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Radler A, Ewers A. [Bedside-teaching on dementia and delirium: Development, implementation, and evaluation in an acute care hospital]. Pflege 2024. [PMID: 38602301 DOI: 10.1024/1012-5302/a000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Bedside-teaching on dementia and delirium: Development, implementation, and evaluation in an acute care hospital Abstract: Background: Demographic change and the accompanying increase in people with dementia and delirium in acute care hospitals pose growing challenges for nurses in acute care wards. Objective: Pilot implementation and evaluation of knowledge gain and implementation of previously defined critical behaviors. Method: Implementation of the training by APNs. Parallel evaluation of the training along the New World Kirkpatrick model using questionnaires and non-participant observation. Analysis of the data using descriptive statistics. Results: The training itself was well evaluated by the participants. It showed an increase in knowledge of the participants in the main topic categories. The targeted critical behaviors were implemented for the most part. There are deficiencies in the mapping of interventions in the nursing care process. Conclusion: The training concept is suitable to give nurses confidence in dealing with people with dementia and delirium. Continuous support in practice is needed to maintain the interventions in the long term and sustainably in everyday life.
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Affiliation(s)
- Andreas Radler
- Universitätsklinik für Orthopädie und Traumatologie, Universitätsklinikum Salzburg, Österreich
- Masterstudiengang Advanced Nursing Practice, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Andre Ewers
- Koordination Klinische Pflegewissenschaft und -forschung, Pflegedirektion, Universitätsklinikum Salzburg, Österreich
- Masterstudiengang Advanced Nursing Practice, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
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Israel S, Perazzo S, Lee M, Samson R, Safari-Ferra P, Badh R, Abera S, Soghier L. Improving Documentation of Pain Reassessment after Pain Management Interventions in the NICU. Pediatr Qual Saf 2023; 8:e688. [PMID: 37780605 PMCID: PMC10538901 DOI: 10.1097/pq9.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/02/2023] [Indexed: 10/03/2023] Open
Abstract
Background Neonates exposed to painful procedures require pain assessment and reassessment using nonverbal scales. Nurses perform initial assessments routinely, but reassessment is variable. The goal was to increase pain reassessments in neonates with a previous score of 4 or higher within 60 minutes from 50% to 75% within 12 months. Methods After identifying key drivers, we tested several interventions using the IHI's Model for Improvement. The outcome measure was the rate of reassessments within 1 hour after scoring ≥4 on the Neonatal Pain Agitation and Sedation Scale (N-PASS). Duration of time between scoring and intervention was documented. Interventions included electronic health record (EHR) changes, direct communication with bedside nurses through text messages and emails, in-person education, and a yearly competency module. The process measure was the number of messages/emails to staff. Sedation scores were the balancing measure. Results Baseline compliance was 50% with significant variability. A centerline shift occurred after the first intervention. After the first four interventions in the following 3 months, a 29% total increase occurred. Overall time-lapse between reassessments decreased from 102 to 90 minutes. Overall sedation scores decreased from -2.5 during the baseline to -1.7 during the sustain period. The goal of 75% pain reassessments was achieved and sustained for two years. Conclusions Automated tools such as the trigger report provided data that increased noncompliance visibility. Real-time and personalized reminders and education improved awareness and set the tone for culture change. Electronic health record reminders for reassessments and standardized annual education helped in sustaining change.
