Effectiveness of an intensive care unit family education intervention on delirium knowledge: a pre-test post-test quasi-experimental study.

PURPOSE: To create, validate, and refine an intensive care unit (ICU) delirium education intervention to prepare family members to partner with the ICU care team to detect delirium symptoms and prevent and manage delirium using nonpharmacological strategies. METHODS: In this pre-test post-test quasi-experimental study, consecutive eligible family members of critically ill patients admitted to an ICU completed an ICU Family Education Delirium intervention in two parts: 1) six-minute video on ICU delirium (risk factors, prevention/management, symptoms, communication with the ICU care team), and 2) two case vignettes to practice detecting delirium using family-administered delirium detection questionnaires (Family Confusion Assessment Method [FAM-CAM] and Sour Seven). Family members' delirium knowledge was measured before, immediately after, and two weeks following the intervention using the Caregiver ICU Delirium Knowledge Questionnaire (CIDKQ). RESULTS: Of 99 family members recruited over eight months, 81 (82%) completed the intervention and 63 (63/81, 78%) completed all follow-up questionnaires. Family members' delirium knowledge improved significantly following the intervention (pre-CIDKQ, 14; 95% confidence interval [CI], 13 to 15; post-CIDKQ, 17; 95% CI, 16 to 17; P < 0.001) and was retained two weeks after the intervention (CIDKQ 16; 95% CI, 16 to 17; P < 0.001). This included increased knowledge regarding delirium risk factors (e.g., medication, mechanical ventilation), prevention/management (e.g., orientation, day/night routine), and symptoms of delirium. More family members correctly detected delirium symptoms in case vignettes using the Sour Seven (92%) compared with the FAM-CAM (78%). CONCLUSIONS: A video-based ICU delirium education intervention is effective in educating family members about prevention, detection, and management of delirium.

RéSUMé: OBJECTIF: Notre objectif était de créer, valider et améliorer une intervention de formation sur le delirium à l'unité de soins intensifs (USI) afin de préparer les membres de la famille à coopérer avec l'équipe de soins de l'USI pour dépister les symptômes de delirium ainsi que prévenir et prendre en charge le delirium à l'aide de stratégies non pharmacologiques. MéTHODE: Dans cette étude quasi expérimentale avant après, les membres éligibles consécutifs de familles de patients en état critique admis dans une USI ont pris part à une formation familiale sur le delirium à deux volets : 1) le visionnement d'une vidéo de six minutes sur le delirium à l'USI (facteurs de risque, prévention/prise en charge, symptômes, communication avec l'équipe de soins de l'USI), et 2) deux vignettes pour pratiquer le dépistage du delirium à l'aide de questionnaires de dépistage du delirium administrés par la famille (Méthode d'évaluation de la confusion par la famille [FAM-CAM] et Questionnaire de dépistage du delirium 'Sour Seven'). Les connaissances sur le delirium des membres de la famille étaient mesurées avant, immédiatement après et deux semaines après l'intervention à l'aide d'un Questionnaire sur les connaissances des aidants concernant le délirium à l'USI (CIDKQ). RéSULTATS: Parmi les 99 membres de famille recrutés au cours d'une période de huit mois, 81 (82 %) ont complété l'intervention et 63 (63/81, 78 %) ont complété tous les questionnaires de suivi. Les connaissances des membres de la famille sur le delirium se sont significativement améliorées après l'intervention (pré-questionnaire, 14; intervalle de confiance [IC] 95 %, 13 à 15; post-questionnaire, 17; IC 95 %, 16 à 17; P < 0,001) et étaient retenues deux semaines après l'intervention (questionnaire 16; IC 95 %, 16 à 17; P < 0,001). Cette amélioration était notable dans les catégories de connaissances en matière de facteurs de risque de delirium (par ex., la médication, la ventilation mécanique), de prévention et de prise en charge (par ex., l'orientation, la routine jour/nuit), et des symptômes de delirium. Un nombre plus élevé de membres des familles est parvenu à dépister correctement les symptômes de delirium dans les vignettes à l'aide du questionnaire Sour Seven (92 %) comparativement au FAM-CAM (78 %). CONCLUSION: Le visionnement d'une vidéo de formation sur le delirium à l'USI est efficace pour former les membres des familles quant à la prévention, le dépistage et la prise en charge du delirium.

