphi) score (n = 561) and its validation (n = 533). We collected potential risk factors for postoperative delirium, which were identified by conducting a comprehensive review of the literatures.Age, low physical activity, hearing impairment, heavy alcoholism, history of prior delirium, intensive care unit (ICU) admission, emergency surgery, open surgery, and increased preoperative C-reactive protein were identified as independent predictors of postoperative delirium. The Delphi score was generated using logistic regression coefficients. The maximum Delphi score was 15 and the optimal cut-off point identified with the Youden index was 6.5. Generated area under the (AUC) of the receiver operating characteristic (ROC) curve was 0.911 (95% CI: 0.88-0.94). In the validation study, the calculated AUC of the ROC curve based on the Delphi score was 0.938 (95% Cl: 0.91-0.97). We divided the validation cohort into the low-risk group (Delphi score 0-6) and high-risk group (7-15). Sensitivity of Delphi score was 80.8% and specificity 92.5%.Our proposed Delphi score could help health-care provider to predict the development of delirium and make possible targeted intervention to prevent delirium in high-risk surgery patients.
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Affiliation(s)
- Min Young Kim
- From the Department of Nursing (MYK), Ulsan University, Ulsan, Korea; and Department of Surgery (UJP, HTK, WHC), Dongsan Medical Center, Keimyung University, Daegu, Korea
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Park EA, Kim MY. Postoperative Delirium in Elderly Patients with Osteoarthritis Surgery: Incidence and Risk Factors. ACTA ACUST UNITED AC 2015. [DOI: 10.5953/jmjh.2015.22.2.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bull MJ, Avery JS, Boaz L, Oswald D. Psychometric Properties of the Family Caregiver Delirium Knowledge Questionnaire. Res Gerontol Nurs 2015; 8:198-207. [PMID: 25893726 DOI: 10.3928/19404921-20150409-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/18/2015] [Indexed: 11/20/2022]
Abstract
A valid, reliable measure of family caregivers' knowledge about delirium was not located in the literature; such an instrument is essential to assess learning needs and outcomes of education provided. The purpose of the current study was to (a) develop a family Caregiver Delirium Knowledge Questionnaire (CDKQ) based on the Symptom Interpretation Model; and (b) establish validity and reliability of the measure. The 19-item CDKQ was developed and administered to 164 family caregivers for community-dwelling older adults. Descriptive statistics were examined for all variables. Psychometric testing included confirmatory factor analysis, item-to-total correlations, and internal consistency reliability. A three-factor model provided the best fit for the data. The findings support initial validity and reliability of the CDKQ with family caregivers. Although the CDKQ was developed for use with family caregivers, it has potential for use with other caregivers, such as home health aides.
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Effect of a cognitive aid on adherence to perioperative assessment and management guidelines for the cardiac evaluation of noncardiac surgical patients. Anesthesiology 2014; 120:1339-49, quiz 1349-53. [PMID: 24705442 DOI: 10.1097/aln.0000000000000251] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation. Recent work has shown that residents and anesthesiologists do not apply these guidelines when tested. This research hypothesized that a decision support tool would improve adherence to this consensus guideline. METHODS Anesthesiology residents at four training programs participated in an unblinded, prospective, randomized, cross-over trial in which they completed two tests covering clinical scenarios. One quiz was completed from memory and one with the aid of an electronic decision support tool. Performance was evaluated by overall score (% correct), number of incorrect answers with possibly increased cost or risk of care, and the amount of time required to complete the quizzes both with and without the cognitive aid. The primary outcome was the proportion of correct responses attributable to the use of the decision support tool. RESULTS All anesthesiology residents at four institutions were recruited and 111 residents participated. Use of the decision support tool resulted in a 25% improvement in adherence to guidelines compared with memory alone (P < 0.0001), and participants made 77% fewer incorrect responses that would have resulted in increased costs. Use of the tool was associated with a 3.4-min increase in time to complete the test (P < 0.001). CONCLUSIONS Use of an electronic decision support tool significantly improved adherence to the guidelines as compared with memory alone. The decision support tool also prevented inappropriate management steps possibly associated with increased healthcare costs.
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Bull MJ, Boaz L, Sjostedt JM. Family Caregivers' Knowledge of Delirium and Preferred Modalities for Receipt of Information. J Appl Gerontol 2014; 35:744-58. [PMID: 24942969 DOI: 10.1177/0733464814535484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/21/2014] [Indexed: 11/16/2022] Open
Abstract
Delirium is a life-threatening, frequently reversible condition that is often a sign of an underlying health problem. In-hospital mortality alone for older adults with delirium ranges from 25% to 33%. Early recognition of delirium is critical because prolonged duration poses a greater risk of poor functional outcomes for older adults. Family caregivers, who are familiar with the older adult's usual behaviors, are most likely to recognize delirium symptoms but might dismiss them as due to aging. It is important to learn what family caregivers know about delirium to ascertain their need for education. The aims of this study were to describe family caregivers' knowledge of delirium and preferred modalities for receipt of information about delirium. A cross-sectional design was used for this study and a survey distributed to family caregivers for older adults. Analysis of 134 usable surveys indicated that family caregivers need and want information about delirium. The preferred modalities for receipt of information included Internet, in-person classes, and newsletters.
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Moon KJ, Piao J, Jin Y, Lee SM. Is Delirium an Unrecognized Threat to Patient Safety in Korean Intensive Care Units? J Nurs Care Qual 2014; 29:91-8. [DOI: 10.1097/ncq.0b013e31829f828b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Simulation curriculum can improve medical student assessment and management of acute coronary syndrome during a clinical practice exam. Am J Med Sci 2013; 347:452-6. [PMID: 24280987 DOI: 10.1097/maj.0b013e3182a562d7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It has been noted that increased focus on learning acute care skills is needed in undergraduate medical curricula. This study investigated whether a simulation-based curriculum improved a senior medical student's ability to manage acute coronary syndrome as measured during a clinical performance examination (CPX). The authors hypothesized that simulation training would improve overall performance when compared with targeted didactics or historical controls. METHODS All 4th-year medical students (n = 291) over 2 years at the authors' institution were included in this study. In the 3rd year of medical school, the "control" group received no intervention, the "didactic" group received a targeted didactic curriculum, and the "simulation" group participated in small group simulation training and the didactic curriculum. For intergroup comparison on the CPX, the authors calculated the percentage of correct actions completed by the student. Data are presented as mean ± standard deviation with significance defined as P < 0.05. RESULTS There was a significant improvement in overall performance with simulation versus both didactics and control (P < 0.001). Performance on the physical examination component was significantly better in simulation versus both didactics and control, as was for diagnosis: simulation versus both didactics and control (P < 0.02 for all comparisons). CONCLUSIONS Simulation training had a modest impact on overall CPX performance in the management of a simulated acute coronary syndrome. Additional studies are needed to evaluate how to further improve curricula regarding unstable patients.
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Current world literature. Curr Opin Psychiatry 2012; 25:565-73. [PMID: 23037966 DOI: 10.1097/yco.0b013e328359edae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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