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Caring for patients with terminal delirium: palliative care unit and home care nurses' experiences.

https://arctichealth.org/en/permalink/ahliterature169148
Source
Int J Palliat Nurs. 2006 Apr;12(4):150-6
Publication Type
Article
Date
Apr-2006
Author
Susan Brajtman
Kathryn Higuchi
Christine McPherson
Author Affiliation
School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada. brajtman@uottawa.ca
Source
Int J Palliat Nurs. 2006 Apr;12(4):150-6
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Canada
Delirium - nursing
Education, Nursing
Home Care Services
Humans
Interprofessional Relations
Interviews as Topic
Palliative Care
Abstract
To explore palliative care unit and home care nurses' experiences of caring for patients with terminal delirium.
A qualitative exploratory design using individual interviews.
Participants included five nurses working in an interdisciplinary palliative care unit located in a large Canadian city hospital, and four nurses from a palliative home care nursing team located in the same city.
Nurses in both sites experienced multiple challenges caring for delirious patients. Additional education on delirium and collaborative teamwork were viewed as key factors in enhancing their ability to care for and support this patient and family population. Four core themes reflected the participants' perceptions and experiences: experiencing distress; the importance of presence; valuing the team; and the need to know more.
Findings suggest the need for interdisciplinary educational initiatives focused on the identification and management of terminal delirium, and targeted to the specific context in which nurses practise.
PubMed ID
16723959 View in PubMed
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Geriatric mental health education in Canada SKIPs into the 21st century.

https://arctichealth.org/en/permalink/ahliterature200137
Source
J Gerontol Nurs. 1999 May;25(5):37-42
Publication Type
Article
Date
May-1999
Author
C. Lusk
Author Affiliation
Royal Arch Masonic Home Intermediate Care Facility, Vancouver, British Columbia, Canada.
Source
J Gerontol Nurs. 1999 May;25(5):37-42
Date
May-1999
Language
English
Publication Type
Article
Keywords
Canada
Curriculum
Delirium - nursing
Dementia - nursing
Depression - nursing
Education, Nursing, Continuing - organization & administration
Forecasting
Geriatric Nursing - education
Geriatric Psychiatry - education
Humans
Needs Assessment
Nursing Staff - education
Program Evaluation
Psychiatric Nursing - education
Skilled Nursing Facilities
Staff Development - organization & administration
Abstract
The Skills Immersion Program (SKIP) provides an educational opportunity for staff nurses who face the challenge of caring for residents who present with psychiatric and behavioral problems in long-term care (LTC) facilities within British Columbia, Canada. With the aging population and an increase in the number of individuals waiting for placement in care facilities, care providers are in substantial need of advanced education and training in the field of geriatric psychiatry nursing. Nurses working in LTC facilities in Canada are not prepared to manage the changing acuity levels and complex needs of their residents. The SKIP was developed by nurses, primarily for nurses, at St. Vincent's Hospital in Vancouver, British Columbia, Canada. Nurses who participate in the SKIP acquire an enhanced knowledge base in geriatric psychiatry nursing and gain access to assessment tools that will assist staff to increase the quality of care for their residents.
PubMed ID
10578764 View in PubMed
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Patients' experiences of being delirious.

https://arctichealth.org/en/permalink/ahliterature163909
Source
J Clin Nurs. 2007 May;16(5):810-8
Publication Type
Article
Date
May-2007
Author
Gill Sörensen Duppils
Karin Wikblad
Author Affiliation
Department of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden. gsd@du.se
Source
J Clin Nurs. 2007 May;16(5):810-8
Date
May-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - nursing - psychology
Communication
Delirium - nursing - psychology
Emotions
Female
Humans
Male
Mental Recall
Sweden
Abstract
The aim was to describe patients' experiences of being delirious.
Delirium is a serious psychiatric disorder that is frequently reported from hospital care settings, particularly among older patients undergoing hip surgery. It involves disturbances of consciousness and changes in cognition, a state which develops over a short period of time and tends to fluctuate during the course of the day. It is a certified fact that delirium is poorly diagnosed and recognized although the state often is described as terrifying. To be able to give professional care, it is of the utmost importance to know more about patients' experience of delirium.
Included in the interviews were patients who had undergone hip-related surgery and during the hospital stay experienced delirium. Fifteen patients participated in the interviews. Of these, six had experienced episodes of nightly delirium (sundown syndrome) and nine experienced delirium during at least one day. The interviews were analysed by qualitative content analysis.
The entry of delirium was experienced as a sudden change of reality that, in some cases, could be connected to basic unfulfilled physiological needs. The delirium experiences were like dramatic scenes that gave rise to strong emotional feelings of fear, panic and anger. The experiences were also characterized by opposite pairs; they took place in the hospital but at the same time somewhere else; it was like dreaming but still being awake. The exit from the delirium was associated with disparate feelings.
It is necessary to understand patients' thoughts and experiences during the delirious phase to be able to give professional care, both during the delirium phase and after the recovery.
PubMed ID
17462032 View in PubMed
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Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur's interpretation theory.

