Nursing, UC San Diego Health

There are 33 publications in this collection, published between 2007 and 2023.

Exploring Distress Caused by Blame for a Negative Patient Outcome

Purpose of this research was to explore the incidence, characteristics and consequences of blame-related distress and its relationship to moral distress. An instrument was created and validated and a conceptual model proposed for relating blame to similar constructs among clinical staff working in acute care.

2 supplemental ZIPs

Testing a Strategy to Identify Incidence of Nurse Suicide in the United States.

The aim of this study was to test a strategy for quantifying incidence of nurse suicide using San Diego County data as a pilot for national investigation.

Worldwide, 1 person dies by suicide every 40 seconds; more than 1 000 000 suicides occur yearly. Suicide rates for nurses in the United States have not been evaluated. This methodological article tested a strategy to identify incidence of nurse suicide compared with those of physicians and the general public.

Deidentified San Diego County Medical Examiner data from 2005 to 2015 were analyzed with a descriptive epidemiologic approach.

Overall RN (18.51) and physician (40.72) incidences of suicide per 100 000 person-years were higher than the San Diego general population, excluding nurses (15.81) normalized to 100 000 person-years.

Establishing incidence of nurse suicide is confounded by variation in reporting mechanisms plus incomplete availability of nurse gender data. Relatively small outcome numbers compared with the general population may underestimate results. Research using a larger sample is indicated. Nurse executives may decrease risk by proactively addressing workplace stressors.

Validation of Caregiver-Centered Delirium Detection Tools: A Systematic Review

Abstract

Objectives: To summarize the validity of caregiver‑centered delirium detection tools in hospitalized adults and assess associated patient and caregiver outcomes.

Design: Systematic review

Setting: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus from inception to May 15, 2017

Participants: Hospitalized adults

Intervention: Caregiver-centered delirium detection tools

Measurements: We drafted a protocol from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently completed abstract and full-text review, data extraction, and quality assessment. We summarized findings using descriptive statistics including mean, median, standard deviation, range, frequencies (percent), and Cohen's Kappa (κ). Included studies reported on the validity of caregiver-centered delirium detection tools or associated patient and caregiver outcomes, and were cohort or cross-sectional in design.

Results: We reviewed 6056 titles and abstracts, included six articles, and identified six caregiver-centered tools. All tools were designed to be used in several minutes or less, and had 11 items or fewer. Three tools were caregiver-administered (completed independently by caregivers): Family Confusion Assessment Method (FAM-CAM), Informant Assessment of Geriatric Delirium (I-AGeD), and Sour Seven. Three tools were caregiver-informed (administered by a healthcare professional using caregiver input): Single Question in Delirium (SQiD), Single Screening Question Delirium (SSQ‑Delirium), and the Stressful Caregiving Response to Experiences of Dying (SCARED). Caregiver‑administered tools had higher psychometric properties [FAM-CAM sensitivity 75% (95%, confidence interval CI, 35-95%), specificity 91% (95% CI, 74-97%); Sour Seven positive predictive value, PPV 89.5%, negative predictive value, NPV 90%] than caregiver-informed tools [SQID: sensitivity 80% (95% CI, 28.3-99.5%), specificity 71% (95% CI, 58.77-99.8%), SSQ-Delirium sensitivity 79.6%, specificity 56.1%].

Conclusions: Delirium detection is essential for appropriate delirium management. Caregiver‑centered delirium detection tools are promising to improve delirium detection and associated patient and caregiver outcomes. Comparative studies utilizing larger sample sizes and multiple centers are required to determine validity and reliability characteristics.

Key Words: delirium; caregiver; family; hospital; screening

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Open Access Policy Deposits (14)

Patients, family members and providers perceive family-administered delirium detection tools in the adult ICU as feasible and of value to patient care and family member coping: a qualitative focus group study

Purpose

While studies report on perceptions of family participation in delirium prevention, little is known about the use of family-administered delirium detection tools in the care of critically ill patients. This study sought the perspectives of patients, their family members, and healthcare providers on the use of family-administered delirium detection tools to detect delirium in critically ill patients and barriers and facilitators to using family-administered delirium detection tools in patient care.

