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Potter KM, Pun BT, Maya K, Young B, Williams S, Schiffman M, Hosie A, Boehm LM. Delirium and Coronavirus Disease 2019: Looking Back, Moving Forward. Crit Care Nurs Clin North Am 2024; 36:415-426. [PMID: 39069360 PMCID: PMC11284274 DOI: 10.1016/j.cnc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
During the coronavirus disease 2019 pandemic, crisis changes in clinical care increased rates of delirium in the intensive care unit (ICU). Deep sedation, unfamiliar environments with visitor restrictions, and such factors due to high workload and health system strain contributed to the occurrence of delirium doubling in the ICU. As the pandemic wanes, health care systems and ICU leadership must emphasize post-pandemic recovery, integrating lessons learned about delirium management, evidence-based care, and family involvement. Strategies to empower clinicians, creatively deliver care, and integrate families pave the way forward for a more holistic approach to patient care in the post-pandemic era.
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Affiliation(s)
- Kelly M Potter
- Department of Critical Care Medicine, CRISMA Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Brenda T Pun
- Department of Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerri Maya
- Sutter Health System, Sacramento, CA, USA
| | - Bethany Young
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stacey Williams
- Monroe Carrell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | - Annmarie Hosie
- School of Nursing & Midwifery Sydney, University of Notre Dame Australia, Sydney, New South Wales, Australia; Cunningham Centre for Palliative Care, St Vincent's Health Network Sydney, Sydney, New South Wales, Australia; IMPACCT- Improving Palliative, Aged and Chronic Care Through Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Wang J, Lu Y, Chen X, Wu Y. Effectiveness of nurse-led non-pharmacological interventions on outcomes of delirium in adults: A meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs 2024. [PMID: 39086052 DOI: 10.1111/wvn.12739] [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: 03/02/2024] [Revised: 06/08/2024] [Accepted: 07/14/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Delirium is a common complication among adults. It is essential to improve the outcomes of delirium. AIM To systematically synthesize the evidence on the effectiveness of the nurse-led non-pharmacological interventions on outcomes of delirium in adults. METHODS Electronic databases including CINAHL, Cochrane Library, MEDLINE, EMBASE, PubMed, Web of Science, PsycINFO, and Clinical Trial Registration were searched comprehensively by the authors. The authors reviewed the full text and assessed the risk of bias using the Cochrane Risk of Bias Tool 2.0. The meta-analysis was performed using RevMan and Stata software. The forest plots showed the overall effect of the included study and the I2 test was used to assess the degree of heterogeneity between studies. Random effects models were used to analyze studies with significant heterogeneity. RESULTS A total of 32 studies (10,122 participants) were included in the meta-analysis. Nurse-led non-pharmacological interventions resulted in a significantly lower incidence of delirium compared with the usual care/control group (risk ratio = 0.74, p < .001) and reduced mortality in the hospital compared with usual care (risk ratio = 0.81, p = .04). However, the implementation of nurse-led, non-pharmacological interventions had no significant effect on the duration, severity of delirium, or length of hospital stay. LINKING EVIDENCE TO ACTION Our findings suggest that the nurse-led, non-pharmacological strategy was effective in reducing the incidence of delirium and mortality in the hospital. Multicomponent interventions were the most effective strategy for reducing the incidence of delirium in adults.
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Affiliation(s)
- Jiamin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yating Lu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohong Chen
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Sist L, Pezzolati M, Ugenti NV, Cedioli S, Messina R, Chiappinotto S, Rucci P, Palese A. Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study. Geriatr Nurs 2024; 58:59-68. [PMID: 38762972 DOI: 10.1016/j.gerinurse.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND This study aimed at (a) exploring how nurses prioritise interventions to prevent delirium among patients identified at risk and (b) describing the underlying prioritisation patterns according to nurses' individual characteristics. METHODS There was used the Q-methodology a research process following specific steps: (a) identifying the concourse, (b) the Q-sample, and (c) the population (P-set); (d) collecting data using the Q-sort table; (e) entering the data and performing the factor analysis; and (f) interpreting the factors identified. RESULTS There were involved 56 nurses working in medical, geriatric and log-term facilities (46; 82.2 %). The preventive intervention receiving the highest priority was 'Monitoring the vital parameters (heart rate, blood pressure, oxygen saturation)' (2.96 out of 4 as the highest priority; CI 95 %: 2.57, 3.36). Two priority patterns emerged among nurses (explained variance 44.78 %), one 'Clinical-oriented' (36.19 %) and one 'Family/caregiver-oriented' (8.60 %) representing 53 nurses out 56. CONCLUSION Alongside the overall tendency to prioritise some preventive interventions instead of others, the priorities are polarised in two main patterns expressing two main individual characteristics of nurses. Knowing the existence of individual patterns and their aggregation informs how to shape educational interventions.
