Educational Intervention to Improve Delirium Recognition by Nurses

Blevins, Cheri; DeGennaro, Regina

doi:10.4037/ajcc2018851

Cited by 25 publications

(20 citation statements)

References 33 publications

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“…Delirium has a strong nursing focus during its assessment and management. [5,29] In this study, there was a focus to implement a non-pharmacological intervention to reduce delirium by the family members. Several studies investigated the effect of reorientation audio message by family members on the consciousness level in comatose head injured patients.…”

Section: Discussionmentioning

confidence: 99%

“…[3,4] Delirium is considered as one of the neurocognitive complications occur in ICU and about 50%-80% of critically ill patients develop delirium. [4,5] Delirium is defined according to the American Psychiatric Association (2013) as "an acute change in consciousness that is accompanied by inattention and either a change in cognition or perceptual disturbance". [6] It usually develops over a short period of time from hours to days and fluctuates over time.…”

Section: Introductionmentioning

confidence: 99%

“…[7,13,15] Use of evidence-based interventions to prevent delirium should not depend only on an individual physician's order but rather should be structured as a daily part of care with clearly defined safety strategy. [5,13] The delirium prevention bundle is considered an essential intervention of the modern-day processes of care. Using such bundle allows optimization of critically ill patients' recovery, regaining their independence or help in peaceful death.…”

Section: Introductionmentioning

confidence: 99%

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Effect of family reorientation messages on delirium prevention among critically ill patients

Elcokany

Ahmed

2019

JNEP

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Background: About 50%-80% of critically ill patients develop delirium during their intensive care unit (ICU) stay. Adverse events associated with delirium can range from functional disability, cognitive and psychological impairment, dementia and even death. Removal of invasive lines, self-extubation, prolonged sedation and ventilation therapies which delay the ICU liberation, and increase the overall hospital length of stay are also negative squeals of delirium. Delirium has series of adverse events that are not limited to the associated morbidies and mortality, but also extended to include the burden placed on caregivers, families and healthcare services, in addition to increasing the cost of care. Using auditory stimulation as a non-pharmacological intervention can stimulate the affected neural networks, accelerate brain plasticity and avoid sensory deprivation that could induce pain, agitation, and delirium and slow down the patients' recovery. It is evident that familiar auditory stimuli by a familiar voice is eliciting more responses to auditory tones as it can grasp patients' attention without much effort and disrupts ongoing cognitive activities. Accordingly, multicomponent family reorientation strategy has recently been proposed to achieve better outcomes. Methods: A quasi experimental research design was used in this study in which one tool was used for data collection: "Confusion Assessment Method-intensive care unit (CAM-ICU)". Results: During the five-day intervention period, the delirium free days was all the days in the family voice group, four days in the unfamiliar voice group and no free days in the control group which indicates a significant difference among groups on number of delirium free days ( M C p < .001*). Conclusion: Reorienting critically ill patients through recorded messages is an effective strategy to reduce the incidence of delirium. Furthermore, using a familiar family sound is more effective in reducing delirium as proved by the number of delirium free days. During the five-day intervention period, the family voice group shows more delirium free days than the unfamiliar voice group. The intervention used in this study is easy, costless and effective strategy in prevention of delirium among critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of family reorientation messages on delirium prevention among critically ill patients

Elcokany

Ahmed

2019

JNEP

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“…The CAM‐ICU is considered the most validated delirium assessment tool with a sensitivity of >90% and reliability of k > 0.79 when used by researchers (van Eijk et al, ; see Table ). Instructions on the use of the CAM‐ICU are standardized, and interrater reliability is enhanced after training (Blevins & DeGennaro, ). A training video is available at http://www.icudelirium.org/delirium/monitoring.html.…”

Section: Methodsmentioning

confidence: 99%

“…Table 1). Instructions on the use of the CAM-ICU are standardized, and interrater reliability is enhanced after training (Blevins & DeGennaro, 2018). A training video is available at http:// www.icudelirium.org/delirium/monitoring.html.…”

Section: Setting/samplementioning

confidence: 99%

Methods of identifying delirium: A research protocol

Mulkey

Hardin

Munro

et al. 2019

Research in Nursing & Health

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Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10‐fold increase in cognitive impairment, triples the rate of in‐hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies. Early detection is crucial because the longer a patient experiences delirium the worse it becomes and the harder it is to treat. Currently, identification is through intermittent clinical assessment using standardized tools, like the Confusion Assessment Method for ICU. Such tools work well in clinical research but do not translate well into clinical practice because they are subjective, intermittent and have low sensitivity. As such, healthcare providers using these tools fail to recognize delirium symptoms as much as 80% of the time. Delirium‐related biochemical derangement leads to electrical changes in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. However, continuous EEG monitoring is not feasible due to cost and need for skilled interpretation. Studies using limited‐lead EEG show large differences between patients with and without delirium while discriminating delirium from other causes. The Ceribell is a limited‐lead device that analyzes EEG. If it is capable of detecting delirium, it would provide an objective physiological monitor to identify delirium before symptom onset. This pilot study was designed to explore relationships between Ceribell and delirium status. Completion of this study will provide a foundation for further research regarding delirium status using the Ceribell data.

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Three-Minute Diagnostic Assessment for Delirium using the Confusion Assessment Method (3D-CAM): French translation and cultural adaptation

Gaudet

Kull

Eskenazi

et al. 2022

Can J Anesth/J Can Anesth

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Purpose The routine use of validated diagnostic instruments is key to identifying delirious patients early and expediting care. The 3-Minute Diagnostic Assessment for Delirium using the Confusion Assessment Method (3D-CAM) instrument is a brief, easy to use, sensitive, and specific delirium assessment tool for hospitalized patients. We aimed to translate the original English version into French, and then adapt it to older high-risk patients. Methods Translation and adaptation of the questionnaire were guided by an expert committee and the 3D-CAM instrument developer. During the translation phase, we achieved semantic and conceptual equivalence of the instrument by conducting forward and backward translations. During the adaptation phase, we assessed the face validity, clarity of wording, and ease of use of the translated questionnaire by administering it to 30 patients and their caregivers in peri-interventional and medical intermediate care units. During both phases, we used qualitative (goal and adequacy of the questionnaire) and quantitative (Sperber score, clarity score) criteria. Results Translation: four items were judged inadequate and were revised until all reached a Sperber score of < 3/7. Face validity: 91% of patients thought the questionnaire was designed to assess memory, thoughts, or reasoning. Clarity: eight items required adjustments until all scored ≥ 9/10 for clarity. Ease of use: all bedside caregivers reported that the questionnaire was easy to complete after receiving brief instructions. Conclusions We produced a culturally adapted French version of the 3D-CAM instrument that is well understood and well-received by older high-risk patients and their caregivers.

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Educational Intervention to Improve Delirium Recognition by Nurses

Cited by 25 publications

References 33 publications

Effect of family reorientation messages on delirium prevention among critically ill patients

Effect of family reorientation messages on delirium prevention among critically ill patients

Methods of identifying delirium: A research protocol

Three-Minute Diagnostic Assessment for Delirium using the Confusion Assessment Method (3D-CAM): French translation and cultural adaptation

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