Development and validation of a delirium care critical-thinking scale for intensive care unit nurses: A mixed-method study.

AIM AND OBJECTIVES: To develop a Delirium Care Critical-Thinking Scale for nurses caring for patients in the intensive care unit and examine the scale's psychometric properties. BACKGROUND: There is a tool to evaluate nurses' critical thinking skills to determine nursing competency when delirium care is required. DESIGN: This cross-sectional, mixed-methods study. METHODS: The Delphi method was applied for collection and analysis of data during conceptualization and item generation of the tool (Phase I). Item analysis, assessment of validity and reliability of the scale (Phase II) involved 318 nurses recruited by convenience sampling from nine adult intensive care units in medicine and surgery at one medical centre. Confirmatory factor analysis assessed construct validity. Internal consistency and 2-week test-retest stability measured reliability. A Critical Thinking Disposition Inventory Scale examined concurrent validity. RESULTS: After three rounds, the Delphi method resulted in 31 scale items. Item analysis demonstrated construct reliability ranged from 9.23 to 16.18. Confirmatory factor analysis eliminated one item and extracted five factors: applying knowledge, confirming the problem and accuracy of information, reasoning logically, choosing appropriate strategies and remaining open-minded. Average variance extracted values of all factors indicated good convergent validity. Cronbach's α for internal consistency was .96 with good test-retest reliability. The correlation coefficient for concurrent validity was .301. CONCLUSION: The new Delirium Care Critical-Thinking Scale for intensive care nurses was demonstrated to be a reliable and valid tool for evaluating their ability to assess patients with delirium. RELEVANCE TO CLINICAL PRACTICE: This new scale could be used to assess outcomes of education interventions and the effectiveness of nursing care quality involving patients with delirium in intensive and critical care units. REPORTING METHOD: The COSMIN checklist was used as the reporting guideline for this study. PATIENT OR PUBLIC CONTRIBUTION: None.

Quality of Life in Patients With Pulmonary Hypertension.

We explored positive and negative affect, quality of life (QOL), and associated factors in patients with pulmonary hypertension. We conducted this cross-sectional study using convenience sampling at a medical center in Taiwan. We used the Social Support Scale, positive and negative affect scale, and Short Form 36-item Health Survey to collect data. In these patients, greater social support was associated with less negative affect and better QOL (mental components). Lower Borg dyspnea scores or greater distances in the six-minute walk test were associated with more positive affect, less negative affect, and better QOL (both physical and mental components). Patients with less negative affect and more positive affect had better QOL (mental components). Therefore, nursing staff should routinely monitor the emotional status and QOL of patients with pulmonary hypertension, especially those with less social support and poorer cardiopulmonary function. Strengthening these aspects may improve patients' emotional status and QOL.

Factors related to quality of life after video-assisted thoracoscopic surgery in patients with stage I adenocarcinoma lung cancer: A longitudinal study.

PURPOSE: This study aimed to assess the 5-year survival, quality of life for cancer- and lung-specific symptoms, and to identify predictive factors of quality of life during a 12-month period after video-assisted thoracic surgery (VATS) for early-stage lung adenocarcinoma. METHODS: A convenience sample of 53 patients who had undergone VATS for lung cancer was used for this longitudinal, prospective study. All participants provided responses to the cancer-specific quality-of-life European Organization for Research and Treatment of Cancer questionnaire as well as a questionnaire for lung cancer-specific symptoms using structured interviews at baseline (T0) and 3-, 6-, 9-, and 12-months post-surgery (T1, T2, T3, and T4, respectively). Generalized estimating equation models were used to investigate whether quality of life scores improved from baseline measures and to determine characteristics associated with changes in scores for quality-of-life post-surgery. RESULTS: The mean age of participants was 58.5 years (SD = 8.76), and most were female (64.2%). Participants received either a wedge or sublobular lobectomy (47.2%) or a lobectomy (52.8%). The size of the primary tumour for most participants was <2 cm (78.7%). The five-year survival rate was 90%. Lung-specific symptoms of insomnia were worse at T1 compared with baseline. Significant improvements in scores for function and cancer symptoms were seen at T4 compared with scores at T0. Age, marital status, smoking, alcohol consumption, and a history of previous cancer were significantly associated with quality of life. CONCLUSIONS: Surgical resection with VATS resulted in good 5-year survival rates and long-term improvements in quality of life. Our findings suggest VATS for patients with early-stage lung adenocarcinoma should be considered as a means of improving long-term survival and quality of life.

Effectiveness of multiple scenario simulations of acute and critical care for undergraduate nursing students: A quasi-experimental design.

BACKGROUND: Acute care and critical care are among the most challenging tasks in nursing, which requires information, knowledge, and skills across multiple areas. Scenario simulations can teach nursing students how to respond to these challenges in a safe environment, which can also reduce the stress of acute and critical care prior to exposure to a clinical setting. However, few studies have examined whether scenario simulations of acute and critical care can improve the abilities of nursing students. OBJECTIVES: To examine the effects of acute and critical care scenario simulations for nursing students. DESIGN: A quasi-experimental design. SETTING: A department of nursing at a university. PARTICIPANTS: A total of 88 senior nursing students enrolled in a course in acute and critical care nursing volunteered to participate. METHODS: The experience provided by scenario simulations was guided by the best practice standards of the International Nursing Association for Clinical Simulation and Learning, which recommends outcome measures include a change in knowledge, skills, and attitudes. Students completed three self-assessment instruments before and after completion of the course: simulation learning effectiveness, self-reflection and insight, and satisfaction with the simulation format. Comparisons of pre-test and post-test scores on the self-assessment instruments evaluated the effects of the simulation learning. RESULTS: Post-test scores for subscale of self-regulation for simulation learning effectiveness and insight were significantly higher compared with pre-test scores (t = -2.85, p < 0.01 and t = -5.23, p < 0.001, respectively). There was also a significant increase for learning satisfaction in post-test, compared with pre-test (t = -3.70, p < 0.001). CONCLUSION: The use of scenario simulations for teaching acute and critical care nursing improved self-regulation, insight and learning satisfaction for undergraduate nursing students.