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Affiliation(s)
- Luisa Sist
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Sviluppo Professionale e Implementazione della Ricerca nelle Professioni Sanitarie (SPIR), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | | | - Nikita Valentina Ugenti
- Sviluppo Professionale e Implementazione della Ricerca nelle Professioni Sanitarie (SPIR), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Wang J, Niu S, Wu Y. Effect of the clinical decision assessment system on clinical outcomes of delirium in hospitalized older adults: study protocol for a pair-matched, parallel, cluster randomized controlled superiority trial. Trials 2023; 24:581. [PMID: 37697324 PMCID: PMC10494451 DOI: 10.1186/s13063-023-07607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Prompt recognition of delirium is the first key step in its proper management. A previous study has demonstrated that nurses' delirium screening using the usual paper version assessment tool has no effect on clinical outcomes. Clinical decision assessment systems have been demonstrated to improve patients' adherence and clinical outcomes. Therefore, We developed a clinical decision assessment system (3D-DST) based on the usual paper version (3-min diagnostic interview for CAM-defined delirium), which was developed for assessing delirium in older adults with high usability and accuracy. However, no high quality evidence exists on the effectiveness of a 3D-DST in improving outcomes of older adults compared to the usual paper version. METHODS A pair-matched, open-label, parallel, cluster randomized controlled superiority trial following the SPIRIT checklist. Older patients aged 65 years or older admitted to four medical wards of a geriatric hospital will be invited to participate in the study. Prior to the study, delirium prevention and treatment interventions will be delivered to nurses in both the intervention and control groups. The nurses in the intervention group will perform routine delirium assessments on the included older patients with 3D-DST, while the nurses in the control group will perform daily delirium assessments with the usual paper version. Enrolled patients will be assessed twice daily for delirium by a nurse researcher using 3D-DST. The primary outcome is delirium duration. The secondary outcomes are delirium severity, incidence of delirium, length of stay, in-hospital mortality, adherence to delirium assessment, prevention, and treatment of medical staff. DISCUSSION This study will incorporate the 3D-DST into clinical practice for delirium assessment. If our study will demonstrate that 3D-DST will improve adherence with delirium assessment and clinical outcomes in older patients, it will provide important evidence for the management of delirium in the future. TRIAL REGISTRATION Chinese Clinical Trial Registry, Identifier: ChiCTR1900028402. https://www.chictr.org.cn/showproj.aspx?proj=47127 . PROTOCOL VERSION 1, 29/7/22.
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Affiliation(s)
- Jiamin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, 102488, China
- School of Nursing, Capital Medical University, 10 You-an-Men Wai Xi-Tou-Tiao, Fengtai District, Beijing, 100069, China
| | - Sen Niu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Ying Wu
- School of Nursing, Capital Medical University, 10 You-an-Men Wai Xi-Tou-Tiao, Fengtai District, Beijing, 100069, China.
