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Ulus M, Durmaz Edeer A. Delirium care burden of intensive care nurses caring for patients undergoing open-heart surgery: A mixed-method research. Nurs Crit Care 2024. [PMID: 39119786 DOI: 10.1111/nicc.13137] [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: 03/05/2024] [Revised: 06/19/2024] [Accepted: 07/20/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Delirium is an acute confusional state characterized by inattention, cognitive dysfunction and an altered level of consciousness. Delirium causes negative outcomes in patients, and patients with delirium increase the workload of nurses. Therefore, it is important to recognize the challenges and burdens experienced by nurses caring for patients with delirium. AIM To determine the subjective burden experienced by intensive care nurses caring for patients who have undergone open-heart surgery. STUDY DESIGN A mixed-method sequential explanatory design. A non-probability purposive sampling method was used for the quantitative stage. Using OpenEpi, we employed the method of sample calculation with an unknown universe. The sample size of the quantitive study comprised 130 nurses. Quantitative data were collected with Google survey. For gathering qualitative data, online video interviews were conducted with 10 nurses, an interpretive phenomenological approach was used and content analysis was performed. RESULTS In the quantitative phase, we found that the subjective burden was high. In the qualitative phase, five main themes emerged: difficulty in recognizing delirium, physical burden, emotional burden, burden in care management of patients with delirium and the effect of patients with delirium on other patients. The nurses experienced physical and emotional burden in delirium management and felt lonely while caring for patients with delirium. CONCLUSIONS Because nurses play a key role in the care of patients with delirium, reducing the burden nurses experience when caring for patients with delirium should be considered important in ensuring that this patient population receives adequate care. RELEVANCE TO CLINICAL PRACTICE Delirium patients create a care burden for intensive care nurses. To reduce this burden of care, in-service training in patient management and bedside teaching support should be provided to nurses. Furthermore, the use of a valid scale to diagnose delirium should be integrated into health policies. Nurses should not be left alone in the management of delirium. Managing delirium patients with a team including physicians, nurses and professionals from other health disciplines will ensure that patients receive high-quality care, thereby reducing the care burden of nurses.
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Affiliation(s)
- Meltem Ulus
- Department of Surgical Nursing, Dokuz Eylul University, Health Sciences Institute, Izmir, Turkey
| | - Aylin Durmaz Edeer
- Department of Surgical Nursing, Dokuz Eylül University Faculty of Nursing, Izmir, Turkey
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Montgomery A, Smerdely P, Hickman L, Traynor V. Comparing the delirium objective structured clinical examination (OSCE) education package to standard education for post-registration nurses: A randomised controlled trial. NURSE EDUCATION TODAY 2024; 139:106211. [PMID: 38676962 DOI: 10.1016/j.nedt.2024.106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND A recent pilot study demonstrated that an interactive delirium educational intervention, The Delirium OSCE Education Package, had a positive impact on self-perceptions of confidence and competence in the use of delirium assessment tools and delirium knowledge; delirium knowledge scores; clinical practice; and planned practice change for participants. However, it is not known if The Delirium OSCE Education Package is superior to standard methods of professional development education. OBJECTIVE To determine if The Delirium OSCE Education Package is superior to standard methods of professional development education on observations of delirium care in practice scores for post-registration nurses. DESIGN Clustered randomised, controlled, and observer-blinded, multisite superiority trial with two parallel groups at each site. SETTINGS Three private hospitals across New South Wales, Australia. PARTICIPANTS Registered nurses (RNs) (n = 153) or enrolled nurses (ENs) (n = 37) working in the eligible inpatient medical or surgical wards at each site. METHODS Within each hospital site wards were clusters, with wards rather than individuals being randomised for The Delirium OSCE Education Package or standard professional development education at a ratio of 1:1. The primary outcome was observations of delirium care in practice, 6-weeks post (T1) allocated intervention. Secondary outcomes were self-perceived confidence and competence (self-efficacy) in delirium assessment tools and delirium knowledge; and delirium knowledge scores. RESULTS A total of 51.3 % (n = 20) in the intervention group obtained a satisfactory observation of delirium care in practice score, compared to 34.9 % (n = 15) in the control group (p = 0.134, χ2). The odds of a satisfactory observation of delirium care in practice score for the intervention group was 10.1 times higher than the control (p = 0.009). The mean MCQ score and perceptions of confidence and competence in the intervention and control group increased from baseline to six-weeks post-intervention, however, there was no significant difference between the groups. CONCLUSION The Delirium OSCE Education Package provides the foundation for facilitating change in delirium care. It is recommended that The Delirium OSCE Education Package is implemented as part of a multicomponent strategy involving a validation delirium screening and assessment tool, hospital-specific policy, interprofessional education, and delirium champions. Future studies are needed to evaluate the sustainability of the intervention and if there is a positive impact on patient-level outcomes.
