验证用于 70 岁及以上接受心脏手术的患者的瑞典语版护理谵妄筛查量表。

Validation of the Swedish version of the Nursing Delirium Screening Scale used in patients 70 years and older undergoing cardiac surgery.

机构信息

Authors: Helena Claesson Lingehall, RN, MSc, Department of Nursing and Department of Surgical and Perioperative Science, Cardiothoracic Surgery Division, Heart Center, University of Umeå; Nina Smulter, RN, MSc, Department of Nursing and Department of Surgical and Perioperative Science, Cardiothoracic Surgery Division, Heart Center, University of Umeå; Karl Gunnar Engström, MD, PhD, Professor, Department of Surgical and Perioperative Science, Cardiothoracic Surgery Division, Heart Center, University of Umeå; Yngve Gustafson, MD, PhD, Professor, Department of Community Medicine and Rehabilitation, Geriatric Medicine, University of Umeå; Birgitta Olofsson, RN, PhD, Research Assistant, Department of Nursing, The Strategic Research Programme in Care Sciences, Umeå University and Karolinska Institutet, Department of Surgical and Perioperative Science, Orthopedic Surgery, University of Umeå, Umeå, Sweden.

出版信息

J Clin Nurs. 2013 Oct;22(19-20):2858-66. doi: 10.1111/j.1365-2702.2012.04102.x.

DOI:10.1111/j.1365-2702.2012.04102.x

PMID:24033713

Abstract

AIMS AND OBJECTIVES

Validation of the Swedish version of the Nursing Delirium Screening Scale as a screening tool for nurses to use to detect postoperative delirium in patients 70 years and older undergoing cardiac surgery.

BACKGROUND

Delirium is common among old patients after cardiac surgery. Underdiagnosis and poor documentation of postoperative delirium is problematic, and nurses often misread the signs.

DESIGN

A prospective observational study.

METHODS

Patients (n = 142) scheduled for cardiac surgery were assessed three times daily by the nursing staff using the Nursing Delirium Screening Scale. Nursing Delirium Screening Scale was compared with the Mini Mental State Examination and the Organic Brains Syndrome Scale, evaluated day one and day four postoperatively. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders - DSM-IV-TR criteria.

RESULTS

A larger proportion of patients were diagnosed with delirium according to the Mini Mental State Examination and Organic Brains Syndrome Scale compared with the Nursing Delirium Screening Scale, both on day one and day four. The Nursing Delirium Screening Scale protocol identified the majority of hyperactive and mixed delirium patients, whereas several with hypoactive delirium were unrecognised.

CONCLUSIONS

The Swedish version of the Nursing Delirium Screening Scale was easily incorporated into clinical care and showed high sensitivity in detecting hyperactive symptoms of delirium. However, in the routine use by nurses, the Nursing Delirium Screening Scale had low sensitivity in detecting hypoactive delirium, the most prevalent form of delirium after cardiac surgery. Nursing Delirium Screening Scale probably has to be combined with cognitive testing to detect hypoactive delirium.

RELEVANCE TO CLINICAL PRACTICE

Nurses play a key role in detecting delirium. The Nursing Delirium Screening Scale was easy incorporated instrument for clinical practice and identified the majority of hyperactive and mixed delirium, but several of the patients with hypoactive delirium were unrecognised. Training of assessment and cognitive testing seems to be necessary to detect hypoactive delirium.

摘要

目的和目标

验证瑞典版护理谵妄筛查量表（Nursing Delirium Screening Scale）作为一种筛查工具，供护士用于检测 70 岁及以上接受心脏手术的患者术后谵妄。

背景

心脏手术后老年患者谵妄很常见。术后谵妄的漏诊和记录不佳是一个问题，护士经常误解这些迹象。

设计

前瞻性观察研究。

方法

护理人员每天三次使用护理谵妄筛查量表（Nursing Delirium Screening Scale）对计划接受心脏手术的患者进行评估。护理谵妄筛查量表（Nursing Delirium Screening Scale）与简易精神状态检查（Mini Mental State Examination）和有机脑综合征量表（Organic Brains Syndrome Scale）进行比较，在术后第一天和第四天进行评估。根据精神障碍诊断与统计手册 - DSM-IV-TR 标准诊断谵妄。

结果

与护理谵妄筛查量表（Nursing Delirium Screening Scale）相比，根据简易精神状态检查（Mini Mental State Examination）和有机脑综合征量表（Organic Brains Syndrome Scale），在第一天和第四天，有更多的患者被诊断为谵妄。护理谵妄筛查量表（Nursing Delirium Screening Scale）方案识别出了大多数活跃型和混合型谵妄患者，而一些表现为不活跃型谵妄的患者则未被识别。

结论

瑞典版护理谵妄筛查量表（Nursing Delirium Screening Scale）易于融入临床护理，对检测谵妄的活跃症状具有较高的敏感性。然而，在护士的常规使用中，护理谵妄筛查量表（Nursing Delirium Screening Scale）对检测心脏手术后最常见的不活跃型谵妄的敏感性较低。护理谵妄筛查量表（Nursing Delirium Screening Scale）可能需要与认知测试相结合，以检测不活跃型谵妄。