Nursing, UC San Diego Health

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.

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.

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

BACKGROUND: The COVID-19 pandemic has affected the well-being of nursing professionals, especially long-term and acute care nurses, many of whom are nurses of color. PURPOSE: We examine the evidence and gaps in the literature addressing psychological well-being of racial/ethnic minority RNs in the United States during COVID-19. METHODS: We searched eight databases during March 2022 and used Joanna Briggs' Scoping Review Methodology and PRISMA-ScR reporting standards. DISCUSSION: Seven studies met inclusion criteria. Two exclusively examined nurses; five reported findings from heterogeneous samples of health care workers. No significant racial/ethnic differences in well-being were reported among health care workers. Among nurses, if a difference existed, White nurses reported decreased psychological well-being relative to ethnic and racial minority nurses. Two studies report modest racial/ethnic differences in nurses' psychological well-being. CONCLUSION: Significant gaps in the literature remain; future studies should analyze groups of health care workers separately, clearly identify racial and ethnic groups, and examine the role of respondents' work setting.

PurposeWhile 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.MethodsIn 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.ResultsKey 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).ConclusionsPatients, 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 registrationwww.ClinicalTrials.gov (NCT03379129); registered 15 December 2017.

Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.