The frequency of sepsis-associated delirium in intensive care unit and its effect on nurse workload.

AIM: To determine the frequency of sepsis-associated delirium (SAD) in the intensive care unit and its effect on nurse workload. DESIGN: A cross-sectional and correlational design was used. METHODS: The study was conducted with 158 patients in the adult intensive care unit of a hospital between October 28 and July 28, 2022. Data analysis included frequency, chi-squared/fisher's exact test, independent samples t-test, correlation analysis, simple and multiple linear regression analyses. The study adhered to the STROBE guidelines. RESULTS: Sepsis was detected in 12.7% of the patients, delirium in 39.9%, and SAD in 10.1%. SAD was more common in males (19%) and 56.3% of the patients were admitted to the unit from the emergency department. Patients developing SAD had significantly higher age and mean sequential organ failure evaluation, acute physiology and chronic health evaluation II, and C-reactive protein and lactate scores, but their Glasgow Coma Scale scores were significantly low. There was a moderate positive relationship between the patients' Sequential Organ Failure Assessment score and the presence of SAD. The most common source of infection in patients diagnosed with SAD was bloodstream infection (44.4%). SAD significantly increased nurse workload and average care time (1.8 h) and it explained 22.8% of the total variance in nurse workload. Additionally, the use of antibiotics, vasopressors and invasive mechanical ventilation significantly increased nurse workload. CONCLUSION: In the study, in patients who developed SAD increased nurse workload and average care time significantly. Preventive nursing approaches and effective management of SAD can reduce the rate of development of SAD and nurse workload. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: It is important to work with routine screening, prevention and patient-nurse ratio appropriate to the workload for SAD.

Intensive care nurses' awareness of identification of early sepsis findings.

AIM: To determine intensive care nurses' awareness of identification of early sepsis findings. BACKGROUND: The incidence of sepsis is increasing in intensive care units, and if not identified early, it increases morbidity, mortality and cost of care. Intervention within one hour after the diagnosis of sepsis increases survival. Nurses' ability to identify early findings of sepsis affects the time of diagnosis of sepsis. DESIGN: The study used a cross-sectional design. METHODS: The sample of the study consisted of 544 nurses working in adult intensive care units of hospitals in Turkey. The study data were collected online between 11 January-8 April 2021 using the snowball method. Data were statically analysed. All procedures of the study adhered to the STROBE guidelines. RESULTS: The nurses who had been working for 11 years or more, had worked with a patient diagnosed with sepsis in the last month and used a measurement tool in the diagnosis thought that it was significantly easier to determine the early warning findings of sepsis. In the study, the majority of nurses correctly identified the early findings of sepsis, but the rates of the correct responses to the variables of lactate >2 mM, leucopenia and hypothermia were low. Female gender, having a graduate degree, unit type, total work experience, having received training on sepsis and working with a patient diagnosed with sepsis in the last month made a significant difference in determining the early warning findings of sepsis accurately. CONCLUSIONS: Nurses had a good rate of identifying early sepsis findings. Yet, they could not distinguish between early sepsis and late sepsis findings. RELEVANCE TO CLINICAL PRACTICE: The results of the study can support nursing practices in the diagnostic process by considering the factors affecting nurses' ability to distinguish early sepsis findings from late sepsis findings and to identify them correctly.

[Pain beliefs of patients and the nonpharmacological methods they use to manage the pain]. / Hastalarin agri inançlari ve agriyi yönetmede kullandiklari ilaç disi yöntemler.

OBJECTIVES: This study was performed to determine the pain beliefs of patients and nonpharmacological methods they use to manage their pain. METHODS: This was a descriptive study conducted with the participation of 163 patients who were hospitalized in the medical and surgical clinics of a university hospital in May 2011. The study data were collected using personal information forms, a nonpharmacological methods form, and a pain belief scale. The data were evaluated using number, percentage, an independent sample t-test, and analysis of variance. RESULTS: The mean age of the patients was 52.7±16.6 years, and it was determined that 23.3% were hospitalized for urinary system diseases, while 21.5% were hospitalized for musculoskeletal system diseases. It was observed that 93.8% of the patients described experiencing pain in the past, while 22.7% described experiencing severe pain within the previous week. The types of pain most frequently described by the patients were headaches (24.8%), joint pain (21.6%), and lumbar pain (19.6%). It was determined that 72.3% of the patients used medication for pain, and that 49.1% also resorted to nonpharmacological methods for their pain. Frequently preferred nonpharmacological methods included hot and cold therapy, massage, and herbal methods. The mean organic score on the pain belief scale (23.6±4.57) was higher than the mean psychological score (19.9±2.64). CONCLUSION: Evaluating the pain beliefs of patients and the nonpharmacological methods used is important for effective management of pain.

The relationship of delirium and risk factors for cardiology intensive care unit patients with the nursing workload.

AIMS AND OBJECTIVES: To evaluate the relationship of delirium and risk factors for cardiology intensive care unit (ICU) patients with the nursing workload. BACKGROUND: Delirium is a common syndrome in patients with cardiac problems. The risk factors causing delirium and the presence and type of delirium affect the nurse workload and patient care quality adversely. DESIGN: This cross-sectional study was conducted with 133 patients staying at the cardiology ICU of a university hospital between 5 January-31 March 2017. METHOD: The study data were collected using the Patient Information Form, Delirium Risk Factors' Form and Therapeutic Intervention Scoring System-28 (TISS-28) scale to identify the nurse workload. The statistical analysis of the data was performed using frequency, chi-square, Mann-Whitney U, correlation and regression analyses. RESULTS: It was found that patients who developed delirium were 65 years or older, they had more nasogastric/total parenteral nutrition (NG/TPN), benzodiazepine and physical restraints in comparison with those with no delirium development, and that the prevalence of hypoxia and hypoalbuminemia were higher in these patients. The mean TISS-28 score was higher in patients with delirium, compared with those without delirium. There was a positive correlation between the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and the mean TISS-28 score of the patients. The mean TISS-28 score was found to significantly increase with being at the age of 65 and above and the administration of mechanical ventilation. The patients with delirium required a mean of 60-min additional care. CONCLUSIONS: Our study results suggest that the presence of delirium and the delirium risk factors, irrespective of delirium, increase the nurse workload. RELEVANCE TO CLINICAL PRACTICE: An effective management of delirium risk factors can improve the patient care quality by reducing delirium occurrence and nurse workload.

The effect of nonpharmacological training on delirium identification and intervention strategies of intensive care nurses.

OBJECTIVE: This study aims to investigate the effect of nonpharmacological intervention training on delirium recognition and the intervention strategies of intensive care (ICU) nurses. METHOD: This is a quasi-experimental study conducted using a pretest-posttest design. The study sample included a total of 95 patients staying in the medical ICU of a university hospital and 19 nurses working in these units. The data were collected using the Patient and Nurse Introduction, Confusion Assessment Method for the ICU, and Delirium Risk Factors, and Non-pharmacological Interventions in Delirium Prevention Forms. RESULTS: Delirium was identified in 26.5% and 20.9% of the patients in the pre- and posttraining phase, respectively. Patients with delirium had a longer duration of stay in the ICU, lower mean Glasgow Coma Scale score and a higher number of medications in daily treatment (p<0.05). The risk of delirium increased 8.5-fold by physical restriction and 3.4-fold by the presence of hypo/hypernatremia. The delirium recognition rate of nurses increased from 7.7% to 33.3% in the post-training phase. CONCLUSION: Our study results show that training can increase the efficiency of ICU nurses in the management of delirium.