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Alaterre C, Fazilleau C, Cayot-Constantin S, Chanques G, Kacer S, Constantin JM, James A. Monitoring delirium in the intensive care unit: Diagnostic accuracy of the CAM-ICU tool when performed by certified nursing assistants - A prospective multicenter study. Intensive Crit Care Nurs 2023; 79:103487. [PMID: 37451087 DOI: 10.1016/j.iccn.2023.103487] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/05/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Monitoring delirium in critically ill patients is recognized as a major challenge. Although involving certified nursing assistants could be a valuable help in this field, such strategy has never been formally investigated. OBJECTIVES Following theoretical training, we conducted a prospective multicenter study assessing the diagnostic accuracy of a CAM-ICU delirium screening strategy performed by CNAs in clinical settings, compared to parallel blinded evaluations conducted by nurses and physicians. METHODS From October 2020 to June 2022, adult intensive care patients admitted in three French University teaching hospitals with Richmond Agitation Sedation Scale ≥-2 were independently assessed for delirium by the three members of the care team (clinical nursing assistant, nurse and physician) using CAM-ICU in a random order. Physician's assessment served as the reference standard for comparisons. RESULTS We analyzed results from 268 triplets of CAM-ICU assessments performed sequentially on 203 patients. Prevalence of delirium was 22%. Compared to physician's assessments, clinical nursing assistants demonstrated a sensitivity (Se) of 88% CI95% [80-96] and a specificity (Sp) of 95% [92-98] in detecting delirium. There was no significant difference in the performance of clinical nursing assistants and nurses (Se = 90 % [82-97] p = 0.77, Sp = 98 % [95-100] p = 0.19). We observed high agreement between results obtained by physicians and clinical nursing assistants (ĸ = 0.82) and clinical nursing assistants performance remained consistent in the subgroups at higher risk of delirium. CONCLUSION Evaluation of the CAM-ICU by clinical nursing assistants is feasible and should be seen as an opportunity to increase routine monitoring of delirium in intensive care patients. IMPLICATION FOR CLINICAL PRACTICE Delirium is a severe and underestimated complication of intensive care unit stay. This study results demonstrate the great performance of trained clinical nursing assistants in detecting delirium using the CAM-ICU. Further research is needed to define the most effective role for clinical nursing assistants in the routine management of delirium in intensive care patients.
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Affiliation(s)
- Camille Alaterre
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Hôpital Pitié-Salpetrière, Department of Anesthesiology, Critical Care and Perioperative Medicine, Paris, France.
| | - Claire Fazilleau
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Hôpital Pitié-Salpetrière, Department of Anesthesiology, Critical Care and Perioperative Medicine, Paris, France
| | - Sophie Cayot-Constantin
- Department of Perioperative Medicine, Adult Intensive Care Unit, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Gerald Chanques
- Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Samia Kacer
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Hôpital Pitié-Salpetrière, Department of Anesthesiology, Critical Care and Perioperative Medicine, Paris, France
| | - Jean-Michel Constantin
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Hôpital Pitié-Salpetrière, Department of Anesthesiology, Critical Care and Perioperative Medicine, Paris, France
| | - Arthur James
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Hôpital Pitié-Salpetrière, Department of Anesthesiology, Critical Care and Perioperative Medicine, Paris, France
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Kimura R, Matsunaga M, Barroga E, Hayashi N. Asynchronous e-learning with technology-enabled and enhanced training for continuing education of nurses: a scoping review. BMC MEDICAL EDUCATION 2023; 23:505. [PMID: 37442970 DOI: 10.1186/s12909-023-04477-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Asynchronous e-learning has become the mainstream choice since the transformation of learning formats by the coronavirus disease-19 pandemic. This scoping review aimed to examine the technologies used in asynchronous e-learning for the continuing education of clinical nurses and their modes of delivery and effectiveness. METHODS This scoping review covered the period between 2011 and 2023. Six databases were searched for relevant studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol. RESULTS Sixty articles met the inclusion criteria. There was a noticeable trend toward using diverse technology-enabled and enhanced training (TEET) options after 2017. The enabling technological approaches, such as interactive online modules (25 articles) and video modules (25 articles), are described in the articles. The most commonly used enhancing technologies were scenario-based learning (nine articles), resource access (eight articles), computer simulation or virtual reality (three articles), and gamification (three articles). Among the outcomes, knowledge acquisition was the most commonly examined outcome (41 articles). CONCLUSIONS Notably, many interactive TEET modules were used in asynchronous e-learning. There were few studies on gamification, computer simulation or virtual reality, and scenario-based learning (techniques to enhance intrinsic motivation further). However, the adoption of asynchronous e-learning with advanced TEET options is anticipated to increase in the future. Therefore, objective outcome measures are required to determine the effects of such learning methods on knowledge acquisition and behavioral changes.
