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Aggar C, Craswell A, Bail K, Compton RM, Hughes M, Sorwar G, Baker J, Greenhill J, Shinners L, Nichols B, Langheim R, Wallis A, Bowen K, Bridgett H. A Toolkit for Delirium Identification and Promoting Partnerships Between Carers and Nurses: A Pilot Pre-Post Feasibility Study. J Gen Intern Med 2024; 39:2001-2008. [PMID: 38647970 PMCID: PMC11306898 DOI: 10.1007/s11606-024-08734-6] [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: 11/08/2023] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Delirium is frightening for people experiencing it and their carers, and it is the most common hospital-acquired complication worldwide. Delirium is associated with higher rates of morbidity, mortality, residential care home admission, dementia, and carer stress and burden, yet strategies to embed the prevention and management of delirium as part of standard hospital care remain challenging. Carers are well placed to recognize subtle changes indicative of delirium, and partner with nurses in the prevention and management of delirium. OBJECTIVE To evaluate a Prevention & Early Delirium Identification Carer Toolkit (PREDICT), to support partnerships between carers and nurses to prevent and manage delirium. DESIGN A pre-post-test intervention and observation study. MAIN MEASURES Changes in carer knowledge of delirium; beliefs about their role in partnering with nurses and intended and actual use of PREDICT; carer burden and psychological distress. Secondary measures were rates of delirium. PARTICIPANTS Participants were carers of Indigenous patients aged 45 years and older and non-Indigenous patients aged 65 years and older. INTERVENTION Nurses implemented PREDICT, with a view to provide carers with information about delirium and strategies to address caregiving stress and burden. KEY RESULTS Participants included 25 carers (43% response rate) (n = 17, 68% female) aged 29-88 (M = 65, SD = 17.7 years). Carer delirium knowledge increased significantly from pre-to-post intervention (p = < .001; CI 2.07-4.73). Carers' intent and actual use of PREDICT was (n = 18, 72%; and n = 17, 68%). Carer burden and psychological distress did not significantly change. The incidence of delirium in the intervention ward although not significant, decreased, indicating opportunity for scaling up. CONCLUSION The prevention and management of delirium are imperative for safe and quality care for patients, carers, and staff. Further comprehensive and in-depth research is required to better understand underlying mechanisms of change and explore facets of nursing practice influenced by this innovative approach.
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Affiliation(s)
- Christina Aggar
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia.
- Northern NSW Local Health District, Lismore, NSW, Australia.
| | - Alison Craswell
- School of Health, University of the Sunshine Coast, Maroochydore BC, QLD, Australia
| | - Kasia Bail
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Roslyn M Compton
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mark Hughes
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Golam Sorwar
- Faculty of Business, Law and Arts, Southern Cross University, Bilinga, QLD, Australia
| | - James Baker
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Jennene Greenhill
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Lucy Shinners
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Belinda Nichols
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
- Northern NSW Local Health District, Lismore, NSW, Australia
| | | | - Allison Wallis
- Northern NSW Local Health District, Lismore, NSW, Australia
| | - Karen Bowen
- Northern NSW Local Health District, Lismore, NSW, Australia
| | - Hazel Bridgett
- Northern NSW Local Health District, Lismore, NSW, Australia
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Wheeler A, Bloch E, Blaylock S, Root J, Ibanez K, Newman K, Diarte J, Voigt LP. Delirium education for family caregivers of patients in the intensive care unit: A pilot study. PEC INNOVATION 2023; 2:100156. [PMID: 37214508 PMCID: PMC10194211 DOI: 10.1016/j.pecinn.2023.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/10/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Objectives Delirium, an acute change in mental state, seen in hospitalized older adults is a growing public health concern with implications for both patients and caregivers; however, there is minimal research on educating caregivers about delirium. Utilizing family caregivers to assist with delirium management in acute care settings demonstrates improved health outcomes supporting the need for patient and family centered care. The primary aims of the study were to determine feasibility of implementing a delirium education video for caregivers of patients in an adult oncology intensive care unit and compare delirium knowledge to caregivers in a control group. Methods A quasi-experimental design comprised of 31 family caregivers of adult patients in an oncology intensive care unit to determine feasibility of implementing a delirium education video. Results The results demonstrate feasibility of implementing a caregiver education video in-person and virtually. While total delirium knowledge scores were not statistically significant, knowledge gained within the delirium presentation subgroup was significant (p = .05). Conclusion This study demonstrates feasibility of implementing a caregiver education video and findings support further research in this area. Innovation Collaborating with caregivers to develop virtual video education for delirium allows for a versatile approach to connect with caregivers to support their caregiving role.
