Effect of a Hospital-Acquired Pressure Injury (HAPI) Risk Score on HAPI Rates in Patients With Vascular Diseases.

PURPOSE: The purpose of this study was to assess whether a validated hospital-acquired pressure injury (HAPI) risk scale and best practice interventions were associated with lower HAPI rates compared with previous care. We also sought to identify a cut score of HAPI risk when using the instrument. DESIGN: Nonequivalent 2-group pre- and postintervention comparative study. SUBJECTS AND SETTING: The sample comprised 2871 patients treated for vascular diseases; data were collected on 2674 patients before the intervention and 197 patients postintervention. Their mean (SD) age was 69.3 (12.4) years; 29.3% (n = 842) had a history of diabetes mellitus. Based on discharge status, more patients received home health care after discharge in the postintervention group, 34% (n = 67/197) versus 16.2% (n = 430/2662), P = .001. The study setting was a quaternary care hospital in the Midwestern United States. METHODS: Patients who were at high risk for HAPI, based on a nomogram score, received a mobility and ambulation program intervention. Pre- and postintervention cohorts were compared using analysis of variance, χ 2 test, and Fisher exact test. A receiver operating characteristic curve plot was generated to determine the ability of the risk score tool to identify HAPI risk at all possible cut points. RESULTS: Despite differences in patient characteristics, primary medical diagnosis, and postdischarge health care needs, the HAPI rate decreased postintervention from 13.8% (n = 370/2674) to 1.5% (n = 3/197), P = .001. A HAPI risk-predicted value cut score of 18 had strong sensitivity (0.81) and specificity (0.81), and positive and negative predictive values of 0.42 and 0.96, respectively. CONCLUSION: Despite higher patient acuity during the intervention period, HAPI rate decreased after HAPI nomogram and nurse-led mobility intervention implementation.

Sub-categories of moral distress among nurses: A descriptive longitudinal study.

BACKGROUND: There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard "narrow" definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. RESEARCH AIMS: To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. RESEARCH DESIGN: A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. PARTICIPANTS: Registered nurses from four hospitals within one large healthcare system in Midwest United States. ETHICAL CONSIDERATIONS: IRB approval was obtained. RESULTS: 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by "other" distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. CONCLUSIONS: Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed.

Anxiety and depression moderate the relationship between quality of life and self-care in patients with heart failure.

The purpose of this study was to determine perceptions of heart failure quality of life and its relationship to self-care as moderated by anxiety and depression. Older adults (n = 85) were surveyed using Kansas City Cardiomyopathy Questionnaire-12, Self-Care of Heart Failure Index V6.2, and Patient Reported Outcomes Measurement Information System Anxiety and Depression Short Forms 4a. As quality of life and anxiety or depression scores increased jointly, their self-care management scores decreased (p < 0.001). However, higher heart failure quality of life, and lower anxiety and depression scores showed an increase in self-care management. Our findings highlight the need for nursing interventions and research targeting heart failure symptom recognition among older adults. Identification of anxiety and depression in older adults with heart failure may be an important first step for improving self-care management for this population.

Factors Associated With Predischarge Versus Postdischarge Scheduling for Early Follow-up Appointments.

BACKGROUND: Per national guidelines, early follow-up appointments should be scheduled before discharge, but in previous research, appointments scheduled before discharge were not associated with appointment adherence. OBJECTIVES: The purpose of this study was to determine whether patient, heart failure (HF), and hospital factors were associated with predischarge appointment scheduling. METHODS: A secondary analysis of a medical record review included patients hospitalized for decompensated HF at 3 health system hospitals who had a scheduled office appointment post discharge at 14 days or less. Patient demographics, and social, HF, and hospital factors were studied for association with predischarge scheduling. RESULTS: In multivariable modeling, the odds of having an appointment scheduled predischarge were based on 3 factors: nonwhite race, history of chronic renal insufficiency, and no admission within 14 days before HF hospitalization. CONCLUSIONS: Appointment scheduling may be based on provider perceptions of readmission risk. Follow-up appointment scheduling practices should be based on systematic processes.

A Call Light Responsiveness Program.