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Watanabe K, Tani T, Suzuki A, Kawakami K, Watanabe M, Yamasaki K, Morota K. Using Video Calls to Reduce Risky Behaviors and Enhance Instruction Understanding of Patients in Acute Care Hospitals During the COVID-19 Pandemic. Cureus 2023; 15:e45074. [PMID: 37842485 PMCID: PMC10568234 DOI: 10.7759/cureus.45074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Backgrounds During the COVID-19 pandemic, visitor restrictions in healthcare settings adversely affected patients. Video calls have emerged as an essential digital alternative that can decrease patients' anxiety and improve satisfaction. This study investigated whether family-initiated video calls could mitigate delirium symptoms and risky behaviors and enhance patients' comprehension of instructions. Methods This observational study used medical chart data and the Diem Payment System from a single acute care hospital in Fukuoka, Japan. The study involved patients hospitalized between May 2020 and August 2021 who used video chat systems. Patients or their relatives used video calls through Skype. The frequency of video chat use served as the primary exposure. Changes in the patients' risky behaviors and instruction comprehension upon discharge were the primary outcomes. Results A total of 532 patients were included in the study, with an average age of over 70 years. After implementing the inverse probability of treatment weighting adjustment, an improved balance across age, sex, BMI categories, and other variables was observed. The effects of video calls on risky behaviors and instruction comprehension varied. Patients with three or more video calls showed distinct effects compared with those with fewer calls. When hospitalization was limited to three weeks, video calls noticeably influenced risky behaviors (p=0.022, 95% CI:1.08-2.63), but not instruction comprehension (p=0.226, 95% CI:0.43-1.22). Conclusions The use of video calls as a visitation method in acute care hospitals during a pandemic suggests that video calls reduce risky behaviors in patients with a three-week stay. This alternative to physical visitations contributes positively to patient safety and supports ongoing efforts to prevent the spread of COVID-19.
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Affiliation(s)
- Kazuya Watanabe
- Department of Physical Therapy, Shimonoseki Nursing and Rehabilitation School, Yamaguchi, JPN
- Department of Psychosomatic Dentistry, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, JPN
| | - Takuaki Tani
- Division of Pharmacoepidemiology, Department of Healthcare and Regulatory Sciences, Showa University School of Pharmacy, Tokyo, JPN
| | - Atsushi Suzuki
- Department of Rehabilitation, Shinkomonji Hospital, Fukuoka, JPN
| | - Kei Kawakami
- Department of Rehabilitation, Shinkomonji Hospital, Fukuoka, JPN
| | - Mami Watanabe
- Department of Rehabilitation, Shinkomonji Hospital, Fukuoka, JPN
| | - Kei Yamasaki
- Department of Physical Therapy, Shimonoseki Nursing and Rehabilitation School, Yamaguchi, JPN
| | - Koichi Morota
- Department of Radiology, Shinkomonji Hospital, Fukuoka, JPN
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Zhou C, Ma H, Qi X, Xu C, Liang Z. The effect of music therapy on delirium in patients receiving mechanical ventilatory support in the Intensive Care Unit: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33956. [PMID: 37327279 PMCID: PMC10270468 DOI: 10.1097/md.0000000000033956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Delirium is a very common sick syndrome in patients receiving mechanical ventilatory support in the Intensive Care Unit (ICU). Music therapy is a promising non-pharmacological intervention. However, its effect on the duration, incidence and severity of delirium is unknown. So we will perform a systematic review and meta-analysis to evaluate the effect of music therapy on delirium in patients receiving mechanical ventilatory support in the ICU. METHODS This systematic review was registered in the PROSPERO. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocol to accomplish the systematic review protocol. Searches of PubMed, EMbase, the Cochrane library, CBM, CNKI and Wanfang databases will be conducted through computer to collect randomized controlled trials (RCTs) on the effects of music therapy on delirium in patients receiving mechanical ventilatory support in the ICU. The search time will be all from database establishment to April 2023. Two evaluators will independently screen the literature, extract information and evaluate the risk of bias of included studies, then data analysis will be performed using Stata 14.0 software. RESULTS The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal. CONCLUSION This study will provide evidence-based medical evidence for music therapy to control delirium in patients receiving mechanical ventilatory support in the ICU.