Methods

In this qualitative study, critical care providers (five physicians, six registered nurses) and participants from the Family ICU Delirium Detection Study (seven past patients and family members) took part in four focus groups at one hospital in Calgary, Alberta.

Results

Key themes identified following thematic analysis from 18 participants included: 1) perceptions of acceptability of family-administered delirium detection (e.g., family feels valued, intensive care unit (ICU) care team may not use a family member's results, intensification of work load), 2) considerations regarding feasibility (e.g., insufficient knowledge, healthcare team buy-in), and 3) overarching strategies to support implementation into routine patient care (e.g., value of family-administered delirium detection for patients and families is well understood in the clinical context, regular communication between the family and ICU providers, an electronic version of the tool).

Conclusions

Patients, family members and healthcare providers who participated in the focus groups perceived family participation in delirium detection and the use of family-administered delirium detection tools at the bedside as feasible and of value to patient care and family member coping.

Trial registration

www.ClinicalTrials.gov (NCT03379129); registered 15 December 2017.

A study protocol for a randomized controlled trial of family-partnered delirium prevention, detection, and management in critically ill adults: the ACTIVATE study

Background

Delirium is very common in critically ill patients admitted to the intensive care unit (ICU) and results in negative long-term outcomes. Family members are also at risk of long-term complications, including depression and anxiety. Family members are frequently at the bedside and want to be engaged; they know the patient best and may notice subtle changes prior to the care team. By engaging family members in delirium care, we may be able to improve both patient and family outcomes by identifying delirium sooner and capacitating family members in care.

Methods

The primary aim of this study is to determine the effect of family-administered delirium prevention, detection, and management in critically ill patients on family member symptoms of depression and anxiety, compared to usual care. One-hundred and ninety-eight patient-family dyads will be recruited from four medical-surgical ICUs in Calgary, Canada. Dyads will be randomized 1:1 to the intervention or control group. The intervention consists of family-partnered delirium prevention, detection, and management, while the control group will receive usual care. Delirium, depression, and anxiety will be measured using validated tools, and participants will be followed for 1- and 3-months post-ICU discharge. All analyses will be intention-to-treat and adjusted for pre-identified covariates. Ethical approval has been granted by the University of Calgary Conjoint Health Research Ethics Board (REB19-1000) and the trial registered. The protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist.

Discussion

Critically ill patients are frequently unable to participate in their own care, and partnering with their family members is particularly important for improving experiences and outcomes of care for both patients and families.

Trial registration

Registered September 23, 2019 on Clinicaltrials.gov NCT04099472.

The association of delirium severity with patient and health system outcomes in hospitalised patients: a systematic review

Background

delirium is an acute state of confusion that affects >20% of hospitalised patients. Recent literature indicates that more severe delirium may lead to worse patient outcomes and health system outcomes, such as increased mortality, cognitive impairment and length of stay (LOS).

Methods

using systematic review methodology, we summarised associations between delirium severity and patient or health system outcomes in hospitalised adults. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus databases with no restrictions, from inception to 25 October 2018. We included original observational research conducted in hospitalised adults that reported on associations between delirium severity and patient or health system outcomes. Quality of included articles was assessed using the Newcastle-Ottawa Scale. The level of evidence was quantified based on the consistency of findings and quality of studies reporting on each outcome.

Results

we included 20 articles evaluating associations that reported: mortality (n = 11), cognitive ability (n = 3), functional ability (n = 3), patient distress (n = 1), quality of life (n = 1), hospital LOS (n = 4), intensive care unit (ICU) LOS (n = 2) and discharge home (n = 2). There was strong-level evidence that delirium severity was associated with increased ICU LOS and a lower proportion of patients discharged home. There was inconclusive evidence for associations between delirium severity and mortality, hospital LOS, functional ability, cognitive ability, patient distress and quality of life.

Conclusion

delirium severity is associated with increased ICU LOS and a lower proportion of patients discharged home. Delirium severity may be a useful adjunct to existing delirium screening to determine the burden to health care system resources.

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Related Research Centers & Groups

UC San Diego Health Journal of Nursing