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Affiliation(s)
- Amy Montgomery
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
| | - Peter Smerdely
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia; Aged Care Department, St. George Hospital, Kogarah, Australia; School of Public Health & Community Medicine, University of New South Wales, Australia.
| | - Louise Hickman
- Health University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia..
| | - Victoria Traynor
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
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Siostrom K, Snowdon D, Sriamareswaran RK, Law YM, Jolliffe L, Moran C. Experiences of healthcare staff caring for hospitalised people with delirium: a qualitative systematic review. Age Ageing 2024; 53:afae159. [PMID: 39078153 DOI: 10.1093/ageing/afae159] [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: 12/06/2023] [Revised: 06/06/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Inpatient delirium is common and associated with poor outcomes. Although most organisations have evidence-based guidelines to improve delirium prevention and management, delirium rates and outcomes have remained relatively unchanged over time. A lack of understanding of healthcare providers' experience of caring for people with delirium and its integration into existing guidance may explain some of the slow progress in improving delirium care. OBJECTIVE To review and synthesise existing qualitative evidence on healthcare providers' experience of caring for inpatients with delirium within and across disciplines. METHODS We systematically searched OVID Medline, CINAHL, Embase, Emcare, PsychINFO, AMED and Web of Science databases for articles published between January 1990 and November 2022. Article inclusion and study quality were assessed by two independent reviewers. Both thematic synthesis and content analysis were then conducted to synthesise findings from included studies. RESULTS Within the 25 included studies, the experience of nurses was the most commonly studied perspective, followed by medical and allied health. Nursing, medical and allied health staff all reported that their experience of caring for people with delirium was challenging, highlighting difficulties in delirium recognition and that they felt unsupported at organisational and local levels. Attitudes towards older people and the importance of delirium influenced identification and prioritisation. CONCLUSIONS Healthcare providers often find caring for hospitalised patients with delirium challenging and complex. Although good communication within multidisciplinary teams was deemed helpful, more work is required to understand how to achieve this, recognising the unique perspectives of individual disciplines.
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Affiliation(s)
- Kristy Siostrom
- Geriatric Medicine, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - David Snowdon
- Geriatric Medicine, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Yu Mei Law
- Geriatric Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Laura Jolliffe
- Geriatric Medicine, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Chris Moran
- Geriatric Medicine, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health of Older People, Alfred Health, Melbourne, Victoria, Australia
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Jiang T, Tung TH, Wang Y, Zheng XT, Jia L, Zhang W. Difficulties faced by intensive care nurses in caring for patients with delirium: A cross-sectional, multicentre study. Aust Crit Care 2024; 37:530-538. [PMID: 38326188 DOI: 10.1016/j.aucc.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Intensive care nurses experience many difficulties in caring for patients with delirium. Thus, it is valuable to conduct in-depth research on the factors that influence the difficulties faced by intensive care nurses in caring for those with delirium as doing so can result in tangible improvements in patient outcomes. OBJECTIVES The objective of this study was to explore the difficulties faced by intensive care nurses in caring for patients with delirium in light of the demographic, clinical, and professional and management characteristics of nurses. METHODS A cross-sectional study involving 360 intensive care nurses from eight general hospitals in Taizhou, Zhejiang Province, China. The participants completed questionnaires assessing the level of difficulty they faced in caring for patients with delirium and their level of delirium-related knowledge. RESULTS The highest overall mean scores on the difficulty scale subscales were observed for ensuring safety (2.92 ± 0.30), dealing with stress and distress (2.80 ± 0.37), and lack of resources (2.85 ± 0.41). The main factors influencing nurses' difficulty in caring for these patients were title, status as a critical care specialist nurse, training regarding delirium, a standardised delirium management process, the knowledge level regarding delirium, the total number of years working in the intensive care unit, and work communication ability. Likewise, most of these characteristics made it difficult for the nurses to use delirium screening tools. CONCLUSIONS This study provides insights into factors influencing the difficulties faced by intensive care nurses in caring for patients with delirium and in using delirium screening tools. Our findings suggested that nursing managers could develop targeted improvement strategies and provide more resources to support nurses, thereby improving the quality of delirium care and patient outcomes by using the results from this study. These findings can also provide evidence to support intervention studies in the future.