BACKGROUND: Purposeful hourly rounding and information on whiteboards in patients' rooms have been known to reduce use of call lights. PROBLEM: Call light activation was higher than desired. METHODS: This continuous improvement initiative used retrospective data collection (pre-, early- and maintenance postintervention) to assess call light responsiveness. INTERVENTION: A bundled purposeful hourly rounding approach was used. RESULTS: Call light frequency was higher in the early postintervention period than in the preintervention; however, there was no change in the frequency of call lights that extended beyond 5 minutes. In the maintenance postintervention period, compared with the pre- and early postintervention periods, call lights per patient/unit day and call lights extending beyond 5 minutes per patient/unit day decreased (all P < .001). CONCLUSIONS: Activation of a bundled purposeful hourly rounding approach was associated with a decrease in all call lights and call lights extending beyond 5 minutes per patient/unit day.

Relationships between physical activity, social isolation, and depression among older adults during COVID-19: A path analysis.

BACKGROUND: There are known significant relationships between greater physical activity and less depression, and greater social isolation and greater depression; therefore, it is important to understand these relationships among older adults during COVID-19. METHODS: The Physical Activity Scale for Elders, Geriatric Depression Scale, and PROMIS Social Isolation were administered. Path analysis was performed to evaluate the relationship between physical activity, social isolation, and depression. RESULTS: Of 803 surveys received, Consistent with our a-priori model, higher social isolation predicted greater depression. (p<0.001). CONCLUSION: Older adults may suffer a high emotional price during times of imposed social distancing.

Association of End-Tidal Carbon Dioxide Monitoring With Nurses' Confidence in Patient Readiness for Postanesthesia Discharge.

PURPOSE: To determine if end-tidal carbon dioxide (etCO2) value increased nurses' perceptions of confidence in patients' readiness for postanesthesia care unit (PACU) discharge. DESIGN: Prospective, cross-sectional, comparative, one-group (pre-post) design. METHODS: Nurses completed 2 assessments of confidence in readiness for discharge, before and after etCO2 monitoring. Patient (discharge pain level, body mass index, sleep apnea history, and opioid use) and nurse factors were assessed. Analyses included descriptive and comparative statistics. FINDINGS: Of 133 patients, mean (standard deviation) etCO2 was 36.1 (5.7) mm Hg. Nurses' confidence in readiness for discharge differed before and after etCO2 assessment. Confidence score decreased when etCO2 was low (P = .003) or high (P = .005), compared with normal values. In linear regression, etCO2 remained a factor in nurses' confidence in readiness for discharge (P < .001). CONCLUSIONS: In a PACU, etCO2 monitoring changed nurses' perceptions of confidence in patients' readiness for discharge.

Factors Associated With Adherence to 14-Day Office Appointments After Heart Failure Discharge.

BACKGROUND: Follow-up within 14 days after hospital discharge for heart failure (HF) may prevent 30-day hospital readmission, but adherence varies. The purpose of this study was to determine predictors of nonadherence to scheduled appointments. METHODS AND RESULTS: A medical record review included patients hospitalized for decompensated HF at 3 health system hospitals who had a scheduled 14-day office appointment. Patient demographics, and social, HF, and hospital factors were studied for association with appointment adherence. Multivariable modeling was used to determine the odds of missing scheduled appointments. Of 701 cases, mean (standard deviation) age was 73.5 (13.8) years, 46.4% were female and 38.9% were nonwhite. Appointment nonadherence was 16.2%. In multivariate analyses, 4 factors predicted missed appointments: drug use history (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.70-9.20; P < .001), nonwhite race (OR, 1.85; 95% CI, 1.08-3.16; P = .024), pulmonary disease (OR, 1.80; 95% CI, 1.12-2.87; P = .014), and anemia (OR, 1.58; 95% CI, 1.01-2.46; P = .044). Scheduling appointments postdischarge vs predischarge was not associated with missed appointments (OR, 0.72; 95% CI, 0.45-1.15; P = .17). CONCLUSIONS: Findings may help practitioners identify patients who are likely to miss a follow-up visit; all 4 predictors were easily retrievable from medical records during hospitalization.

Functional Capacity but Not Early Uptake of Cardiac Rehabilitation Predicts Readmission in Patients With Metabolic Syndrome.