Psychometric evaluation of the family caregiver ICU delirium knowledge questionnaire.

BACKGROUND: Delirium is a common condition in critically ill patients, affecting nearly half of all patients admitted to an intensive care unit (ICU). Family caregivers of critically ill patients can be partners in the early recognition, prevention and management of delirium provided they are aware of the signs/symptoms and appropriate non-pharmacological strategies that might be taken. Valid, reliable instruments that assess family caregiver knowledge are essential so that nurses can prepare family caregivers to be effective partners. The purpose of the current study was to (a) adapt an existing caregiver delirium knowledge questionnaire (CDKQ) for use by nurses to measure a family caregiver's delirium knowledge in the ICU; and (b) examine the psychometric properties and structure of the adapted Caregiver ICU Delirium Knowledge Questionnaire (CIDKQ). METHODS: In this cross-sectional study, a multidisciplinary team developed the 21-item CIDKQ (possible score range: 0-21) and administered it to 158 family caregivers of critically ill patients. Descriptive statistics were examined for all variables. The CIDKQ was analyzed for face validity, content validity, reliability and internal consistency. RESULTS: The mean CIDKQ score was 14.1 (SD: 3.5, range = 2 to 21). Path analysis revealed that a family caregiver's delirium knowledge in the actions and symptoms dimensions had a direct effect on knowledge of delirium risk factors. The CIDKQ was found to have face validity and reliability (Cronbach's α = 0.79). CONCLUSIONS: The findings indicated good validity and reliability of the CIDKQ as a measure of ICU delirium knowledge in family caregivers of critically ill patients.

Nurses' Experiences Empowering Hospitalized Patients.

Four focus groups were conducted to explore acute care nurses' experiences empowering patients and the facilitators and barriers they encountered during the process. Thirty-four nurses employed at four hospitals in the Midwestern United States participated in the study between February and April 2015. Facilitators of empowerment included establishing a therapeutic relationship, fostering communication, providing education, respecting patient autonomy, engaging support systems, and lifting spirit/giving hope. Barriers included conflicting information about plans of care, lack of time, fear and anxiety over unfamiliar environments and routines, ineffective or inadequate support systems, lack of/low accountability, and killing the soul. Nurses also described innovative strategies they used to overcome the barriers. The development of future inpatient empowerment interventions needs to focus on the innovative strategies nurses used to overcome barriers in addition to considering the facilitators and barriers to empowerment that nurses identified.

Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty.

OBJECTIVES: To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. DESIGN: Mixed-method, pre-post quasi-experimental design. SETTING: A Midwest Veterans Affairs Medical Center and a nonprofit health system. PARTICIPANTS: Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention. INTERVENTION: Four telephone-based education modules using vignettes were completed during the 3 weeks before the older adult's hospital admission for elective hip or knee replacement. Each module required 20 to 30 minutes. MEASUREMENTS: Interviews were conducted before the intervention and 2 weeks and 2 months after the older adult's hospitalization. A researcher completed the Confusion Assessment Method (CAM) and a family caregiver completed the Family Version of the Confusion Assessment Method (FAM-CAM) 2 days after surgery to assess the older adults for delirium symptoms. RESULTS: Family caregivers' knowledge of delirium symptoms improved significantly from before the intervention to 2 weeks after the intervention and was maintained after the older adult's hospitalization. They also were able to recognize the presence and absence of delirium symptoms in the vignettes included in the intervention and in the older adult after surgery. In 94% of the cases, the family caregiver rating on the FAM-CAM approximately 2 days after the older adult's surgery agreed with the researcher rating on the CAM. Family caregivers expressed satisfaction with the intervention and stated that the information was helpful. CONCLUSION: Delivery of a telephone-based intervention appears feasible. All family caregivers who began the program completed the four education modules. Future studies evaluating the effectiveness of the educational program should include a control group.

Engaging Nursing Staff in Research: The Clinical Nurse Specialist Role in an Academic-Clinical Partnership.