https://arctichealth.org/en/permalink/ahliterature279974
Source
J Clin Nurs. 2016 Oct;25(19-20):2807-15
Publication Type
Article
Date
Oct-2016
Author
Helle Svenningsen
Ingrid Egerod
Pia Dreyer
Source
J Clin Nurs. 2016 Oct;25(19-20):2807-15
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Delirium - nursing - psychology
Denmark
Humans
Intensive Care Units
Interviews as Topic
Longitudinal Studies
Memory
Models, Psychological
Abstract
To describe the content of former intensive care unit patients' memories of delusions.
Intensive care unit patients often have strange and frightening experiences during the critical stage of illness. Earlier studies have provided small-sample in-depth descriptions of patient experiences in intensive care unit, but large-scale studies are also needed to inform intensive care unit follow-up.
The study had a qualitative design using phenomenological hermeneutic analysis inspired by Ricoeur's interpretive theory. Patients were assessed with Confusion Assessment Method of the Intensive Care Unit for delirium in intensive care unit, and after discharge, memories of delusions were described by 114 of 325 patients in face-to-face (after two weeks) and telephone interviews (after two and six months) using the Intensive Care Unit Memory Tool.
Four themes emerged: the ever-present family, dynamic spaces, surviving challenges and constant motion. Memories of delusions were a vivid mix of fact and fiction, demonstrating dynamic shifts in time, place and motion, but not dependent on the presence of delirium assessed by Confusion Assessment Method of the Intensive Care Unit.
Analysis based on Ricoeurian phenomenological hermeneutics provided insights into themes in intensive care unit patients' memories of delusions. More studies are needed to understand the meaning of memories of delusions, the commonality of themes and the association between delusions and delirium after an intensive care unit stay.
Understanding patients' memories of delusions is beneficial to nurses caring for patients that are anxious, upset or agitated. It opens a window to the world of the patient who is unable to communicate due to intubation and general weakness. We recommend the provision of nurse-led intensive care unit follow-up enabling patients to describe and discuss their intensive care unit experiences.
PubMed ID
27457029 View in PubMed
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Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial.