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Affiliation(s)
- Smitha Israel
- From the Division of Neonatology at Children's National Hospital
| | - Sofia Perazzo
- From the Division of Neonatology at Children's National Hospital
- The Department of Pediatrics at the George Washington University School of Medicine and Health Sciences
| | - Morgan Lee
- The Neonatal Intensive Care Unit at Children's National Hospital
| | - Rachel Samson
- The Neonatal Intensive Care Unit at Children's National Hospital
| | - Parissa Safari-Ferra
- The Quality Improvement and Safety Department at Children's National Hospital
- Center of Pediatric Informatics at Children's National Hospital
| | - Ranjodh Badh
- The Quality Improvement and Safety Department at Children's National Hospital
| | - Solomon Abera
- The Quality Improvement and Safety Department at Children's National Hospital
| | - Lamia Soghier
- From the Division of Neonatology at Children's National Hospital
- The Department of Pediatrics at the George Washington University School of Medicine and Health Sciences
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Leppla I, Tobolowsky W, Patel S, Mahdanian A, Lobner K, Caufield-Noll C, Ponor IL, Roy D. Scoping Review on Educational Programs for Medical Professionals on the Management of Acute Agitation. J Acad Consult Liaison Psychiatry 2023; 64:457-467. [PMID: 37211211 DOI: 10.1016/j.jaclp.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Agitation is a common reason for psychiatric consultation in the general hospital. The consultation-liaison (CL) psychiatrist is often tasked with teaching the medical team how to manage agitation. OBJECTIVE The purpose of this scoping review is to explore what resources the CL psychiatrist has for educational tools on teaching about agitation management. Given the frequency with which CL psychiatrists help with on-the-ground management of agitation, we hypothesized that there would be a scarcity of educational resources to teach front-line providers how to manage agitation. METHODS Following current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a scoping review was conducted. The literature search focused on the electronic databases MEDLINE (PubMed), Embase (Embase.com), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), PsycInfo (EbscoHost), Cumulated Index to Nursing and Allied Health Literature (CINAHL) (EbscoHost), and Web of Science. Using Covidence software, after screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, we created a predefined set of criteria according to which each article was analyzed. We then grouped the articles in the full-text review according to which patient population a curriculum was designed for. RESULTS The search yielded a total of 3250 articles. After removing duplicates and reviewing procedures, we included 51 articles. Data extraction captured article type and details; educational program information (staff training, web modules, instructor led seminar); learner population; patient population; and setting. The curricula were further divided based on their target patient population, specifically the acute psychiatric patient (n = 10), the general medical patient (n = 9), and the patient with a major neurocognitive disorder such as dementia or traumatic brain injury (n = 32). Learner outcomes included staff comfort, confidence, skills, and knowledge. Patient outcomes included measurements of agitation or violence using validated scales, PRN medication use, and restraint use. CONCLUSIONS Despite there being numerous agitation curricula in existence, we found that a large majority of these educational programs were done for patients with major neurocognitive disorders in the long-term care setting. This review highlights the gap in education related to agitation management for both patients and providers in the general medical setting, as less than 20% of total studies are focused on this population. The CL psychiatrist plays a critical role in assisting in agitation management in this setting, which often requires collaboration between technicians, nurses, and nonpsychiatric providers. It calls into question whether the lack of educational programs makes the implementation of management interventions more difficult and less effective, even with the assistance of the CL psychiatrist.
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Affiliation(s)
- Idris Leppla
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Psychiatry & Behavioral Sciences, Baltimore, MD.
| | - William Tobolowsky
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Psychiatry & Behavioral Sciences, Baltimore, MD
| | | | - Artin Mahdanian
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Psychiatry & Behavioral Sciences, Baltimore, MD
| | | | | | - I Lucia Ponor
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Department of Medicine, Baltimore, MD
| | - Durga Roy
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Psychiatry & Behavioral Sciences, Baltimore, MD
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Makhija H, Fine JM, Pollack D, Novelli F, Davidson JE, Cotton SA, Diaz De Leon B, Reyes PA, Montoya JL, Arroyo-Novoa CM, Figueroa-Ramos MI, Song Y, Fuentes AL, LaBuzetta JN, Moore AA, Ely EW, Malhotra A, Needham DM, Martin JL, Kamdar BB. Development and Validation of an ICU Delirium Playbook for Provider Education. Crit Care Explor 2023; 5:e0939. [PMID: 37457918 PMCID: PMC10348729 DOI: 10.1097/cce.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Although delirium detection and prevention practices are recommended in critical care guidelines, there remains a persistent lack of effective delirium education for ICU providers. To address this knowledge-practice gap, we developed an "ICU Delirium Playbook" to educate providers on delirium detection (using the Confusion Assessment Method for the ICU) and prevention. DESIGN Building on our previous ICU Delirium Video Series, our interdisciplinary team developed a corresponding quiz to form a digital "ICU Delirium Playbook." Playbook content validity was evaluated by delirium experts, and face validity by an ICU nurse focus group. Additionally, focus group participants completed the quiz before and after video viewing. Remaining focus group concerns were evaluated in semi-structured follow-up interviews. SETTING Online validation survey, virtual focus group, and virtual interviews. SUBJECTS The validation group included six delirium experts in the fields of critical care, geriatrics, nursing, and ICU education. The face validation group included nine ICU nurses, three of whom participated in the semi-structured feedback interviews. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 44-question quiz had excellent content validity (average scale-level content validity index [S-CVI] of individual items = 0.99, universal agreement S-CVI = 0.93, agreement κ ≥ 0.75, and clarity p ≥ 0.8). The focus group participants completed the Playbook in an average (sd) time of 53 (14) minutes, demonstrating significant improvements in pre-post quiz scores (74% vs 86%; p = 0.0009). Verbal feedback highlighted the conciseness, utility, and relevance of the Playbook, with all participants agreeing to deploy the digital education module in their ICUs. CONCLUSIONS The ICU Delirium Playbook is a novel, first-of-its-kind asynchronous digital education tool aimed to standardize delirium detection and prevention practices. After a rigorous content and face validation process, the Playbook is now available for widespread use.
