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Denninger NE, Brefka S, Skudlik S, Leinert C, Mross T, Meyer G, Sulmann D, Dallmeier D, Denkinger M, Müller M. Development of a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers: A multi-method study. Int J Nurs Stud 2024; 150:104645. [PMID: 38091654 DOI: 10.1016/j.ijnurstu.2023.104645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Delirium is a common yet challenging condition in older hospitalized patients, associated with various adverse outcomes. Environmental factors, such as room changes, may contribute to the development or severity of delirium. Most previous research has focused on preventing and reducing this condition by addressing risk factors and facilitating reorientation during hospital stay. OBJECTIVE We aimed to systematically develop a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers during and after these procedures. The intervention combines stakeholder and expert opinions, evidence, and theory. This article provides guidance and inspiration to research groups in developing complex interventions according to the recommendations in the Medical Research Council framework for complex interventions. DESIGN AND METHODS A stepwise multi-method study was conducted. The preparation phase included analysis of the context and current practice via focus groups. Based on these results, an expert workshop was organized, followed by a Delphi survey. Finally, the intervention was modeled and a program theory was developed, including a logic model. RESULTS A complex intervention was developed in an iterative process, involving healthcare professionals, delirium experts, researchers, as well as caregiver and patient representatives. The key intervention component is an 8-point-program, which provides caregivers with recommendations for preventing delirium during the transition phase and in the post-discharge period. Information materials (flyers, handbook, videos, posters, defined "Dos and Don'ts", discharge checklist), training for healthcare professionals, and status analyses are used as implementation strategies. In addition, roles were established for gatekeepers to act as leaders, and champions to serve as knowledge multipliers and trainers for the multi-professional team in the hospitals. CONCLUSIONS This study serves as an example of how to develop a complex intervention. In an additional step, the intervention and implementation strategies will be investigated for feasibility and acceptability in a pilot study with an accompanying process evaluation. TWEETABLE ABSTRACT Delirium prevention can benefit from optimizing discharge and transfer processes and involving caregivers of older patients in these procedures. STUDY REGISTRATION DRKS00017828, German Register of Clinical Studies, date of registration 17.09.2019.
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Affiliation(s)
- Natascha-Elisabeth Denninger
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany.
| | - Simone Brefka
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Stefanie Skudlik
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany
| | - Christoph Leinert
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Thomas Mross
- Agaplesion Bethanien Hospital Heidelberg, Centre for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany
| | | | - Dhayana Dallmeier
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Boston University School of Public Health, Department of Epidemiology, Boston, USA
| | - Michael Denkinger
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Martin Müller
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany
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Wood M, Gandhi K, Chapman A, Skippen P, Krahn G, Görges M, Stewart SE. Pediatric Delirium Educational Tool Development With Intensive Care Unit Clinicians and Caregivers in Canada: Focus Group Study. JMIR Pediatr Parent 2023; 6:e53120. [PMID: 38091377 PMCID: PMC10734902 DOI: 10.2196/53120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Background Pediatric intensive care unit (PICU)-associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. Objective This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child's PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Methods Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. Results In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Conclusions Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary.
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Affiliation(s)
| | | | - Andrea Chapman
- BC Children’s Hospital, VancouverBC, Canada
- Department of Psychiatry, University of British Columbia, VancouverBC, Canada
| | - Peter Skippen
- BC Children’s Hospital, VancouverBC, Canada
- Department of Pediatrics, University of British Columbia, VancouverBC, Canada
| | | | - Matthias Görges
- BC Children’s Hospital, VancouverBC, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, VancouverBC, Canada
| | - S Evelyn Stewart
- BC Children’s Hospital, VancouverBC, Canada
- Department of Psychiatry, University of British Columbia, VancouverBC, Canada
- BC Mental Health and Substance Use Services Research Institute, VancouverBC, Canada
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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 Innov 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Shrestha P, Fick DM. Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool? Geriatrics (Basel) 2023; 8. [PMID: 36826364 DOI: 10.3390/geriatrics8010022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Delirium in persons with dementia (DSD) is a common occurrence. Over the past three decades, several tools have been developed and validated to diagnose delirium, yet there is still a shortage of tools recommended in persons with dementia and there is a lack of sufficient research on the accuracy of performance of such tools in this growing population. The purpose of this article is to (1) conduct a clinical review of the detection of DSD across settings of care by formal health care professionals and informal family members and care partners; (2) identify barriers and facilitators to detection and highlight delirium tools that have been tested in person with dementia; and (3) make recommendations for future research, practice, and policy. Given this review, an "ideal" tool for DSD would point to tools being brief, easy to integrate into the EMR, and accurate with at least 90% accuracy given the poor outcomes associated with delirium and DSD. Knowing the baseline and communication between family members and healthcare professionals should be a top priority for education, research, and health systems policy. More work is needed in better understanding DSD and optimizing and standardizing feature assessment, especially the acute change feature at the bedside for DSD.
