Christine Waszynski is a geriatric NP in the Department of Geriatric Medicine at Hartford Hospital in Hartford, CT. Patricia Veronneau is the nursing coordinator and Angela Massa and Sarah Levick are staff nurses in the Department of Nursing at Hartford Hospital; at the time of this project, Melissa Brousseau was also a staff nurse at Hartford Hospital. Karyn Therrien is a nursing education supervisor in the Practical Nursing Program at Porter and Chester Institute, Rocky Hill, CT; at the time of this project, she was a nurse manager at Hartford Hospital, where she continues to teach per diem in the Parent Education Program. The Catherine and Alexander Wright Fund provided funding for materials used in the project. Contact author: Christine Waszynski,
Am J Nurs. 2013 Oct;113(10):32-9; quiz 40. doi: 10.1097/01.NAJ.0000435345.23040.42.
Hospitalized patients who are suffering from cognitive impairment, delirium, suicidal ideation, traumatic brain injury, or another behavior-altering condition are often placed under continuous observation by designated "sitters." These patients may become agitated, which can jeopardize their safety even when a sitter is present. This quality improvement project was based on the hypothesis that agitation can be decreased by engaging these patients in individualized therapeutic activities. The authors created a tool that allowed continuous observers to identify a patient's abilities and interests, and then offer such activities to the patient. Data were collected using a scale that measured patient agitation before, during, and after these activities. The authors found that during the activities, 73% of patients had decreased levels of agitation compared with baseline, and 64% remained less agitated for at least one hour afterward.The intervention appeared effective in reducing levels of agitation in selected patients who were receiving continuous observation on nonpsychiatric units at a large, urban level 1 trauma center. Many patients expressed gratitude for the diversion from their health issues. Further investigation into the effectiveness of this intervention and its impact on the use of medications or restraints is warranted.
住院患者如果出现认知障碍、意识混乱、自杀意念、创伤性脑损伤或其他行为改变的情况，通常会由指定的“陪护人员”进行持续观察。这些患者可能会变得躁动不安，即使有陪护人员在场，他们的安全也会受到威胁。本质量改进项目基于这样一种假设，即通过让这些患者参与个性化的治疗活动，可以减少躁动。作者创建了一种工具，允许连续观察者识别患者的能力和兴趣，然后向患者提供这些活动。使用一种量表收集数据，该量表在活动前后测量患者的躁动程度。作者发现，在活动期间，与基线相比，73%的患者的躁动程度降低，64%的患者在至少一个小时后仍然保持不那么躁动。该干预措施似乎在减少非精神科病房接受连续观察的特定患者的躁动水平方面是有效的，这些患者在一家大型城市一级创伤中心接受治疗。许多患者对这种从他们的健康问题中转移注意力的方式表示感谢。有必要进一步研究这种干预措施的有效性及其对药物或约束使用的影响。