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Affiliation(s)
- Rika Kimura
- Department of Adult Health Nursing, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-0044, Japan.
| | - Mayumi Matsunaga
- Department of Nursing, Faculty of Human Sciences, Sophia University, Tokyo, Japan
| | - Edward Barroga
- Department of Medical Education, Showa University School of Medicine, Tokyo, Japan
| | - Naoko Hayashi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Makhija H, Fine JM, Pollack D, Novelli F, Davidson JE, Cotton SA, Diaz De Leon B, Reyes PA, Montoya JL, Arroyo-Novoa CM, Figueroa-Ramos MI, Song Y, Fuentes AL, LaBuzetta JN, Moore AA, Ely EW, Malhotra A, Needham DM, Martin JL, Kamdar BB. Development and Validation of an ICU Delirium Playbook for Provider Education. Crit Care Explor 2023; 5:e0939. [PMID: 37457918 PMCID: PMC10348729 DOI: 10.1097/cce.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Although delirium detection and prevention practices are recommended in critical care guidelines, there remains a persistent lack of effective delirium education for ICU providers. To address this knowledge-practice gap, we developed an "ICU Delirium Playbook" to educate providers on delirium detection (using the Confusion Assessment Method for the ICU) and prevention. DESIGN Building on our previous ICU Delirium Video Series, our interdisciplinary team developed a corresponding quiz to form a digital "ICU Delirium Playbook." Playbook content validity was evaluated by delirium experts, and face validity by an ICU nurse focus group. Additionally, focus group participants completed the quiz before and after video viewing. Remaining focus group concerns were evaluated in semi-structured follow-up interviews. SETTING Online validation survey, virtual focus group, and virtual interviews. SUBJECTS The validation group included six delirium experts in the fields of critical care, geriatrics, nursing, and ICU education. The face validation group included nine ICU nurses, three of whom participated in the semi-structured feedback interviews. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 44-question quiz had excellent content validity (average scale-level content validity index [S-CVI] of individual items = 0.99, universal agreement S-CVI = 0.93, agreement κ ≥ 0.75, and clarity p ≥ 0.8). The focus group participants completed the Playbook in an average (sd) time of 53 (14) minutes, demonstrating significant improvements in pre-post quiz scores (74% vs 86%; p = 0.0009). Verbal feedback highlighted the conciseness, utility, and relevance of the Playbook, with all participants agreeing to deploy the digital education module in their ICUs. CONCLUSIONS The ICU Delirium Playbook is a novel, first-of-its-kind asynchronous digital education tool aimed to standardize delirium detection and prevention practices. After a rigorous content and face validation process, the Playbook is now available for widespread use.