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Affiliation(s)
- Tianxiang Jiang
- Intensive Care Unit, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China.
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Yuecong Wang
- Department of Nursing, College of Medical Science, Huzhou University, 759 Second Ring Road, Huzhou, Zhejiang Province, China
| | - Xu Tong Zheng
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Limin Jia
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Wenyuan Zhang
- Intensive Care Unit, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
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Ye F, Ho MH, Lee JJ. Prevalence of post-stroke delirium in acute settings: A systematic review and meta-analysis. Int J Nurs Stud 2024; 154:104750. [PMID: 38552472 DOI: 10.1016/j.ijnurstu.2024.104750] [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: 08/25/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Although post-stroke delirium is a frequent complication in acute settings and has significant long-lasting implications for patients, the prevalence of post-stroke delirium diagnosed according to gold-standard criteria remains uncertain. This highlights the importance of updating the current evidence. OBJECTIVE This review aims to provide a precise estimation of the prevalence of delirium in acute post-stroke settings and to explore potential differences in the reported prevalence according to the characteristics of the study and stroke survivors. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Post-stroke survivors with delirium in acute settings. DATA SOURCES Five English and two Chinese language databases from inception to June 2023, and the reference lists of published reviews. METHODS Studies reporting the prevalence of post-stroke delirium according to the Diagnostic and Statistical Manual of Mental Disorders criteria with the description of assessment method in the absence of interventions for delirium were eligible. Two reviewers independently screened searched records and extracted data from eligible studies. A meta-analysis was conducted using a random-effects model to evaluate the prevalence of post-stroke delirium, and predefined subgroup analyses, sensitivity analyses, and mixed-effects meta-regression were conducted to explore the contribution of heterogeneity. RESULTS Twenty-nine eligible studies involving 8839 survivors were included. In acute settings, the overall weighted prevalence of post-stroke delirium was 25 % (95 % CI, 20-30; I2, 95 %). Subgroup analyses revealed age-dependent variations in delirium prevalence, with rates of 20 %, 25 %, and 34 % for ages 60-64, 65-74, and 75-79, respectively. Delirium prevalence varied by assessment duration (7 days: 31 %, >7 days: 24 %, <7 days: 20 %). Initial screening significantly reduced reported prevalence to 15 %, compared with 30 % when no initial screening was conducted. Delirium prevalence was lower when nurses were involved in assessments (13 % vs. 29 %). No significant effects were detected for economic status, publication year, female percentage, onset-to-admission time, stroke type, and assessment frequency. Meta-regression analysis revealed that higher delirium prevalence was associated with increased survivors' age (β = 0.051; 95 % CI, -0.0002 to 0.103; P = 0.05; R2 = 13.36 %). CONCLUSION A high prevalence of post-stroke delirium was observed in acute settings. Nurses are required to integrate and coordinate the prevention, early detection, and management of delirium following stroke into their nursing practice, particularly for older stroke survivors. The findings necessitate the need for incorporating specialized training within nursing education to identify and manage the delirium effectively and accurately. This reinforces the pivotal role of nurses in the early detection and prevention of delirium within the acute stroke care continuum. REGISTRATION The protocol was registered on PROSPERO (CRD42022352097). TWEETABLE ABSTRACT Evidence suggests 25 % prevalence of post-stroke delirium in acute settings, with higher rates in older patients, emphasizing the need for prevention, early detection, and management in nursing practice.
