45 research outputs found
Étude pilote randomisée évaluant une intervention infirmière de mentorat d’aidants familiaux pour gérer le délirium post-chirurgie cardiaque
Le délirium est un état confusionnel aigu se manifestant entre autres par de l’agitation, de la léthargie (APA, 2013). Le délirium survient chez près de la moitié des patients subissant une chirurgie cardiaque malgré les interventions de prévention basées sur des guides de pratique clinique (Gosselt et al., 2015). Les complications associées au délirium sont importantes incluant une augmentation de la durée de séjour et un ralentissement du rétablissement (Inouye, Wastendrop & Saczynski, 2013; Saczynski et al., 2012).
Cette étude portait sur le développement et l’évaluation d’une nouvelle intervention infirmière de mentorat visant à faciliter la participation d’un aidant familial dans la gestion du délirium. L’étude portait également sur la validité d’une nouvelle mesure de monitoring du délirium, l’oxymétrie cérébrale.
Le but principal de cette étude pilote randomisée était d’évaluer l’acceptabilité et la faisabilité du devis et de l’intervention infirmière de mentorat, ainsi que la validité de l’oxymétrie cérébrale. Le but secondaire était d’évaluer les effets préliminaires de l’intervention. Trente dyades comprenant un patient présentant un délirium post-chirurgie cardiaque et un aidant familial ont été assignées aléatoirement au groupe contrôle recevant les soins usuels ou au groupe recevant l’intervention infirmière. L’intervention, ancrée dans une approche caring, visait à faciliter la transition des aidants dans un rôle participatif auprès de leur proche atteint de délirium ainsi qu’à favoriser le rehaussement de leur sentiment d’efficacité personnelle.
L’indicateur principal d’évaluation de l’acceptabilité du devis était l’obtention du consentement d’au moins 75% des aidants approchés pour participer à l’étude. Par la suite, l’acceptabilité et la faisabilité ont été évaluées en se basant sur des critères d’évaluation des études pilotes pour le devis, par exemple, sur des données de recrutement et du domaine de l’évaluation d’interventions infirmières pour l’intervention, par exemple, la satisfaction des participants. Les effets préliminaires de l’intervention pour les patients ont été mesurés au moyen d’un score de sévérité du délirium, du nombre de complications, de la durée du séjour et du rétablissement psychofonctionnel. Auprès des aidants, des scores d’anxiété et d’efficacité personnelle ont été obtenus. Afin de tester la validité de la nouvelle mesure, les valeurs d’oxymétrie cérébrale ont été comparées à des scores de trois échelles d’évaluation du délirium validées.
L’indicateur principal d’acceptabilité du devis, a été atteint avec un taux de consentement chez les aidants de 76,9 %. Cependant, le recrutement s’est avéré un grand défi, principalement parce que la prévalence des délirium détectés fut moindre qu’anticipée. L'intervention était acceptable et réalisable, comme en témoigne la participation des aidants familiaux. Les résultats de sévérité du délirium se sont avérés similaires dans les deux groupes, tout comme ceux relatifs aux complications. Les autres mesures de résultats ont présenté une tendance favorisant le groupe intervention dont une durée d’hospitalisation plus courte ainsi qu’un niveau d’anxiété moindre et d’un niveau sentiment d’efficacité personnelle plus élevé chez les aidants. Un effet statistiquement significatif de l’intervention favorisant le groupe intervention a été observé sur le rétablissement psychofonctionnel (p = 0,01). Une relation statistiquement significative entre les valeurs d’oxymétrie cérébrale et la présence et la sévérité du délirium a été observée (p ≤ 0,001).
Cette étude contribue à l’avancement des connaissances par la démonstration de l’acceptabilité et la faisabilité d’une intervention pour rehausser la gestion du délirium par un mentorat des aidants familiaux. Une autre contribution réside dans les résultats prometteurs quant à la validité de l’oxymétrie cérébrale comme nouvelle mesure de monitoring du délirium qui pourra rehausser la détection et la gestion du délirium.Delirium is an acute confusional state accompanied by agitation or lethargy (APA, 2013). Despite the prevention strategies based on clinical practice guidelines, nearly half of the patients undergoing a cardiac surgery will present delirium (Gosselt et al., 2015). Complications of delirium are important and include increased length of stay in addition to a slower recovery (Inouye, Wastendrop & Saczynski, 2013; Saczynski et al., 2012).