BACKGROUND: Phase II cardiac rehabilitation reduces hospital readmissions and cardiovascular disease risk factors and improves functional capacity. Cardiovascular disease risk factors double with patients with metabolic syndrome, a population less likely to adhere to cardiac rehabilitation. PURPOSE: The aim of this study was to determine relationships between cardiac rehabilitation uptake timing, demographic variables and functional capacity, and readmission in patients with metabolic syndrome. METHODS: This retrospective, medical records study involved 353 patients with metabolic syndrome who subsequently received cardiac rehabilitation. Logistic regression was used to examine relationships between time from discharge to cardiac rehabilitation uptake and readmission. Unordered categorical factors were compared between readmission groups using Pearson χ tests. Multivariable logistic regression was used to identify predictors of readmission. RESULTS: Patients readmitted within 30 and 90 days of hospitalization were more often women (P ≤ .018) and nonwhite (P ≤ .002) and had lower functional capacity (P < .001). In multivariable analysis, white race (odds ratio [OR], 0.50 [95% confidence interval (CI), 0.25-0.99]; P = .045) and higher functional capacity (OR, 0.80 [95% CI, 0.68-0.93]; P = .005) were protective against hospital readmission within the first 90 days. Race, sex, and functional capacity remained significant predictors of readmission at 1 year. In multivariable analysis, only race (OR, 0.41 [95% CI, 0.22-0.79]; P = .007) and functional capacity (OR, 0.83 [95% CI, 0.73-0.95]; P = .007) were significant. Early cardiac rehabilitation was not associated with readmission at any time point (P > .05). CONCLUSIONS: Sex, race, and functional capacity were important predictors of readmission for metabolic syndrome, even when cardiac rehabilitation intake was delayed. Results raise questions about the unique traits of patients with metabolic syndrome and need for novel approaches to improve cardiac rehabilitation utilization and functional capacity in metabolic syndrome.

Staff Perceptions of Decision-Making in a Shared Governance Culture.

OBJECTIVE: To evaluate differences in the shared decision-making perceptions of clinical nurses between initial implementation of a shared governance model and perceptions 3 years later after the model has matured. BACKGROUND: Shared decision-making empowers nurses to have a voice in their practice and supports engagement and retention. METHODS: A prospective, 2-group comparative design was conducted using the Index of Professional Nursing Governance, a validated, reliable tool. After comparing data univariately, a multivariable linear regression model was used to evaluate the impact of nurse characteristics on shared decision-making responses. RESULTS: Mean overall shared decision-making score (P = .23) and domain scores (P values between .055 and .63) did not increase in 2015 compared with 2012. After adjusting for differences in nurse characteristics between groups, overall score (P = .017) and 3 of 6 domain scores improved: professional control of work, structures for decisions and access to information (all P values between .005 and .031). CONCLUSION: As shared governance became established, shared decision-making scores increased.

Pediatric Vascular Access Peripheral IV Algorithm Success Rate.

PURPOSE: Determine if the pediatric peripheral vascular access algorithm (PPVAA) led to differences in first-attempt and overall peripheral intravenous (PIV) success, staff attempting PIV access per episode and overall attempts and first PIV attempt success by provider. DESIGN/METHODS: A two-cohort pre-/post-implementation comparative design involved pediatric nurses and patients. The PPVAA included four components: a patient comfort plan, PIV grading score, nurses' self-assessed IV access capability and nurse decision to stop-the-line. Two sample t-test or Wilcoxon rank sum test and Pearson's chi-square test were used to evaluate differences between groups and measures. RESULTS: Healthcare providers (N=96) attempted 721 PIV insertions (pre-PPVAA, n=419 and post-PPVAA, n=302). Of 78 nurse providers, mean (SD) age was 37.4 (11.0) years and 20.0% self-assessed PIV capability as expert. Of children, mean age was 8.3 (7.0) years. Post-PPVAA, first-attempt (p=0.86) and overall (p=0.21) success did not change, though fewer staff were needed per episode to initiate PIV; p=0.017. Overall rate of success after one attempt in the post-PPVAA period compared to pre-PPVAA was reduced (p=0.002), reflecting greater awareness to stop-the-line. Compared to pre-PPVAA, advanced practice nurses and non-clinician providers were more likely to achieve success on first attempt. CONCLUSIONS: The PPVAA did not increase first-attempt or overall PIV success; however, it decreased overall IV attempts and the number of staff attempting access per episode. PRACTICE IMPLICATIONS: The multi-component PPVAA provided a guide for nurses during PIV and assisted decision making to stop attempts in difficult cases.