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Azhar G, Sharma S, Lau O, Alkharisi B, Anandam A, Isa S, Mendiratta P, Pangle AK, Coker K, Wei J. Quality Improvement in Delirium Health Literacy in Older Adult Patients and Their Caregivers Attending a Geriatric Clinic. Clin Interv Aging 2022; 17:1901-1906. [PMID: 36597428 PMCID: PMC9805724 DOI: 10.2147/cia.s388325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/06/2022] [Indexed: 12/29/2022] Open
Abstract
Background Delirium is a common medical condition that is highly prevalent in older adults who are at increased risk for its development with any illness, post-surgery or during hospitalization. The purpose of our study was to evaluate the health literacy of older adult patients and their caregivers about delirium, offer a brief educational intervention, and reevaluate their knowledge post intervention. Materials and Methods We conducted a quality improvement project, focused on delirium health literacy in older adult patients ≥60 years and their caregivers. Delirium knowledge of participants was evaluated in a pre-education survey after which they were given a delirium education booklet to read. A post-education delirium survey was conducted within 2-3 weeks of the educational intervention. Chi-square test was used to analyze the knowledge base of older adults. Results The study population consisted of a total of 70 older adults who participated in pre-education (n=35) and post-education (n=35) surveys. Older adult patients and their caregivers had significant knowledge gaps about the potential causes or etiologies, risk factors, symptomatology, and prevention of delirium in the pre-education survey. After the educational intervention, in the post-education survey, there were overall improvements in knowledge base of older adults in differentiating delirium with dementia (43% vs 94%, p<0.01) recognizing signs and symptoms (77% vs 94%, p<0.05), complications (76% vs 100%, p<0.01) and identifying the etiological factors associated with delirium. Conclusion The quality improvement project demonstrated that older adults and caregivers have significant knowledge deficits about the common condition of delirium. This study also demonstrated that older adults were able to improve their health literacy regarding delirium after the intervention. Appropriate education on delirium for patients and caregivers might help in earlier identification, prevention, and better overall management of delirium.
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Affiliation(s)
- Gohar Azhar
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA,Correspondence: Gohar Azhar, Email
| | - Shakshi Sharma
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Onna Lau
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bader Alkharisi
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Anil Anandam
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sakiru Isa
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Priya Mendiratta
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amanda K Pangle
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Karen Coker
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanne Wei
- Department of Geriatrics, Donald W. Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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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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Carbery M, Schwartz S, Werner N, Fields B. Education and skills training for care partners of hospitalised older adults: A scoping review. Health Educ J 2021; 80:921-933. [PMID: 37131526 PMCID: PMC10150946 DOI: 10.1177/00178969211034192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The care partners of hospitalised older adults often feel dissatisfied with the education and skills training provided to them, resulting in unpreparedness and poor health outcomes. Objective This review aimed to characterise and identify gaps in the education and skills training used with the care partners of older adults in the hospital. Methods We conducted a scoping review on the education and skills training practices used with the care partners of hospitalised older adults in the USA via sources identified in the PubMed, PsychINFO and CINAHL databases. Results Twelve studies were included in this review. Results illustrate that nurses utilise multiple modes of delivery and frequently provide education and skills training tailored to the needs of care partners at the latter end of hospital care. The provision of education and skills training varies greatly, however, including who provides education, in what way information is conveyed, and how care partner outcomes are measured. Conclusion This is the first scoping review to describe and synthesise the education and skills training practices used with care partners of hospitalised older adults. Findings highlight the need for education and skills training to be interprofessional, tailored to individual care partners' needs and begin at, or even before, the hospital admission of older adult patients.