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Affiliation(s)
- Fen Ye
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Oldham MA, Heinrich T, Luccarelli J. Requesting That Delirium Achieve Parity With Acute Encephalopathy in the MS-DRG System. J Acad Consult Liaison Psychiatry 2024; 65:302-312. [PMID: 38503671 PMCID: PMC11179982 DOI: 10.1016/j.jaclp.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/21/2024]
Abstract
Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap between these sets of diagnostic codes. Toxic and metabolic encephalopathy codes are designated as major complication or comorbidity, whereas causally specified delirium codes are designated as complication or comorbidity and thus associated with a lower reimbursement and lesser impact on value metrics. The authors led a submission to the U.S. Centers for Medicare and Medicaid Services requesting that causally specified delirium be designated major complication or comorbidity alongside toxic and metabolic encephalopathy. Delirium warrants reclassification because it satisfies U.S. Centers for Medicare and Medicaid Services' guiding principles for re-evaluating Medicare Severity Diagnosis Related Group severity levels. Delirium: (1) has a bidirectional relationship with the permanent condition of dementia (major neurocognitive disorder per DSM-5-TR), (2) indexes vulnerability across populations, (3) impacts healthcare systems across levels of care, (4) complicates postoperative recovery, (5) consigns patients to higher levels of care, (6) impedes patient engagement in care, (7) has several recent treatment guidelines, (8) often indicates neuronal/brain injury, and (9) represents a common expression of terminal illness. The proposal's impact was explored using the 2019 National Inpatient Sample, which suggested that increasing delirium's complexity designation would lead to an upcoding of less than 1% of eligible discharges. Parity for delirium is essential to enhancing awareness of delirium's clinical and economic costs. Appreciating delirium's impact would encourage delirium prevention and screening efforts, thereby mitigating its dire outcomes for patients, families, and healthcare systems.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
| | - Thomas Heinrich
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI; Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Yamagata H, Takihara T, Kobayashi R, Hirose K, Higuchi K, Miyahara M, Komatsu D. Burnout and perceived burden levels related to delirium in physicians and nurses. Gen Hosp Psychiatry 2024; 87:162-163. [PMID: 38216409 DOI: 10.1016/j.genhosppsych.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Hirotaka Yamagata
- Kokoro Hospital Machida, 2140 Kamioyamadamachi, Machida, Tokyo 194-0201, Japan; Department of Psychiatry, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa 243-0433, Japan; Department of Internal Medicine, Hirose Hospital, 2-3-16 Kubosawa, Midori-ku, Sagamihara, Kanagawa 252-0105, Japan.
| | - Takahisa Takihara
- Department of Respiratory Medicine, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa 243-0433, Japan
| | - Rieko Kobayashi
- Department of Nursing, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa 243-0433, Japan
| | - Kenichi Hirose
- Department of Internal Medicine, Hirose Hospital, 2-3-16 Kubosawa, Midori-ku, Sagamihara, Kanagawa 252-0105, Japan
| | - Kuniko Higuchi
- Mediva Incorporated, 2-32-18-301, Yoga, Setagaya-ku, Tokyo 158-0097, Japan
| | - Maki Miyahara
- Mediva Incorporated, 2-32-18-301, Yoga, Setagaya-ku, Tokyo 158-0097, Japan
| | - Daisuke Komatsu
- Mediva Incorporated, 2-32-18-301, Yoga, Setagaya-ku, Tokyo 158-0097, Japan
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Gopaldas JA. Nurse Education in Care of Delirium: Achieving a Change from Transcription and Translation to Interpretation for Reduced Strain. Indian J Crit Care Med 2024; 28:95-96. [PMID: 38323254 PMCID: PMC10839924 DOI: 10.5005/jp-journals-10071-24650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
How to cite this article: Gopaldas JA. Nurse Education in Care of Delirium: Achieving a Change from Transcription and Translation to Interpretation for Reduced Strain. Indian J Crit Care Med 2024;28(2):95-96.
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Affiliation(s)
- Justin A Gopaldas
- Department of Critical Care Medicine, Manipal Hospital, Bengaluru, Karnataka, India
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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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Wang Y, Li L, Tan S, Guan Y, Luo X. Psychological stress and associated factors in caring for patients with delirium among intensive care unit nurses: A cross-sectional study. Aust Crit Care 2023; 36:793-798. [PMID: 36371293 DOI: 10.1016/j.aucc.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for patients with delirium is challenging and overwhelming for intensive care unit (ICU) nurses. Investigating the psychological impact of delirium care on ICU nurses is crucial to maintaining their psychological health and improving the quality of care. OBJECTIVE The objective of this study was to investigate the psychological stress of ICU nurses in caring for patients with delirium and potential factors. METHODS A total of 355 nurses from three tertiary care hospitals in Hunan Province, China, participated in this cross-sectional survey. Data were collected using the demographic sheet, Impact of Event Scale-Revised, Connor-Davidson Resilience Scale, and Occupational Coping Self-Efficacy Scale for Nurses. Descriptive and multiple linear regression analyses were used to examine the factors associated with psychological stress. RESULTS ICU nurses suffered moderate psychological stress related to delirium care. The recent time to care for patients with delirium (P < 0.001), familiarity with delirium-related knowledge (P = 0.002), satisfaction with delirium-related support (P = 0.046), psychological resilience (P < 0.001), and occupational coping self-efficacy (P < 0.001) were significant contributors to psychological stress. CONCLUSION Nurse managers and researchers need to focus on the psychological well-being of ICU nurses in caring for patients with delirium, especially those who are currently caring for patients with delirium, and provide tailored support, increase their knowledge of delirium, and also boost psychological resilience and coping skills.