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Affiliation(s)
- Hirsh Makhija
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Janelle M Fine
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Daniel Pollack
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
| | - Francesca Novelli
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
- School of Nursing, Oregon Health and Science University, Ashland, OR
| | - Judy E Davidson
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Department of Psychiatry, UCSD Health, San Diego, CA
| | - Shannon A Cotton
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
| | - Bianca Diaz De Leon
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Paola Alicea Reyes
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | | | - Yeonsu Song
- School of Nursing, University of California, Los Angeles (UCLA), Los Angeles, CA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Ana Lucia Fuentes
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | | | - Alison A Moore
- Division of Geriatrics, Gerontology and Palliative Care, UCSD Health, San Diego, CA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Dale M Needham
- Division of Pulmonary & Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
- School of Nursing, Johns Hopkins University, Baltimore, MD
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
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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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Ormonde C, Igwe EO, Nealon J, O'Shaughnessy P, Traynor V. Delirium education and post-anaesthetics care unit nurses' knowledge on recognising and managing delirium in older patients. Aging Clin Exp Res 2023; 35:995-1003. [PMID: 37014618 PMCID: PMC10149476 DOI: 10.1007/s40520-023-02390-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a major complication following a surgical procedure. There is evidence that improving knowledge about POD could enhance POD care and patient outcomes. AIM The study aimed to evaluate whether the amount of delirium education among registered nurses working in post-anaesthetics care units (PACU) impacts on their self-reported confidence and competence in recognising and managing delirium as well as prior knowledge on factors that influence the risk of delirium onset for older people. METHOD The current study utilised an online survey on delirium care practice among registered nurses in PACUs. The survey consisted of 27 items. There were questions about confidence and competence in delirium care, knowledge about delirium risk factors, and ranked responses to two case scenario questions to evaluate the application of POD care. There were also demographic questions, including previous experience with delirium care education. RESULTS A total of 336 responses were generated from registered nurses working in PACU. Our findings found substantial variability among the respondents about their delirium care education. The amount of delirium education did not influence the PACU registered nurses' confidence or competence in delirium care. In addition, previous education did not have an impact on their knowledge about delirium risk factors. DISCUSSION AND CONCLUSION These findings suggested that the quantity of prior education about delirium did not improve the confidence, competence, knowledge, or case scenario questions of PACU registered nurses. Thus, delirium care education needs to be transformed to ensure it has a positive effect on delirium care clinical practice by registered nurses in PACU.
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Affiliation(s)
- Callum Ormonde
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Ezinne O Igwe
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia.