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Affiliation(s)
- Madeline Carbery
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, USA
| | - Samantha Schwartz
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, USA
| | - Nicole Werner
- Department of Industrial and Systems Engineering, University of Wisconsin–Madison, WI, Madison, USA
| | - Beth Fields
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, USA
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Wu H, Kapur A, Gibson B, Bubb K, Alrawashdeh M, Cipkala-Gaffin J. Preoperative Delirium Nursing Model Initiatives to Determine the Incidence of Postoperative Delirium Among Elderly Orthopaedic Patients. Orthop Nurs 2021; 40:81-8. [PMID: 33756535 DOI: 10.1097/NOR.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Delirium is a common neurocognitive disorder prevalent in hospitalized older adults. The development of delirium is associated with adverse health outcomes, including functional decline and mortality. This study aimed to investigate the incidence and risk factors of postoperative delirium in older adults (≥60 years) who underwent orthopaedic surgery. Elderly orthopaedic patients were recruited from a large urban hospital over 12 months. Patients were preoperatively screened for delirium and followed up at least once daily postoperatively until discharge. Of the 124 patients in the sample, 21 (16.9%) had postoperative delirium. There were no significant differences in any of the baseline characteristics between the delirious and nondelirious patients. Patients using antidepressants were more likely to develop postoperative delirium compared with those not using antidepressants (odds ratio: 2.72, p = .05). Postoperative delirium was common in this sample of older adults who underwent orthopaedic surgery. Aiming prevention strategies toward patients using antidepressants may help reduce the incidence of delirium in this population.
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Soroka JT, Fling KJ, Heibel JM, Kutcher GR, Ward SJ. Terminal Delirium in Hospice: The Experiences and Perspectives of Caregivers Providing Care to Terminally Ill Patients in Home Settings. Am J Hosp Palliat Care 2021; 39:27-33. [PMID: 33685252 DOI: 10.1177/10499091211000729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Little is known about the experiences of caregivers who provide care to persons with terminal delirium (TD) in home settings. This scarcity of information is suggestive that further research is needed about care for hospice patients with delirium in the home and community. AIM To elicit views, feelings, and end-of-life care experiences of primary caregivers assisting dying persons with TD in hospice at home. DESIGN Qualitative, exploratory, cross-sectional study design was chosen. In-depth semistructured interviews explored caregiver experiences in caring for persons with TD. Qualitative thematic framework analysis was used. PARTICIPANTS Fifteen bereaved adult primary caregivers who received services from a hospice care program affiliated with a large nonprofit health system in the US Midwest. RESULTS Caregiver experiences were broad and reflected 4 major themes: symptomology, coping, effective and noneffective interventions, and support. The most distressing factors for caregivers were behaviors and symptomology of TD. They did not know what to say, how to respond, and how best to behave with someone who had delirium. Many caregivers had the impression that medication does not lessen delirium symptoms and that nonpharmacologic interventions are effective and beneficial only when they were important and meaningful to patients before delirium onset. CONCLUSIONS This study added new knowledge from direct and personal perspectives of caregivers providing end-of-life care to patients at home. Understanding developed about provision of care to someone with TD in home hospice. Improved comprehension of caregiver experiences can help professional hospice and palliative care staff better prepare caregivers for when patients have TD.
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Affiliation(s)
- Jacek T Soroka
- Chaplain Services, Mayo Clinic Health System, Mankato, MN, USA
| | - Krista J Fling
- Hospice Care, Mayo Clinic Health System, Mankato, MN, USA
| | | | | | - Sarah J Ward
- Social Services, Mayo Clinic Health System, Mankato, MN, USA
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Krewulak KD, Bull MJ, Wesley Ely E, Davidson JE, Stelfox HT, Fiest KM. Effectiveness of an intensive care unit family education intervention on delirium knowledge: a pre-test post-test quasi-experimental study. Can J Anaesth 2020; 67:1761-1774. [PMID: 32959203 PMCID: PMC7716844 DOI: 10.1007/s12630-020-01810-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To create, validate, and refine an intensive care unit (ICU) delirium education intervention to prepare family members to partner with the ICU care team to detect delirium symptoms and prevent and manage delirium using nonpharmacological strategies. METHODS In this pre-test post-test quasi-experimental study, consecutive eligible family members of critically ill patients admitted to an ICU completed an ICU Family Education Delirium intervention in two parts: 1) six-minute video on ICU delirium (risk factors, prevention/management, symptoms, communication with the ICU care team), and 2) two case vignettes to practice detecting delirium using family-administered delirium detection questionnaires (Family Confusion Assessment Method [FAM-CAM] and Sour Seven). Family members' delirium knowledge was measured before, immediately after, and two weeks following the intervention using the Caregiver ICU Delirium Knowledge Questionnaire (CIDKQ). RESULTS Of 99 family members recruited over eight months, 81 (82%) completed the intervention and 63 (63/81, 78%) completed all follow-up questionnaires. Family members' delirium knowledge improved significantly following the intervention (pre-CIDKQ, 14; 95% confidence interval [CI], 13 to 15; post-CIDKQ, 17; 95% CI, 16 to 17; P < 0.001) and was retained two weeks after the intervention (CIDKQ 16; 95% CI, 16 to 17; P < 0.001). This included increased knowledge regarding delirium risk factors (e.g., medication, mechanical ventilation), prevention/management (e.g., orientation, day/night routine), and symptoms of delirium. More family members correctly detected delirium symptoms in case vignettes using the Sour Seven (92%) compared with the FAM-CAM (78%). CONCLUSIONS A video-based ICU delirium education intervention is effective in educating family members about prevention, detection, and management of delirium.