This study focused, on a new nursing intervention aiming to facilitate participation from a family caregiver in the management of delirium. The study also focused on the validity of a new measure to monitor delirium, cerebral oximetry, a non-invasive measure potentially able to indicate the presence and severity of the delirium.
The primary objective of the randomized pilot study was to assess the acceptability and feasibility of the design and nursing interventions, and the validity of cerebral oximetry to monitor delirium. The secondary objective was to assess the preliminary efficacy of the intervention. Thirty dyads including a patient who had post-cardiac surgery delirium and a family caregiver were randomly assigned to either the control group receiving the usual care or a group receiving the experimental nursing interventions. The intervention, rooted in a caring approach, aimed to facilitate family caregivers’ transition to an involved role in delirium management in addition to promoting the enhancement of their self-efficacy.
The primary indicator to assess the acceptability of the design was the consent of at least 75 % of family caregivers who were approached to participate in the study. Afterwards, the acceptability and feasibility was were evaluated based on criteria in the field of pilot studies for the study design, for example, on recruitment data, and on criteria in the field of evaluation of nursing interventions for the intervention, for example, the satisfaction of the caregivers . The preliminary effects of the intervention of the patients were measured using a score reflecting delirium severity, the amount of postoperative complications as well as the length of hospital stay and patient’s psycho-functional recovery. Scores for anxiety and self-efficacy were also obtained from the caregivers. In order to test the validity of the new measure of delirium, cerebral oximetry values were compared to scores on three validated delirium rating scales.
The primary indicator of the acceptability estimate was achieved with a 76.9 % consent rate among caregivers. However, recruitment has sown itself to be a great challenge, mainly because the number of eligible patients was less than anticipated. The experimental intervention was acceptable and feasible, as evidenced by the participation of the caregivers. Results on delirium severity and complications were similar in the two groups. Results favoring the intervention groups included shorter length of stay and less anxiety along with the added feeling of greater personal effectiveness among caregivers. In addition, a statistically significant effect of the intervention was observed on the psycho-functional recovery favoring the intervention group. (p=0.01). A statistically significant relationship between cerebral oximetry and occurrence and severity of delirium was observed (p ≤ 0.001), supporting the potential of this measure in monitoring the delirium.
This study contributes to the advancements of knowledge through the demonstration of the acceptability and feasibility of an intervention to enhance the management of delirium by mentoring caregivers. Another contribution lies in the promising results on the validity of cerebral oximetry as a new monitoring measure of delirium, which has the potential of enhancing delirium detection and management
Translation, adaptation, and content validation of a French version of the Nurse Competence Scale in Canada.
Background: While everyone agrees that it is important for nurses to be competent practitioners,
no validated French questionnaire measuring nurse competence is available to date.
Internationally, one of the most frequently used questionnaires used to measure the competence
level of nurses working in a clinical setting is the Nurse Competence Scale (NCS).
Objective: The objective of this study was to translate and culturally adapt a French version of the
NCS (NCS-Fr) with nurses working in the province of Quebec (Canada).
Methods: It had a multi-method design, inspired by guidelines for translation, adaptation, and
validation of scales in health research. The scale instructions and items were translated from
English to French by two translators knowledgeable in nursing/healthcare and then back-translated
to English by two other translators. Versions were compared; ambiguities and discrepancies were
resolved during a synthesis discussion. A convenience sample of registered nurses (n=8) and
experts in nursing education (n=10) assessed instructions and items for comprehensibility.
Results: Content validity index (CVI) for items (I-CVI) of the preliminary version ranged from
0.56 to 1, with most items (n=64) meeting the threshold of 0.78. The scale CVI (S-CVI) was 0.89.
