Virtual reality stimulation to reduce the incidence of delirium in critically ill patients: study protocol for a randomized clinical trial.

BACKGROUND Delirium has been long considered as a major contributor to cognitive impairments and increased mortality following a critical illness. Pharmacologic and non-pharmacologic strategies are used against delirium in the intensive care unit (ICU), despite these strategies remaining controversial. Previous studies have shown the feasibility of using virtual reality within the ICU setting, and we propose to use this technology to investigate the effect of immersive virtual reality stimulation on the incidence of delirium in the ICU. Moreover, we propose to use motion sensors to determine if patient movement patterns can lead to early prediction of delirium onset. METHODS This study is conducted as a randomized clinical trial. A total of 920 critically ill patients in the ICU will participate. The control group will receive standard ICU care, whereas the intervention group will, in addition to the standard ICU care, receive relaxing 360-degree immersive virtual reality content played inside a head-mounted display with noise-cancelling headphones, three times a day. The first 100 patients, regardless of their group, will additionally have their movement patterns recorded using wearable and ambient sensors. Follow-up measurements will take place 6 months after discharge from the ICU. DISCUSSION Delirium is widely present within the ICU setting but lacks validated prevention and treatment strategies. By providing patients with virtual reality stimulation presented inside a head-mounted display and noise-cancelling headphones, participants may be isolated from disturbances on an ICU. It is believed that by doing so, the incidence of delirium will be decrease among these patients. Moreover, identifying movement patterns associated with delirium would allow for early detection and intervention, which may further improve long-term negative outcomes associated with delirium during critical care. TRIAL REGISTRATION ClinicalTrials.gov NCT04498585 . Registered on August 3, 2020

Overview and Strategy Analysis of Technology-Based Nonpharmacological Interventions for In-Hospital Delirium Prevention and Reduction:Systematic Scoping Review

BACKGROUND: Delirium prevention is crucial, especially in critically ill patients. Nonpharmacological multicomponent interventions for preventing delirium are increasingly recommended and technology-based interventions have been developed to support them. Despite the increasing number and diversity in technology-based interventions, there has been no systematic effort to create an overview of these interventions for in-hospital delirium prevention and reduction. OBJECTIVE: This systematic scoping review was carried out to answer the following questions: (1) what are the technologies currently used in nonpharmacological technology-based interventions for preventing and reducing delirium? and (2) what are the strategies underlying these currently used technologies? METHODS: A systematic search was conducted in Scopus and Embase between 2015 and 2020. A selection was made in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies were eligible if they contained any type of technology-based interventions and assessed delirium-/risk factor–related outcome measures in a hospital setting. Data extraction and quality assessment were performed using a predesigned data form. RESULTS: A total of 31 studies were included and analyzed focusing on the types of technology and the strategies used in the interventions. Our review revealed 8 different technology types and 14 strategies that were categorized into the following 7 pathways: (1) restore circadian rhythm, (2) activate the body, (3) activate the mind, (4) induce relaxation, (5) provide a sense of security, (6) provide a sense of control, and (7) provide a sense of being connected. For all technology types, significant positive effects were found on either or both direct and indirect delirium outcomes. Several similarities were found across effective interventions: using a multicomponent approach or including components comforting the psychological needs of patients (eg, familiarity, distraction, soothing elements). CONCLUSIONS: Technology-based interventions have a high potential when multidimensional needs of patients (eg, physical, cognitive, emotional) are incorporated. The 7 pathways pinpoint starting points for building more effective technology-based interventions. Opportunities were discussed for transforming the intensive care unit into a healing environment as a powerful tool to prevent delirium. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020175874; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=17587

REALIDADE VIRTUAL NA UNIDADE DE TERAPIA INTENSIVA (UTI)

