Violent Event Severity Tool for Reporting Violent Incidents.

OBJECTIVES: To explore the usefulness of the Violent Event Severity Tool (VEST). BACKGROUND: The Joint Commission and many governing bodies require establishing workplace violence prevention programs in hospitals. Inconsistent processes have hampered the efficacy evaluation of such programs for collecting and reporting violence. The VEST was developed as a standardized tool for capturing violence data. METHODS: Ninety-six healthcare workers attending the 2022 Magnet® conference completed the survey. The VEST includes 6 types and 4 intensities of violent incidents. RESULTS: Most participants reported that the VEST is easy to use (79%), relevant (85%), and useful (85%). Fewer than half were satisfied with their incident report filing processes. Only 38% of participants experiencing grade 1 physical assault filed an incident report, whereas 70% and 100% experiencing grades 3 and 4 physical assaults filed. CONCLUSIONS: The VEST appears to be a useful and relevant tool for consistent collection and reporting of various violence types and severities.

Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments.

Objective: Violence is a major preventable problem in emergency departments (EDs), and validated screening tools are needed to identify potentially violent patients. We aimed to test the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening patients in the ED. Methods: A prospective cohort study was conducted among adult and pediatric patients aged ≥10 years visiting 3 emergency departments in Michigan between May 1, 2021, and June 30, 2021. Triage nurses completed the 16-item checklist using electronic health records (EHRs), and the occurrence of violent incidents were collected before ED disposition. A multivariate logistic regression model was applied to select a parsimonious set of items. Results: Among 10,554 patients, 127 had ≥1 violent incidents (1.2%). The regression model resulted in a 7-item ABRAT for EDs, including history of aggression and mental illness and reason for visit, as well as 4 violent behavior indicators. Receiver operating characteristics analysis showed that the area under the curve was 0.91 (95% confidence interval [CI], 0.87-0.95), with a sensitivity of 84.3% (95% CI, 76.5%-89.9%) and specificity of 95.3% (95% CI, 94.8%-95.7%) at the optimal cutoff score of 1. An alternative cutoff score of 4 for identifying patients at high risk for violence had a sensitivity and specificity of 70.1% and 98.9%, respectively. Conclusion: The ABRAT for EDs appears to be a simple yet comprehensive checklist with a high sensitivity and specificity for identifying potentially violent patients in EDs. The availability of such a screening checklist in the EHR may allow rapid identification of high-risk patients and implementation of focused mitigation measures to protect emergency staff and patients.

Nurses' mental health from early COVID-19 pandemic to vaccination.

AIMS: The influence of the COVID-19 vaccine and the evolution of the pandemic over time on nurses' mental health have not been thoroughly examined. This study aimed to explore the changes in nurses' mental health from the early pandemic to the early vaccination period over a 1-year time span and examine vaccination and coping mechanisms as predictors of nurses' poor mental health and burnout. METHODS: Three cross-sectional surveys were conducted: Early-pandemic (n = 320), pre-vaccination (n = 228), and early-vaccination cohorts (n = 292). FINDINGS: About 72% of nurses in the early-vaccination cohort were fully vaccinated with two doses of mRNA COVID-19 vaccines. There were significant decreases in moderate/severe anxiety and moderate/severe depression for the early-vaccination cohort compared to the other cohorts. In multivariate analyses, vaccination had almost three-fold higher odds of moderate/severe anxiety (Odds Ratio [OR] = 2.87; 95% Confidence Interval [CI] = 1.28-6.44). High resilience, family functioning, and spirituality were associated with two- to five-fold lower odds of poor mental health and burnout. CONCLUSIONS: Although nurses in the early-vaccination cohort had lower anxiety and depression than earlier cohorts, COVID-19 vaccination had minimal associations with nurses' mental health. Coping mechanisms and organizational support appear to be important predictors of nurses' poor mental health and burnout. CLINICAL RELEVANCE: The evidence gathered over 1 year of the pandemic may be helpful for a better understanding of the challenges facing frontline nurses and preparing for future healthcare crises. As a part of the preparedness plan for the future, evidence-based interventions that raise frontline nurses' resilience, as well as family and spiritual support, should be considered.