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Affiliation(s)
- Yiya Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan province, 410013, China.
| | - Lezhi Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan province, 410013, China.
| | - Simin Tan
- Xiangya School of Nursing, Central South University, Changsha, Hunan province, 410013, China.
| | - Yuzhu Guan
- Nursing Department, Lanzhou University Second Hospital, Lanzhou, Gansu province, 730030, China.
| | - Xianmei Luo
- The Second Xiangya Hospital, Central South University, Changsha, Hunan province, 410013, China.
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Alhalaiqa F, Masa’Deh R, Al Omari O, Shawashreh A, Khalifeh AH, Gray R. The Impact of an Educational Programme on Jordanian Intensive Care Nurses' Knowledge, Attitudes, and Practice Regarding Delirium and their Levels of Self-Efficacy: A Quasi-Experimental Design. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:312-319. [PMID: 37575493 PMCID: PMC10412801 DOI: 10.4103/ijnmr.ijnmr_437_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/06/2021] [Accepted: 09/21/2022] [Indexed: 08/15/2023]
Abstract
Background Delirium is a common problem among patients in Intensive Care Units (ICUs); however, it remains underdiagnosed. We aimed to determine the impact of a nursing education program on Jordanian nurses' knowledge, practice, attitudes, self-efficacy, and ability to detect delirium among ICU patients. Materials and Methods We conducted a nonequivalent, quasi-experimental design from January 2019 to January 2020. A total of 175 nurses who work in an ICU were included at the baseline and divided into two groups: (1) intervention (86 nurses), who received education for 6 hours each day across two different days and (2) a control group (89 nurses), who maintained their usual routine of care. Data were collected by means of a booklet of questionnaires about the nurses' knowledge and practice, attitudes, and self-efficacy. Results Data from 160 nurses were included in the analysis. The education program intervention (n = 81) significantly increased nurses' knowledge and practice, positive attitudes, and self-efficacy compared with the control group (n = 79, p < 0.001). In addition, nurses who received the educational intervention were able to detect more cases of delirium (28%, from a total of 51 patients) than the controls, who detected three (6.50%) out of a total of 31 patients (p = 0.003). Conclusions The ICU nurses who received the delirium-focused educational program increased their knowledge and practice, positive attitudes, and their self-efficacy; in addition, their ability to detect delirium was increased. The implementation of such a program is recommended for the health policymakers and stakeholders.
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Affiliation(s)
- Fadwa Alhalaiqa
- Professor Psychiatric Mental Health Nursing, Faculty of Nursing, Dean of Allied Medical Sciences, Oman
| | - Rami Masa’Deh
- School of Nursing, Applied Science Private University, Jordan, Philadelphia University, Jordan
| | - Omar Al Omari
- Professor, Fundamentals and Administration, Faculty of Nursing, Sultan Qaboos University, Oman
| | - Atef Shawashreh
- Training and Consultation Unit, Institute of Family Health, Noor Al-Hussein Foundation, Amman, Jordan
| | | | - Richard Gray
- Professor of Clinical Nursing Practice and Director, The La Trobe Alfred Clinical School, The Alfred Centre, 99 Commercial Rd, Melbourne VIC 3004, Australia
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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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Orlando F, Giuffrida S, Vicari R, Sansalone A, Dell'Avo A, Bernasconi S, Villa M. Adverse clinical events during the first 24 h of bedrest following cardiac electronic device implantation: a prospective observational study. Eur J Cardiovasc Nurs 2023; 22:175-183. [PMID: 35709305 DOI: 10.1093/eurjcn/zvac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022]
Abstract
AIMS To describe the incidence and impact of adverse clinical events (ACEs) during first 24 h of bedrest of patients after cardiac implantable electronic device (CIED) implantation. METHODS AND RESULTS We conducted a prospective observational study of patients aged over 18 years undergoing elective placement of permanent bicameral pacemaker (PM), cardiac resynchronization therapy (CRT) PM, CRT defibrillator, or implantable cardioverter-defibrillator. Patients were maintained on bedrest post-operatively for 24 h and delirium, post-operative urinary retention, severe post-operative pain, pressure ulcer, and sleep disturbance were recorded using standardized assessments. Of 90 patients, 66 (73.3%) were male and average age was 76 ± 10 years. The median time to first mobilization was 23 (21-24) h. The adverse clinical events occurred in 48/90, with severe pain (38/90), sleep disturbance (12/90), delirium (9/90), and urinary retention requiring urinary catheterization (8/90) most frequent. Patients receiving implantable cardioverter-defibrillator or CRT defibrillator experienced ACEs significantly more frequently than those receiving PM. Adverse clinical event was associated with prolonged hospital stay [odds ratio (OR) 2.5; 95% confidence interval (CI) 1.16-6.17]. Patients with delirium were more dependent for daily living activities on admission (OR 8.0; 95% CI 1.55-41.3). CONCLUSION Adverse clinical events frequently occur post-insertion of a CIED and impact patient clinical course and experience. The progressive increase in ageing and frailty of CIED implant candidates requires special nursing attention to improve patients' satisfaction and to prevent increased healthcare resource use.