PURPOSE: The purpose of this article is to describe the processes of exploring and implementing an academic-clinical study, engaging nursing staff in research, and maintaining their enthusiasm within the context of an academic-clinical research partnership. DESCRIPTION: The core competencies of the clinical nurse specialist (CNS) role address evidence-based practice, quality improvement, and research. Studies and exemplars of the CNS role in the literature illustrate expert practitioner and facilitator of evidence-based practice, but less attention is given to methods used by the CNS to engage staff in clinical research. OUTCOME: The CNS was successful in obtaining staff engagement in the research project from exploration through sustainment. CONCLUSION: Collaborative research between academic and clinical partners enhances the educational and professional environment for students and clinicians, promotes evidence-based practice, and from this project may promote Veteran and family-centered care. The CNS played a key role in engaging and sustaining staff commitment, which contributed to the success of this study.

Educating Family Caregivers for Older Adults About Delirium: A Systematic Review.

BACKGROUND: Delirium in older adults is considered a medical emergency; it contributes to a cascade of functional decline and to increased mortality. Early recognition of delirium symptoms is critical to prevent these negative consequences. Family caregivers who are educated about delirium could partner with nurses and other healthcare professionals in early recognition of delirium symptoms. Before implementing such partnership models, it is important to examine the effectiveness of educating family caregivers about delirium. AIMS: To examine whether providing education on delirium to family caregivers improved their knowledge, emotional state, or response in reducing the incidence of delirium in older adults. METHODS: For this systematic review, we conducted literature searches in CINAHL, Cochrane Library, Medline, PsycINFO, Web of Science, Social Sciences in ProQuest, Dissertations and Theses, and the Virginia Henderson Global Nursing eRepository for studies published in the English language between January 2000 and June 2015. Criteria for inclusion were: (a) primary focus on educating family caregivers for older adults about delirium; (b) use of experimental, quasi-experimental, or comparative design; (c) measured family caregiver outcomes of delirium knowledge, emotional state, or response in reducing delirium incidence in older adults; and (d) published in the English language. Articles were appraised using Melnyk's rapid critical appraisal guides. RESULTS: Seven studies met the review criteria. Four studies found that family caregivers' delirium knowledge increased; two noted that delirium incidence in older adults declined; and one study reported less distress following receipt of education. LINKING EVIDENCE TO ACTION: Providing family caregivers with information about delirium can be beneficial for both family caregivers and older adults. However, rigorous evaluation of education programs for family caregivers about delirium is needed.

Family Caregivers' Knowledge of Delirium and Preferred Modalities for Receipt of Information.

Delirium is a life-threatening, frequently reversible condition that is often a sign of an underlying health problem. In-hospital mortality alone for older adults with delirium ranges from 25% to 33%. Early recognition of delirium is critical because prolonged duration poses a greater risk of poor functional outcomes for older adults. Family caregivers, who are familiar with the older adult's usual behaviors, are most likely to recognize delirium symptoms but might dismiss them as due to aging. It is important to learn what family caregivers know about delirium to ascertain their need for education. The aims of this study were to describe family caregivers' knowledge of delirium and preferred modalities for receipt of information about delirium. A cross-sectional design was used for this study and a survey distributed to family caregivers for older adults. Analysis of 134 usable surveys indicated that family caregivers need and want information about delirium. The preferred modalities for receipt of information included Internet, in-person classes, and newsletters.

Psychometric Properties of the Family Caregiver Delirium Knowledge Questionnaire.

A valid, reliable measure of family caregivers' knowledge about delirium was not located in the literature; such an instrument is essential to assess learning needs and outcomes of education provided. The purpose of the current study was to (a) develop a family Caregiver Delirium Knowledge Questionnaire (CDKQ) based on the Symptom Interpretation Model; and (b) establish validity and reliability of the measure. The 19-item CDKQ was developed and administered to 164 family caregivers for community-dwelling older adults. Descriptive statistics were examined for all variables. Psychometric testing included confirmatory factor analysis, item-to-total correlations, and internal consistency reliability. A three-factor model provided the best fit for the data. The findings support initial validity and reliability of the CDKQ with family caregivers. Although the CDKQ was developed for use with family caregivers, it has potential for use with other caregivers, such as home health aides.