COVID-19: Update on Health Care Workers' Mental Health and Coping During the Pandemic.

During the COVID-19 pandemic, health care workers experienced much higher symptoms of anxiety or depression than during the prepandemic period. As coping mechanisms, high resilience, spirituality, and satisfaction with family functioning were associated with 2- to 3-fold lower odds of anxiety or depression. Health care organizations may consider implementing evidence-based and practical supportive measures to help health care workers maintain good mental health during and after the pandemic.

Impacts of Coping Mechanisms on Nursing Students' Mental Health during COVID-19 Lockdown: A Cross-Sectional Survey.

The COVID-19 pandemic and consequent lockdown have precipitated significant disruption in the educational system. Nursing students are known to have higher levels of stress and anxiety than other non-nursing students, but there is a dearth of evidence regarding the impacts of the COVID-19 lockdown on their mental health and coping mechanisms. PURPOSE: The aim of this study was to explore the influence of coping mechanisms as predictors of stress, anxiety, and depression among nursing students during the COVID-19 lockdown. METHODS: A cross-sectional online survey was conducted from 20 April to 10 May 2020 among 173 nursing students at a private university in Southern California, USA. RESULTS: Self-reported stress, anxiety, and depression were significantly higher during the lockdown compared to the pre-lockdown period (p < 0.001). Almost a quarter of participants reported high stress, while more than half reported moderate-to-severe symptoms of anxiety and depression. High resilience was negatively associated with high stress (Odds Ratio (OR) = 0.46; 95% Confidence Interval (CI) = 0.22-0.98; p = 0.045), moderate-to-severe anxiety (OR = 0.47; 95%CI = 0.25-0.90; p = 0.022), and moderate-to-severe depression (OR = 0.50; 95%CI = 0.26-0.95; p = 0.036). Similarly, high family functioning was negatively associated with high stress (OR = 0.41; 95%CI = 0.20-0.86; p = 0.018), moderate-to-severe anxiety (OR = 0.41; 95%CI = 0.21-0.80; p = 0.009), and moderate-to-severe depression (OR = 0.41; 95%CI = 0.20-0.81; p = 0.011). High spiritual support was negatively associated with moderate-to-severe depression (OR = 0.48; 95%CI = 0.24-0.95; p = 0.035). CONCLUSIONS: During the COVID-19 lockdown, nursing students experienced remarkable levels of poor mental health. High levels of resilience and family functioning were associated with 2- to 2.4-fold lower risk of stress, anxiety, and depression, whereas high spiritual support was associated with 2-fold lower risk of depression. As the pandemic evolves, fostering these coping mechanisms may help students to maintain their psychological wellbeing.

Severe Burnout and Poor Mental Health Among Healthcare Workers 6 Months After COVID-19 Pandemic Declaration: What Can We Learn for Future Emergencies?

OBJECTIVES: The aim of this study was to examine the predictors associated with severe burnout and poor mental health among healthcare workers during the COVID-19 pandemic as a learning opportunity for future emergent situations. BACKGROUND: Modifiable predictors of mental health need to be further examined and quantified to prioritize human resource support in organizations as healthcare workers confront stressful situations. METHODS: A cross-sectional survey was conducted among 271 healthcare workers from September 8 to October 10, 2020. RESULTS: Approximately one-third reported severe burnout, as well as moderate/severe anxiety and depression. Feeling protected working with COVID-19 patients, high family functioning, and spirituality were associated with 2- to 4-fold lower odds of severe burnout. Satisfaction with the organization's communications predicted 2-fold lower odds of anxiety, whereas high resilience was associated with almost 4-fold lower odds of stress and depression. CONCLUSIONS: Healthcare organizations may consider adopting programs to foster resilience, family and spiritual support, and effective communication strategies to reduce burnout and poor mental health among healthcare workers during pandemics and other situations of high stress.

Predictors of poor mental health among nurses during COVID-19 pandemic.

