Enhancing delirium assessment and management through nursing education interventions: A scoping review.

AIM/OBJECTIVE: The purpose of this scoping review was to explore the characteristics and outcomes of education interventions for nurses focused on delirium assessment and management. BACKGROUND: Delirium is a prevalent acute and reversible neuropsychiatric syndrome in hospitalized patients. Delirium can cause cognitive, psychiatric and physical impairments and result in prolonged hospital stay, increased risk of readmission and elevated morbidity and mortality rates. Nurses play an essential role in managing delirium. There is a lack of understanding of the existing nursing educational interventions on delirium management. DESIGN: The study was a scoping review. METHODS: In this scoping review, we used Arksey and O'Malley's (2005) scoping review framework. We searched articles published between 2019 and 2023 in Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE using the following CINAHL/MeSH suggested subject terms: "delirium" in conjunction with "education" "intervention" and "nurse", "nurses" or "nursing." Studies on improving nursing knowledge and practices regarding delirium were included while those focusing on nursing students were excluded. Initial screening involved evaluating article titles and abstracts for relevance from 164 identified articles, followed by a full-text review of 42 articles. Finally, 17 articles were selected for comprehensive analysis. We extracted relevant information from each article and charted the findings in an evidence table. RESULTS: The 17 selected articles showcased a variety of interventions used to educate nursing staff, such as workshops, simulations, group discussions, online modules and one-on-one coaching. Educational interventions primarily focused on delirium definition, risk factors, assessment and management. These educational interventions enhanced nurses' perception of delirium, boosting their confidence and knowledge in managing delirium. These interventions also led to increased compliance with delirium assessment and management protocols, which ultimately resulted in improved documentation accuracy and patient outcomes. CONCLUSIONS: Findings from this scoping review suggest that nursing administration need to provide support and education for delirium prevention and management to enhance nursing staff confidence and competence in assessing and managing delirium. The use of interactive educational techniques has demonstrated profound benefits in schema development, expertize promotion and critical thinking. These findings have significant implications for future research, including the identification of essential nursing competencies for educational interventions and the assessment of long-term knowledge retention and its application in nursing practice.

Finite element analysis of braided dense-mesh stents for carotid artery stenosis.

When braided dense-mesh stents are used to treat carotid stenosis, the structural mechanics of vascular stents, the contact mechanics with blood vessels, and the fluid mechanics in the blood environment need to be studied in depth to reduce the damage of stents to blood vessels and the incidence of in-stent restenosis. Three types of braided stents with 8, 16, and 24 strands and laser-cut stents with the corresponding size parameters were designed, and the bending behavior of each of these types of stent, deployment, and fluid dynamic analysis of the 24-strand braided stent were simulated. The results show that the bending stress of the 8-, 16-, and 24-strand braided stents is 46.33%, 50.24%, and 31.86% of that of their laser-cut counterparts. In addition, higher strand density of the braided stents was associated with greater bending stress; after the 24-strand braided stent was expanded within the stented carotid artery, the carotid stenosis rate was reduced from 81.52% to 46.33%. After stent implantation, the maximum stress on the vessel wall in a zero-pressure diastolic environment decreased from 0.34 to 0.20 MPa, the maximum pressure on the intravascular wall surface decreased from 4.89 to 3.98 kPa, the area of high-pressure region decreased, the wall shear force of the stenotic segment throat decreased, and blood flow increased in the stenosis segments. The braided stent had less bending stress and better flexibility than the laser-cut stent under the same stent size parameters; after the 24-strand braided stent was implanted into the stented vessel, it could effectively dilate the vessel, and the blood flow status was improved.

Dementia and Postoperative Delirium in Surgical Hip Fracture Patients: Unveiling Contrasting Risk Factors and Implications.

Postoperative delirium is a serious complication, particularly in older adults with hip fractures. Using the 2019 American College of Surgeons National Surgical Quality Improvement Program data file, we performed multiple regression analyses to compare risk factors for postoperative delirium in hip fracture patients with and without dementia. Preoperative delirium and mobility aid use were common risk factors in both groups. However, differential effects were observed for other factors. Pathological fracture increased delirium risk in patients with dementia but had a protective effect in those without dementia. In patients with dementia, American Society of Anesthesiology score IV/V was identified as a risk factor, whereas advanced age, severe chronic obstructive pulmonary disease, weight loss, sepsis, elevated international normalized ratio, and serum creatinine level were additional risk factors in patients without dementia. These findings enhance our understanding of the complex relationship among dementia, hip fractures, and postoperative delirium. Identifying specific risk factors for each group can inform tailored interventions and preventive strategies. Further research is needed to validate and expand these findings, ultimately improving care and outcomes. [Journal of Gerontological Nursing, 49(12), 25-30.].

