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Balsalobre-Martínez P, Montosa-García R, Marín-Yago A, Baeza-Mirete M, Muñoz-Rubio GM, Rojo-Rojo A. Challenges of the Implementation of a Delirium Rate Scale in a Pediatric Intensive Care Unit: A Qualitative Approach. Healthcare (Basel) 2023; 12:52. [PMID: 38200958 PMCID: PMC10779040 DOI: 10.3390/healthcare12010052] [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: 10/31/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Delirium in the pediatric population admitted to intensive care is a worrying reality due to its potential complications and the increase in associated costs. This study aims to explore the experiences of nursing staff of a Pediatric Intensive Care Unit after 15 months of starting a program to fight against childhood delirium in their unit. METHODOLOGY A qualitative study was conducted through semi-structured interviews with Pediatric Intensive Care Unit (PICU) Key Informants. The Standards for Reporting Qualitative Research (SRQR) and the consolidated criteria for Reporting Qualitative Research (COREQ) were followed as quality measures for the study. Seven nurses (33% of the eligible population) from the PICU of a referral hospital were interviewed. Text transcripts were analyzed using the Interpretative Description and Qualitative Content Analysis method. RESULTS The interviewees indicated not identifying delirium as an important reality; with great deficiencies observed in what is related to the identification of delirium; identifying CAPD as an unreliable tool in their unit; and not sharing therapeutic objectives in this respect with the medical staff. CONCLUSIONS The nursing staff presented a series of negative attitudes towards the phenomena of delirium in their unit, with gaps in training and in clinical management, and the diagnostic tool used, and did not see it as a priority objective of the unit, partly due to a resistance to change and a latent interprofessional communication conflict. A change at the formative, attitudinal, and relational levels is urgently needed for the success of the program and the well-being of the children in the unit.
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Affiliation(s)
| | - Raquel Montosa-García
- Pediatric Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Public Murcian Healthcare System, 30120 Murcia, Spain (A.M.-Y.)
| | - Ana Marín-Yago
- Pediatric Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Public Murcian Healthcare System, 30120 Murcia, Spain (A.M.-Y.)
| | - Manuel Baeza-Mirete
- Faculty of Nursing, Catholic University of Murcia (UCAM), 30107 Murcia, Spain
| | - Gloria María Muñoz-Rubio
- Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Public Murcian Health System, 30120 Murcia, Spain
| | - Andrés Rojo-Rojo
- Faculty of Nursing, Catholic University of Murcia (UCAM), 30107 Murcia, Spain
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Zilezinski M, Denninger NE, Tannen A, Kottner J. Non-pharmacological interventions to prevent and manage delirium in critically ill children in neonatal and paediatric intensive care units (NICU/PICU): a scoping review protocol. BMJ Open 2023; 13:e073883. [PMID: 37899161 PMCID: PMC10619068 DOI: 10.1136/bmjopen-2023-073883] [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: 03/20/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Delirium is one of the most common forms of acute cerebral dysfunction in critically ill children leading to increased morbidity and mortality. Prevention, identification and management of delirium is an important part of paediatric and neonatological intensive care. This scoping review aims to identify and map evidence on non-pharmacological interventions for paediatric delirium prevention and management in paediatric and neonatal intensive care settings. METHODS AND ANALYSIS This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches will be performed in the databases Medline (via PubMed), CINAHL, Cochrane Library, Ovid (Journals), EMBASE and Web of Science (01/2000-current). Two reviewers will independently review retrieved studies, and relevant information will be extracted using data extraction forms. The results will be presented in tabular format and accompanied by a narrative summary. INCLUSION CRITERIA The review will include references that describe or evaluate non-pharmacological interventions to prevent or manage paediatric delirium. Conference abstracts, editorials, opinion papers and grey literature will be excluded. ETHICS AND DISSEMINATION Due to the nature of research involving humans or unpublished secondary data, approval of an ethics committee are not required. The dissemination of findings is planned via professional networks and publication in an open-access scientific journal.
