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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 2024:10.1007/s11606-024-08734-6. [PMID: 38647970 DOI: 10.1007/s11606-024-08734-6] [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: 11/08/2023] [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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Xing H, Zhu S, Liu S, Xia M, Tong S, Li L, Li L. An online delirium detection tool: Cross-cultural adaptation of a Chinese version of the Family Confusion Assessment Method. Aust Crit Care 2024:S1036-7314(24)00026-2. [PMID: 38580485 DOI: 10.1016/j.aucc.2024.01.010] [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: 11/26/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Intensive care unit (ICU) delirium is a common complication in older critically ill patients that has a significant impact. The Family Confusion Assessment Method (FAM-CAM) is a vital tool for assisting family members in identifying delirium; however, no study has yet been reported on the Chinese version of the scale. OBJECTIVES The objective of this study was to translate the FAM-CAM into a Chinese version and to verify its effectiveness for delirium detection in an online patient visit setting. METHODS This was a cross-sectional study. The FAM-CAM was translated to Chinese according to the International Society for Pharmacoeconomics and Outcomes Research guidelines. Patients and family members were recruited to participate in delirium assessments in three ICUs of one hospital. Family members then used the Chinese version of the FAM-CAM to assess for delirium via online visitation, and ICU nurses assessed patients for delirium using the Intensive Care Delirium Screening Checklist (ICDSC). Results were then compared between family members' and nurses' assessments. RESULTS Overall, 190 critically ill patients and 190 family members were included, of whom 117 (61.6%) were assessed for delirium using the Intensive Care Delirium Screening Checklist. The Cohen's kappa coefficient between the Intensive Care Delirium Screening Checklist and FAM-CAM was 0.759 (P < 0.01). The sensitivity of the Chinese version of the FAM-CAM was 0.880, specificity was 0.890, positive predictive value was 0.928, negative predictive value was 0.823, and area under the receiver operating characteristic curve was 0.881 (95% confidence interval: 0.872-0.935, P < 0.01). CONCLUSION The Chinese version of the FAM-CAM was shown to effectively help families detect delirium and was suggested as a crucial tool for assisting ICU nurses in the early identification of delirium. This tool may effectively be used to assess delirium during online visits.
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Affiliation(s)
- Huanmin Xing
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Shichao Zhu
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Shiqing Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Henan Province, China.
| | - Ming Xia
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Shuaihong Tong
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Long Li
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Liming Li
- Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Nursing Department, Henan Provincial People's Hospital, Henan Province, China.
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Pandhal JK, Van Der Wardt V. Exploring perceptions regarding family-based delirium management in the intensive care unit. J Intensive Care Soc 2022; 23:447-452. [PMID: 36751350 PMCID: PMC9679907 DOI: 10.1177/17511437211037928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Delirium is a common complication in patients treated in the intensive care unit (ICU). Family members can help alleviate patient anxiety and may be able to aid in the management of delirium. This study aimed to explore the perceptions of former ICU patients and their families together, regarding the involvement of family in delirium management. Method Nine audio-recorded, semi-structured interviews took place with former ICU patients together with a family member. Participants were interviewed after their intensive care follow-up clinic appointment in an East Midlands hospital in England. Interviews were transcribed, coded and analysed using thematic analysis. Results Three themes were identified: 'understanding about delirium'; 'influencers of delirium management: family and healthcare professionals' and 'family-based delirium care'. Participants expressed that family have a valuable role to play in the management of delirium in the ICU. However, education and guidance is needed to support the family in how delirium can be managed and the current treatment options available. It is important for ICU staff to gain an understanding of the patient's life and personality to personalise delirium management to the needs of the patient and their family. Conclusion This study found that family presence and knowledge about the patient may be beneficial to delirium management in the ICU. Further research should investigate the effectiveness of the strategies and interventions to understand their influence on delirium management in ICU patients.
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Affiliation(s)
- Jasmin Kaur Pandhal
- Critical care Research, Leicester Royal
Infirmary, Leicester, UK; Rheumatology and Dermatology
Research, Wellhouse Lane, Barnet, UK,Jasmin Kaur Pandhal, Rheumatology and
Dermatology Research, Wellhouse Lane, Barnet EN5 3DJ
| | - Veronika Van Der Wardt
- Department of primary practice, Philipps-Universität.
Karl-von-Frisch-Straße 4, Marburg, Germany; Division of Rehabilitation, Ageing and
Wellbeing, University of
Nottingham, Nottingham, UK
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