AIMS: To examine the impact of various factors affecting nurses' mental health during the COVID-19 pandemic. DESIGN: An online cross-sectional study. METHODS: Registered nurses who graduated from a nursing school in Southern California, USA, participated in the study from 20 April-10 May 2020 (N = 320). Kendall's tau correlations and multivariate logistic regression procedures were performed with stress, anxiety and depression as outcome variables. RESULTS: Most nurses reported moderate/high stress (80.1%), while 43% and 26% reported moderate/severe anxiety and depression, respectively. COVID-19 patient care was positively associated with moderate/severe high stress (OR = 2.25; p = .012) and moderate/severe anxiety (OR = 3.04; p < .001), whereas quarantine was associated with moderate/severe depression (OR = 2.68; p < .001). High levels of family functioning, resilience and spirituality predicted two- to sixfold lower odds of moderate/severe stress, anxiety or depression. High resilience, spirituality and family functioning appear to be good coping mechanisms for nurses against stress, anxiety and depression during the pandemic.

Impacts of peer tutoring on academic performance of first-year baccalaureate nursing students: A quasi-experimental study.

BACKGROUND: Peer tutoring has multiple benefits for students and the nursing program. However, little is known about the impacts of a peer tutoring on students' academic success. OBJECTIVES: This study aimed to examine the impacts of a peer tutoring program on the course failure rates and exam scores among first-year baccalaureate nursing students. DESIGN: A quasi-experimental study was conducted at a public university in the USA. A formal peer tutoring program was offered to the Class of 2020 over their first three semesters (n = 317), and the Class of 2018 without peer tutoring served as a historical comparison group (n = 285). The peer tutoring program provided free, one-on-one assistance to any students who needed additional academic support. RESULTS: The overall course failure rate was 3.47% for the class with peer tutoring compared to 7.02% without peer tutoring (χ2 = 3.87; p = 0.049). For the class with peer tutoring, about one half attended the sessions. The attendees had lower first exam scores compared to the non-attendees, but the final exam scores of attendees improved by 4 points out of 100 possible (p < 0.001). For the non-attendees, the exam scores did not change significantly. Students who attended two or more sessions per semester improved their scores by about 5 points. There was a positive association between the improvements in exam scores and the frequency of tutoring sessions attended per semester (p = 0.002). CONCLUSIONS: It appears that the peer tutoring was effective in reducing course failure rates as well as improving exam scores among first-year baccalaureate-nursing students. Peer tutoring may be a useful and cost-effective strategy to help at-risk nursing students as they adjust to the challenges of academic demands in nursing programs.

Impact of an extracurricular, student-led journal club on evidence-based practice among baccalaureate nursing students.

Objective Journal clubs are accepted as an effective strategy for promoting evidence-based practice (EBP). However, journal clubs are underutilized in nursing education, and little is known about the impact of extracurricular, student-led journal clubs on EBP implementation among baccalaureate nursing students. The purpose of this study was to estimate the impact of journal club attendance on EBP implementation. Methods A web-based survey was conducted in April 2019 following eight sessions of monthly journal club among senior nursing students (n=78). Results Fifteen students attended four or more extracurricular, student-led journal club sessions (19.2%). EBP practice score was significantly higher among frequent journal club attendees. In multivariate analysis, journal club attendance was the significant predictor of EBP practice (ß=0.34; p=0.006). Conclusion Graduating senior nursing students who attend extracurricular, student-led journal club sessions are more likely to carry out EBP practice. Participation in journal clubs may help increase their EBP competencies.

Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity.