https://arctichealth.org/en/permalink/ahliterature188078
Source
CMAJ. 2002 Oct 1;167(7):753-9
Publication Type
Article
Date
Oct-1-2002
Author
Martin G Cole
Jane McCusker
François Bellavance
François J Primeau
Robert F Bailey
Michael J Bonnycastle
Johanne Laplante
Author Affiliation
Department of Psychiatry, St. Mary's Hospital and McGill University, Montreal, Que.
Source
CMAJ. 2002 Oct 1;167(7):753-9
Date
Oct-1-2002
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Delirium - nursing - prevention & control
Female
Geriatric Assessment
Humans
Male
Patient Care Planning
Patient care team
Proportional Hazards Models
Quebec
Abstract
Delirium is common and often goes undetected in older patients admitted to medical services. It is associated with poor outcomes. We conducted a randomized clinical trial to determine whether systematic detection and multidisciplinary care of delirium in older patients admitted to a general medical service could reduce time to improvement in cognitive status.
Consecutive patients aged 65 or more who were newly admitted to 5 general medical units between Mar. 15, 1996, and Jan. 31, 1999, were screened with the Confusion Assessment Method within 24 hours after admission to detect prevalent delirium and rescreened within a week to detect incident cases. Patients with delirium were randomly allocated to receive the intervention or usual care. Subjects in the intervention group were seen by a geriatric specialist consultant and followed in hospital for up to 8 weeks by an intervention nurse who liaised with the consultant, attending physicians, family and the primary care nurses. Subjects in the usual care group received standard hospital services but could consult geriatric specialists as needed. A research assistant, blinded as to treatment allocation, administered within 24 hours after enrolment the MiniMental Status Exam (MMSE), Delirium Index (measuring the severity of the delirium) and Barthel Index (measuring independence of personal care). Improvement was defined as an increase in the MMSE score of 2 or more points, with no decrease below baseline plus 2 points, or no decrease below a baseline MMSE score of 27. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly was completed to identify patients with possible dementia. Subjects were assessed 3 times during the first week and weekly thereafter for up to 8 weeks in hospital or until discharge. Data on clinical severity of illness, length of stay and living arrangements after discharge were also collected. The primary outcome measure was time to improvement in MMSE score.
Of the 1925 patients who met the inclusion criteria and were screened, 227 had prevalent or incident delirium and consented to participate (113 in intervention group and 114 in usual care group). There were no clinically significant differences between the intervention and usual care groups except for sex (female 58.4% v. 50.0%) and marital status (married 34.8% v. 41.2%). Overall, 48% of the patients in the intervention group and 45% of those in the usual care group met the predetermined criteria for improvement. The Cox proportional hazards ratio (HR) for a shorter time to improvement with the intervention versus usual care, adjusted for age, sex and marital status, was 1.10 (95% confidence interval [CI] 0.74-1.63). There were no significant differences within 8 weeks after enrolment between the 2 groups in time to and rate of improvement of the Delirium Index, the Barthel Index, length of stay, rate of discharge to the community, living arrangements after discharge or survival. Outcomes between the 2 groups did not differ statistically significantly for patients without dementia (HR 1.54, 95% CI 0.80-2.97), for those who had less co-morbidity (HR 1.36, 95% CI 0.75-2.46) or for those with prevalent delirium (HR 1.15, 95% CI 0.48-2.79).
Systematic detection and multidisciplinary care of delirium does not appear to be more beneficial than usual care for older patients admitted to medical services.
Notes
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PubMed ID
12389836 View in PubMed
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Toward better care of delirious patients at the end of life: a pilot study of an interprofessional educational intervention.

https://arctichealth.org/en/permalink/ahliterature123339
Source
J Interprof Care. 2012 Sep;26(5):422-5
Publication Type
Article
Date
Sep-2012
Author
Susan Brajtman
David Wright
Pippa Hall
Shirley H Bush
Enkenyelesh Bekele
Author Affiliation
School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada K1H8M5. brajtman@uottawa.ca
Source
J Interprof Care. 2012 Sep;26(5):422-5
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Canada
Delirium - nursing
Humans
Interdisciplinary Communication
Pilot Projects
Problem-Based Learning
Quality of Health Care
Residential Facilities
Terminal Care - standards
Abstract
Symptom distress with end-of-life delirium (EOLD) is complex and multidimensional, and interprofessional (IP) teams require knowledge and skill to effectively care for these patients and their families. The purpose of this pilot study was to test an educational intervention about EOLD for IP teams at a long-term care facility and a hospice. The intervention included a comprehensive self-learning module (SLM) on EOLD and IP teamwork; a modified McMaster-Ottawa team objective structured clinical encounter (TOSCE) and a didactic "theory burst" on the principles of delirium assessment, diagnosis and management. Evaluation tools completed by participants included the interprofessional collaborative competencies attainment survey (ICCAS) and the W(e) Learn. Two groups at each site participated in 1-hour sessions, repeated 2 weeks later. Only one group from each site received the SLM after the first session. Researchers scored EOLD knowledge and IP team functioning in both sessions. Results suggest that the intervention improved EOLD knowledge and perceptions of IP competence and supports the value of the TOSCE as an IP teaching method. The module does not appear responsible for the changes. Future studies are required to evaluate the effectiveness of the individual components used in this study, and to tailor the intervention to individual care contexts.
PubMed ID
22708995 View in PubMed
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6 records – page 1 of 1.