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Affiliation(s)
- Fabio Orlando
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Silvia Giuffrida
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Raffaello Vicari
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Andrea Sansalone
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alessandro Dell'Avo
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Stefano Bernasconi
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Michele Villa
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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14
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Sabbe K, Aerts N, van der Mast R, Van Rompaey B. Certified Nursing Assistants' Perspectives on Delirium Care. J Gerontol Nurs 2023; 49:43-51. [PMID: 36719657 DOI: 10.3928/00989134-20230106-07] [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: 02/01/2023]
Abstract
The current descriptive qualitative study provides an in-depth understanding of the perspectives of certified nursing assistants (CNAs, N = 7) regarding delirium. Data were collected through interviews with seven CNAs working in a long-term care facility. Five themes emerged: Knowledge About Delirium, Caring for Residents With Delirium, Delirium Education, Psychological Burden, and Quality of Care. CNAs' care of residents with delirium was based on prior experiences and gut feelings, indicating a high need for delirium training. [Journal of Gerontological Nursing, 49(2), 43-51.].
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15
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Igarashi M, Okuyama K, Ueda N, Sano H, Takahashi K, P Qureshi Z, Tokita S, Ogawa A, Okumura Y, Okuda S. Incremental medical cost of delirium in elderly patients with cognitive impairment: analysis of a nationwide administrative database in Japan. BMJ Open 2022; 12:e062141. [PMID: 36521906 PMCID: PMC9756163 DOI: 10.1136/bmjopen-2022-062141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Delirium is a neuropsychiatric disorder that commonly occurs in elderly patients with cognitive impairment. The economic burden of delirium in Japan has not been well characterised. In this study, we assessed incremental medical costs of delirium in hospitalised elderly Japanese patients with cognitive impairment. DESIGN Retrospective, cross-sectional, observational study. SETTING Administrative data collected from acute care hospitals in Japan between April 2012 and September 2020. PARTICIPANTS Hospitalised patients ≥65 years old with cognitive impairment were categorised into groups-with and without delirium. Delirium was identified using a delirium identification algorithm based on the International Classification of Diseases 10th Revision codes or antipsychotic prescriptions. OUTCOME MEASURES Total medical costs during hospitalisation were compared between the groups using a generalised linear model. RESULTS The study identified 297 600 hospitalised patients ≥65 years of age with cognitive impairment: 39 836 had delirium and 257 764 did not. Patient characteristics such as age, sex, inpatient department and comorbidities were similar between groups. Mean (SD) unadjusted total medical cost during hospitalisation was 979 907.7 (871 366.4) yen for patients with delirium and 816 137.0 (794 745.9) yen for patients without delirium. Adjusted total medical cost was significantly greater for patients with delirium compared with those without delirium (cost ratio=1.09, 95% CI: 1.09 to 1.10; p<0.001). Subgroup analyses revealed significantly higher total medical costs for patients with delirium compared with those without delirium in most subgroups except patients with hemiplegia or paraplegia. CONCLUSIONS Medical costs during hospitalisation were significantly higher for patients with delirium compared with those without delirium in elderly Japanese patients with cognitive impairment, regardless of patient subgroups such as age, sex, intensive care unit admission and most comorbidities. These findings suggest that delirium prevention strategies are critical to reducing the economic burden as well as psychological/physiological burden in cognitively impaired elderly patients in Japan.