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Affiliation(s)
- Max Zilezinski
- Institute of Clinical Nursing Science, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Natascha-Elisabeth Denninger
- Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- Institute for Health and Nursing Science, International Graduate Academy, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Antje Tannen
- Institute of Clinical Nursing Science, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Institute of Clinical Nursing Science, Charité Universitätsmedizin Berlin, Berlin, Germany
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Bittencourt JM, Martins LP, Paiva SM, Pordeus IA, Bendo CB. Psychosocial associated factors of early childhood caries and oral health-related quality of life: structural equation model approach. J Dent 2023; 133:104506. [PMID: 37028544 DOI: 10.1016/j.jdent.2023.104506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE To identify a structural model for the identification of psychosocial associated factors of early childhood caries (ECC) and oral health-related quality of life (OHRQoL) in preschool children and their families. METHODS A population-based cross-sectional study was conducted with 533 preschool children from 4 to 6 years-old public and private preschools, from XXX, XXX. Parents/caregivers self-completed the Brazilian versions of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and Resilience Scale as well as a structured questionnaire addressing socioeconomic status and child's oral health behavior. Two dentists who had undergone training and calibration exercises for ICDAS-epi and pufa index (Kappa≥0.95) performed the examinations for ECC. Stages of ECC were classified as free of visible carious lesion, initial caries, moderate caries, extensive caries without pulp consequences and extensive caries with pulp consequences. Data were analyzed using structural equation modeling, using Mplus version 8.6. RESULTS Lower socioeconomic status (b=-0.250; p<0.001) and higher frequency of free sugar consumption (b=0.122; p=0.033) were directly associated with a more severe stage of ECC. Lower parental resilience had an indirect impact on more severe stage of ECC which was mediated by the variable 'frequency of free sugar consumption' (b=-0.089; p=0.048). ECC was associated with lower child's OHRQoL (b=0.587; p<0.001) and lower family's OHRQoL (b=0.506; p<0.001). CONCLUSION Structural modeling revealed that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families. The main associated factors of the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience. CLINICAL SIGNIFICANCE T The findings indicate that psychosocial and behavior variables can be associated with the severity of ECC, and ECC can be associated with negative impact on wellbeing and ability to perform daily activities of preschoolers and their families.
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Affiliation(s)
- Jéssica Madeira Bittencourt
- Department of Paediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31270-901, Brazil.
| | - Letícia Pereira Martins
- Department of Paediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31270-901, Brazil
| | - Saul Martins Paiva
- Department of Paediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31270-901, Brazil
| | - Isabela Almeida Pordeus
- Department of Paediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31270-901, Brazil
| | - Cristiane Baccin Bendo
- Department of Paediatric Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31270-901, Brazil
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Oostra Cortés LE, Henao Castaño ÁM, Motta Robayo CL. Rol de enfermería frente al delirium en unidad de cuidado intensivo pediátrico: Scoping Review. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: El manejo integral de delirium tiene componentes de diferente índole y el rol de enfermería frente a éste puede ser difuso. Objetivo: Identificar en la literatura disponible los cuidados de enfermería no farmacológicos para niños hospitalizados en Unidad de Cuidado Intensivo Pediátrica que presenten delirium. Materiales y métodos: Se realizó una búsqueda estratégica en Web Of Science, Medline, Science Direct, Scielo, Biblioteca Virtual en Salud, LILACS y Open Grey utilizando los términos “nursing care”, “child OR children”, “delirium”, y “Pediatric Intensive Care Unit”. La extracción y análisis de los datos se dio por medio de una matriz. Resultados: Se identificaron 12 artículos que cumplían con los criterios de inclusión y se clasificaron en 4 categorías según la intervención principal desarrollada en el estudio: Abordaje investigativo, intervenciones de confort, intervenciones integrales, e intervenciones educativas. Discusión: El cuidado de enfermería frente al delirium comprende medidas preventivas o curativas que parten del paciente como centro y se extienden hasta su entorno y su familia. Las intervenciones de enfermería pueden estar interrelacionadas de manera que se sustentan y complementan entre ellas. Algunas actividades de cuidado pueden considerarse un indicador de calidad de la atención en salud. Conclusiones: Para abordar integralmente el delirium pediátrico es necesario incidir sobre los factores individuales, ambientales y estructurales que contribuyen a su aparición. El cuidado de enfermería frente al delirium constituye una forma de proteger y promover el bienestar y el desarrollo inmediato y futuro de los niños.