| | - Jessica Nealon
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia
| | - Pauline O'Shaughnessy
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Victoria Traynor
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia
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Development and Evaluation of an Intensive Care Unit Video Series to Educate Staff on Delirium Detection. ATS Sch 2022; 3:535-547. [PMID: 36726713 PMCID: PMC9885989 DOI: 10.34197/ats-scholar.2022-0011oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/08/2022] [Indexed: 02/04/2023] Open
Abstract
Background Delirium affects up to 80% of patients who are mechanically ventilated in the intensive care unit (ICU) but often goes undetected because of incomplete and/or inaccurate clinician evaluation and documentation. A lack of effective, feasible, and sustainable educational methods represents a key barrier to efforts to optimize, scale, and sustain delirium detection competencies. Progress with such barriers may be addressed with asynchronous video-based education. Objective To evaluate a novel ICU Delirium Video Series for bedside providers via a knowledge assessment quiz and a feedback questionnaire. Methods An interdisciplinary team scripted and filmed an educational ICU Delirium Video Series, providing detailed instruction on delirium detection using the validated CAM-ICU (Confusion Assessment Method for the ICU). A cohort of bedside nurses subsequently viewed and evaluated the ICU Delirium Video Series using a feedback questionnaire and a previously developed knowledge assessment quiz pre- and post-video viewing. Results Twenty nurses from four ICUs viewed the ICU Delirium Video Series and completed the pre-post quiz and questionnaire. Ten (50%) respondents had 10 or more years of ICU experience, and seven (35%) reported receiving no CAM-ICU education locally. After video viewing, overall pre-post scores improved significantly (66% vs. 79%; P < 0.0001). In addition, after video viewing, more nurses reported comfort in their ability to evaluate and manage patients with delirium. Conclusion Viewing the ICU Delirium Video Series resulted in significant improvements in knowledge and yielded valuable feedback. Asynchronous video-based delirium education can improve knowledge surrounding a key bedside competency.
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The Influence of Nursing Simulation on Patient Outcomes and Patient Safety: A Scoping Review. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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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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Lee SY, Chang CY. Nursing management of the critical thinking and care quality of ICU nurses: A cross-sectional study. J Nurs Manag 2022; 30:2889-2896. [PMID: 35293063 DOI: 10.1111/jonm.13591] [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: 03/10/2022] [Indexed: 12/11/2022]
Abstract
AIM To explore the effectiveness of a digital learning management system in enhancing intensive care unit nurses' critical care knowledge and critical thinking tendency. BACKGROUND Learning intensive care unit knowledge and skills is essential for the continuing education of nurses, and impacts patient health outcomes. Enhancing intensive care unit nurses' critical care abilities is a medical care quality concern in clinical practice. METHODS A cross-sectional study was conducted with 212 participants to investigate the effects of a digital learning system on care quality. RESULTS After the implementation of the digital learning system, intensive care unit nurses' critical care knowledge and critical thinking skills increased significantly. High-level nurses had higher critical thinking scores. All participants associated critical care knowledge with improved quality of care. CONCLUSION The digital learning management system enhanced intensive care unit nurses' critical care knowledge. Optimizing nursing care safety and quality requires that nursing staff to be at an adequate level, which improves their critical care ability. IMPLICATIONS FOR NURSING MANAGEMENT A well-designed digital learning management system with structured classes may allow intensive care unit nurses to learn effectively and can be used for continuing education. These results are of interest to nursing management staff who want to invest in the continued professional development of intensive care unit nurses to improve critical care knowledge, critical thinking skills, care quality, and health care value.
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Affiliation(s)
- Shu-Yen Lee
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan, ROC.,School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ching-Yi Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University, Taiwan
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Najafi Ghezeljeh T, Rahnamaei F, Omrani S, Haghani S. The effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. J Intensive Care Soc 2022; 23:44-52. [PMID: 37593534 PMCID: PMC10427842 DOI: 10.1177/1751143720972627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background Nursing care for patients with delirium is very complex and stressful and is associated with considerable care strain for nurses. Delirium recognition is the first step to the prevention and management of delirium and reduction of strain of care. Education is one of the strategies for improving nurses' delirium recognition ability. Objectives This study aimed to evaluate the effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. Methods This quasi-experimental study was conducted in 2019 using a two-group pretest-posttest design. Participants were 98 critical care nurses recruited through a census from two hospitals in Iran. They were non-randomly allocated to an intervention and a control group. Study intervention was an interactive E-learning program with four parts on delirium, its prevention, its treatment, and its diagnostic and screening procedures. The program was uploaded on a website and its link was provided to participants in the intervention group. Before and two months after the intervention, data were collected using the Strain of Care for Delirium Index and five case vignettes. For data analysis, the Chi-square, Fisher's exact, independent-sample t, and paired-sample t tests were performed usingthe SPSS software (v. 16.0). Findings Groups did not significantly differ from each other regarding the pretest mean scores of delirium recognition ability and strain of care. After the intervention, the mean score of delirium recognition ability in the intervention group was significantly greater and the mean score of strain of care was significantly lower than the control group (P < 0.05). Conclusion Interactive E-learning is effective in significantly improving critical care nurses' delirium recognition ability and reducing their strain of care. As nurses' heavy workload and limited free time are among the main barriers to their participation in face-to-face educational programs, interactive E-learning can be used for in-service education.