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Affiliation(s)
- Changyan Zhou
- Department of Critical Care Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Ma
- Department of Critical Care Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoxue Qi
- Child Intensive Care Unit, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chunru Xu
- Child Intensive Care Unit, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zina Liang
- Child Intensive Care Unit, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Welsch E, Vashisht A, Stutzman SE, Olson DM. Family Presence May Reduce Postoperative Delirium After Spinal Surgery. J Neurosci Nurs 2023; 55:97-102. [PMID: 37094374 DOI: 10.1097/jnn.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
ABSTRACT BACKGROUND: Delirium is associated with worse outcomes, but there is a gap in literature identifying nurse-led interventions to reduce delirium in postoperative (postop) surgical spine patients. Because family presence has been associated with a variety of beneficial effects, we aimed to examine whether family presence in the spine intensive care unit (ICU) during the night after surgery was associated with less confusion or delirium on postop day 1. METHODS: This is a prospective nonrandomized pilot clinical trial with pragmatic sampling. Group designation was assigned by natural history. The family-present group was designated as patients for whom a family member remained present during the first night after surgery. The unaccompanied group was designated as patients who did not have a family member stay the night. Data include the Richmond Agitation Sedation Scale, the Confusion Assessment Method for the ICU, the 4AT (Alertness, Attention, Abbreviated mental test, and Acute change) score, and confusion measured with the orientation item on the Glasgow Coma Scale. Baseline data were collected after admission to the spine ICU and compared with the same data collected in the morning of postop day 1. RESULTS: At baseline, 5 of 16 patients in the family-present group (31.3%) had at least 1 incidence of delirium or confusion. Similarly, 6 of 14 patients in the unaccompanied group (42.9%) had at least 1 incidence of delirium or confusion. There was a clinically relevant, but not statistically significant, reduction in postop day 1 delirium or confusion comparing the family-present (6.3%) and unaccompanied (21.4%) groups ( P = .23). CONCLUSION: Family presence may reduce delirium and confusion for patients after spine surgery. The results support continued research into examining nurse-led interventions to reduce delirium and improve outcomes for this population.
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Zhou W, Bai X, Yang Y, Huang M, Zheng Q, Wu J, Wang R, Gan X. Revelations of delirium subtype research: A bibliometric analysis of publications in the past twenty years in the field. Asian J Psychiatr 2023; 83:103561. [PMID: 36989982 DOI: 10.1016/j.ajp.2023.103561] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/05/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Delirium is an acute confusion state that is common and costly. According to different clinical manifestations, delirium can be divided into three subtypes: hyperactive, hypoactive and mixed. Subtype research has become a necessary branch. However, it is difficult to record all the changes in subtype research. METHODS Publications on delirium subtypes in the Web of Science Core Collection (WOSCC) were identified and analyzed by visualization software VOSviewer and CiteSpace. RESULTS A total of 247 articles published from 1999 to 2022 were identified in the WOSCC, and the largest number of articles was published in 2021 (n = 33). The top three countries that contributed publications were the USA (n = 75), Ireland (n = 26), and the United Kingdom (n = 25), which communicated more often and focused on delirium subtypes earlier. Critical Care Medicine published the most articles regarding delirium subtypes, with 11 publications. Three instrument validation studies were cited most frequently. Six clusters were summarized, including descriptions of delirium among elderly people, delirium research, postoperative delirium, delirium motor subtype validation, critical delirium, and motor characteristics. The "postoperative delirium", "intensive care unit", and "cardiac surgery" keywords were seen in recent years. CONCLUSION Based on this bibliometric analysis of the publications in the last twenty years, a comprehensive analysis of the literature clarified the contributions, changes, and evolution regarding delirium subtypes. This research can provide medical staff and researchers with revelations into future directions of delirium subtype advancements.
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Affiliation(s)
- Wen Zhou
- Department of Nursing, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; The Second Department of Nursing School, Chongqing Medical University, Chongqing, China
| | - Xue Bai
- Department of Nursing, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Yang
- Department of Geriatrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; The Second Department of Nursing School, Chongqing Medical University, Chongqing, China
| | - Miao Huang
- Department of Nursing, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; The Second Department of Nursing School, Chongqing Medical University, Chongqing, China
| | - Qiulan Zheng
- Department of Nursing, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; The Second Department of Nursing School, Chongqing Medical University, Chongqing, China
| | - Jiaqian Wu
- Department of Nursing, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; The Second Department of Nursing School, Chongqing Medical University, Chongqing, China
| | - Rui Wang
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China; Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuni Gan
- Department of Nursing, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Lange S, Mędrzycka-Dąbrowska W, Friganovic A, Oomen B, Krupa S. Non-Pharmacological Nursing Interventions to Prevent Delirium in ICU Patients-An Umbrella Review with Implications for Evidence-Based Practice. J Pers Med 2022; 12:760. [PMID: 35629183 PMCID: PMC9143487 DOI: 10.3390/jpm12050760] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/06/2023] Open
Abstract
Delirium in ICU patients is a complication associated with many adverse consequences. Given the high prevalence of this complication in critically ill patients, it is essential to develop and implement an effective management protocol to prevent delirium. Given that the cause of delirium is multifactorial, non-pharmacological multicomponent interventions are promising strategies for delirium prevention. (1) Background: To identify and evaluate published systematic review on non-pharmacological nursing interventions to prevent delirium in intensive care unit patients. (2) Methods: An umbrella review guided by the Joanna Briggs Institute was utilized. Data were obtained from PubMed, Scopus, EBSCO, Web of Science, Cochrane Library, and Google Scholar. The last search was conducted on 1 May 2022. (3) Results: Fourteen reviews met the inclusion criteria. Multicomponent interventions are the most promising methods in the fight against delirium. The patient's family is an important part of the process and should be included in the delirium prevention scheme. Light therapy can improve the patient's circadian rhythm and thus contribute to reducing the incidence of delirium. (4) Conclusions: Non-pharmacological nursing interventions may be effective in preventing and reducing the duration of delirium in ICU patients.