A Team Approach to Enhance Scholarship Among Honors Students in Nursing.

Honors programs within schools of nursing have the potential to enhance young nurses' interest in developing programs of research early in their careers and can thus contribute to the successful development of nursing knowledge. Such programs also provide opportunities to enhance knowledge and skill in leadership and teamwork at a critical time during the development of their professional nurse identity. This article presents the successful approach one organization took when revising its honors program to meet the current needs of students, society, and the profession.

Cardiac Rehabilitation Facebook Intervention: Feasibility Randomized Controlled Trial.

BACKGROUND: The adherence to cardiac rehabilitation is low. Social media has been used to improve motivation and cardiac rehabilitation completion, but the authors did not find Facebook interventions for these purposes in the literature. OBJECTIVE: The purpose of this study was to determine the feasibility of the Cardiac Rehabilitation Facebook Intervention (Chat) for affecting changes in exercise motivation and need satisfaction and adherence to cardiac rehabilitation. METHODS: The Behavioral Regulation in Exercise Questionnaire-3 and Psychological Need Satisfaction for Exercise were used to measure motivation and need satisfaction (competence, autonomy, and relatedness) before and after the Chat intervention. To support need satisfaction, the intervention included educational posts, supportive posts, and interaction with peers. The feasibility measures included recruitment, engagement, and acceptability. Groups were compared using analysis of variance and Kruskal-Wallis tests. Paired t tests were used to assess motivation and need satisfaction change, and Pearson or Spearman correlations were used for continuous variables. RESULTS: A total of 32 participants were lost to follow-up and 22 were included in the analysis. Higher motivation at intake (relative autonomy index 0.53, 95% CI 0.14-0.78; P=.01) and change in need satisfaction-autonomy (relative autonomy index 0.61, 95% CI 0.09-0.87; P=.02) were associated with more completed sessions. No between-group differences were found. Engagement included "likes" (n=210) and "hits" (n=157). For acceptability, mean scores on a 1 (not at all) to 5 (quite a bit) Likert scale for feeling supported and in touch with providers were 4.6 and 4.4, respectively. CONCLUSIONS: Acceptability of the Chat group was high; however, intervention feasibility could not be determined due to the small sample size. Those with greater motivation at intake completed more sessions, indicating its importance in cardiac rehabilitation completion. Despite challenges with recruitment and engagement, important lessons were learned. TRIAL REGISTRATION: ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.7554.

Outcomes after implementing a heart failure diuretic pathway in an emergency department setting.

BACKGROUND: Among patients with acute decompensated heart failure (HF), national and international loop diuretic therapy recommendations may not be followed in the emergency department (ED). OBJECTIVES: To examine if loop diuretic treatment and patient disposition from the ED differed after implementing a clinical pathway based on national HF guidelines. METHODS: Using an observational, pre- and post-intervention design, after clinical pathway implementation, loop diuretic medications and clinical outcomes were retrieved from medical records. Analyses included Pearson's Chi-square or Fisher's exact test, 2-sample T-test or Wilcoxon rank sum test. RESULTS: Of 182 pre- and 122 post-intervention patients, mean (SD) patient age was 67.9 (13.4) years and 44.2% were Caucasian. There were no between-group differences in pre-ED visit loop diuretic prescription or dosages. More post-intervention ED patients received at least one dose of loop diuretic (94.3% vs. 81.9%, p = 0.010); however, the overall dose (mg) across groups was lower than the home dose and was not based on national guideline expectations. Doses from home to ED decreased less in the post-intervention group for patients who received doses at both time points and for all patients: p = 0.047 and p = 0.048, respectively. There was no between-group differences in short-stay unit (SSU) admissions, p = 0.33. Post-intervention patients were hospitalized from the ED (p = 0.050) and SSU (p = 0.005) less often than pre-intervention patients. Discharge to home from the ED or SSU increased in the post-intervention period; 16.4% vs. 4.9%, p = 0.009. CONCLUSIONS: Among ED patients treated for HF, diuretic dosing was non-optimized. New interventions are needed to enhance adherence to national guidelines.

Assessment of the Value of a Carriage System to Organize and Elevate Intravenous Tubing.