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Affiliation(s)
- Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahnamaei
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soghra Omrani
- Distance Education Planning, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Statistic and Mathematics Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Bourgault A, Mayerson E, Nai M, Orsini-Garry A, Alexander IM. Implications of the COVID-19 pandemic: Virtual nursing education for delirium care. J Prof Nurs 2022; 38:54-64. [PMID: 35042590 PMCID: PMC8654606 DOI: 10.1016/j.profnurs.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/22/2022]
Abstract
Background Technology is increasingly used in nursing education, particularly during the SARS-CoV-2 (COVID-19) pandemic. COVID-19 also brought new challenges to patient care and limited access to in-person clinical experiences for nursing students. Pivoting to virtual simulation (VS) for clinical was necessary during the height of the pandemic. With students' return to clinical settings, VS experiences continue to be needed, due to quarantine of clinical settings and/or shortage of available clinical sites. VS clinical experiences have been successfully utilized over the past decade; however, the literature lacks resources on the use of VS for delirium care of patients. Method In this article, the authors describe the creation and provision of a VS clinical day using interactive computer-based technology to educate nursing students to prevent, recognize, and manage delirium. The VS clinical was in conjunction with a Behavioral Health course. Results Evaluation of students demonstrated attainment of objectives. Students reported satisfaction with the VS experience. Conclusion Technology in nursing education and use of VS clinical provide effective strategies for clinical learning when in-person clinical experiences are unavailable, either due to access limitations or lack of patients with specific health needs.
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Affiliation(s)
- Anna Bourgault
- University of Connecticut School of Nursing, United States of America
| | | | - Michelle Nai
- University of Connecticut School of Nursing, United States of America
| | | | - Ivy M Alexander
- University of Connecticut School of Nursing, United States of America
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13
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Bunting J, de Klerk M. Strategies to Improve Compliance with Clinical Nursing Documentation Guidelines in the Acute Hospital Setting: A Systematic Review and Analysis. SAGE Open Nurs 2022; 8:23779608221075165. [PMID: 35620302 PMCID: PMC9127672 DOI: 10.1177/23779608221075165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction This systematic review attempts to answer the following question - which strategies to improve clinical nursing documentation have been most effective in the acute hospital setting? Methods A keyword search for relevant studies was conducted in CINAHL and Medline in May 2019 and October 2020.Studies were appraised using the Joanna Briggs Institute (JBI) critical appraisal for quasi-experimental studies. The studies were graded for level of evidence according to GRADE principles.The data collected in each study were added to a Summary of Data (SOD) spreadsheet. Pre intervention and a post intervention percentage compliance scores were calculated for each study where possible i.e. (mean score/possible total score) × (100/1). A percentage change in compliance for each study was calculated by subtracting the pre intervention score from the post intervention score. The change in compliance score and the post intervention compliance score were both added to the SOD and used as a basis for comparison between the studies. Each study was analyzed thematically in terms of the intervention strategies used. Compliance rates and the interventions used were compared to determine if any strategies were effective in achieving a meaningful improvement in compliance. Results Seventy six full text articles were reviewed for this systematic review. Fifty seven of the studies were before and after studies and 66 were conducted in western countries. Publishing dates for the studies ranged from 1991 to 2020.Eleven studies included documentation audits with personal feedback as one of the strategies used to improve nursing documentation. Ten of these studies achieved a post intervention compliance rate ≥ 70%. Conclusion Notwithstanding the limitations of this study, it may be that documentation audit with personal feedback, when combined with other context specific strategies, is a reliable method for gaining meaningful improvements in clinical nursing documentation. The level of evidence is very low and further research is required.
