重症监护病房谵妄:对重症监护病房护理及医务人员关于当前实践的知识以及对重症监护病房谵妄的认知障碍的调查。
ICU delirium: a survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit.
作者信息
Elliott Sara R
机构信息
Intensive Care Unit, Monklands District General Hospital, Lanarkshire, Scotland ML6 0JS, UK.
出版信息
Intensive Crit Care Nurs. 2014 Dec;30(6):333-8. doi: 10.1016/j.iccn.2014.06.004. Epub 2014 Sep 6.
BACKGROUND
Delirium is an independent predictor of mortality and morbidity in the intensive care unit and is associated with a prolonged hospital and intensive care unit stay. National guidelines suggest that intensive care unit delirium is screened for daily using the confusion assessment method for the intensive care unit validated screening tool. Research suggests that there is a lack of knowledge on intensive care unit delirium, its screening tools and that it is inadequately screened for.
AIMS
The aim of the study is to assess nursing and medical staff knowledge, understanding and management of intensive care unit delirium and assess the perceived barriers associated with intensive care unit delirium screening using a validated screening tool.
RESEARCH DESIGN AND SETTING
A survey design was used and a questionnaire designed to collect the data. The sample consisted of 149 nursing and medical staff working in three district intensive care units within the United Kingdom.
RESULTS
The data yielded reveals that 44% (n = 33) of the respondents were not educated on ICU delirium. Furthermore the confusion assessment method for the intensive care unit was only being used in one out of the three sites surveyed and this was found to be at best sporadic, this fails to adhere to current delirium guidelines (NICE, 2010). Those using a non structured way of detecting delirium observed for hallucinations and agitation. Common associated barriers quoted in the literature such as time restraints did not appear to be an issue in this study.
CONCLUSION
This study has shown that despite national guidelines screening with a validated delirium screening tool is not being performed in two of the intensive care unit surveyed and one site employs the confusion assessment method for the intensive care however screening is sporadic. This study contributes to the evidence base suggesting that intensive care unit delirium is under recognised and screened for despite current guidelines.
背景
谵妄是重症监护病房死亡率和发病率的独立预测因素,且与住院时间和重症监护病房停留时间延长相关。国家指南建议,使用针对重症监护病房的意识模糊评估方法(一种经过验证的筛查工具)对重症监护病房谵妄进行每日筛查。研究表明,人们对重症监护病房谵妄及其筛查工具缺乏了解,且对其筛查不足。
目的
本研究的目的是评估护理和医务人员对重症监护病房谵妄的知识、理解和管理,并使用经过验证的筛查工具评估与重症监护病房谵妄筛查相关的感知障碍。
研究设计与设置
采用调查设计,并设计了一份问卷来收集数据。样本包括在英国三个地区重症监护病房工作的149名护理和医务人员。
结果
所得数据显示,44%(n = 33)的受访者未接受过关于重症监护病房谵妄的教育。此外,在所调查的三个地点中,只有一个地点使用针对重症监护病房的意识模糊评估方法,而且发现其使用情况最多只是偶尔为之,这不符合当前的谵妄指南(英国国家卫生与临床优化研究所,2010年)。那些采用非结构化方式检测谵妄的人员通过观察幻觉和躁动来进行判断。文献中提到的常见相关障碍,如时间限制,在本研究中似乎不是问题。
结论
本研究表明,尽管有国家指南,但在所调查的两个重症监护病房中,并未使用经过验证的谵妄筛查工具进行筛查,且有一个地点采用针对重症监护病房的意识模糊评估方法,但筛查是零星进行的。本研究为证据库做出了贡献,表明尽管有当前的指南,但重症监护病房谵妄仍未得到充分认识和筛查。