Impact of nursing interventions on discharge disposition in patients with postoperative delirium.

PURPOSE: To identify patient characteristics and perioperative factors associated with non-home patient discharges and the impact of current delirium nursing interventions on discharge disposition, especially non-home dispositions. METHODS: A retrospective pilot chart review was conducted using electronic health records from five networked hospitals in the Mountain West region of the US. The sample comprised 75 randomly selected patients aged 65 or older who screened positive for delirium during hospitalization. Relationships between patient characteristics, nursing interventions, and discharge dispositions were analyzed using chi-square tests and logistic regression. RESULTS: Most participants (69.3%) were discharged to non-home facilities. Delayed urinary catheter removal was a significant nursing intervention factor. Patients with delayed urinary catheter removal were at increased risk of being discharged to a non-home setting compared with those with early urinary catheter removal (aOR: 14.11, P = .010). Preoperative hypoalbuminemia and surgery durations exceeding 60 minutes were associated with non-home dispositions. CONCLUSION: Delayed urinary catheter removal, surgery duration greater than 1 hour, and preoperative hypoalbuminemia increased the likelihood of non-home discharge placement for older adults who experience postoperative delirium.

Experimental Investigation on Interface Performance of UHPC-Strengthened NC Structure through Push-Out Tests.

Strengthening concrete structures with ultra-high performance concrete (UHPC) can both improve the bearing capacity of the original normal concrete (NC) structure and prolong the service life of the structure due to the high strength and durability of UHPC. The key to the synergistic work of the UHPC-strengthened layer and the original NC structures lies in the reliable bonding of their interfaces. In this research study, the shear performance of the UHPC-NC interface was investigated by the direct shear (push-out test) test method. The effects of different interface preparation methods (smoothing, chiseling, and planting straight and hooked rebars) and different aspect ratios of planted rebars on the failure mode and shear performance of the pushed-out specimens were studied. Seven groups of push-out specimens were tested. The results show that the interface preparation method can significantly affect the failure mode of the UHPC-NC interface, which is specifically divided into interface failure, planted rebar pull-out, and NC shear failure. The critical aspect ratio for the pull-out or anchorage of planted rebars in UHPC is around 2. The interface shear strength of straight-planted rebar interface preparation is significantly improved compared with that of the chiseled and smoothened interfaces, and as the embedding length of the planted rebar becomes longer, it first increases greatly and then tends to be stable when the rebar planted in UHPC is fully anchored. The shear stiffness of UHPC-NC increases with the increase of the aspect ratio of planted rebars. A design recommendation based on the experimental results is proposed. This research study supplements the theoretical basis of the interface design of UHPC-strengthened NC structures.

Investigation on Roles of Packing Density and Water Film Thickness in Synergistic Effects of Slag and Silica Fume.

The ternary blended cement with finer slag and silica fume (SF) could improve the packing density (PD) through the filling effect. The excess water (water more than needed for filling into voids between the cement particles) can be released to improve the fresh properties and densify the microstructure which is beneficial for improving the hardened properties. To verify the hypothesis and reveal how and why (cement + slag + SF) the ternary blends could bring such advantages, the binder pastes incorporating slag and SF with various water-to-binder ratios were produced to determine the PD experimentally. To evaluate the optimum water demand (OWD) for maximum wet density, the influence of the dispersion state of the binder on PD was investigated using the wet packing density approach. The effect of PD of various binary and ternary binder systems on water film thickness (WFT), fluidity, setting time, and compressive strength development of cement paste was also investigated. The results show that the ternary blends could improve the PD and decrease the water film thickness (WFT). The enhanced PD and altered WFT are able to increase fluidity and compressive strength. The ternary blends could improve the compressive strengths by increasing PD and exerting nucleation and pozzolanic effects.

Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury: A Retrospective Cohort Study.