Conclusion: This study used a rigorous method to translate and adapt a French version of the NCS.
The next step will be to evaluate the psychometric properties and items performance of the NCSFr
Prise en charge infirmière du délirium chez les personnes âgées en soins critiques : détection, évaluation et interventions non pharmacologiques
Les unités de soins critiques sont un milieu
propice à la survenue du délirium chez les
personnes âgées qui y sont hospitalisées. Il est
décrit comme une dysfonction aiguë du cerveau
qui s’accompagne d’un déficit de l’attention, de
la cognition et de l’état de conscience. Cette
complication fréquente chez les personnes âgées
hospitalisées en soins critiques peut occasionner,
notamment, des chutes et laisser des séquelles
fonctionnelles et cognitives qui affectent le
rétablissement de la personne atteinte et risque
d’augmenter la mortalité. Puisque les interventions
pharmacologiques ne sont pas curatives face au
délirium, tout repose sur la détection précoce,
la recherche des causes et la mise en place
d’interventions non pharmacologiques pour le
prévenir lorsque possible ou en diminuer l’ampleur
ainsi que les conséquences délétères chez le
patient et ses proches. Les infirmières et les
autres professionnels de la santé jouent un rôle
crucial tant dans la détection que dans la gestion
du délirium. Cet article présente des outils pour
le détecter dans un contexte de soins critiques,
les éléments à surveiller lors de sa survenue et les
interventions infirmières à mettre en place pour
le gérer. Des avenues futures pour la recherche
sur le délirium chez les personnes âgées en soins
critiques sont abordées
Cerebral oximetry as a biomarker of postoperative delirium in cardiac surgery patients
Purpose
A promising monitoring strategy for delirium is the use of cerebral oximetry, but its validity during delirium is unknown. We assessed the relationship between oximetry and delirium. We hypothesized that as cerebral oximetry values increased, delirium would resorb.
Materials and methods
An observational study was conducted with 30 consecutive adults with delirium after cardiac surgery. Oximetry, delirium assessments, and clinical data were collected for 3 consecutive days after delirium onset. Oximetry was obtained using near-infrared spectroscopy. Delirium was assessed using diagnosis, occurrence (Confusion Assessment Method-ICU), and severity scales (Delirium Index).
Results
All patients presented delirium at entry. The mean oximetry value decreased from 66.4 ± 6.7 (mean ± SD) to 50.8 ± 6.8 on the first day after delirium onset and increased in patients whose delirium resorbed over the 3 days. The relationship between oximetry, delirium diagnosis, and severity was analyzed with a marginal model and linear mixed models. Cerebral oximetry was related to delirium diagnosis (P ≤ .0001) and severity (P ≤ .0001).
Conclusion
This study highlighted the links between increased cerebral oximetry values and delirium resorption. Oximetry values may be useful in monitoring delirium progression, thus assisting in the management of this complicated condition
An emergency department delirium screening and management initiative : the development and refinement of the SCREENED-ED intervention
The current article describes an intervention aimed at emergency department (ED) nurses and physicians that was designed to address the challenges of managing delirium in the ED environment. The intervention development process followed the Medical Research Council principles paired with a user-centered design perspective. Expert clinicians and nursing staff were involved in the development process. As a result, the SCREENED-ED intervention includes four major components: screening for delirium, informing providers, an acronym (ALTERED), and documentation in the electronic health record. The acronym “ALTERED” includes seven key elements of delirium management that were considered the most evidence-based, relevant, and practical for the ED. Nurses are at the frontline of delirium recognition and management and the SCREENED-ED intervention with the ALTERED acronym holds the potential to improve nursing care in this complex clinical setting
Effect of simulation-based education on the preparedness of healthcare professionals for the COVID-19 pandemic : a systematic review and meta-analysis
Healthcare organizations around the world have embraced simulation to prepare healthcare professionals to the COVID-19 pandemic. However, this pandemic implies additional educational challenges in rapidly designing simulation activities, while remaining compliant with health and safety measures to prevent the spread of the virus. The effect of simulation-based education in this context remains to be evaluated. Objective: The purpose of this systematic review was to describe the features and evaluate the effect of simulation activities on the preparedness of healthcare professionals and students to safely deliver care during the COVID-19 pandemic. Methods: Databases were searched up to November 2020 using index terms and keywords related to healthcare professions, simulation, and COVID-19. All learning outcomes were considered