Public health model identifies recruitment barriers among older adults with delirium and dementia.

Recruiting older adults and their family caregivers into research studies presents challenges. Although the literature notes some general recruitment challenges, no studies specifically address the unique challenges of recruiting older adults who have Alzheimer's Disease (AD) and their family caregivers in studies about delirium or suggest using a framework to identify barriers to recruiting this population. In conducting a pilot study about preparing family caregivers to detect delirium symptoms in older adults with (AD) the researchers used the Public Health Model for identifying barriers to recruitment. The goals of this methodological article are to: (1) briefly describe the methodology of the pilot study to illustrate how the Public Health Model was applied in the context of the present study and (2) discuss the benefits of the Public Health Model for identifying the barriers to recruitment in a study that prepared family caregivers to detect delirium symptoms in older adults with AD. The Public Health Model helped us to identify four specific barriers to recruitment (lack of knowledge about delirium, desire to maintain normalcy, protective caregiving behaviors, and older adult's fears) and ways to overcome them. The Public Health Model might also help other researchers address similar issues.

Strategies for sustaining self used by family caregivers for older adults with dementia.

The negative health consequences of caring for an older adult family member with dementia are well documented. However, not all family caregivers experience these negative health consequences. The purposes of this study were to describe strategies family caregivers use to help them continue to provide care for an older family member with dementia despite challenges and describe these family caregivers' resilience and psychological distress. A mixed methods design was used with a narrative approach dominant and standardized scales for resilience and psychological distress used to enhance the description of the sample. Data were collected through telephone interviews with 18 family caregivers residing in an urban area. The findings indicate that family caregivers used four strategies to sustain the self: drawing on past life experiences, nourishing the self, relying on spirituality, and seeking information about dementia. Understanding strategies used by family caregivers to sustain themselves is essential for providing holistic nursing care and developing effective interventions.

A framework of academic persistence and success for ethnically diverse graduate nursing students.

AIM: The goal of this qualitative study was to examine how ethnically diverse graduate nursing students persisted with academic studies. BACKGROUND: Ethnically diverse nurses are vastly underrepresented in the workforce.This problem is accentuated by high attrition rates in academic programs. METHOD: A grounded theory approach was used. Five focus groups were conducted with 16 ethnically diverse graduate students in nursing and interviews were conducted with two diversity advisers. RESULTS: Analysis of the data indicated that the process of learning to balance stressors with moderators was key to academic persistence and retention.A conceptual framework emerged from the data that provides a guide for academic institutions seeking to implement strategies to promote retention and graduation of diverse graduate nursing students. CONCLUSION: Recommendations are offered to address faculty development, administrative action, and student resources.

Use of the resiliency model of family stress, adjustment and adaptation in the analysis of family caregiver reaction among families of older people with congestive heart failure.

BACKGROUND: Little attention has been given to the resiliency process of family caregivers for older people hospitalized with congestive heart failure. AIMS: The purpose of this study was to examine the influences of older peoples' activities of daily living dependency, family caregivers' spiritual well-being, quality of relationship, family support, coping and care continuity on the burden of family caregivers of hospitalized older people with congestive heart failure using the Resiliency Model of Family Stress, Adjustment, and Adaptation. DESIGN AND SAMPLE. A descriptive, correlational research design was used. There were 50 family caregivers and 50 older people diagnosed with congestive heart failure recruited from medical and surgical units of two Midwest medical centres. METHODS: Data on activities of daily living dependence of older people, family caregiver burden, spiritual well-being, coping strategies, quality of older people-caregiver relationship and care continuity were collected using structured questionnaires. RESULTS: The findings indicated that there were significant positive associations between patients' activities of daily living dependence and family caregiver burden and between lack of family support and family caregiver burden. There were significant negative associations between quality of relationship and family caregiver burden, between care continuity and family caregiver burden, between coping and family caregiver burden and between spiritual well-being and burden. In hierarchical multiple regression, the model variables accounted for 66% of the variance in family caregiver burden. Patients' activities of daily living dependence, quality of relationship and lack of family support are significant predictors of family caregiver burden. CONCLUSIONS: The best predictors of family caregiver burden, using the resiliency model, were the older persons' activities of daily living dependence, family support, quality of relationship, care continuity, coping strategies and spiritual well-being. Implications for practice. It is vital for nurses to assess family caregivers' needs and resources and the quality of the older person-family caregiver relationship in developing a plan of care that reduces family caregiver burden.