BACKGROUND AND PURPOSE: Nutrition knowledge, attitudes, and eating self-regulation are important determinants of overweight and obesity. Eating self-regulation is the link between eating intention and behavior. However, the extent to which these factors influence overweight and obesity has not been thoroughly studied. The study examined nutrition knowledge, attitudes, and eating self-regulation as predictors of overweight and obesity among adults in a community setting. METHODS: A total of 313 adults participated in an online survey, which included the General Nutrition Knowledge Questionnaire-Revised, the Nutrition Attitudes Questionnaire, and the Self-Regulation of Eating Behavior Questionnaire. Descriptive statistics, Kendall's tau tests, and multivariate logistic regression procedures were performed. CONCLUSIONS: More than half of the participants were either overweight or obese (56.5%). The mean nutrition knowledge score was 74.1%, and only 28.1% correctly identified the body mass index for obesity. Positive predictors of overweight and obesity included poor eating self-regulation of giving up too easily on eating intentions (odds ratio [OR] = 3.81), male gender (OR = 2.0), and age (OR = 1.03), whereas nutrition attitudes were a negative predictor (OR = 0.74). IMPLICATIONS FOR PRACTICE: The odds of overweight or obesity were nearly four times greater for those who gave up too easily on their eating intentions. Nurse practitioners can play a critical role in establishing healthy dietary habits to maintain weight control by promoting good eating self-regulation, despite the current obesogenic environment. After assessing patient readiness and motivation, it is important to help patients make eating self-regulation as manageable as possible to promote long-term weight management.

Aggressive behaviour risk assessment tool for long-term care (ABRAT-L): Validation study.

This prospective cohort study was conducted to validate the usefulness of the Aggressive Behaviour Risk Assessment Tool for Long-Term Care (ABRAT-L) in predicting aggressive events. A total of 615 newly admitted residents at 22 long-term care homes in Canada were included. The risk of aggression was assessed using the six-item ABRAT-L within 24 hours of admission, and incident reports of aggressive events occurring within 30 days of admission were collected. Forty-seven residents out of 615 had one or more aggressive events (7.6%). The receiver operating characteristics analysis of ABRAT-L showed a good discriminant ability at the previously recommended cut-off score of 4, with satisfactory sensitivity and specificity. The usefulness of ABRAT-L in identifying potentially aggressive residents at the time of admission was confirmed. This validation study supports the adoption of a proactive risk assessment tool, ABRAT-L, as a part of routine admission assessments at long-term care homes.

Validity and reliability of sleep promotion questionnaire and predictors of quality of care.

BACKGROUND: Sleep disturbance is common among hospitalized patients. However, sleep promotion is not a high priority for most healthcare providers, which potentially impacts quality of care. Due to a paucity of validated tools to assess sleep promotion, little is known about the relationship between sleep promotion and quality of care. This study was conducted to assess the validity and reliability of a newly-developed instrument, the Sleep Promotion Questionnaire, and to examine sleep promotion as a predictor of quality of care. The Sleep Promotion Questionnaire includes dimensions of attitude, control, unit norms, intention, and behavior that are associated with sleep promotion. METHODS: A total of 302 nurses participated in an online survey. The survey included the initial 36-item Sleep Promotion Questionnaire, a quality of care question, Caring Behavior Inventory, and Professional Quality of Life scale. An exploratory factor analysis was performed to determine the factor structure of the Sleep Promotion Questionnaire. The internal consistency reliability as well as the convergent and divergent validities was assessed. Pearson's correlations and hierarchical multiple regression procedures were performed to explore the predictors of perceived quality of care. RESULTS: Exploratory factor analysis of the Sleep Promotion Questionnaire yielded 28 items in five subscales, comprising Attitude, Control, Unit Norms, Sleep-aid Intention, and Behavior. Convergent and divergent validities were supported (r = 0.37; r = -0.38, respectively). The Cronbach's alphas of internal consistency reliabilities of the Sleep Promotion Questionnaire subscales ranged from 0.70 to 0.89. Regression models showed that sleep-promoting Unit Norms was the only significant predictor of perceived quality of care among both ICU and non-ICU nurses (ß = 0.40; ß = 0.28, respectively). CONCLUSION: The Sleep Promotion Questionnaire appears to be a reliable and valid instrument with satisfactory psychometric properties for assessing sleep promotion, and it seems that having unit norms conducive to sleep promotion may positively impact the quality of care. However, further studies are needed to confirm these results.

Utility of the Aggressive Behavior Risk Assessment Tool in long-term care homes.