Virtual Reality (VR) has shown positive aspects in the rehabilitation of patients admitted to the Intensive Care Unit (ICU). Thus, the study aimed to understand how VR can bring benefits to patients admitted to the ICU, showing from studies already published the various applications of Virtual Reality in the ICU, corroborating future studies about it and pointing out its benefits. This is a study that has a qualitative content, based on bibliographic studies of sources of published articles. To answer the guiding question "how the use of Virtual Reality can bring benefits to patients hospitalized in the intensive care unit" the databases Latin American and Caribbean Literature in Health Sciences (LILACS), the SciELO library – Scientific Electronic Library Online and PUBMED searches in journals, theses and dissertations were accessed through the advanced search. Thus, the terms delimiters of the research, "Intensive care unit", "Virtual reality", "Benefit of virtual reality" and "Rehabilitation" were used. Thus, the studies showed a positive effect of Virtual Reality in patients admitted to the ICU, helping in early mobilization, improving the quality of sleep and cognition, and promoting relaxation. Therefore, the use of Virtual Reality in the ICU should be considered as a promising resource for the assistance to this patient profile, favoring them with improved quality of life and even early discharge.La Realidad Virtual (RV) ha mostrado aspectos positivos en la rehabilitación de los pacientes ingresados en la Unidad de Cuidados Intensivos (UCI). Así, el estudio tuvo como objetivo comprender cómo la RV puede aportar beneficios a los pacientes ingresados en la UCI, mostrando a partir de estudios ya publicados las diversas aplicaciones de la Realidad Virtual en la UCI, corroborando futuros estudios al respecto y señalando sus beneficios. Se trata de un estudio que tiene un contenido cualitativo, basado en estudios bibliográficos de fuentes de artículos publicados. Para responder a la pregunta orientadora "cómo el uso de la Realidad Virtual puede traer beneficios a los pacientes internados en la unidad de cuidados intensivos" se accedió a las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), la biblioteca SciELO – Scientific Electronic Library Online y búsquedas PUBMED en revistas, tesis y disertaciones a través de la búsqueda avanzada. Así, se utilizaron los términos delimitadores de la investigación, "Unidad de cuidados intensivos", "Realidad virtual", "Beneficio de la realidad virtual" y "Rehabilitación". Así, los estudios mostraron un efecto positivo de la Realidad Virtual en pacientes ingresados en la UCI, ayudando en la movilización temprana, mejorando la calidad del sueño y la cognición, y promoviendo la relajación. Por lo tanto, el uso de la Realidad Virtual en la UCI debe considerarse como un recurso prometedor para la asistencia a este perfil de paciente, favoreciéndolos con una mejor calidad de vida e incluso un alta temprana.A Realidade Virtual (RV) tem mostrado vertentes positivas na reabilitação de pacientes internados na Unidade de Terapia Intensiva (UTI). Assim, o estudo objetivou compreender como a RV pode trazer benefícios aos pacientes internados na UTI mostrando, a partir de estudos já publicados, as várias aplicações da Realidade Virtual na UTI, corroborando com estudos futuros a respeito dela e apontando os seus benefícios. Trata-se de um estudo que tem teor qualitativo, fundamentado através de estudos bibliográficos de fontes de artigos publicados. Para responder à questão norteadora “como o uso da Realidade Virtual pode trazer benefícios aos pacientes internados na unidade de terapia intensiva” foram acessadas as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), na biblioteca SciELO – Scientific Electronic Library Online e PUBMED buscas em periódicos, teses e dissertações por meio da busca avançada. Assim, foram utilizados os termos delimitadores de pesquisa, “Unidade de terapia intensiva”, “Realidade virtual”, “Benefício da realidade virtual” e “Reabilitação”. Dessa forma os estudos evidenciaram efeito positivo da Realidade Virtual nos pacientes internados na UTI, auxiliando na mobilização precoce, melhora na qualidade do sono e da cognição, além de promover relaxamento. Logo, o uso da Realidade Virtual na UTI deve ser considerado como um recurso promissor para a assistência a este perfil de paciente, favorecendo-os com melhora da qualidade de vida e até a alta precoce.A Realidade Virtual (RV) tem mostrado vertentes positivas na reabilitação de pacientes internados na Unidade de Terapia Intensiva (UTI). Assim, o estudo objetivou compreender como a RV pode trazer benefícios aos pacientes internados na UTI mostrando, a partir de estudos já publicados, as várias aplicações da Realidade Virtual na UTI, corroborando com estudos futuros a respeito dela e apontando os seus benefícios. Trata-se de um estudo que tem teor qualitativo, fundamentado através de estudos bibliográficos de fontes de artigos publicados. Para responder à questão norteadora “como o uso da Realidade Virtual pode trazer benefícios aos pacientes internados na unidade de terapia intensiva” foram acessadas as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), na biblioteca SciELO – Scientific Electronic Library Online e PUBMED buscas em periódicos, teses e dissertações por meio da busca avançada. Assim, foram utilizados os termos delimitadores de pesquisa, “Unidade de terapia intensiva”, “Realidade virtual”, “Benefício da realidade virtual” e “Reabilitação”. Dessa forma os estudos evidenciaram efeito positivo da Realidade Virtual nos pacientes internados na UTI, auxiliando na mobilização precoce, melhora na qualidade do sono e da cognição, além de promover relaxamento. Logo, o uso da Realidade Virtual na UTI deve ser considerado como um recurso promissor para a assistência a este perfil de paciente, favorecendo-os com melhora da qualidade de vida e até a alta precoce

