以家庭为中心的儿科谵妄综合方案：一项可行性研究。
A Family-Centred Paediatric Delirium Bundle: A Feasibility Study.
作者信息
Stenkjaer Rikke Louise, Egerod Ingrid, Moszkowicz Mala, Greisen Gorm, Weis Janne, Ista Erwin, Gjedsted Jakob, Jensen Marianne Steen, Reichl Kirsten Krone, Herling Suzanne Forsyth
机构信息
Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
出版信息
Nurs Crit Care. 2025 Jul;30(4):e70103. doi: 10.1111/nicc.70103.
BACKGROUND
Paediatric delirium (PD) is a common disorder in critically ill children. PD management, however, needs improvement. To this end, we developed a family-centred non-pharmacological delirium management bundle based on consensus from paediatric intensive care unit experts and parents. The bundle included interventions such as developing a day structure and encouraging parent presence.
AIM
We aimed to test the feasibility of our PD bundle by investigating acceptability, implementation and practicality for parents, nurses and physicians.
STUDY DESIGN
A multiple-method process evaluation study with quantitative and qualitative data, using questionnaires and focus group interviews. To determine the feasibility of the PD bundle, we set provisional goals for the acceptability, implementation and practicality prior to conducting our study. The study took place in two paediatric cardiac units from March to May 2024.
RESULTS
Two focus group interviews were held with 15 nurses and four physicians. Parents, nurses and physicians found the PD bundle acceptable because all the interventions were intuitively relevant and familiar, meeting our target goals to proceed with an RCT study. We surveyed 31 parents to estimate the degree of implementation of the 11 interventions in the PD bundle. Six of the interventions in the bundle were delivered in more than 80% reported by the parents, while five fell short of our target goals. Nurses and physicians suggested that the PD bundle could be implemented if the interventions were consolidated into fewer elements. We trained 90% of the invited nurses and physicians to deliver the PD bundle, which met our target goal of 80%. Hospital organisation, environment and differences in hygienic policy interpretations challenged the practical application of the PD bundle according to the nurses and physicians.
CONCLUSIONS
The PD bundle appears promising for acceptance, implementation and practical application in clinical practice. However, as the delivery of the PD bundle fell short of our target goals, a revised PD bundle should be tested before performing an RCT.
RELEVANCE TO CLINICAL PRACTICE
A non-pharmacological paediatric delirium bundle is now available to critical care nurses to prevent and manage delirium in critically ill children.
背景
小儿谵妄（PD）是危重症儿童中的常见病症。然而，PD的管理仍有待改进。为此，我们基于儿科重症监护室专家和家长的共识，制定了以家庭为中心的非药物性谵妄管理方案。该方案包括制定日间活动安排和鼓励家长陪伴等干预措施。
目的
我们旨在通过调查家长、护士和医生对该方案的可接受性、实施情况和实用性，来测试我们的PD方案的可行性。
研究设计
一项采用问卷调查和焦点小组访谈收集定量和定性数据的多方法过程评估研究。为确定PD方案的可行性，我们在开展研究之前为可接受性、实施情况和实用性设定了临时目标。该研究于2024年3月至5月在两个儿科心脏科进行。
结果
对15名护士和4名医生进行了两次焦点小组访谈。家长、护士和医生认为PD方案是可接受的，因为所有干预措施直观相关且为人熟悉，达到了我们进行随机对照试验（RCT）研究的目标。我们对31名家长进行了调查，以评估PD方案中11项干预措施的实施程度。方案中的6项干预措施在家长报告中实施率超过80%，而5项未达到我们的目标。护士和医生建议，如果将干预措施整合为更少的要素，PD方案可以实施。我们对90%受邀的护士和医生进行了培训，使其能够实施PD方案，达到了我们80%的目标。护士和医生表示，医院组织、环境以及卫生政策解释的差异对PD方案的实际应用构成了挑战。
结论
PD方案在临床实践中的接受度、实施情况和实际应用方面似乎很有前景。然而，由于PD方案的实施未达到我们的目标，在进行RCT之前应测试修订后的PD方案。
与临床实践的相关性
现在有一个非药物性小儿谵妄方案可供重症监护护士用于预防和管理危重症儿童的谵妄。
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