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Affiliation(s)
- Hirsh Makhija
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Janelle M Fine
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Daniel Pollack
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
| | - Francesca Novelli
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
- School of Nursing, Oregon Health and Science University, Ashland, OR
| | - Judy E Davidson
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Department of Psychiatry, UCSD Health, San Diego, CA
| | - Shannon A Cotton
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
| | - Bianca Diaz De Leon
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Paola Alicea Reyes
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | | | - Yeonsu Song
- School of Nursing, University of California, Los Angeles (UCLA), Los Angeles, CA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Ana Lucia Fuentes
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | | | - Alison A Moore
- Division of Geriatrics, Gerontology and Palliative Care, UCSD Health, San Diego, CA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Dale M Needham
- Division of Pulmonary & Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
- School of Nursing, Johns Hopkins University, Baltimore, MD
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
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Yıldırım F, Türkleş S, Altundal Duru H. The effect of delirium information training given to intensive care nurses on patient care: quasi-experimental study. PeerJ 2022; 10:e13143. [PMID: 35419213 PMCID: PMC8997191 DOI: 10.7717/peerj.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/28/2022] [Indexed: 01/12/2023] Open
Abstract
Background Training programs aiming to improve delirium diagnosis and management skills increase nurses' care efficiency and improve patients' health outcomes. This study was conducted to examine the effect of delirium information training on patient care by intensive care nurses. Methods In the research, one group pretest-posttest quasi-experimental design was used. The study sample consisted of 30 nurses working in four intensive care units of a university hospital between November 05, 2018, and February 15, 2019. The Personal Information Form, the Checklist for the Care of the Patient in Delirium, and the Confusion Assessment Scale for the Intensive Care Unit were used to collect the data. Intensive care nurses were provided with information training supported by a training booklet in two sessions of 40 min each. Results In the study, according to the Checklist for the Care of the Patient in Delirium, while the pre-test point average of the nurses was 6.17 ± 2.29, the post-test point average had increased to 11.17 ± 1.51 (p < 0.001). After the training, it was determined that there was a significant increase in the percentage of nurses who stated that they evaluated and detected whether their patients had pain, hallucinations, and delusions (p < 0.001). As a result, it has been determined that providing delirium information training to intensive care nurses positively affects the care of patients with delirium. In addition, it has been determined that with the Confusion Assessment Scale for Intensive Care Unit, nurses can provide the care they need to patients at risk in terms of delirium by identifying delirium.
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Affiliation(s)
- Fulya Yıldırım
- Department of Pediatric Surgery Service, Mersin University Hospital, Mersin, Turkey
| | - Serpil Türkleş
- Department of Psychiatric and Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
| | - Hilal Altundal Duru
- Department of Psychiatric and Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
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Back JS, Jin T, Jin H, Lee SM. Patient Factors That Influence Reliable Delirium Assessments in a Medical Intensive Care Unit During the Routine Clinical Practice. Clin Nurs Res 2021; 32:742-751. [PMID: 34889155 DOI: 10.1177/10547738211058983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to determine patient and therapeutic characteristics of patients in the medical intensive care unit (MICU) that contribute to inconsistent results of delirium assessments performed during routine clinical practice. Therefore, electronic health records were reviewed and compared with secondary data collected from the same medical ICU patients who were assessed using the Confusion Assessment Method in the ICU (CAM-ICU). Of 5,241 cases involving 762 patients, 827 (15.78%) cases showed disagreement between assessments. Continuous renal replacement therapy, physical restraint use, and altered mental status were factors that increased the likelihood of inconsistencies between assessments. A significant positive correlation was found between the CAM-ICU disagreement rate and the total number of assessments per month. To maximize the reliability of delirium assessments, individual-targeted approaches considering the patient's level of consciousness and type of treatment implemented are required, along with ensuring a stable, and regulated working environment and customized educational programs.
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Affiliation(s)
- Ji-Sun Back
- The Catholic University of Korea, Seoul, Republic of Korea
| | - Taixian Jin
- The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Sun-Mi Lee
- The Catholic University of Korea, Seoul, Republic of Korea
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Piot MA, Dechartres A, Attoe C, Romeo M, Jollant F, Billon G, Cross S, Lemogne C, Layat Burn C, Michelet D, Guerrier G, Tesniere A, Rethans JJ, Falissard B. Effectiveness of simulation in psychiatry for nursing students, nurses and nurse practitioners: A systematic review and meta-analysis. J Adv Nurs 2021; 78:332-347. [PMID: 34378236 DOI: 10.1111/jan.14986] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction. REVIEW METHODS We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels. RESULTS A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners' attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences. CONCLUSION These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions.