Participatory Approaches and the Measurement of Human Well-being

participation, appraisal, methodology

Madness decolonized?: Madness as transnational identity in Gail Hornstein’s Agnes’s Jacket

The US psychologist Gail Hornstein’s monograph Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness (2009) is an important intervention in the identity politics of the mad movement. Hornstein offers a resignified vision of mad identity that embroiders the central trope of an “anti-colonial” struggle to reclaim the experiential world “colonized” by psychiatry. A series of literal and figurative appeals make recourse to the inner world and (corresponding) cultural world of the mad, as well as to the ethno-symbolic cultural materials of dormant nationhood. This rhetoric is augmented by a model in which the mad comprise a diaspora without an origin, coalescing into a single transnational community. The mad are also depicted as persons displaced from their metaphorical homeland, the “inner” world “colonized” by the psychiatric regime. There are a number of difficulties with Hornstein’s rhetoric, however. Her “ethnicity-and-rights” response to the oppression of the mad is symptomatic of Western parochialism, while her proposed transmutation of putative psychopathology from limit upon identity to parameter of successful identity is open to contestation. Moreover, unless one accepts Hornstein’s porous vision of mad identity, her self-ascribed insider status in relation to the mad community may present a problematic “re-colonization” of mad experience

The occupational therapy intensive care unit guide: a practical guide for implementing occupational therapy services with people who are critically ill

Patients who are critically ill in the intensive care unit (ICU) or critical care unit are at risk for cognitive, psychosocial, and physical impairments as a result of their admitting diagnosis or secondary diagnoses acquired during their hospital stay. Occupational therapy is a profession that facilitates patients’ recovery through holistic evaluation and treatment. Occupational therapy in the ICU improves patients’ strength, cognition, functional independence in activities of daily living and walking, decreases the duration and incidence of delirium, decreases time spent on mechanical ventilation, decreases the length of time patients spend in the hospital, and saves the hospital money (Alvarez et al., 2017; Lord et al., 2013; Schweickert et al., 2009; Weinreich, Herman, Dickason & Mayo, 2017). However, the problem is that a small number of patients are receiving occupational therapy when they are in the ICU. Due to the complexity of the medical environment, severity of patients’ illness, limited education on ICU care in entry- level occupational therapy and occupational therapy assistant programs, and limited research on the efficacy of occupational therapy evaluations and treatments, many occupational therapy practitioners do not have the knowledge and confidence to work in the critical care setting (Accreditation Council for Occupational Therapy Education (ACOTE) 2018; Foreman, 2005). In addition, many critical care team members are not aware of the benefits of early intervention occupational therapy in the ICU, impacting the number of referrals placed for patients while they are in the ICU setting (Zanni et al., 2010). The Occupational Therapy Intensive Care Unit Guide (OT ICU Guide) was created to improve the knowledge, confidence, and competency of occupational therapy practitioners working in the ICU in order to increase the presence of occupational therapy practitioners in the ICU. Increasing the presence of occupational therapy practitioners in the ICU will lead to an increase in the number of patients receiving occupational therapy during their stay in the ICU. The OT ICU Guide is a “one-stop shop” to guide occupational therapy practitioners on providing safe and evidence-based evaluations and treatments to patients in the ICU. The OT ICU Guide includes handouts, resources, guides, and brochures highlighting the role and benefits of occupational therapy in the ICU, safety and medical information for working with medically complex patients, and examples of occupational therapy assessments and treatment interventions for patients in the ICU. The OT ICU Guide is a steppingstone for increasing the presence and frequency of occupational therapy services in the ICU