Delirium in older adults attending adult day care and family caregiver distress.

UNLABELLED: BACKGROUND; Delirium is a critical, costly, frequently reversible problem in older adults. Findings of previous studies indicate that delirium occurs in up to 65% of hospitalised older adults and up to 80% of terminally ill patients. Few studies address the frequency of delirium in community dwelling older adults and the extent to which delirium symptoms create distress for their family caregivers. AIMS: To determine the frequency of delirium in older people attending two adult day centers (ADC) in the United States and identify the extent to which delirium symptoms were associated with family caregivers' mental health symptoms, and ways of coping with the older adults' care. METHOD: A descriptive, cross-sectional design was used. Thirty older adults and their family caregivers were randomly selected from the rosters of the ADC. RESULTS: Only 6.7% of the older adults had a positive screen for delirium. The majority of family caregivers (96.6%) stated that they had no knowledge of delirium prior to participating in this study. IMPLICATIONS FOR PRACTICE: Both older adults and their family caregivers need education about delirium symptoms and risks.

A complex elder care simulation using improvisational actors.

Complex simulations can facilitate students' synthesis of knowledge. Simulations of cognitively impaired elders provide nursing students the opportunity to use critical thinking and clinical decision-making skills in complex patient care situations. The authors report their experiences in designing, implementing, and evaluating a simulation on cognitive problems in elders using actors. This simulation required third-year baccalaureate nursing students to differentiate delirium from dementia, identify symptoms of heart failure, and address a family member's concerns.

Influences of spiritual well-being and coping on mental health of family caregivers for elders.

The purpose of the study was to describe spiritual well-being of family caregivers of elders with congestive heart failure and examine the relationships among family caregivers' spiritual well-being, coping, and mental health. A descriptive, correlational research design was used, and data were collected from a convenience sample of 50 family caregivers. The findings indicated that positive spiritual well-being was inversely related to negative mental health. Examination of the spiritual well-being subscales suggested that faith/belief systems and life satisfaction contributed to the significant correlation. Positive coping strategies were inversely related to negative mental health. Examination of the coping subscales suggested that scores on Problem Solving and Coping, Alternative Perception of Events, and Dealing with Stress Symptoms contributed to the significant correlation with mental health scores. It is vital to identify processes that contribute to family caregivers' mental health to support them in their role.

Preparing teacher-scholars to reduce health disparities.

Health disparities are a major public health problem in the United States. Doctorally prepared nurse scholars, who understand factors contributing to these disparities, possess research competence to study these factors, and pose strategies to be tested are essential to improve the health of these vulnerable populations. This article describes how a PhD curriculum was designed to prepare teacher-scholars to assume leadership roles in reducing health disparities.

Seeking what's best during the transition to adult day health services.

Family caregivers provide more than 80% of the long-term care for elders in the United States and experience a variety of transitions that are intertwined with those of their elders. Previous research on health care transitions documents problems elders and family caregivers encountered following hospitalization, following nursing home admission, and in adjusting to home health care. Little is known about the transition to adult day health services (ADHS). The purpose of this study was (a) to examine family caregivers' perspectives on the transition to ADHS and (b) to develop a situation-specific theory to guide interventions for elders and their family caregivers during the transition. Semistructured interviews were conducted with 16 family caregivers 1 month and 3 months following the elder's enrollment in ADHS. The constant comparative method was used in analyzing the data. The findings indicate that family caregivers consistently sought what was best for elders throughout the transition.

Using structured academic controversy with nursing students.

Nurse educators use a variety of strategies to foster critical thinking in undergraduate and graduate students. Structured academic controversy, although used by other disciplines, offers a novel approach for nurse educators. The author describes structured academic controversy and its use in a graduate course in gerontological nursing. The article also presents a rubric developed to grade the structured academic controversy assignment.