Caregiver/patient fall injury risks increase when medical tubing drapes on floors. The objective of this research was to examine the value of a novel carriage system that organizes and elevates medical and intravenous (IV) tubing. Using a prospective, multicenter, cohort design, value of the IV carriage system was assessed using a valid, reliable survey that provided the total score and scores of 3 involvement factors: personal relevance, attitude, and importance. The survey was scored on a 0-100 scale, and questions about tubing elevation, patient mobility, and ease of use were rated on 0-10 scales. Participants were adult and pediatric inpatient caregivers (n = 131). In adult intensive care environments (n = 61), carriage system value scores were higher in the quaternary care site compared to 4 enterprise adult intensive care sites (median [Q1, Q3]: 90.0 [69.2, 97.5] vs 72.5 [52.5, 78.3], respectively; P = .008). Compared to nurses working in adult environments (n = 58), pediatric nurses (n = 40) had higher value scores (median [Q1, Q3]: 89.2 [68.3, 97.5] vs 97.5 [85.8, 100.0], respectively; P = .007). High median score ratings (9-10) were given for tubing elevation, patient mobility, and ease of use. In conclusion, the IV carriage system was valued by nurses as an important tool in clinical practice.

Simulation Versus Written Fall Prevention Education in Older Hospitalized Adults: A Randomized Controlled Study.

Using a randomized controlled, non-blinded, two-group design, differences in fall risk assessment, post-discharge sustainable fall risk changes, fall events and re-hospitalization were examined in 77 older adults who received a simulation (n = 36) or written (n = 41) education intervention. Between-group differences and changes in pre- versus post-fall risk assessment scores were examined using Pearson's chi-square, Wilcoxon rank sum or Fisher's exact tests (categorical variables) and two-sample t-tests (continuous variables). There were no statistically significant differences between groups in demographic characteristics. Patients who received simulation education had higher fall risk post-assessment scores than the written education group, p = .022. Change in fall risk assessment scores (post-vs.-pre; 95% confidence intervals) were higher in the simulation group compared to the written education group, 1.43 (0.37, 2.50), p = .009. At each post-discharge assessment, fall events were numerically fewer but not significantly different among simulation and education group participants. There were no statistically significant between-group differences in re-hospitalization.

Efficacy of One Dose of Laxative on Postoperative Constipation Following Total Knee Arthroplasty.

Postoperative constipation is a common problem among orthopaedic surgical patients leading to discomfort, increased length of stay, and other complications. The primary purpose of this study was to determine the effectiveness of polyethylene glycol compared with docusate sodium for the prevention of constipation, after total knee arthroplasty. The secondary purpose was to examine the effectiveness of polyethylene glycol on pain and strain with bowel movement. A two-group nonequivalent cohort design was used to evaluate the effect of one 17-g dose of polyethylene glycol by mouth on postoperative day 1 compared with usual care with docusate sodium 100 mg starting the day of surgery and continued twice daily at home. There was no significant difference in the rate of constipation between the two cohorts in the 3 days after surgery. There was no difference in reported pain and strain. Future research should focus on the use of pharmacologic and nursing interventions together for prevention of postoperative constipation in patients with arthroplasty surgery.

Association of SGLT-2 Inhibitors With Treatment Satisfaction and Diabetes-Specific and General Health Status in Adults With Cardiovascular Disease and Type 2 Diabetes.

Background It is unknown if initiation of a sodium-glucose cotransporter-2 inhibitor (SGLT-2i) is associated with changes in patient-reported health status outside of clinical trials. Methods and Results Using a prospective observational study design, adults with type 2 diabetes and cardiovascular disease were recruited from 14 US hospitals between November 2019 and December 2021 if they were new users of noninsulin antidiabetic medications. The primary outcome was change in 6-month diabetes treatment satisfaction. Secondary outcomes included diabetes-related symptom distress, diabetes-specific quality of life, and general health status for all patients and based on cardiovascular disease type. Inverse probability of treatment weight using propensity score was performed to compare outcome changes based on medication use. Of 887 patients (SGLT-2i: n=242) included in the inverse probability of treatment weight analyses, there was no difference in changes in treatment satisfaction in SGLT-2i users compared with other diabetes medication users (0.99 [95% CI, -0.14 to 2.13] versus 1.54 [1.08 to 2.00], P=0.38). Initiating an SGLT-2i versus other diabetes medications was associated with a greater reduction in ophthalmological symptoms (-3.09 [95% CI, -4.99 to -1.18] versus -0.38 [-1.54 to 0.77], P=0.018) but less improvement in hyperglycemia (1.08 [-2.63 to 4.79] versus -3.60 [-5.34 to -1.86], P=0.026). In subgroup analyses by cardiovascular disease type, SGLT-2i use was associated with a greater reduction in total diabetes symptom burden and neurological sensory symptoms in patients with heart failure. Conclusions Among patients with type 2 diabetes and cardiovascular disease, initiating an SGLT-2i was not associated with changes in diabetes treatment satisfaction, total diabetes symptoms, diabetes-specific quality of life, or general health status.