(Re) evaluating Critical Care Nurse Support Program(s) in a Tertiary Care Hospital: Intersecting the Art and Science of Nursing

There is a growing critical care nurse staffing shortage with increases in nurse vacancy rates. Moral distress has been exacerbated by the SARS-CoV-2 (COVID-19) pandemic and, in particular, impacting critical care nurses. COVID-19 is a significant contributor to staffing shortages and continued nursing crisis. Thus, the impetus for the Problem of Practice (PoP): the lack of support to address the psychological, emotional, and spiritual distress suffered by critical care registered nurses in a tertiary care hospital in Central Ontario. To comprehend the realities of working in the intensive care units, leaders must first understand nurses’ lived experiences, narratives, and what it means to work on the frontline in an intensive care unit. The Organizational Improvement Plan (OIP) is underpinned by interpretive phenomenology and authentic and transformational leadership approaches. Lewin’s three-stage force field model of change theory is utilized for leading change and Burke and Litwin’s performance change model for the organizational analysis. The overall goal of the OIP is to implement a change plan that brings leaders and critical care registered nurses together to co-create support program(s) to address critical care nurses’ psychological, emotional, and spiritual distress, decrease nurse attrition, and enhance critical care nurses’ well-being

United Kingdom National Health Services: a case study of workforce transformation in an integrated care organisation using actor-network theory

Background: Since the 1950s the UK’s NHS went through many changes. Those changes including the most recent one; bringing care as close as possible to patients home have affected the services provided as well as those who provide them. One of the local acute health care organisations has chosen to integrate with the community and primary care services in response to this policy. A gap in literature about the role of the frontline health care professionals in the health care policy process was observed. Aim: The primary aim of this study was to examine the role that the health care professionals have in relation to health policy processes and the implications of the service integration to their professional practice. Methodology: To overcome the limitation of a single snapshot of the integration process that continues to emerge over the time, an instrumental case study approach to data collection was selected. To maintain the scope of the study, the case study approach also delineated the boundaries of what was to be studied. For the purpose of this study, two methods of data collection were utilised; in depth semi structured interviews with purposefully selected informants and documentary analyses. Actor Network Theory (ANT) was used as a theoretical framework to guide the research process. Findings: Though it could be explicit for health organisations integration as a special form of change, this study suggests that, neither the context nor the actors were the sole determinants of the outcome of the integration, it was rather the dynamic interplay between the actors, their context, the shared agency (social structures, rules, values, norms) and the resources available to them that shaped the end result. Conclusion: This thesis addresses an important issue in UK health care policy in relation to the reciprocal effect of frontline health care professionals and other policy driver on the policy implementation process and result

Comparison Between Conventional Intervention and Non-immersive Virtual Reality in the Rehabilitation of Individuals in an Inpatient Unit for the Treatment of COVID-19: A Study Protocol for a Randomized Controlled Crossover Trial.

Background: The new human coronavirus that leads to COVID-19 (coronavirus disease 2019) has spread rapidly around the world and has a high degree of lethality. In more severe cases, patients remain hospitalized for several days under treatment of the health team. Thus, it is important to develop and use technologies with the aim to strengthen conventional therapy by encouraging movement, physical activity, and improving cardiorespiratory fitness for patients. In this sense, therapies for exposure to virtual reality (VR) are promising and have been shown to be an adequate and equivalent alternative to conventional exercise programs. Aim: This is a study protocol with the aim of comparing the conventional physical therapy intervention with the use of a non-immersive VR software during COVID-19 hospitalization. Methods: Fifty patients hospitalized with confirmed diagnosis of COVID-19 will be divided in two groups under physiotherapy treatment using conventional or VR intervention: Group A: participants with COVID-19 will start the first day of the protocol with VR tasks in the morning and then in the second period, in the afternoon, will perform the conventional exercises (n = 25) and Group B: participants with COVID-19 will start the first day with conventional exercises in the morning and in the second period, in the afternoon, will perform activity with VR (n = 25). All participants will be evaluated with different motor and physiologic scales before and after the treatment to measure improvements. Conclusion: Considering the importance of benefits from physical activity during hospitalization, VR software shows promise as a potential mechanism for improving physical activity. The results of this study may provide new insights into hospital rehabilitation. Trial Registration: ClinicalTrials.gov, identifier: NCT04537858. Registered on 01 September 2020