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Affiliation(s)
| | | | | | | | | | - Zaina P Qureshi
- Center for Observational and Real-world Evidence (CORE), Merck & Co, Inc, Rahway, New Jersey, USA
| | | | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan
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Poikajärvi S, Rauta S, Salanterä S, Junttila K. Delirium in a surgical context from a nursing perspective: A hybrid concept analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100103. [PMID: 38745600 PMCID: PMC11080469 DOI: 10.1016/j.ijnsa.2022.100103] [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: 12/10/2021] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 10/14/2022] Open
Abstract
Background The term delirium has been defined in medical diagnosis criteria as a multidimensional disorder, and the term acute confusion is included in nursing classifications. Delirium can be a serious complication assessed in a patient after a surgical procedure. Still, the patient's delirium frequently remains unrecognised. Care of patients with delirium after surgical procedure is complex, and it challenges nursing expertise. From the nurses' viewpoint, delirium is associated with ambiguity of concepts and lack of knowledge. Therefore, reseach on how nurses perceive patients with delirium in a surgical context is needed. Objective The aim of this study was to describe the concepts of delirium and acute confusion, as well as the associated dimensions, in adult patients in a surgical context from the nursing perspective. Design The study used Schwartz and Barcott's hybrid concept analysis with theoretical, fieldwork, and final analytical phases. Settings Surgical wards, surgical intensive care units, and post-anaesthesia care units. Data sources A systematic literature search was performed through Pubmed (Medline), Cinahl, PsycInfo, and Embase. Participants Registered nurses and licensed practical nurses (n = 105) participated in the fieldwork phase. Methods In the theoretical phase, the concepts' working definitions were formulated based on a systematic literature search with the year limitations from 2000 until February 2021. At the fieldwork phase, the nurses' descriptions of patients with delirium were analysed using the deductive content analysis method. At the final analytical phase, findings were combined and reported. Results The concepts of delirium, subsyndromal delirium, and acute confusion are well defined in the literature. From the perspective of the nurses in the study, concepts were seen as a continuum not as individual diagnoses. Nurses described the continuum of delirium as a process with acute onset, duration, and recovery with the associated dimensions of symptoms, symptom severity, risk factors, and early signs. The acute phase of delirium was emphasised, and preoperative or prolonged disturbance did not seem to be relevant in the surgical care context. Patients' compliance with care may be decreased with the continuum of delirium, which might challenge both patients' recovery from surgery and the quality of nursing care. Conclusions In clinical practice the nurses used term confusion inaccurately. The term acute confusion might be used when illustrating an early stage of delirium. Nurses could benefit from further education where the theoretical knowledge is combined with the clinical practice. The discussion about the delirium, which covers the time both before surgery and after the acute phase should be increased.
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Affiliation(s)
- Satu Poikajärvi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Perioperative, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Satu Rauta
- Department of Perioperative, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sanna Salanterä
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Kristiina Junttila
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Nursing Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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17
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Jokwiro Y, Wilson E, Bish M. Losing passion and injured self-image: An interpretive description study of troubled conscience among registered nurses caring for older people with delirium in hospital. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Akroute AR, Brinchmann BS, Hovland A, Fredriksen STD. ICU nurses´ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study. BMC Nurs 2022; 21:214. [PMID: 35927677 PMCID: PMC9354289 DOI: 10.1186/s12912-022-01005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit. Methods This study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’. Conclusions ICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.
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Affiliation(s)
- Abder Rahim Akroute
- Department of Anesthesia and Intensive Care Medicine, Nordland Hospital, N-8049, Bodø, Norway.
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, 8026, Bodø, Norway.,Nordland Hospital, 8076, Bodø, Norway
| | - Anders Hovland
- Department of Cardiology, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Sven-Tore Dreyer Fredriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,, Campus Harstad, Havnegata 5, 9480, Harstad, Norway.,Huntington network, Knorrebakken 2, 9411, Harstad, Norway
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19
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Swarbrick CJ, Partridge JSL. Evidence‐based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia 2022; 77 Suppl 1:92-101. [DOI: 10.1111/anae.15607] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 12/18/2022]
Affiliation(s)
- C. J. Swarbrick
- Department of Anaesthesia Royal Devon and Exeter Hospital Exeter UK
| | - J. S. L. Partridge
- Peri‐operative medicine for Older People undergoing Surgery Department of Ageing and Health Guy's and St Thomas' NHS Foundation Trust London UK
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20