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Affiliation(s)
- Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services& University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, 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
| | - Judy E Davidson
- Department of Education, Development and Research, University of California, San Diego Health, San Diego, CA, USA
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services& University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Community Health Sciences & 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, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
- Department of Community Health Sciences & 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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Schnitker L, Nović A, Arendts G, Carpenter CR, LoGiudice D, Caplan GA, Fick DM, Beattie E. Prevention of Delirium in Older Adults With Dementia: A Systematic Literature Review. J Gerontol Nurs 2020; 46:43-54. [PMID: 32852044 DOI: 10.3928/00989134-20200820-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
Although dementia is the largest independent risk factor for delirium and leads to poor health outcomes, we know little about how to prevent delirium in persons with dementia (PWD). The purpose of the current systematic literature review was to identify interventions designed to prevent delirium in older PWD. Seven studies meeting inclusion criteria were extracted. Five studies were in the acute care setting and two were community settings. One study used a randomized controlled trial design. Five of the seven interventions comprised multiple components addressing delirium risk factors, including education. Two studies addressed delirium by administration of medication or vitamin supplementation. Using the GRADE framework for the evaluation of study quality, we scored three studies as moderate and four studies as low. Thus, high-quality research studies to guide how best to prevent delirium in PWD are lacking. Although more research is required, the current review suggests that multicomponent approaches addressing delirium risk factors should be considered by health care professionals when supporting older PWD. [Journal of Gerontological Nursing, 46(10), 43-54.].
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Requena MDC, Suárez-Álvarez S. [Pre-death grief in caregivers of Alzheimer patients. A validation of a guide]. Rev Esp Geriatr Gerontol 2020; 55:216-224. [PMID: 32249007 DOI: 10.1016/j.regg.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The pre-death grief in family caregivers (FC) of people with Alzheimer's disease has not been sufficiently treated in studies on this group. Thus, the design and validation of informative printed materials is relevant due to its important implications for the well-being of these FCs and their training in the proper performance of their role. The objective was to design and validate a booklet aimed at informing FCs about this topic, as well as the procedure for its dissemination and use. MATERIALS AND METHODS After a review of the literature, a booklet and a questionnaire were designed to determine the acceptability and dissemination procedure and use of the booklet by 73 professionals working with FCs. With the suggestions made, modifications were made to both the content and format of the booklet. RESULTS The questionnaire used presented adequate content validity and reliability in its different sections (α=0.793 and α=0.888). The level of acceptability of the booklet was high by professionals (83.85% of total score). Its dissemination was especially valued in the initial stages of the disease, and its use in therapeutic and supportive group contexts, with professional advice. CONCLUSIONS The study made it possible to verify the relevance and acceptability of a booklet as a training resource for FCs about pre-death grief, making it a useful tool for professionals that work in this area of great relevance.
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Eckstein C, Burkhardt H. Multicomponent, nonpharmacological delirium interventions for older inpatients : A scoping review. Z Gerontol Geriatr 2019; 52:229-242. [PMID: 31628611 PMCID: PMC6820613 DOI: 10.1007/s00391-019-01627-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/10/2019] [Indexed: 01/19/2023]
Abstract
Background Older people represent a risk group for acquiring or further development of delirium during hospitalization, therefore requiring suitable nonpharmacological delirium interventions. Objective This scoping review analyzed nonpharmacological intervention programs for older inpatients with or without cognitive decline on regular or acute geriatric wards to present the range of interventions. Methods A systematic literature search was conducted using scientific databases. A total of 4652 records were screened by two independent reviewers, leaving 81 eligible articles for full-text screening and 25 studies were finally included. Inclusion criteria were older patients ≥65 years in regular or acute geriatric wards and nonpharmacological multicomponent interventions. Results More than a half of the included studies (14, 56%) recruited patients with pre-existing cognitive decline as part of the study population and 12% focused exclusively on patients with cognitive decline. On average 11 intervention components were integrated in the programs and two programs included full coverage of all 18 identified components. Conclusion Only few programs were described for older inpatients and even fewer regarding pre-existing cognitive decline. The low numbers of interventions and data heterogeneity restricted the assessment of outcomes; however, delirium incidence, as reported by two thirds of the studies was reduced by nonpharmacological multicomponent interventions. Electronic supplementary material The online version of this article (10.1007/s00391-019-01627-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Eckstein
- Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany.