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Affiliation(s)
- Sandra Lange
- Department of Internal and Pediatric Nursing, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Adriano Friganovic
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- University of Applied Health Sciences, Mlinarska cesta 38, 10000 Zagreb, Croatia
| | - Ber Oomen
- ESNO, European Specialist Nurses Organization, 6821 HR Arnhem, The Netherlands;
| | - Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland;
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Nurse-Driven Assessment, Prevention, and Management of Delirium on an Acute Inpatient Neurology Unit. J Nurs Care Qual 2022; 37:334-341. [PMID: 35486389 DOI: 10.1097/ncq.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delirium commonly affects hospitalized patients and is associated with increased hospital length of stay, discharge to skilled care, cost, morbidity, and mortality. LOCAL PROBLEM At our organization, there was no formal delirium assessment performed by the nursing staff outside of the intensive care unit. METHODS Assessment of nurses' knowledge about delirium, a nurse-driven delirium screening protocol, and patient education were implemented on an adult inpatient neurology unit. Knowledge change, protocol implementation, and patient-level outcomes were assessed. INTERVENTIONS Staff nurse delirium education and a nurse-driven delirium screening protocol were implemented. RESULTS No change in nursing knowledge occurred pre/postintervention. Falls, falls with injury, and restraint and sitter usage decreased. Changes in length of stay varied over the intervention period. The trend to discharge to home increased, while the trend to discharge to skilled nursing care decreased. CONCLUSIONS Formal delirium screening protocols may add organizational value by positively impacting patient outcomes.
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Applicability of the interventions recommended for patients at risk or with delirium in medical and post-acute settings: a systematic review and a Nominal Group Technique study. Aging Clin Exp Res 2022; 34:1781-1791. [PMID: 35451735 DOI: 10.1007/s40520-022-02127-7] [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: 02/08/2022] [Accepted: 03/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium is a common condition during hospitalisation that should be prevented and treated. Several recommendations have been established to date, whereas few studies have investigated their applicability in daily practice for medical and post-acute settings. AIM The aim of this research exercise was to emerge the applicability of the interventions recommended by studies in the daily care of patients at risk or with delirium cared in medical and post-acute settings. METHODS The study was organised in three phases. A systematic literature review according to Centre for Reviews and Dissemination was conducted (January-February 2021). Cochrane Library, Pubmed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Psychological Information Database, and the Joanna Briggs Institute databases were searched. Primary and secondary studies were evaluated in their methodological quality with the Standard Quality Assessment Criteria, the Critical Appraisal Skills Programme, and the Appraisal of Guidelines for Research & Evaluation. Then, the interventions identified were assessed in their applicability using the Nominal Group Technique who ranked their judgement on a four-point Likert scale from 1 (totally inapplicable) to 4 (totally applicable). Qualitative feedbacks were also considered, and a validation of the final list was performed by the Nominal Group. RESULTS A total of 12 studies were included producing a list of 96 interventions categorised into four macro-areas (prevention, non-pharmacological, communication and pharmacological management). The Nominal Group identified 51 interventions (average score > 3.5) as applicable in medical and post-acute settings. Then, through a process of re-reading, and revising according to the comments provided by the Nominal Group, a list of 35 interventions out of the initial 96 were judged as applicable. CONCLUSION Applicability should be assessed with experts in the field to understand the involved factors. One-third of interventions have been judged as applicable in the Italian context; the nurses' expertise, the work environment features, and the time required for each intervention in a high workload setting may prevent the full applicability of the interventions recommended by the literature.
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