Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Intensive Care Medicine, Postbus 9101, 6500, HB, Nijmegen, the Netherlands.
Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Intensive Care Medicine, Postbus 9101, 6500, HB, Nijmegen, the Netherlands; HAN University of Applied Sciences, School of Health Studies, Research Department of Emergency and Critical Care, Nijmegen, the Netherlands.
Int J Nurs Stud. 2023 Jan;137:104386. doi: 10.1016/j.ijnurstu.2022.104386. Epub 2022 Nov 8.
Delirium frequently occurs in intensive care unit patients and is associated with worse outcomes. Recently, a multicomponent non-pharmacological nursing intervention program called UNDERPIN-ICU, was implemented in ten Dutch intensive care units. The program was aimed at delirium reduction by optimizing four modifiable risk factors: visual and hearing impairment, cognitive impairment, immobility, and sleep deprivation. Despite its scientific fundament and extensive implementation, this program showed no effect on delirium outcomes.
To explore factors that hindered or facilitated the application of the UNDERPIN-ICU delirium program in daily practice as experienced by healthcare professionals.
Semi-structured focus group interviews were conducted in all participating centers between April and June of 2019. Directed content and thematic analyses were applied. Interviews were coded. Codes were grouped into categories based on factors that hindered or facilitated program application.
In total, 22 ICU nurses, 3 ICU physicians, 5 local delirium group members and one research manager participated in 10 focus group interviews. We found 41 factors that hindered or facilitated program application, grouped into five categories: interventions; individual healthcare professional; patient; implementation process; capacity for change, incentives and resources. Among the factors identified in this study, the facilitating factors included standardized interventions, a structured implementation, interactive educational meetings and, feedback and support. The hindering factors included doubts about usefulness, feasibility, the extensive number of program components, limited knowledge about the program and a focus on physical care.
Factors that hindered program application may explain why the UNDERPIN-ICU program did not have positive effects on delirium outcomes. Factors that facilitated application should be strengthened in future non-pharmacological nursing interventions to prevent or reduce delirium in intensive care.
ClinicalTrials.gov Identifier: NCT03002701; registration date December 26, 2016.
谵妄经常发生在重症监护病房患者中，并与更差的结局相关。最近，一种名为 UNDERPIN-ICU 的多组分非药物护理干预方案在 10 家荷兰重症监护病房实施。该方案旨在通过优化四个可改变的风险因素（视觉和听觉障碍、认知障碍、活动受限和睡眠剥夺）来减少谵妄。尽管该方案具有科学依据并得到广泛实施，但并未显示对谵妄结局的影响。
探索在日常实践中，医护人员在实施 UNDERPIN-ICU 谵妄方案时遇到的阻碍或促进因素。
在 2019 年 4 月至 6 月期间，在所有参与的中心进行了半结构式焦点小组访谈。采用定向内容分析和主题分析。对访谈进行编码。根据阻碍或促进方案实施的因素，将代码分组为类别。
共有 22 名重症监护病房护士、3 名重症监护病房医生、5 名当地谵妄小组成员和 1 名研究经理参加了 10 次焦点小组访谈。我们发现了 41 个阻碍或促进方案实施的因素，分为五类：干预措施；个体医护人员；患者；实施过程；改变的能力、激励和资源。在本研究中确定的因素中，促进因素包括标准化干预措施、结构化实施、互动性教育会议以及反馈和支持。阻碍因素包括对有用性、可行性、方案组件数量多、对方案了解有限以及关注身体护理的怀疑。
阻碍方案实施的因素可能解释了 UNDERPIN-ICU 方案为何对谵妄结局没有积极影响。在未来的非药物护理干预中，应加强促进方案实施的因素，以预防或减少重症监护中的谵妄。
ClinicalTrials.gov 标识符：NCT03002701；注册日期 2016 年 12 月 26 日。