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Lim XM, Lim ZHT, Ignacio J. Nurses' experiences in the management of delirium among older persons in acute care ward settings: A qualitative systematic review and meta-aggregation. Int J Nurs Stud 2021; 127:104157. [PMID: 35033990 DOI: 10.1016/j.ijnurstu.2021.104157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Delirium is a multifactorial syndrome closely associated with negative hospitalisation outcomes. Given the global growth of the ageing population, delirium becomes increasingly prevalent among older persons. Nurses play a pivotal role in delirium management and receive direct impacts of delirious presentations. Yet, there is a dearth of literature reviewing nurses' experiences. OBJECTIVE To synthesise the best available evidence exploring nurses' experiences in managing delirium of older persons in acute care wards. DESIGN Systematic review of qualitative studies and meta-aggregation. DATA SOURCES Published and unpublished literature between January 2010 and December 2020 were identified from PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO and ProQuest. REVIEW METHODS A systematic search strategy was applied in October 2020, with an update in January 2021. Two reviewers independently screened the titles and abstracts and selected the eligible studies after reading the full texts. This review included studies focusing on licensed nurses providing care to patients aged 65 and above, having any type of delirium during their hospitalisation stays in acute care settings. Studies included are qualitative papers with research designs such as phenomenology, ethnography, qualitative descriptive and grounded theory. The eligible studies were appraised independently using The JBI Critical Appraisal Checklist for Qualitative Research. Data of included studies were extracted by two independent reviewers using a standardised form. Findings were synthesised by the meta-aggregative approach. RESULTS Thirty-one papers that considered nurses' (n = 464) experiences in managing older persons' delirium were included. A total of 375 findings were extracted, aggregated into 23 categories, and developed 5 synthesised findings: (i) delirium detection could be hindered when nurses possess a narrowed view of delirium, (ii) nurses navigate through complexity when providing multi-faceted care, (iii) nurses carry personal emotions, assumptions, and identities, (iv) various stakeholders have double-edged influences, and (v) nurses display preferences in their learning needs. CONCLUSION This review informed about nurses' perceptions of delirium, delirious older persons, and their nursing management which were specific to older persons and acute care settings. Nurses should practise self-awareness regarding their own knowledge and attitudes while performing delirium management in older adults. Meanwhile, healthcare professionals and policymakers should make a concerted effort in cultivating a better working environment. Future research of delirium care that specifically investigates with a geriatric perspective would better contribute to the improvement of evidence-based nursing practices for older persons.
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Affiliation(s)
- Xin Min Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11 Level 2, 10 Medical Drive, Singapore 117597, Singapore.
| | - Zhi Hui Trina Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11 Level 2, 10 Medical Drive, Singapore 117597, Singapore.
| | - Jeanette Ignacio
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11 Level 2, 10 Medical Drive, Singapore 117597, Singapore.
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21
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Dai Y, Walpole G, Ding J, Scanlon C, Ho L, Khoo RH, Huang C, Cook A, William L, Johnson CE. Symptom trajectories for palliative care inpatients with and without hyperactive delirium in the last week of life. J Adv Nurs 2021; 78:142-153. [PMID: 34252213 DOI: 10.1111/jan.14966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
AIMS Hyperactive delirium (HD) is a common and distressing symptom among palliative care patients. This study aimed to describe the characteristics of HD and associated symptoms among palliative care inpatients and evaluate relationships between HD development and symptom trajectories in this population. DESIGN A retrospective study was conducted. METHODS A retrospective review of medical records was conducted for all patients who died in a large Australian specialist palliative care unit between 1 January and 31 December 2019. Patients were assessed daily using the Symptoms Assessment Scale (SAS) and Palliative Care Problem Severity Scale (PCPSS). Multilevel models were used to estimate the differences in symptoms trajectories in the last 7 days of life between the two groups. RESULTS Of the 501 included patients, 64.5% (323) had an episode of HD. For 30% (95) of patients, HD occurred prior to admission. Compared with patients without HD, those with HD had significantly higher odds ratios (ORs) for four of the seven SAS symptoms (sleep problems, appetite, fatigue and pain; OR range: 1.94-4.48, p < .05), and all four PCPSS items (OR range: 2.00-3.00, p < .05) in the last week of life. CONCLUSIONS Palliative care inpatients commonly experience HD in their last week of life. There are higher levels of symptom distress, complexity, psychological concerns and family/carer concerns among patients with HD compared with those without HD. IMPACT The high prevalence of HD, and its association with higher levels of symptom distress, highlights the importance of routine screening and optimal management for HD among palliative care patients. Given the widely recognized challenges facing palliative care professionals in assessment and management of delirium, provision of relevant training among these professionals is recommended.
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Affiliation(s)
- Yunyun Dai
- School of Nursing, Guilin Medical University, Guilin, China
| | - Grace Walpole
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Cian Scanlon
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia
| | - Luke Ho
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia
| | - Ru Hui Khoo
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Angus Cook
- Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Leeroy William
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Claire E Johnson
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Monash Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
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