according to the Kirkpatrick model adapted by Barr et al. (2020). Reference selection, data extraction, and quality assessment were performed in pairs and independently. Results were synthesized using meta-analytical methods and narrative summaries. Results: 22 studies were included, 21 of which were single-group studies and 14 of those included pretest/posttest assessments. Simulation activities were mostly implemented in clinical settings using manikins for training on the use of personal protective equipment, hand hygiene, identification and management of COVID-19 patients, and work processes and patient flow. Large improvements in learning outcomes after simulation activities were reported in all studies. Discussion and conclusion: Results should be interpreted cautiously due to significant threats to the internal validity of studies and the absence of control groups. However, these findings are coherent with the overall evidence on the positive effect of simulation-based education. Future studies should include control groups if feasible.Les organisations de santé ont adopté la simulation pour préparer les professionnels à la pandémie de COVID-19. La conception en accéléré de simulations tout en respectant les mesures de prévention de la propagation du virus amène des défis. Dans ces conditions, l’efficacité de la simulation reste à être évaluée. Objectif : Décrire les caractéristiques et évaluer l’effet de simulations sur la préparation des professionnels de la santé et des étudiants pour fournir des soins sécuritaires pendant cette pandémie. Méthodes : Les bases de données ont été consultées jusqu’en novembre 2020 en utilisant des descripteurs et des mots-clés relatifs aux professions de la santé, à la simulation et à la COVID-19. Tous les résultats d’apprentissage ont été considérés. La sélection des articles, l’extraction des données et l’évaluation de la qualité ont été effectuées par paires. Les résultats ont été synthétisés par des méthodes méta-analytiques et des résumés narratifs. Résultats : 22 études ont été incluses ; 21 à groupe unique et, parmi ces 21, 14 évaluations pré-posttest. Les simulations ont principalement été déployées en milieux cliniques avec des mannequins pour la formation à l’utilisation d’équipements de protection individuelle, au lavage de mains, à l’identification et la prise en charge de patients atteints de la COVID-19 et à l’implantation de procédés organisationnels. Toutes les études rapportent des apprentissages importants après les simulations. Discussion et conclusion : Malgré les limites de validité interne et l’absence de groupes de contrôle, ces résultats sont cohérents avec l’état des connaissances sur les effets positifs de la simulation. De futures études devraient inclure des groupes de contrôle si possible
Activité de formation continue portant sur le délirium basée sur la pratique réflexive auprès d’infirmières en soins cardiologiques
Le délirium est d’origine multifactorielle, il fluctue dans le temps et est caractérisé par une
apparition soudaine de perturbations de l’attention, de l’état de conscience et des fonctions cognitives
(American Psychiatric Association [APA], 2013). Il peut atteindre jusqu’à 60 % des personnes âgées,
hospitalisées sur une unité de soins aigus, mais jusqu’aux deux tiers des épisodes ne sont pas dépistés
(Mittal et al., 2011; Voyer et al., 2015). Le projet visait à développer et mettre à l’essai une activité basée
sur les principes de la pratique réflexive auprès d’infirmières afin d’identifier et d’expérimenter des
activités de détection et de gestion du délirium chez la clientèle hospitalisée sur des unités de soins aigus
d’un centre hospitalier ultraspécialisé en cardiologie. Il a été développé selon un cadre de référence
incluant deux modèles complémentaires: la trousse de « mise en œuvre des lignes directrices sur les
pratiques exemplaires », proposée par l’Association des infirmières et infirmiers autorisés de l’Ontario
[AIIAO] (2012) et le modèle de réflexion structurée de Johns (2006). Le groupe participant à l’activité
de réflexion était composé de huit infirmières. L’évaluation du projet incluait une discussion de groupe
et un questionnaire d’évaluation portant sur le contenu, le format, la personne-ressource et l’appréciation
de l’activité. La démarche réflexive engendrée par cette approche a favorisé le développement des
compétences infirmières et les a soutenues dans l’identification et l’analyse rationnelle de leurs
préoccupations reliées au délirium, dans leur réflexion, la recherche de pistes de solution et la mise en
application de ces dernières
Assessing and addressing sexual concerns in individuals diagnosed with coronary artery disease
Background/Aims
Sexual concerns are frequently reported in people diagnosed with coronary artery disease. These concerns may be related to disorders in one or more phases of the sexual response cycle (i.e. desire, arousal and orgasm). Sexual concerns have been linked to anxiety, depressive symptoms and feelings of despair. As such, nurses should have an understanding of the aetiology of sexual concerns in this population and use appropriate assessment and support strategies.