OBJECTIVE: To identify factors associated with subsequent hospital-acquired pressure injury (HAPrI) formation among patients in surgical and cardiovascular surgical ICUs with an initial HAPrI. METHODS: Patients admitted to a level 1 trauma center and academic medical center in the Western US between 2014 and 2018 were eligible for this retrospective cohort study. Inclusion criteria were development of an HAPrI stage 2 or above, age older than 18 years, the use of mechanical ventilation for at least 24 hours, and documentation of a risk-based HAPrI-prevention plan including repositioning at least every 2 hours. The primary outcome measure was development of a second, subsequent HAPrI stage 2 or higher. Potential predictor variables included demographic factors, shock, Charleston comorbidity score, blood gas and laboratory values, surgical factors, vasopressor infusions, levels of sedation or agitation, Braden Scale scores, and nursing skin assessment data. RESULTS: The final sample consisted of 226 patients. Among those, 77 (34%) developed a second HAPrI. Independent risk factors for subsequent HAPrI formation were decreased hemoglobin (odds ratio, 0.71; 95% confidence interval [CI], 0.53-0.92; P < .000), vasopressin infusion (odds ratio, 2.20; 95% CI, 1.17-4.26; P = .02), and longer length of stay in the ICU (odds ratio, 1.01; 95% CI, 1.00-1.02; P = .009). CONCLUSIONS: Patients with an HAPrI are at high risk of subsequent HAPrI development. Anemia, vasopressin infusion, and longer ICU stays are independent risk factors for repeat HAPrI formation.

Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury: A Retrospective Cohort Study.

PURPOSE: Community-acquired pressure injuries (CAPIs) are present among approximately 3% to 8% of patients admitted to acute care hospitals. In the critical care population, little is known about hospital-acquired pressure injury (HAPI) development among patients with CAPIs because most studies exclude patients with CAPIs. The purpose of our study was to determine the incidence of HAPI development and the associated risk factors among surgical critical care patients with CAPIs. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: We used electronic health record data from adult critical care patients admitted to the surgical and cardiovascular surgical intensive care units (ICUs) at a level 1 trauma center and academic medical center between 2014 and 2018. METHODS: Univariate analysis was used to compare patients with CAPIs who developed a HAPI and those who did not, as well as logistic regression analysis to identify independent risk factors for HAPIs among patients with CAPIs. RESULTS: Among 5101 patients admitted to 2 surgical critical care units, 167 (3%) patients were admitted with CAPIs. Hospital-acquired pressure injuries were 4 times more common among patients with CAPIs compared to patients without CAPIs. Among the 167 patients with CAPIs, 47 patients (28%) went on to also develop a HAPI, whereas in the 4934 patients without CAPIs, 352 patients (7%) went on to develop a HAPI. Findings from the multivariate logistic regression analysis (n = 151) showed that decreased serum albumin (odds ratio [OR] = 0.47; 95% confidence interval [CI], 0.25-0.85; P = .02) and excessively dry skin (OR = 2.6; 95% CI, 1.1-6.22; P = .03) were independent predictors of HAPI development among patients admitted with CAPIs. CONCLUSIONS: Results from our study show that patients with CAPIs are at high risk for developing a HAPI, particularly among patients with decreased serum albumin or excessively dry skin. Patients with excessively dry skin may benefit from the application of skin moisturizers.

Risk factors for falls in homebound community-dwelling older adults.

OBJECTIVE: To examine risk factors associated with falls among homebound community-dwelling older adults, a vulnerable population often possessing functional disabilities and chronic conditions. DESIGN AND SAMPLE: The study was a cross-sectional study utilizing round 6 data of the National Health and Aging Trend Study (NHATS). Descriptive statistics and multiple logistic regression analyses were conducted. A total of 1,356 homebound community-dwelling older adults aged 65 and above participated in the NHATS. MEASURES: The outcome variable was falls within the last month reported in NHATS. Independent variables were selected based on the NHATS disability conceptual model and literature review, including personal conditions, environmental conditions, and physical functioning limitations. RESULTS: In the sample population, 21.2% reported falls. Males were more likely to experience a fall than females. Hypertension or depression/anxiety increased risk for falls. Older adults with hearing impairment or balance problems limiting activities were also more likely to fall. CONCLUSIONS: Public health nurses need to conduct thorough fall risk assessment for homebound older adults, especially those with chronic health problems or functioning limitations. Studies are needed to examine the association between home environment and falls in homebound older adults.

Outcomes Associated With Stage 2 Pressure Injuries Among Surgical Critical Care Patients: A Retrospective Cohort Study.