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Affiliation(s)
- Marie-Aude Piot
- Université de Paris, Institute Mutualiste Montsouris, Department of Psychiatry, Paris-Saclay University, UVSQ, INSERM 1018, CESP, Ilumens, Simulation Center, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), F75013, Paris, France
| | - Chris Attoe
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Marie Romeo
- Université de Paris, Institute Mutualiste Montsouris, Department of Psychiatry, Paris-Saclay University, UVSQ, INSERM 1018, CESP, Ilumens, Simulation Center, Paris, France
| | - Fabrice Jollant
- Université de Paris, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Department of Psychiatry, Moods Team, INSERM UMR-1178, CESP, Paris, France.,Nîmes academic hospital (CHU), Nîmes, France.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Grégoire Billon
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Sean Cross
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
| | - Carine Layat Burn
- Department of Orthopaedic Surgery, La Providence Hospital, Neuchâtel, Switzerland.,Department of Psychotherapy, Berger Psychotherapeutic Centre, Neuchâtel, Switzerland
| | - Daphné Michelet
- Department of Pediatric Anesthesia, CHU of Reims Hôpital Maison Blanche, Reims, France
| | - Gilles Guerrier
- Université de Paris, AP-HP, Cochin Hospital, Anaesthesiology Department, Ilumens, Simulation Center, Paris, France
| | - Antoine Tesniere
- Université de Paris, AP-HP, Cochin Hospital, Anaesthesiology Department, Ilumens, Simulation Center, Paris, France
| | - Jan-Joost Rethans
- Skillslab, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bruno Falissard
- Public Health Department, School of Medicine, University Paris Saclay, INSERM 1018, CESP, Villejuif, Ile-de-France, France
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Montgomery A, Chang HCR, Ho MH, Smerdely P, Traynor V. The use and effect of OSCES in post-registration nurses: An integrative review. NURSE EDUCATION TODAY 2021; 100:104845. [PMID: 33721715 DOI: 10.1016/j.nedt.2021.104845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/08/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Objective structured clinical examinations (OSCEs) have been used in the undergraduate medical setting since the 1970s, however little is known about its use and effectiveness in post-registration nurse education. OBJECTIVES The purpose of this review was to critically analyse studies using OSCEs in post-registration nurse education and to explore the use and effectiveness of OSCEs in this cohort. DESIGN This review was conducted using the Whittemore and Knafl's framework for integrated reviews. DATA SOURCES Using the search terms OSCE OR OSCA OR objective structured clinical examination AND nursing NOT undergraduate, a comprehensive review was conducted using CINHAL and MEDLINE. METHODS The initial search located 173 studies. After screening and checking eligibility 19 studies were critically appraised. The final number of studies included in this review was 16. RESULTS Three themes were generated: (i) Application of OSCEs in post-registration level nursing (ii) OSCEs more than an exam: Learning enhancements and (iii) Participant perceived impact of OSCEs. CONCLUSION OSCEs for post-registration nurses have evolved from the original OSCE design and have been adapted to a wide range of clinical settings and specialities. OSCEs were recognized as a valuable learning and assessment tool across the world for post-registration nurses. OSCEs offered strengths in terms of learner satisfaction and increased self-efficacy for this cohort. There was limited evidence supporting the effects of OSCEs within post-registration nursing education in comparison with other educational tools. Further research is needed to explore whether the knowledge gained in OSCEs is translated into clinical practice and whether simulation-based education is more effective in achieving enhanced knowledge compared to traditional-based education. Future research is required using RCT methods to compare the impact of OSCE to traditional-based education.
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Affiliation(s)
- Amy Montgomery
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), Australia; Aged Care Department, St. George Hospital, NSW Health, Kogarah, Australia; St. George and Sutherland Clinical School, University of New South Wales, Australia
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), Australia.