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Liao J, Kui C, Zhou Y, Huang L, Zuo D, Huang Y, Pan R. Effect of Programmed Comprehensive Nursing for Postoperative Delirium in Intensive Care Unit Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1227659. [PMID: 35600946 PMCID: PMC9117019 DOI: 10.1155/2022/1227659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
Abstract
Background This study is to evaluate the effect of programmed comprehensive nursing for postoperative delirium in intensive care unit (ICU) patients. Methods A total of 90 cases of ICU surgery patients admitted to our hospital from July 2019 to July 2020 were recruited and assigned via the random number table method (1 : 1) to receive either conventional nursing (control group) or programmed comprehensive nursing (experimental group). The delirium assessment method was used to record the incidence of delirium events at different time points after the intervention. Outcome measures included delirium events, the Visual Analogue Scale (VAS) scores, the Pittsburgh sleep quality index (PSQI) scores, the activities of daily living (ADL) scale scores, nursing satisfaction, and total nursing efficiency. Results Programmed comprehensive nursing was associated with significantly better nursing satisfaction, ADL scores, VAS scores, PSQI scores, and nursing efficiency than conventional nursing (all P < 0.05). Programmed comprehensive nursing resulted in a significantly lower incidence of postoperative delirium than conventional nursing (P < 0.05). Conclusion The application of programmed comprehensive nursing for postoperative delirium in ICU patients shows a promising efficiency, effectively alleviates the clinical symptoms of patients, and optimizes various clinical indicators of patients; hence, it is worthy of further application and promotion.
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Affiliation(s)
- Juanjuan Liao
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Chuanran Kui
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Yangchun Zhou
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Li Huang
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Dandan Zuo
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Yuqin Huang
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Ruihong Pan
- Department of Nursing, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
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Acosta-Murillo NR. Delirio en niños críticamente enfermos. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n4.77430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El delirio en pacientes críticos es una condición médica que afecta tanto a adultos como a niños; en ambas poblaciones implica graves complicaciones como estancia hospitalaria prolongada, alto riesgo de muerte y deterioro cognitivo a largo plazo, así como mayores costos económicos en cuanto a la prestación de servicios de salud. La principal dificultad de esta condición en la población pediátrica es su adecuado reconocimiento, ya que puede presentarse en edades muy tempranas, incluso en niños lactantes, cuando sus signos y síntomas pueden confundirse o superponerse con otras patologías, tales como el síndrome de abstinencia. En consecuencia, en estos casos el uso de herramientas diagnósticas puede ser una labor compleja que implica múltiples dificultades.Antes de 2011 no había muchos estudios que abordaran la evaluación del delirio en niños. Sin embargo, ese mismo año se estableció la primera escala desarrollada específicamente para el monitoreo de pacientes en unidades de cuidado intensivo pediátrico, lo que llevó a un aumento significativos del número de casos de delirio en niños menores de 5 años críticamente enfermos; esta situación hizo que los pediatras se interesaran más en estudiar esta importante patología.La presente reflexión, basada en una revisión de la literatura, busca actualizar el amplio espectro fisiopatológico del delirio en niños críticamente enfermos y, de esta forma, mejorar su tamizaje, diagnóstico e intervenciones terapéuticas tempranas en todas las edades pediátricas, incluso en menores de 5 años.
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Neurobehavioral Complications After Abdominal Organ Transplantation: Considering a Broader Phenotype and Care Plan. Pediatr Crit Care Med 2020; 21:837-838. [PMID: 32890084 DOI: 10.1097/pcc.0000000000002401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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