Delirium-related distress in the ICU: A qualitative meta-synthesis of patient and family perspectives and experiences.

BACKGROUND: Better understanding of patient and family member experiences of delirium and related distress during critical care is required to inform the development of targeted nonpharmacologic interventions. OBJECTIVE: To examine and synthesize qualitative data on patient and family member delirium experiences and relieving factors in the Intensive Care Unit (ICU). DESIGN: We conducted a systematic review and qualitative meta-synthesis. Eligible studies contained adult patient or family quotes about delirium during critical care, published in English in a peer-reviewed journal since 1980. Data sources included PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane and Clinicaltrials.gov. METHODS: Systematic searches yielded 3238 identified articles, of which 14 reporting 13 studies were included. Two reviewers independently extracted data into a Microsoft Excel spreadsheet. Qualitative meta-synthesis was performed through line-by-line coding of relevant quotes, organization of codes into descriptive themes, and development of analytical themes. Five patients/family members with experience of ICU delirium contributed to the thematic analysis. RESULTS: Qualitative meta-synthesis resulted in four major themes and two sub-themes. Key new patient and family-centric insights regarding delirium-related distress in the ICU included articulation of the distinct emotions experienced during and after delirium (for patients, predominantly fear, anger and shame); its 'whole-person' nature; and the value that patients and family members placed on clinicians' compassion, communication, and connectedness. CONCLUSIONS: Distinct difficult emotions and other forms of distress are experienced by patients and families during ICU delirium, during which patients and families highly value human kindness and empathy. Future studies should further explore and address the many facets of delirium-related distress during critical care using these insights and include patient-reported measures of the predominant difficult emotions.

Delirium the under-recognised syndrome: survey of healthcare professionals' awareness and practice in the intensive care units.

AIMS AND OBJECTIVES: To survey intensive care unit healthcare professionals' awareness and practice related to delirium. BACKGROUND: Despite the current evidence revealing the risks linked to delirium and advances in practice guidelines promoting delirium assessment, healthcare professionals show little sensitivity towards delirium and evident training needs. DESIGN: The study had a cross-sectional survey design. METHODS: A sample of 168 intensive care unit healthcare professionals including nurses and physicians completed a semistructured questionnaire to survey their awareness, screening and management of delirium in intensive care units. The survey took place at 11 intensive care units from academic (university) and nonacademic (nonuniversity) governmental hospitals in Mansoura, Egypt. RESULTS: The mean score of delirium awareness was 64·4 ± 14·0 among intensive care unit healthcare professionals. Awareness of delirium was significantly lower when definition of delirium was not provided, among diploma nurses compared to bachelor degree nurses and physicians, among those who did not attend any workshop/lecture or read an article related to delirium and lastly, those who work in an intensive care unit when <50% of patients develop delirium. The survey found that only 26·8% of the healthcare professionals screen for delirium on a routine basis, and 14·3% reported attending workshops or lectures or reading an article related to delirium in the last year. In screening delirium, healthcare professionals did not use any tools, nor did they follow adopted protocols or guidelines to manage delirium. To manage delirium, 52·4% of the participants reported using sedatives, 36·9% used no drugs, and 10·7% reported using antipsychotics (primarily haloperidol). CONCLUSION: Intensive care unit healthcare professionals do not have adequate training or routine screening of delirium. There is an evident absence of using standardised tools or adapting protocols to monitor and manage delirium. RELEVANCE TO CLINICAL PRACTICE: This study has the potentials to shed some lights on the variables that might explain the problem of underdiagnosing delirium by healthcare professionals at intensive care units in Mansoura.

Objective structured video examination in psychiatric and mental health nursing: a learning and assessment method.

In the current study, the Objective Structured Video Examination (OSVE) was conducted to assess undergraduate nursing students' knowledge, observation, and clinical reasoning related to clinical psychiatric nursing competencies. The OSVE showed acceptable reliability and validity (Cronbach's α = 0.714, r = 0.6, respectively). Students highly appraised the OSVE because it covered a wide area of knowledge and clinical skills; the examination instructions were clear, concrete, and easily understood; the sounds and pictures of the videos were clear; and the videos simulated real patients. The examination was fair, well-administered, well-structured, and well-sequenced. The OSVE reflected learned skills, it provided opportunities for learning, grades were clearly identified, and it eliminated personal bias. Overall, the OSVE provided a practical and useful experience. On the other hand, some students negatively perceived the OSVE as being stressful and requiring more time.

Using Objective Structured Clinical Examination (OSCE) in undergraduate psychiatric nursing education: is it reliable and valid?

UNLABELLED: While there is widespread use of OSCE in general nursing specialties, psychiatric nursing has been slow to adopt this evaluation method and it has only recently been introduced to psychiatric nursing education. AIM: The main aim of the present study is to test the first application, validity and reliability of the OSCE in undergraduate psychiatric nursing education. METHOD: OSCE was developed to assess undergraduate psychiatric nursing students' clinical skills. The students' evaluation of the OSCE process was obtained after the completion of each OSCE circuit. RESULTS: The psychiatric nursing OSCE proved to be a reliable and valid method in assessing psychiatric nursing clinical competencies. In general, the students perceived OSCE as a positive experience and stressful on the other hand. CONCLUSION: OSCE is a reliable and valid method of assessing the students' psychiatric nursing competency skills. It has been shown to have many advantages over traditional methods of assessment and has the ability to objectively assess psychiatric nursing skills.