This study was conducted to determine the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) and the Aggressive Behavior Scale (ABS) for predicting aggressive incidents among newly-admitted and existing residents of two long-term care homes in Canada. Of 316 residents, 27 had at least one aggressive incident (8.5%). Receiver operating characteristics analysis showed that the area under the curve for the ABRAT was 0.86 (95% Confidence Interval [CI], 0.81-0.92) and that for the ABS was 0.75 (95% CI, 0.64-0.85). Sensitivity and specificity at the optimal cutoff score of 2 for the ABRAT were 96.3% and 65.4%, respectively, and those for the ABS at the optimal cutoff score of 3 were 59.3% and 80.6%, respectively. The ABRAT appears to be promising for use in long-term care homes for identifying potentially aggressive residents. However, further studies are needed to test the utility of the ABRAT among newly-admitted residents.

Six-Month Follow-up of a Regional Evidence-based Practice Fellowship Program.

OBJECTIVE: This study examined a 6-month follow-up of a regional evidence-based practice (EBP) fellowship program and the predictors of EBP adoption at hospital units. BACKGROUND: The immediate beneficial effects of a regional EBP program are known, but the medium-term effects are not certain. METHODS: A matched pretest/posttest study was conducted using a mailed questionnaire 6 months after the completion of a 9-month regional EBP fellowship program among 3 annual cohorts of participants. RESULTS: Statistically significant improvements in the mean scores of EBP beliefs, EBP implementation, and group cohesion were found (P < .05). Of the 47 participants who completed their EBP projects, more than three-quarters reported EBP adoption at their own hospital units, and EBP beliefs were a positive predictor of EBP adoption (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P = .017). CONCLUSIONS: The outcome improvements continued 6 months after the fellowship program, and strong EBP beliefs predicted EBP adoption in the participants' units.

Benefits of a Regional Evidence-Based Practice Fellowship Program: A Test of the ARCC Model.

BACKGROUND: The Advancing Research and Clinical practice through close Collaboration (ARCC) model postulates that improvement in nurses' evidence-based practice (EBP) beliefs results in improved EBP implementation, which in turn improves nurse-related outcomes, such as nurses' job satisfaction and group cohesion. However, there is a dearth of interventional studies that evaluate the relationships among these variables. AIMS: This study evaluated whether a regional EBP fellowship program improved participants' EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness, and examined the relationships among these improvements, using structural equation modeling. METHODS: A pretest-posttest design was used among three annual cohorts of a regional, 9-month EBP fellowship program, from 2012 to 2014, in San Diego, California. Matched pretest and posttest questionnaires, including EBP Beliefs, EBP Implementation, Job Satisfaction, Group Cohesion, and Group Attractiveness scales, were analyzed (N = 120). RESULTS: Paired t-tests showed statistically significant improvements in EBP beliefs, EBP implementation, job satisfaction, and group cohesion (p < .05). Structural equation modeling showed that improvement in EBP implementation had no direct effect on improvements in job satisfaction, group cohesion, or group attractiveness. However, improvement in EBP beliefs had direct effects on improvements in job satisfaction (ß = .24; p = .002) and group attractiveness (ß = .22; p = .010). LINKING EVIDENCE TO ACTION: A regional, collaborative EBP fellowship program was effective in improving EBP beliefs, EBP implementation, job satisfaction, and group cohesion. Improvement in EBP beliefs appears to have had direct effects on improvements in job satisfaction and group attractiveness. Regional fellowship programs that educate and support EBP champions and their mentors may enhance EBP adoption in nursing practice across multiple health care institutions.

Aggressive Behaviour Risk Assessment Tool for newly admitted residents of long-term care homes.