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Affiliation(s)
- Jeanette Bunting
- Joondalup Health Campus Librarian, Joondalup, Western Australia,
Australia
| | - Melissa de Klerk
- Joondalup Health Campus Library
Technician, Joondalup, Western Australia, Australia
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14
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Sinvani L, Delle Site C, Laumenede T, Patel V, Ardito S, Ilyas A, Hertz C, Wolf-Klein G, Pekmezaris R, Hajizadeh N, Thomas L. Improving delirium detection in intensive care units: Multicomponent education and training program. J Am Geriatr Soc 2021; 69:3249-3257. [PMID: 34402046 DOI: 10.1111/jgs.17419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Delirium is a common, devastating, and underrecognized syndrome in the intensive care unit (ICU). The study aimed to describe and evaluate a multicomponent education and training program utilizing a "Train-The-Trainer" (TTT) model, to improve delirium detection across a large health system. METHODS Fourteen ICUs across nine hospitals participated in a multicomponent delirium program consisting of a 1-day workshop that included: (1) patient testimonials, (2) small group discussions, (3) didactics, and (4) role-playing. Additionally, four ICUs received direct observation/training via telehealth (tele-delirium training). The Kirkpatrick model was used for program evaluation in a pre/post-test design. RESULTS A 1-day delirium workshop was held at two time points and included 73 ICU nurses. Of the 65 nurses completing the post-workshop satisfaction survey, most (46.2) had >10 years of clinical experience, and no or minimal delirium training (69.2%). All nurses (100%) identified lack of knowledge as a barrier to delirium detection, while time constraints and lack of importance accounted for only 25%. Overall, nurses rated the workshop positively (excellent 66.7%, and very good 23.3%), and likely to change practice (definitely 73.3% and very likely 15.0%). All validated Confusion Assessment Method for the ICU (CAM-ICU) cases demonstrated improvement in number of correct responses. Delirium detection across the health system improved from 9.1% at baseline to 21.2% in ICUs that participated in the workshop and 30.1% in those ICUs that also participated in the tele-delirium training (p = 0.005). CONCLUSION A multicomponent delirium education and training program using a TTT model was rated positively, improved CAM-ICU knowledge, and increased delirium detection.
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Affiliation(s)
- Liron Sinvani
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Division of Geriatrics and Palliative Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA.,Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA
| | | | - Tara Laumenede
- Patient Care Services, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Vidhi Patel
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Suzanne Ardito
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Anum Ilyas
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Craig Hertz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Tele-Intensive Care Unit (eICU), Division of TeleHealth, Northwell Health, New Hyde Park, New York, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health, Manhasset, New York, USA
| | - Gisele Wolf-Klein
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Renee Pekmezaris
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Negin Hajizadeh
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health, Manhasset, New York, USA
| | - Lily Thomas
- Institute for Nursing, Northwell Health, New Hyde Park, New York, USA
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15
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Piot MA, Dechartres A, Attoe C, Romeo M, Jollant F, Billon G, Cross S, Lemogne C, Layat Burn C, Michelet D, Guerrier G, Tesniere A, Rethans JJ, Falissard B. Effectiveness of simulation in psychiatry for nursing students, nurses and nurse practitioners: A systematic review and meta-analysis. J Adv Nurs 2021; 78:332-347. [PMID: 34378236 DOI: 10.1111/jan.14986] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction. REVIEW METHODS We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels. RESULTS A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners' attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences. CONCLUSION These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions.