BACKGROUND: Hospital-acquired pressure injuries are a serious problem among critical care patients. Although most hospital-acquired pressure injuries are stage 2 (partial-thickness skin loss with exposed dermis), no studies have examined outcomes of stage 2 pressure injuries among critical care patients. OBJECTIVES: To examine outcomes of stage 2 hospital-acquired pressure injuries among critical care patients and identify factors associated with nonhealing stage 2 hospital-acquired pressure injuries. METHODS: Electronic health record data were used to identify surgical critical care patients with stage 2 hospital-acquired pressure injuries at a level I trauma center. Univariate Cox regressions were used to identify factors associated with healed stage 2 hospital-acquired pressure injuries. RESULTS: Of 6376 surgical critical care patients, 298 (4.7%) developed stage 2 hospital-acquired pressure injuries; complete data were available for 253 patients. Of these 253 patients, 160 (63%) had unhealed pressure injuries at hospital discharge. Factors inversely related to the presence of a healed hospital-acquired pressure injury were older age (hazard ratio, 0.98; 95% CI, 0.97-0.99; P = .003), elevated serum lactate (hazard ratio, 0.85; 95% CI, 0.75-0.96; P = .01), elevated serum creatinine (hazard ratio, 0.87; 95% CI, 0.77-0.98; P = .02), and lower oxygenation (hazard ratio, 0.64; 95% CI, 0.41-1.00; P = .05). CONCLUSIONS: Stage 2 hospital-acquired pressure injuries were not healed at discharge in 63% of the patients in our sample. Nurses should be especially vigilant in treating pressure injury patients who are older, have altered oxygenation or perfusion (elevated serum lactate level or decreased oxygenation), or have evidence of renal compromise.

Home modifications for older people with cognitive impairments: Mediation analysis of caregivers' information needs and perceptions of fall risks.

AIMS AND OBJECTIVES: The aims were to (a) identify how many older people with cognitive impairments are living in modified homes and (b) explore associated factors, and (c) examine the mediating effects that their caregivers' information needs and perceptions of fall risk and other factors. BACKGROUND: Older people and their informal caregivers may consider implementing home modifications as an effective strategy for fall prevention. However, there is a lack of information on which older people's homes receive modifications and the various factors associated with such modifications among community-dwelling older people with cognitive impairments. DESIGN: This cross-sectional and correlational study utilises a secondary data analysis. METHODS: The data for this secondary analysis were taken from the 2015 National Online Survey of Caregivers, which includes information provided by 226 adult caregivers for older people with cognitive impairments. Descriptive analyses, hierarchical binary logistic regression and structural equation modelling were performed based on the Andersen and Newman framework of health services utilisation. RESULTS: Overall, 46.5% of the older people lived in modified homes. Older people's impaired activities for daily living (ADLs), caregivers' information needs and perceptions of fall risk were all associated with home modifications (all p values<0.05). Caregivers' information needs mediated the relationship between impaired ADLs and home modifications (indirect effect = 0.026, p < 0.05), whereas the caregivers' perceptions of fall risk did not. CONCLUSIONS: Older people with both cognitive and functional impairments are more likely to modify their home on behalf of care recipient's staying at home. Caregivers' information needs should thus be prioritized when considering home modifications to facilitate caring for older people with impaired ADLs. IMPLICATION FOR PRACTICE: Nurses and other healthcare professionals should be prepared to offer appropriate information and comprehensive assessments of older people's conditions with regard to home modifications.

Evidence on Fall and Injurious Fall Prevention Interventions in Acute Care Hospitals.

Falls and injurious falls are a major safety concern for patient care in acute care hospitals. Inpatient falls and injurious falls can cause extra financial burden to patients, families, and healthcare facilities. This article provides clinical implications and recommendations for adult inpatient fall and injurious fall prevention through a brief review of factors associated with falls and injurious falls and current fall prevention practices in acute care hospitals.

Outcomes Associated With Stage 1 Pressure Injuries: A Retrospective Cohort Study.

BACKGROUND: Approximately half of hospital-acquired pressure injuries identified among critical care patients are stage 1. Although stage 1 injuries are common, outcomes associated with them among critical care patients have not been examined. OBJECTIVES: To examine the outcomes of stage 1 pressure injuries among critical care patients and to identify factors associated with worsening of pressure injuries. METHODS: Electronic health records were used to determine which surgical critical care patients at a level I trauma center and academic medical center had stage 1 pressure injuries. Competing risk survival analysis was used to identify factors associated with worsening of pressure injuries. RESULTS: Review of 6377 patient records indicated that 259 patients (4.1%) experienced stage 1 injuries. The injuries persisted until discharge from the hospital in 92 patients (35.5%), worsened into injuries of stage 2 or greater in 84 (32.4%), and healed in 83 (32.0%). Patients whose pressure injuries worsened were more likely to be older (subdistribution hazard ratio [SHR], 1.02; 95% CI, 1.01-1.03; P = .002), or to have higher levels of serum lactate (SHR, 1.06; 95% CI, 1.02-1.10; P = .007), lower levels of hemoglobin (SHR, 0.82; 95% CI, 0.71-0.96; P = .01), or decreased oxygen saturation by pulse oximetry (< 90%; SHR, 1.50; 95% CI, 1.00-2.25; P = .05). CONCLUSIONS: Stage 1 pressure injuries worsen in about one-third of patients (32.4%). Nurses should consider maximal treatment for patients who are older or who experience alterations in oxygen delivery or perfusion.