| | - Mu-Hsing Ho
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Peter Smerdely
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Aged Care Department, St. George Hospital, NSW Health, Kogarah, Australia; School of Public Health & Community Medicine, University of New South Wales, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), Australia
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Henao Castaño ÁM, Baquero Lizarazo AC, Gonzalez Pabon N, Burgos Tulcán GF, Lozano Gonzalez L. Enfermería en la monitorización del delirium en cuidado intensivo adulto: una revisión de alcance. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2021. [DOI: 10.11144/javeriana.ie22.emdc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introducción. El delirium es una alteración cognitiva secundaria a una situación clínica aguda que puede estar presente en el paciente crítico, y la enfermería juega un rol protagónico en la prevención, monitoreo y tratamiento no farmacológico del delirium en el paciente en unidad de cuidado intensivo. Objetivo. Identificar las investigaciones actuales que describen las estrategias que utilizan las enfermeras para la monitorización del delirium en la unidad de cuidado intensivo adulto. Método. Revisión de alcance, utilizando la pregunta orientadora ¿qué estrategias utiliza enfermería en la monitorización del delirium en la unidad de cuidado intensivo?, estudios obtenidos en las bases de datos PubMed, Biblioteca Virtual en Salud, Science Direct y Cochrane. Se realizó una revisión crítica con el instrumento CASPe, los datos se extrajeron, y se llevaron a cabo registros en tablas de gráficos elaboradas para condensar la información. Resultados. Trece estudios se consideraron relevantes y fueron analizados. Las estrategias de monitorización del delirium empleadas por enfermería son, principalmente, el juicio clínico, la observación de la agitación y, en menor medida, el empleo de instrumentos validados para la detección. Conclusión. La enfermería requiere comprender mejor el delirium, y para esto la educación es vital para mejorar su conocimiento, y aumentar la autoconfianza y competencia en la evaluación a través del uso correcto de instrumentos.
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Choi M, DeGennaro R, Blevins C. Multimodal Education Program to Improve Nurses' Knowledge and Confidence on Delirium Recognition in a Surgical-Trauma Intermediate-Care Setting. J Dr Nurs Pract 2020; 13:31-41. [DOI: 10.1891/2380-9418.jdnp-d-19-00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundHigh incidence of delirium in hospitalized patients has been reported in the United States and is significantly associated with increased morbidity and mortality. The lack of knowledge and confidence in performing delirium assessment (KCDA) has led to significant underrecognition of delirium by nurses regardless of evidence-based education intervention.ObjectiveThe purpose of this study was to determine the effectiveness of a multimodal educational program (MEP) to enhance nurses' KCDA.MethodsA MEP including an online didactic with a video-simulation and 1:1 bedside coaching with delirium screening (DS) was conducted in the surgical intermediate-care unit of an academic medical center. A quasi-experimental pre- and post-test design was used.ResultsOf 23 nurses, the majority were <41 years old (73.9%) and had at least a bachelor of science in nursing degree (78.3%) with <6 years of experience (60.9%). The overall KCDA scores and the performance of DS improved significantly after the MEP (p < .001). A positive correlation was noted between the changes of the KCDA scores (p = .009).ConclusionsThe MEP demonstrated improvement in nurses' KCDA. The MEP should focus on an individualized learning approach with a targeted patient population, using current delirium screening tools.Implications for NursingEducational programs are recommended in either an orientation or continuing education program on nursing units. This is also recommended for use in other academic centers that encompass similar clinical settings and could possibly be considered for use in other disease processes.
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Linn AC, Caregnato RCA, Souza END. Clinical simulation in nursing education in intensive therapy: an integrative review. Rev Bras Enferm 2019; 72:1061-1070. [PMID: 31432966 DOI: 10.1590/0034-7167-2018-0217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/18/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE to analyze the publications on clinical simulation practices for education in Nursing in Intensive Care. METHOD an integrative review carried out through LILACS, PubMed, Cochrane Library, CINAHL and SciELO databases, of articles published from 2008 to 2017. RESULTS 29 articles were selected, of which 76% discuss the use of simulation in continuing education of nursing professionals, while the others describe their use for student education. There is a higher prevalence of studies with a level of evidence 6 (17), with 28 international publications. There was an increase in scientific production, with 16 articles published in the last three years. CONCLUSION variables after simulation use, such as confidence, communication skills, efficiency in the identification of clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that this tool is effective in qualifying care for critical patients.
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Affiliation(s)
- Amanda Chlalup Linn
- Centro Universitário Ritter dos Reis. Porto Alegre, Rio Grande do Sul, Brazil
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