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Affiliation(s)
- Marie-Aude Piot
- Université de Paris, Institute Mutualiste Montsouris, Department of Psychiatry, Paris-Saclay University, UVSQ, INSERM 1018, CESP, Ilumens, Simulation Center, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), F75013, Paris, France
| | - Chris Attoe
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Marie Romeo
- Université de Paris, Institute Mutualiste Montsouris, Department of Psychiatry, Paris-Saclay University, UVSQ, INSERM 1018, CESP, Ilumens, Simulation Center, Paris, France
| | - Fabrice Jollant
- Université de Paris, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Department of Psychiatry, Moods Team, INSERM UMR-1178, CESP, Paris, France.,Nîmes academic hospital (CHU), Nîmes, France.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Grégoire Billon
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Sean Cross
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
| | - Carine Layat Burn
- Department of Orthopaedic Surgery, La Providence Hospital, Neuchâtel, Switzerland.,Department of Psychotherapy, Berger Psychotherapeutic Centre, Neuchâtel, Switzerland
| | - Daphné Michelet
- Department of Pediatric Anesthesia, CHU of Reims Hôpital Maison Blanche, Reims, France
| | - Gilles Guerrier
- Université de Paris, AP-HP, Cochin Hospital, Anaesthesiology Department, Ilumens, Simulation Center, Paris, France
| | - Antoine Tesniere
- Université de Paris, AP-HP, Cochin Hospital, Anaesthesiology Department, Ilumens, Simulation Center, Paris, France
| | - Jan-Joost Rethans
- Skillslab, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bruno Falissard
- Public Health Department, School of Medicine, University Paris Saclay, INSERM 1018, CESP, Villejuif, Ile-de-France, France
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16
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Gaa CA, Akintade BF. Implementing Delirium Screening in an Intermediate Care Unit. J Dr Nurs Pract 2021; 14:JDNP-D-20-00035. [PMID: 34016784 DOI: 10.1891/jdnp-d-20-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delirium occurs in as many as 82% of hospitalized patients. Use of a valid and reliable tool allows for early detection and management to mitigate adverse effects, including a decrease in patient falls. OBJECTIVE To conduct a quality improvement project to implement the confusion assessment method (CAM) tool in an intermediate care unit and measure delirium screening compliance, feasibility of the tool, and the effect on reported patient falls. METHODS Web-based training using a 14-item pre-post assessment for knowledge comprehension. The CAM tool was added to the electronic health record (EHR), and documentation compliance was measured for eight weeks. Afterwards, a nurse perception survey was distributed, and 60-day pre- and post-intervention patient falls were compared. RESULTS Forty-seven nurses completed the training. Post-test averages were higher than the pre-test (p = .16); five answers showed significant improvement (p < .02). Screening and documentation compliance were 79.1%. Twenty-one nurses completed the perception survey, demonstrating agreement that delirium CAM screening is a feasible intervention. Patient falls were reduced by 57%. CONCLUSION Addition of the CAM tool into the EHR-enhanced screening compliance. IMPLICATIONS FOR NURSING Early delirium detection may reduce patient falls. The CAM is a feasible instrument and delirium screening is a worthwhile intervention.
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Effect of a Multistage Educational Skill-Based Program on Nurse's Stress and Anxiety in the Intensive Care Setting: A Randomized Controlled Trial. Behav Neurol 2021; 2021:8811347. [PMID: 33986878 PMCID: PMC8093071 DOI: 10.1155/2021/8811347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Psychological problems such as stress and anxiety are prevalent among working nurses in the intensive care units (ICUs). This study was aimed at investigating the effects of three skill-based educational programs on stress and anxiety among critical care nurses. Methods Using a randomized controlled trial, 160 nurses were assigned to four groups including one control and three intervention groups. A standard skill-based educational program was delivered to three intervention groups using booklet, booklet+oral presentation, and booklet+oral presentation+clinical teaching over a period of one month to reduce different types of stress and anxiety. The control group received routine education only. Perceived stress, state anxiety, trait anxiety, and work-related stress were assessed at baseline and three times after the intervention (15 days, 3 months, and 21 months). Repeated-measure analysis of variance was used for data analysis. Results There was no significant change in the control group in terms of study variables during follow-up assessments, whereas measures of stress and anxiety were reduced after intervention in the trial groups except trait anxiety. Nurses in the mixed-method group (booklet+oral presentation+clinical teaching) showed less stress and anxiety during follow-ups. Although the stress and anxiety scores decreased in the first and second follow-ups, there was no significant reduction in the third follow-up. Conclusions To improve the mental health and performance of the intensive care unit nurses, knowledge-based and skill-based training programs seem useful. Continuous training may help to maintain the effectiveness of these programs over time.
