Prevention of ICU Delirium Through Implementation of a Sleep Promotion Bundle

Background: Intensive care unit (ICU) delirium is the prevalence of delirium in ICU patientswho do not have a history of drug/alcohol abuse, an admission for a mental status change, or anadmission to the ICU for less than 24 hours. Serious adverse outcomes have been linked to thepresence of ICU delirium resulting in overall longer hospital lengths of stay, longer duration ofmechanical ventilation, higher rates of mortality, and long-term neuropsychological deficits afterdischarge. At the site of this quality improvement project, the prevalence of ICU delirium was92.3% in a population determined to be high risk using the PRE-DELIRIC screening tool. Aim: The aim of this quality improvement project was to decrease the prevalence rate of ICUdelirium ICU through the implementation of a sleep-wake cycle bundle. Methods: The process began with screening new admissions within twenty-four hours ofadmission to determine whether intervention is needed. Intervention ended at their dischargefrom the unit, death, or the designation of “comfort measures only (CMO)” by the physician. The site of this quality improvement project was a surgical/trauma ICU in a large urban teachinghospital. ICU delirium prevalence rates were determined through a retrospective chart reviewover a period of thirty days. Using the PDSA framework, new admissions to the ICU werescreened using the PRE-DELIRIC model over a period of 30 days to determine their percent riskof developing delirium. Patients with a score of greater than 40% were enrolled in the projectand had a sleep promotion bundle initiated. These patients were followed throughout their ICUstay and presence of delirium was tracked. Compliance with the sleep promotion bundle wasalso tracked. Results: The 30 day rate of ICU delirium was reduced by 47.3% (p = 0.019).Conclusion: Limitations and implications of this quality improvement project will be discussed.Recommendations for practice will be made and the role of the Clinical Nurse Leader (CNL)will be addressed

The need for support: Young people living through a family health crisis

Young people living with a family health crisis are found to experience high levels of distress, anxiety, low mood and depressive symptoms and are at risk of becoming disengaged with education, socially isolated and uncertain regarding what the future will hold for them. A body of research indicates that practical intervention, including youth work, engagement with other young people and targeted support can have a significant impact upon a young person’s capacity to cope with a complex family health crisis and develop self-reliant behaviours. Despite the plethora of evidence to indicate the need for systems of support for children and young people experiencing a family health crisis, current provision across the UK is inconsistent, inequitable and not clearly underpinned by policy intervention. This study sets out to indicate the extent and nature of need of children and young people who are living with a family health crisis in Britain, the type of support they require and the ways in which Hope Support meets those needs

The NERC Earth Observation Data Centre (NEODC) (2006)

A poster describing the airborne and satellite data, website, community and projects provided by the NEOD

Understanding the meaning of the equal sign : an investigation of elementary students and teachers.

The purpose of this study was to investigate the impact of two different policies for implementing new mathematics standards in two schools, for grades two through five, on student understanding of the equal sign. The study also examined teachers’ knowledge of the equal sign. The research used a mixed methods design to explore differences in student understanding of the equal sign as a result of how standards were implemented in two adjoining states with two different decisions as to when the standards would be implemented. This dissertation shares research that may be of interest to teachers, administrators, teacher educators and other stakeholders. The main constructs under investigation were student understanding of the equal sign, teacher knowledge regarding the equal sign including how it is taught and assessed, and the impact of different implementation schedules for new mathematics standards on student performance on their knowledge of the meaning of the equal sign - a standard that was not previously explicit in either state. The study was conducted in two adjoining Midwestern states in three separate schools (fifth grade students from one of the states are housed in a middle school building for overcrowding reasons and are equivalent to fifth grade students in an elementary setting). Each school as per their state mandates, followed the timeline for new mathematics standards implementation with one school in the fourth year of implementation and the other two (same district) in their first year. The sample was 1,182 students in second, third, fourth and fifth grade and their forty-two classroom teachers. Students and teachers from the three schools were given the Mathematical Equivalence Knowledge Assessment (MEKA) as a measurement of teacher knowledge and student understanding of the equal sign. Data from teacher interviews and surveys were used to complement findings related to their students’ understanding of the equal sign and their classroom practices related to this topic. A hierarchical linear model was used to detect differences between student scores on the MEKA in each school in the two states. To determine the impact of teacher knowledge of the equal sign on student understanding of the equal sign an unconditional hierarchical linear model and a follow up ANCOVA were conducted using the MEKA results from both teacher and student participants. The same model was also used to detect significant differences found between student scores on the MEKA in one state and student scores on the MEKA from another state where each state followed a different timeline for new standard implementation. Findings from the study reveal that the different timeline for the implementation of the mathematics standards in the two states appears to have an impact on students’ understanding of the equal sign and indicated that teacher knowledge was not a significant predictor of student understanding of the equal sign. However, the results also show that state implementation timeline and a students’ grade level were significant predictors of student understanding of the equal sign. Through the interviews teachers were also found to have difficulty predicting their students’ performance on the MEKA, had varying definitions of the meaning of the equal sign, and many suggested that they did not explicitly teach or assess the meaning of the equal sign