Methods
This clinical article discusses several key aspects of evidence-based practice to assess and address sexual concerns in people diagnosed with coronary artery disease.
Findings
Early assessment of biological, psychological and pharmacological causes of sexual concerns should be carried out. Sexual counselling may be offered to meet specific information needs. Adding pharmacological agents and referring to a sex therapist can be considered to effectively address the sexual concerns of people within this population.
Conclusions
Approaches to sexual assessment, main information needs of patients with coronary artery disease regarding their sexual health, and support strategies are presented
Acceptability and feasibility of recruitment and data collection in a field study of hospital nurses’ handoffs using mobile devices
Background
The portability and multiple functionalities of mobile devices make them well suited for collecting field data for naturalistic research, which is often beset with complexities in recruitment and logistics. This paper describes the implementation of a research protocol using mobile devices to study nurses’ exchanges of patient information at change of shift.
Methods
Nurses from three medical and surgical units of an acute care teaching hospital in Montreal, Canada, were invited to participate. On 10 selected days, participants were asked to record their handoffs using mobile devices and to complete paper questionnaires regarding these exchanges. Nurse acceptance of mobile devices was assessed using a 30-item technology acceptance questionnaire and focus group interviews. The principal feasibility indicator was whether or not 80 complete handoffs could be collected on each unit.
Results
From October to December 2017, 63 of 108 eligible nurses completed the study. Results suggest that the use of mobile devices was acceptable to nurses, who felt that the devices were easy to use but did not improve their job performance. The principal feasibility criterion was met, with complete data collected for 176, 84, and 170 of the eligible handoffs on each unit (81% of eligible handoffs). The research protocol was acceptable to nurses, who felt the study’s demands did not interfere with their clinical work.
Conclusions
The research protocol involving mobile devices was feasible and acceptable to nurses. Nurses felt the research protocol, including the use of mobile devices, required minimal investment of time and effort. This suggests that their decision to participate in research involving mobile devices was based on their perception that the study protocol and the use of the device would not be demanding. Further work is needed to determine if studies involving more sophisticated and possibly more demanding technology would be equally feasible and acceptable to nurses
Nurses’ judgments of patient risk of deterioration at change-of-shift handoff : agreement between nurses and comparison with early warning scores
Background
Nurses begin forming judgments regarding patients’ clinical stability during change-of-shift handoffs.
Objectives
To examine the agreement between incoming and outgoing nurses’ judgments of deterioration risk following handoff and compare these judgments to commonly used early warning scores (MEWS, NEWS, ViEWS).
Methods
Following handoffs on three medical/surgical units, nurses completed the Patient Acuity Rating. Nurse ratings were compared with computed early warning scores based on clinical data. In follow-up interviews, nurses were invited to describe their experiences of using the rating scale.
Results
Sixty-two nurses carried out 444 handoffs for 158 patients. While the agreement between incoming and outgoing nurses was fair, correlations with early warning scores were low. Nurses struggled with predicting risk and used their impressions of differential risk across all the patients to whom they had been assigned to arrive at their ratings.
Conclusion
Nurses shared information that influenced their clinical judgments at handoff; not all of these cues may necessarily be captured in early warning scores