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Affiliation(s)
- Amanda Wheeler
- Department of Neurology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Elise Bloch
- Occupational Therapy Department, Nova Southeastern University, Fort Lauderdale, USA
| | - Sarah Blaylock
- Occupational Therapy Department, Jacksonville University, Jacksonville, USA
| | - James Root
- Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Kateriza Ibanez
- Department of Neurology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Kristine Newman
- Department of Neurology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Jose Diarte
- Department of Neurology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Louis P. Voigt
- Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, NY, USA
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Sun X, Gao Y, Chen Y, Qin L, Lin Y, Song J, Zhang Z, Wang H, Feng H, Tan H, Chen Q, Peng L, Dai W, Wu IXY. Development and validation of frailty and malnutrition knowledge assessment scale for community-dwelling older adults. Appl Physiol Nutr Metab 2023; 48:974-1004. [PMID: 37669568 DOI: 10.1139/apnm-2023-0141] [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] [Indexed: 09/06/2023]
Abstract
There is a lack of reliable tools to assess the knowledge of frailty and malnutrition in community-dwelling older adults. To develop and validate reliable frailty and malnutrition knowledge assessment scales for this population, two scales were developed and validated through five phases. Phase 1: the item pools were constructed through a literature review and research panel based on the symptom interpretation model. Phase 2: the expert consultation was performed to select the items. Phase 3: a pilot survey was conducted to assess the clarity of the items and further revise the scales. Phase 4: 242 older adults were surveyed to finalize the items. Phase 5: 241 older adults were surveyed to test the psychometric properties. The two scales each comprise 3 dimensions (symptoms, risk factors, and management strategies) and 11 items. They had good construct validity, with all indicators of correlation analysis and confirmatory factor analysis meeting their specific criteria. The reliability of the frailty and malnutrition knowledge assessment scales was good, with composite reliability coefficients all >0.60, Cronbach's alpha being 0.81 and 0.83, and the Spearman-Brown coefficient being 0.74 and 0.80, respectively. Their acceptability was good, with both having a completion rate of 92.18% and an average completion time of 3 min. The two scales are reliable tools to assess the knowledge of frailty and malnutrition among community-dwelling older adults, especially for large-scale surveys. They can help identify knowledge gaps in older adults and provide a basis for developing targeted educational interventions.
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Affiliation(s)
- Xuemei Sun
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Yinyan Gao
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Yancong Chen
- Changsha Municipal Center for Disease Control and Prevention, Changsha, China
| | - Lang Qin
- Sinocare Inc., No. 265 Guyuan Road Hi-tech Zone, Changsha, Hunan, China
| | - Yali Lin
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Jinlu Song
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Zixuan Zhang
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Huan Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Hui Feng
- Xiangya Nursing School, Central South University, Changsha, China
| | - Hongzhuan Tan
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Qiong Chen
- Xiangya Hospital of Central South University, Changsha, China
| | - Linlin Peng
- Xiangya Hospital of Central South University, Changsha, China
| | - Wenjie Dai
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Irene X Y Wu
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
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Delirium Education for Geriatric Patients and their Families: A Quality Improvement Initiative. AGING AND HEALTH RESEARCH 2023. [DOI: 10.1016/j.ahr.2023.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Fiest KM, Krewulak KD, Sept BG, Spence KL, Davidson JE, Ely EW, Soo A, Stelfox HT. A study protocol for a randomized controlled trial of family-partnered delirium prevention, detection, and management in critically ill adults: the ACTIVATE study. BMC Health Serv Res 2020; 20:453. [PMID: 32448187 PMCID: PMC7245836 DOI: 10.1186/s12913-020-05281-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background Delirium is very common in critically ill patients admitted to the intensive care unit (ICU) and results in negative long-term outcomes. Family members are also at risk of long-term complications, including depression and anxiety. Family members are frequently at the bedside and want to be engaged; they know the patient best and may notice subtle changes prior to the care team. By engaging family members in delirium care, we may be able to improve both patient and family outcomes by identifying delirium sooner and capacitating family members in care. Methods The primary aim of this study is to determine the effect of family-administered delirium prevention, detection, and management in critically ill patients on family member symptoms of depression and anxiety, compared to usual care. One-hundred and ninety-eight patient-family dyads will be recruited from four medical-surgical ICUs in Calgary, Canada. Dyads will be randomized 1:1 to the intervention or control group. The intervention consists of family-partnered delirium prevention, detection, and management, while the control group will receive usual care. Delirium, depression, and anxiety will be measured using validated tools, and participants will be followed for 1- and 3-months post-ICU discharge. All analyses will be intention-to-treat and adjusted for pre-identified covariates. Ethical approval has been granted by the University of Calgary Conjoint Health Research Ethics Board (REB19–1000) and the trial registered. The protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist. Discussion Critically ill patients are frequently unable to participate in their own care, and partnering with their family members is particularly important for improving experiences and outcomes of care for both patients and families. Trial registration Registered September 23, 2019 on Clinicaltrials.gov NCT04099472.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada. .,Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada. .,Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Krista L Spence
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Judy E Davidson
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, California, USA
| | - E Wesley Ely
- Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (VA GRECC), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada.,Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Krewulak KD, Bull MJ, Ely EW, Stelfox HT, Fiest KM. Psychometric evaluation of the family caregiver ICU delirium knowledge questionnaire. BMC Health Serv Res 2020; 20:116. [PMID: 32059716 PMCID: PMC7023729 DOI: 10.1186/s12913-020-4892-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Delirium is a common condition in critically ill patients, affecting nearly half of all patients admitted to an intensive care unit (ICU). Family caregivers of critically ill patients can be partners in the early recognition, prevention and management of delirium provided they are aware of the signs/symptoms and appropriate non-pharmacological strategies that might be taken. Valid, reliable instruments that assess family caregiver knowledge are essential so that nurses can prepare family caregivers to be effective partners. The purpose of the current study was to (a) adapt an existing caregiver delirium knowledge questionnaire (CDKQ) for use by nurses to measure a family caregiver’s delirium knowledge in the ICU; and (b) examine the psychometric properties and structure of the adapted Caregiver ICU Delirium Knowledge Questionnaire (CIDKQ). Methods In this cross-sectional study, a multidisciplinary team developed the 21-item CIDKQ (possible score range: 0–21) and administered it to 158 family caregivers of critically ill patients. Descriptive statistics were examined for all variables. The CIDKQ was analyzed for face validity, content validity, reliability and internal consistency. Results The mean CIDKQ score was 14.1 (SD: 3.5, range = 2 to 21). Path analysis revealed that a family caregiver’s delirium knowledge in the actions and symptoms dimensions had a direct effect on knowledge of delirium risk factors. The CIDKQ was found to have face validity and reliability (Cronbach’s α = 0.79). Conclusions The findings indicated good validity and reliability of the CIDKQ as a measure of ICU delirium knowledge in family caregivers of critically ill patients.
