Travers Catherine, Graham Frederick, Henderson Amanda, Beattie Elizabeth
School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
Princess Alexandra Hospital, Queensland Department of Health, 199 Ipswich Rd, Wooloongabba, QLD, 4102, Australia.
BMC Health Serv Res. 2017 Mar 14;17(1):202. doi: 10.1186/s12913-017-2136-0.
Delirium and dementia (cognitive impairment; CI), are common in older hospital patients, and both are associated with serious adverse outcomes. Despite delirium often being preventable, it is frequently not recognized in hospital settings, which may be because hospital nurses have not received adequate education or training in recognizing or caring for those with CI. However, the most effective way of increasing nurses' awareness about delirium and dementia, and initiating regular patient screening and monitoring to guide best practices for these patients in hospital settings is not known. Hence this current project, conducted in 2015-2017, aims to redress this situation by implementing a multi-component non-pharmacological evidence-based intervention for patients with CI, through educating and mentoring hospital nurses to change their practice.
The development of the practice change component is informed by recent findings from implementation science that focuses on facilitation as the active ingredient in knowledge uptake and utilization. This component focuses on educating and empowering experienced nurses to become Cognition Champions (CogChamps) across six wards in a large Australian tertiary referral hospital. The CogChamps will, in turn, educate other nursing team members to more effectively care for patients with CI. The hospital leadership team are supportive of the project and are directly involved in selecting the CogChamps. CogChamps will be provided with comprehensive education in evidence-based delirium assessment, prevention and management, and practice change management skills. They will receive continuing support from research and education staff about raising awareness, upskilling other staff in delirium assessment and in the adoption of best practices for preventing and managing delirium. Both qualitative and quantitative data are being collected at multiple time-points to evaluate process, impact and outcome, and to provide clarity regarding the most effective aspects of the intervention.
This paper describes the study protocol for the implementation of multi-component evidence-based non-pharmacological practices designed to improve the care of older hospital patients with CI. Findings will inform subsequent initiatives directed towards enhancing the capacity of the nursing workforce to implement best practices for providing high quality care for this growing patient population throughout their acute care hospital stay.
谵妄和痴呆（认知障碍；CI）在老年住院患者中很常见，且二者均与严重不良后果相关。尽管谵妄通常是可预防的，但在医院环境中它常常未被识别，这可能是因为医院护士未接受足够的关于识别或护理认知障碍患者的教育或培训。然而，提高护士对谵妄和痴呆的认识，并启动定期的患者筛查和监测以指导医院环境中针对这些患者的最佳实践的最有效方法尚不清楚。因此，在2015 - 2017年开展的这个当前项目旨在通过对认知障碍患者实施多成分非药物循证干预，即通过教育和指导医院护士改变其做法来纠正这种情况。
实践变革部分的开展借鉴了实施科学的最新研究结果，该研究聚焦于促进作用，将其作为知识吸收和利用的有效要素。这部分内容着重于教育并赋能经验丰富的护士，使其成为澳大利亚一家大型三级转诊医院六个病房的认知冠军（CogChamps）。这些认知冠军反过来将教育其他护理团队成员，以便更有效地护理认知障碍患者。医院领导团队支持该项目，并直接参与挑选认知冠军。将为认知冠军提供关于循证谵妄评估、预防和管理以及实践变革管理技能的全面教育。他们将在提高认识、提升其他工作人员在谵妄评估方面的技能以及采用预防和管理谵妄的最佳实践方面，获得来自研究和教育人员的持续支持。在多个时间点收集定性和定量数据，以评估过程、影响和结果，并明确干预措施最有效的方面。
本文描述了实施多成分循证非药物实践以改善老年住院认知障碍患者护理的研究方案。研究结果将为后续举措提供参考，这些举措旨在提高护理人员的能力，以便在这些患者整个急性住院期间为其提供高质量护理时实施最佳实践。
