心脏手术后在重症监护病房接受监测的患者中，术后谵妄预防、诊断及干预方案的有效性：一项准实验研究。
The effectiveness of postoperative delirium prevention, diagnosis, and intervention protocol in patients monitored in the intensive care unit after cardiac surgery: a quasi-experimental study.
作者信息
Söylemez Gönül Kara, Bulut Hülya
机构信息
Department of Surgical Diseases Nursing, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, Türkiye.
Department of Surgical Diseases Nursing, Nursing Faculty, Gazi University, Ankara, Türkiye.
出版信息
BMC Nurs. 2024 Dec 18;23(1):904. doi: 10.1186/s12912-024-02547-y.
BACKGROUND
The incidence of delirium is high in the intensive care unit (ICU) after cardiac surgery. The development of evidence-based care protocols for delirium management and training of nurses in this regard can ensure effective management of delirium. This quasi-experimental study aimed to assess the effectiveness of a postoperative delirium prevention, diagnosis, and intervention protocol in patients undergoing monitoring in the ICU after cardiac surgery.
METHODS
This study included 64 patients who underwent cardiac surgery and met the inclusion criteria, along with 14 nurses working in the ICU. Patients were divided into control (n = 32) and intervention (n = 32) groups. The study comprised three phases: determining the incidence of delirium in the control group and the delirium diagnosis status of the nurses; providing training to nurses on postoperative delirium prevention, diagnosis and intervention protocol; implementing a preliminary study of the protocol; and finally, implementing the protocol in the intervention group. Statistical significance was set at p < 0.05.
RESULTS
While there was no significant agreement in delirium diagnosis between researcher and nurses in the control group (kappa: 0.207) (p > 0.05), significant agreement was observed in the intervention group (kappa: 1.00) (p < 0.001). The delirium diagnosis rate of the nurses was 14.3% in the control group and 100% in the intervention group, which was a significant difference. The incidence of delirium was 21.9% in the control group and 9.4% in the intervention group, although the difference was not significant.
CONCLUSION
Postoperative delirium prevention, diagnosis, and intervention protocol effectively enhance delirium diagnosis compliance among researchers and nurses and improve the accuracy of delirium diagnosis among postcardiac surgery ICU patients. The implementation of this protocol is recommended for delirium management in such patients.
TRIAL REGISTRATION
This study was retrospectively registered at Clinicaltrials.gov on 19.02.2024 (Clinical Trials ID: NCT06268119).
背景
心脏手术后重症监护病房（ICU）中谵妄的发生率很高。制定基于证据的谵妄管理护理方案并对护士进行这方面的培训，可确保对谵妄进行有效管理。这项准实验研究旨在评估术后谵妄预防、诊断和干预方案对心脏手术后在ICU接受监测的患者的有效性。
方法
本研究纳入了64例接受心脏手术且符合纳入标准的患者，以及14名在ICU工作的护士。患者分为对照组（n = 32）和干预组（n = 32）。该研究包括三个阶段：确定对照组中谵妄的发生率以及护士的谵妄诊断状况；就术后谵妄预防、诊断和干预方案对护士进行培训；对该方案进行初步研究；最后，在干预组实施该方案。统计学显著性设定为p < 0.05。
结果
对照组中研究人员与护士在谵妄诊断方面无显著一致性（kappa值：0.207）（p > 0.05），而干预组中观察到显著一致性（kappa值：1.00）（p < 0.001）。对照组中护士的谵妄诊断率为14.3%，干预组为100%，差异显著。对照组中谵妄的发生率为21.9%、干预组为9.4%，尽管差异不显著。
结论
术后谵妄预防、诊断和干预方案有效提高了研究人员和护士对谵妄诊断的依从性，并提高了心脏手术后ICU患者谵妄诊断的准确性。建议对这类患者实施该方案以管理谵妄。
试验注册
本研究于2024年2月19日在Clinicaltrials.gov上进行回顾性注册（临床试验标识符：NCT06268119）。
Zotero 插件