A Comprehensive Assessment of Risk Factors for Falls in Community-Dwelling Older Adults.

Falls in community-dwelling older adults are a complicated phenomenon that are attributed to sociodemographic characteristics, health conditions, functional problems, and environmental factors. The current cross-sectional and correlational study aimed to explore comprehensive risk factors for falls in community-dwelling older adults using a nationally representative data file (N = 5,930). Descriptive statistics were used and multiple logistic regression analyses were performed. Study findings showed that homebound or semi-homebound older adults were 50% more likely to experience a fall than non-homebound individuals. Impaired balance was the strongest predictor (odds ratio [OR] = 2.37, p < 0.001), followed by problems moving around in the home. Arthritis (OR = 1.39, p = 0.009) and depression or anxiety (OR = 1.28, p = 0.013) were additional risk factors. Community health or home health nurses need to assess these risk factors when planning fall intervention programs for older adults using evidence-based prevention strategies. [Journal of Gerontological Nursing, 44(10), 40-48.].

Multilevel Factors Associated With Injurious Falls in Acute Care Hospitals.

Using National Database of Nursing Quality Indicators data from July 2013 to June 2014, this correlational study examined the associations of injurious falls among all patient falls with multilevel factors in hospitals. The sample included all falls recorded in adult medical, surgical, combined medical-surgical, and step-down units (N = 2299) in participating hospitals (N = 488). Hierarchical negative binominal regression analyses were performed. Results revealed hospital and unit organizational factors associated with inpatient injurious falls.

Relationships Among Substance Use, Multiple Sexual Partners, and Condomless Sex.

Male and female students manifest different behaviors in condomless sex. This cross-sectional, exploratory, correlational study examined the differences in risk factors for condomless sex between male and female high school students, using secondary data from 4,968 sexually active males and females participating in the 2011 National Youth Risk Behavior Survey. Results in descriptive statistics and multivariate binary logistic regressions revealed that condomless sex was reported as 39.70% in general. A greater proportion of females engaged in condomless sex (23.26%) than did males (16.44%). Physical abuse by sex partners was a common reason for failure to use condoms regardless of gender. Lower condom use was found in (1) those experiencing forced sex by a partner in males, (2) female smokers, and (3) female with multiple sex partners. Thus, sexual health education should address the different risk factors and consider gender characteristics to reduce condomless sex.

Complete chloroplast genome sequence of Nicotiana tabacum TN90 (Solanaceae).

This study reported the complete nucleotide sequence of the Nicotiana tabacum TN90 chloroplast (cp) genome. The cpDNA was 155 992 bp in length and contained 133 individual genes (79 protein encoding genes, 30 tRNA genes and four rRNA genes). Maximum-likelihood (ML) phylogenetic tree for 17 species with Arabidopsis thaliana, Oryza sativa, and Anomochloa marantoidea as an outgroup resulted in a single tree with - lnL =542 222.71, where the Nicotiana tabacum TN90 plastid was clustered with three previous reported Nicotiana species: N. tomentosiformis, N. undulata and N. tabacum. The TN90 variety of tobacco cp genome sequence reported in this study will accelerate tobacco improvement in the future.

Older Adult Inpatient Falls in Acute Care Hospitals: Intrinsic, Extrinsic, and Environmental Factors.

The current integrative literature review of 23 studies aimed to identify multidimensional risk factors of falls among older adult patients in acute care hospitals. The incidence rate of fall-related injuries ranged from 6.8% to 72.1%. Advanced age was a major intrinsic risk factor, whereas being a patient in a geriatric unit was a significant extrinsic factor for inpatient falls and fall-related injuries based on statistical significance obtained from quantitative data analyses. Other critical risk factors were: (a) cognitive impairment; (b) impaired mobility; (c) prolonged length of hospital stay; and (d) fall history. Environmental/situational factors, such as patient ambulation and fall locations, also contributed to inpatient falls. In clinical practice, nurses need to know who are the most vulnerable patients in the hospital and develop comprehensive interventions to decrease intrinsic, extrinsic, and environmental risk factors. Prospective mixed-methods studies are needed to examine psychosocial factors and consequences of falls.