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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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19
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Wong IMJ, Thangavelautham S, Loh SCH, Ng SY, Murfin B, Shehabi Y. Sedation and Delirium in the Intensive Care Unit—A Practice-Based Approach. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmed.sg.202013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Critically ill patients often require sedation for comfort and to
facilitate therapeutic interventions. Sedation practice guidelines provide an evidencebased framework with recommendations that can help improve key sedation-related
outcomes. Materials and Methods: We conducted a narrative review of current
guidelines and recent trials on sedation. Results: From a practice perspective, current
guidelines share many limitations including lack of consensus on the definition
of light sedation, optimal frequency of sedation assessment, optimal timing for
light sedation and consideration of combinations of sedatives. We proposed several
strategies to address these limitations and improve outcomes: 1) early light sedation
within the first 48 hours with time-weighted monitoring (overall time spent in
light sedation in the first 48 hours—sedation intensity—has a dose-dependent
relationship with mortality risk, delirium and time to extubation); 2) provision of
analgesia with minimal or no sedation where possible; 3) a goal-directed and balanced
multimodal approach that combines the benefits of different agents and minimise
their side effects; 4) use of dexmedetomidine and atypical antipsychotics as a
sedative-sparing strategy to reduce weaning-related agitation, shorten ventilation
time and accelerate physical and cognitive rehabilitation; and 5) a bundled approach
to sedation that provides a framework to improve relevant clinical outcomes.
Conclusion: More effort is required to develop a practical, time-weighted sedation
scoring system. Emphasis on a balanced, multimodal appraoch that targets light
sedation from the early phase of acute critical illness is important to achieve optimal
sedation, lower mortality, shorten time on ventilator and reduce delirium.
Ann Acad Med Singapore;49:215–25
Key words: Analgesia, Benzodiazepine, Critical Care, Dexmedetomidine, Propofol
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Affiliation(s)
- Irene MJ Wong
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore
| | | | | | - Shin Yi Ng
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore
| | - Brendan Murfin
- Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Yahya Shehabi
- Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
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20
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Mitchell G, McVeigh C, Carlisle S, Brown-Wilson C. Evaluation of a co-produced delirium awareness programme for undergraduate nursing students in Northern Ireland: a pre-test/post-test study. BMC Nurs 2020; 19:34. [PMID: 32351326 PMCID: PMC7183703 DOI: 10.1186/s12912-020-00427-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Delirium is recognised internationally as a common disorder that causes acute deterioration in a person's cognitive abilities. Healthcare professionals play a key role in the early identification and management of delirium and effective education can support timely recognition and treatment. There is currently a lack of research exploring the delirium education provided to undergraduate nursing students. The aim of this study was to evaluate the effectiveness of a co-produced delirium awareness programme on undergraduate nursing students in Northern Ireland. METHODS The intervention was a 2-h delirium workshop, delivered in April 2019, to a convenience sample of year one undergraduate nursing students (n = 206) completing a BSc Honours Nursing degree programme in a Northern Ireland University. The workshop focused on four core elements: defining delirium, reflecting on practice, recognition of delirium and management of delirium. Participants completed a 35-item true-false Delirium Knowledge Questionnaire (DKQ) at baseline and post intervention using Socrative, a cloud-based student response system. In addition, students also completed a short questionnaire at baseline and post-workshop, designed by the authors, to ascertain perceived confidence about caring for people with delirium. Data were analysed using paired t-tests and descriptive statistics. RESULTS In the DKQ, Scores were normally distributed around the mean at baseline (71.89%) and post intervention (81.89%). Students improved across all three core areas in the post-test questionnaire, demonstrating improvements in knowledge about symptoms of delirium (7.32% increase), causes and risk factors of delirium (17.91% increase) and management of delirium (5.72% increase). In relation to perceived confidence, students reported a 60.20% increase in confidence related to recognition of delirium, a 49.51% increase in relation to delirium management and a 45.04% increase their ability to communicate about delirium. Both questionnaires were statistically significant (P < 0.01). CONCLUSIONS A 2-h workshop on delirium improved first year student nurse knowledge about delirium. Nursing students expressed that this approach to delirium education enabled collective thinking about how knowledge could be transferred into individual practises. Students also stated that learning incorporating the voice of the person who has experienced delirium, was an effective and powerful way to deliver education.
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Affiliation(s)
- Gary Mitchell
- Queen’s University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, County Antrim, Belfast, Northern Ireland BT9 7BL
| | - Clare McVeigh
- Queen’s University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, County Antrim, Belfast, Northern Ireland BT9 7BL
| | - Susan Carlisle
- Queen’s University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, County Antrim, Belfast, Northern Ireland BT9 7BL
| | - Christine Brown-Wilson
- Queen’s University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, County Antrim, Belfast, Northern Ireland BT9 7BL
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