Do patient and nurse outcome differences exist between 2 negative pressure wound therapy systems?

PURPOSE: We prospectively compared the effectiveness of foam- and gauze-based negative pressure wound therapy (NPWT) systems on wound healing, pain, cost, and hospital length of stay. We also compare ease of use and time in performing dressing changes reported by nurses. DESIGN: Randomized, controlled clinical trial comparing foam- and gauze-based NPWT systems. SUBJECTS AND SETTING: Eleven adult subjects with physician orders for NPWT participated in the study. Subjects were middle-aged, white, and male. METHODS: Six subjects were randomly allocated to foam-based and 5 to gauze-based NPWT systems. Wound healing rates and pain at the first dressing change were measured using a centimeter ruler and a visual analog scale, respectively. Wound care costs were tabulated from a checklist of supplies used and nurse perceptions were measured by responses to Likert-type surveys. Relationships between NPWT system and selected variables were measured using Wilcoxon rank sum tests. RESULTS: Median wound healing rates did not differ significantly between foam-based and gauze-based NPWT systems when measured in centimeters at first dressing change for length (10.6 vs 16.5, P = .58), width (2.7 vs 4.2, P = .41), depth (2.2 vs 2.5, P = .78), and tunneling and undermining (both 0 vs 0, P = .82 and .79, respectively). No differences were detected in pain rating at first dressing change (3.2 vs 2.4, P = .77), cost of wound care ($510.18 vs $333.54 P = .86), or hospital length of stay (26.33 vs 14.8 days; P = .58), respectively. There were no differences in nurses' experiences in ease of performing dressing changes and mean time to perform the first dressing change for foam- or gauze-based NPWT systems: 32.3 vs 38.8 minutes; P = .52, respectively. CONCLUSIONS: In a pilot study comparing the effectiveness of foam- and gauze-based NPWT systems, no statistically significant differences were found in patient wound healing, pain, length of stay, or cost of wound care. Nursing time and perceptions about the ease of preparing and completing dressing changes did not differ between systems. Additional research is needed to more definitively determine any differences in wound healing or nurse satisfaction using gauze- versus foam-based NPWT systems.

Postoperative Cardiovascular Surgery Delirium: Interrater Agreement Between Nurses and Clinical Nurse Specialist and Factors Associated With Prevalence.

PURPOSE: The aims of this study were to examine interrater agreement of delirium between clinical nurses and a clinical nurse specialist, determine delirium subtype prevalence, and examine associated patient, procedure, and hospital factors. DESIGN: A descriptive cross-sectional design and a convenience sample of nurses and patients on progressive care units were used in this study. METHODS: Clinical nurse specialist data were collected on a case report form, and clinician and patient data were obtained from electronic databases. Interrater agreement of delirium prevalence was assessed by κ statistic, and logistic regression models were used to determine patient factors associated with delirium. RESULTS: Of 216 patients, 23 had delirium; clinical nurses identified fewer cases than the clinical nurse specialist: 1.8% versus 10.7%; κ agreement, 0.27 (0.06, 0.49). By delirium subtype, hypoactive delirium was more frequent (n = 10). Factors associated with delirium were history of cerebrovascular disease (odds ratio [95% confidence interval], 2.8 [1.01-7.7]; P = .044), history of mitral valve disease (odds ratio [95% confidence interval], 0.31 [0.09-0.90]; P = .041), and longer perfusion time (odds ratio [95% confidence interval], 1.7 [1.1-2.7]; P = .016). One factor was associated with hypoactive delirium, longer perfusion time (odds ratio [95% confidence interval], 2.2 [1.3-4.2]; P = .008). CONCLUSIONS: Because clinician-clinical nurse specialist delirium agreement was low and hypoactive delirium was common, clinical interventions are needed.