| | - Heinrich Burkhardt
- Department of Geriatric Medicine, University Medicine Mannheim, Mannheim, Germany
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Ogawa A, Okumura Y, Fujisawa D, Takei H, Sasaki C, Hirai K, Kanno Y, Higa K, Ichida Y, Sekimoto A, Asanuma C. Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial. Support Care Cancer 2018; 27:557-565. [DOI: 10.1007/s00520-018-4341-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
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Molony SL, Kolanowski A, Van Haitsma K, Rooney KE. Person-Centered Assessment and Care Planning. The Gerontologist 2018; 58:S32-S47. [DOI: 10.1093/geront/gnx173] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 11/13/2022] Open
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Mailhot T, Cossette S, Côté J, Bourbonnais A, Côté MC, Lamarche Y, Denault A. A post cardiac surgery intervention to manage delirium involving families: a randomized pilot study. Nurs Crit Care 2017; 22:221-228. [PMID: 28371230 DOI: 10.1111/nicc.12288] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/28/2016] [Accepted: 01/23/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND As many delirium manifestations (e.g., hallucinations or fears) are linked to patients' experiences and personality traits, it is suggested that interventions should be tailored to optimize its management. The inclusion of family members, as part of an intervention, has recently emerged as a solution to developing individualised patient care, but has never been assessed in post-cardiac surgery intensive care unit where almost half of patients will present with delirium. AIMS To assess the feasibility, acceptability and preliminary efficacy of an nursing intervention involving family caregivers (FC) in delirium management following cardiac surgery. DESIGN A randomized pilot study. METHODS A total of 30 patient/FC dyads were recruited and randomized to usual care (n = 14) or intervention (n = 16). The intervention was based on the Human Caring Theory, a mentoring model, and sources informing self-efficacy. It comprised seven planned encounters spread over 3 days between an intervention nurse and the FC, each including a 30-min visit at the patient's bedside. During this bedside visit, the FC used delirium management strategies, e.g. reorient the person with delirium. The primary indicator of acceptability was to obtain consent from 75% of approached FCs. The preliminary effect of the intervention on patient outcomes was assessed on (1) delirium severity using the Delirium Index, (2) occurrence of complications, such as falls, (3) length of postoperative hospital stay and (4) psycho-functional recovery using the Sickness Impact Profile. The preliminary effect on FC outcomes was assessed on FC anxiety and self-efficacy. Data were analysed using descriptive statistics, ANCOVAs and logistic regressions. RESULTS The primary indicator of obtaining consent from FC was achieved (77%). Of the 14 dyads, thirteen (93%) dyads received all seven encounters planned in the experimental intervention. Intervention group patients presented better psycho-functional recovery scores when compared with control group patients (p = 0·01). Mean delirium severity scores showed similar trajectories on days 1, 2 and 3 in both groups. CONCLUSION The mentoring intervention was acceptable and feasible and shows promising results in improving patients and FC outcomes. RELEVANCE TO CLINICAL PRACTICE Nurses should involve, if willing, FC to participate in activities that optimise patient well-being FC to use recognized delirium management strategies like reorientation and reassurance.
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Affiliation(s)
- Tanya Mailhot
- Montreal Heart Institute Research Center S-2490, University of Montreal, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada
| | - Sylvie Cossette
- University of Montreal, Montreal Heart Institute Research Center S-2510, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada
| | - José Côté
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, University of Montreal, PO Box 6128, Downtown Branch, Montréal (Québec) H3C 3J7, Canada
| | - Anne Bourbonnais
- University of Montreal, Chair of the Desjardins Research, Chair in Nursing Care for Older People and their Families, Centre de recherche de l'Institut universitaire de gériatrie de Montréal, PO Box 6128, Downtown Branch, Montréal (Québec) H3C 3J7, Canada
| | - Marie-Claude Côté
- Department of Psychosomatics, Montreal Heart Institute, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, Montreal Heart Institute, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada
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