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Affiliation(s)
- Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Margaret J Bull
- College of Nursing, Marquette University, Milwaukee, WI, USA
| | - E Wesley Ely
- Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (VA GRECC), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. .,Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Hobday JV, Gaugler JE, Mittelman MS. Feasibility and Utility of Online Dementia Care Training for Hospital Staff: The CARES ® Dementia-Friendly Hospital ™ Program. Res Gerontol Nurs 2017; 10:58-65. [PMID: 28152156 DOI: 10.3928/19404921-20170131-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/06/2017] [Indexed: 11/20/2022]
Abstract
The current project tested the feasibility and utility of the CARES® Dementia-Friendly Hospital™ (CDFH) program, a 4-module, online training program for nursing assistants (NAs) and allied hospital workers (AHWs) who provide care to individuals with dementia. A single group pretest/posttest design was used for 25 hospital NAs/AHWs, and quantitative and qualitative data were collected to determine whether NAs'/AHWs' knowledge of hospital-based dementia care significantly increased, and if CDFH was perceived as useful and acceptable. Dementia care knowledge increased significantly (p < 0.001). Open- and closed-ended data suggested that the delivery of online training to NAs/AHWs to enhance dementia care is feasible, useful, and efficient. Ongoing gaps in care exist for individuals with dementia in hospitals, and delivering robust training for NAs/AHWs may serve as an effective modality to enhance quality of dementia care in such settings. [Res Gerontol Nurs. 2017; 10(2):58-65.].
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Bull MJ, Boaz L, Maadooliat M, Hagle ME, Gettrust L, Greene MT, Holmes SB, Saczynski JS. Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty. J Am Geriatr Soc 2016; 65:e13-e17. [PMID: 27861701 DOI: 10.1111/jgs.14535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. DESIGN Mixed-method, pre-post quasi-experimental design. SETTING A Midwest Veterans Affairs Medical Center and a nonprofit health system. PARTICIPANTS Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention. INTERVENTION Four telephone-based education modules using vignettes were completed during the 3 weeks before the older adult's hospital admission for elective hip or knee replacement. Each module required 20 to 30 minutes. MEASUREMENTS Interviews were conducted before the intervention and 2 weeks and 2 months after the older adult's hospitalization. A researcher completed the Confusion Assessment Method (CAM) and a family caregiver completed the Family Version of the Confusion Assessment Method (FAM-CAM) 2 days after surgery to assess the older adults for delirium symptoms. RESULTS Family caregivers' knowledge of delirium symptoms improved significantly from before the intervention to 2 weeks after the intervention and was maintained after the older adult's hospitalization. They also were able to recognize the presence and absence of delirium symptoms in the vignettes included in the intervention and in the older adult after surgery. In 94% of the cases, the family caregiver rating on the FAM-CAM approximately 2 days after the older adult's surgery agreed with the researcher rating on the CAM. Family caregivers expressed satisfaction with the intervention and stated that the information was helpful. CONCLUSION Delivery of a telephone-based intervention appears feasible. All family caregivers who began the program completed the four education modules. Future studies evaluating the effectiveness of the educational program should include a control group.
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Affiliation(s)
- Margaret J Bull
- College of Nursing, Marquette University, Milwaukee, Wisconsin
| | - Lesley Boaz
- College of Nursing, Marquette University, Milwaukee, Wisconsin
| | - Mehdi Maadooliat
- Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee, Wisconsin
| | - Mary E Hagle
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Lynn Gettrust
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | | | | | - Jane S Saczynski
- Department of Epidemiology, Northeastern University, Boston, Massachusetts
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