AIM: The aim of this study was to revise the 10-item Aggressive Behaviour Risk Assessment Tool for predicting aggressive events among residents newly admitted to long-term care homes. BACKGROUND: The original tool had acceptable sensitivity and specificity for identifying potentially aggressive patients in acute care medical-surgical units, but its usefulness in long-term care homes is unknown. DESIGN: A retrospective cohort study design was used. METHODS: All residents admitted to 25 long-term care homes in western Canada were assessed for the risk of aggression using the original tool within 24 hours of admission from January 2014 - December 2014 (n = 724). Incident reports of aggressive events occurring within 30 days of admission were collected. Multiple logistic regression and receiver operating characteristics analyses were performed. RESULTS: Fifty-three residents of 724 exhibited aggressive behaviours. The demographic variable of age less than 85 years was found to be a positive predictor of aggressive events in multivariate logistic regression model and was added to the tool. The revised six-item Aggressive Behaviour Risk Assessment Tool for Long-Term Care consists of one new item, age less than 85 years and five items from the original tool: History of physical aggression, physically aggressive/threatening, anxiety, confusion/cognitive impairment and threatening to leave. The receiver operating characteristics of the revised tool with weighted scoring showed a good discriminant ability with satisfactory sensitivity and specificity at the recommended cut-off score of 4. CONCLUSION: The revised six-item tool may be useful in identifying potentially aggressive residents newly admitted to long-term care homes.

Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants.

BACKGROUND: A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. AIMS: This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. METHODS: A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. RESULTS: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (ß = 0.33; p <.001) and job satisfaction (ß = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. LINKING EVIDENCE TO ACTION: In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

Impact of Interprofessional Education Among Nursing and Paramedic Students.

Simulation-based interprofessional education is beneficial, but it is not clear whether the nature of the simulation has any impact. A pretest and posttest study was conducted among nursing (n = 131) and paramedic (n = 58) students participating in mass casualty incident (MCI) simulations versus handoff communication simulations. Nursing students had better attitudes toward interprofessional education, as well as higher levels of satisfaction and self-confidence, after handoff communication simulations in comparison with MCI simulations. Active participation in clinical simulations appears to have a greater positive impact on nursing students.

Positive Tuberculosis Blood Test as a Predictor of Health Status Among HIV-Infected Persons.

This cross-sectional study explored tuberculosis (TB) knowledge, attitudes, practice, and TB interferon-gamma release assay (IGRA) results as the predictor of self-reported poor mental and physical health among HIV-infected persons attending a sexually transmitted diseases clinic (N = 111). The participants correctly responded to only 56.6% of the TB knowledge questions. Most had positive attitudes and would not be ashamed of TB diagnosis. The TB practice was suboptimal with only half having been tested for TB within the past 2 years. Eight percent of the participants had positive IGRA (n = 9). Simultaneous multiple regression models showed that positive IGRA, an indicator of latent TB infection, was the only significant predictor of both poor mental health (p = .006) and physical health days (p = .016). IGRA screening and treatment of latent TB infection in HIV-infected persons could potentially improve their mental and physical health status in addition to reducing the TB reactivation rate.

Preoperative education on postoperative delirium, anxiety, and knowledge in pulmonary thromboendarterectomy patients.

BACKGROUND: Delirium is the most common postoperative psychiatric condition in intensive care settings and can lead to increased complications and costs. OBJECTIVES: To evaluate the impact of multifaceted preoperative patient education on postoperative delirium, anxiety, and knowledge and to explore predictors of postoperative delirium, days of mechanical ventilation, and days in the intensive care unit (ICU) in patients undergoing pulmonary thromboendarterectomy. METHOD: A prospective, randomized controlled trial was conducted on consented patients from October 2011 to April 2013. Patients were randomized in a 1 to 1 ratio to receive either an individualized 45-minute multifaceted preoperative education (experimental group, n = 63) or standard education (control group, n = 66). Participants completed the State-Trait Anxiety Inventory and Knowledge Test before and after the education. Data on incidence of delirium, days of mechanical ventilation, ICU days, and cardiopulmonary parameters were collected. RESULTS: The experimental group had significantly more knowledge about postoperative care (P< .001) and fewer days of mechanical ventilation (P = .04) than the control group. The 2 groups did not differ significantly in anxiety, incidence of delirium, or ICU days. In exploratory multivariate analyses, hearing impairment was a positive predictor for days of delirium (P = .009), days of mechanical ventilation (P< .001), and ICU days (P= .049), whereas the posttest knowledge was a negative predictor for days of mechanical ventilation (P = .02). CONCLUSION: The patient education appeared to be effective in improving knowledge and reducing days of mechanical ventilation. Hearing impairment was an unexpected predictor of adverse outcomes for patients but may be amenable to nursing intervention.