Delirium post-cardiac surgery: Incidence and associated factors.

BACKGROUND: Post-operative delirium among cardiac surgery patients is a prevalent complication that associated with multiple negative outcomes. AIM: This study aimed to assess delirium incidence, associated factors, and outcomes for adult patients who underwent elective cardiac surgery. DESIGN: An exploratory prospective cohort design was used for this study. METHODS: Delirium was diagnosed by the Confusion Assessment Method for the Intensive Care Unit. Incidence, preoperative, intraoperative, and post-operative variables for 245 patients during 3-month period were collected and analysed. RESULTS: Delirium developed in 9% (n = 22) of the sample. Patients with delirium were significantly older (mean age = 65.7, SD = 8.1), t (243) = -3.66, P < .05); had longer surgery time (mean time = 286.3, SD = 82.2), t (243) = -2.25, P < .05); received more blood post-surgery (t (243) = -3.86, P < .05); spent more time on mechanical ventilation (t [21.6] = -2.2, P < .05); had longer critical care unit stay (t [21.7] = -4.0, P < 0.05); and had longer hospitalization than patients without delirium. CONCLUSIONS: The risk factors associated with development of delirium were advanced age and increased duration of surgery. Negative outcomes associated with delirium were increased duration of mechanical ventilation, increased volume of post-operative infused colloids and blood/products, increased critical care unit stay, and increased hospitalization. A multifactorial model for delirium risk factors should be considered to detect and work on potentially preventable delirium factors. RELEVANCE TO CLINICAL PRACTICE: Post-cardiac surgery delirium leads to longer mechanical ventilation time, increased ICU stay, and prolonged hospitalization. Delirium post-cardiac surgery is potentially preventable with appropriate identification of risk factors by nurses.

Maturity Level of the Stigma Concept Associated with Cancer Diagnosis in the Nursing Literature

Objective: This study aimed to evaluate the maturity level of stigma as a concept in nursing and its relationship to care provided for patients with cancer. Methods: The four principles of Morse and his colleagues were used to evaluate the maturity level of the stigma concept: epistemological, logical, pragmaticl, and linguistic. Analysis was conducted with the literature published between 2006 and 2016. Results: The findings of this study suggest that the concept of stigma in nursing is immature, defined inconsistently, and measured with different instruments. How stigma is defined can influence nurses in their assessment of patients with cancer and identification of their needs. Conclusion: Although extensive studies have been conducted in the field of mental illness, it is only recently that the effect of stigma on treatment of cancer patients has attracted attention. Thus, substantial work yet needs to be done to understand the breadth and scope of stigma impacting on individuals with cancer.

Nurses' Experiences of Grief Following Patient Death: A Qualitative Approach.

PURPOSE: To explore the lived experiences of nurses' feelings, emotions, grief reactions, and coping mechanisms following their patients' death. BACKGROUND: On a daily basis, nurses are experiencing patients' death, which exposes them to grief. Nurses' grief has not been sufficiently addressed in practice settings, although it has been a well-known threat to health and work performance. DESIGN: A qualitative design guided by a phenomenological approach was adopted. METHOD: Data were collected from a purposive sample of 21 Jordanian nurses by conducting three focus groups and analyzed using Colaizzi's framework. FINDINGS: Four themes were generated in which participants reported feelings of grief following their patients' death. Their grief emotions were reported as sadness, crying, anger, shock, denial, faith, fear, guilt, fear of the family's reaction, and powerlessness. CONCLUSIONS: The study provided evidence that nurses respond emotionally to patients' death and experience grief. Nurses are burdened by recurrent patients' deaths and try to cope and overcome their grief. This study emphasizes the importance of developing strategies to help nurses positively cope with their grief from a holistic perspective. This will reflect positively on the nurses' performance.