Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside
Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside
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DOI：
10.1186/cc6793
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发表时间：
2008-01-01
期刊：
影响因子：
15.1
通讯作者：
Skrobik, Yoanna
中科院分区：
文献类型：
--
作者：
Devlin, John W.;Marquis, Francois;Skrobik, Yoanna
背景虽然护士在识别谵妄中起着关键作用，但一些作者注意到他们识别谵妄的能力存在差异。我们试图衡量一个简单的教育干预的能力，重症监护病房（ICU）护士临床识别谵妄和使用标准化的谵妄scalescorrect.Methods五十ICU护士从两个不同的医院（大学医学和社区教学）评估ICU患者的疼痛，镇静水平和谵妄的存在之前和之后的教育干预的影响。同一名患者同时但独立地由经验证的法官（rho = 0.98）进行评价，该法官在所有情况下均作为参考标准。教育包括两个脚本一致性的情况下，幻灯片介绍规模为基础的谵妄assessment，和两个进一步的cases.Results护士的临床认识谵妄是穷人在教育前的时期，只有24%的护士报告的存在或不存在谵妄，只有16%是正确的相比，法官。教育后，能够使用任何量表评估谵妄的护士人数（12%比82%，P < 0.0005）和正确使用量表的护士人数（8%比62%，P < 0.0005）显著增加。而法官-护士协议（斯皮尔曼。）教育前后谵妄发生率均较高（r = 0.74，P = 0.262），教育前评估谵妄人数少，教育后评估谵妄人数少，差异有统计学意义。结论结合脚本一致性理论的简单复合教育干预可提高ICU护士的谵妄筛查能力，与专家组相比，差异无统计学意义（P = 0.125）。由护士自我报告完成谵妄筛查可能不构成充分的质量保证过程。
Background While nurses play a key role in identifying delirium, several authors have noted variability in their ability to recognize delirium. We sought to measure the impact of a simple educational intervention on the ability of intensive care unit (ICU) nurses to clinically identify delirium and to use a standardized delirium scale correctly.Methods Fifty ICU nurses from two different hospitals (university medical and community teaching) evaluated an ICU patient for pain, level of sedation and presence of delirium before and after an educational intervention. The same patient was concomitantly, but independently, evaluated by a validated judge (rho = 0.98) who acted as the reference standard in all cases. The education consisted of two script concordance case scenarios, a slide presentation regarding scale- based delirium assessment, and two further cases.Results Nurses' clinical recognition of delirium was poor in the before-education period as only 24% of nurses reported the presence or absence of delirium and only 16% were correct compared with the judge. After education, the number of nurses able to evaluate delirium using any scale (12% vs 82%, P < 0.0005) and use it correctly (8% vs 62%, P < 0.0005) increased significantly. While judge- nurse agreement (Spearman.) for the presence of delirium was relatively high for both the before- education period (r = 0.74, P = 0.262) and after- education period (r = 0.71, P < 0.0005), the low number of nurses evaluating delirium before education lead to statistical significance only after education. Education did not alter nurses' self- reported evaluation of delirium (before 76% vs after 100%, P = 0.125).Conclusion A simple composite educational intervention incorporating script concordance theory improves the capacity for ICU nurses to screen for delirium nearly as well as experts. Self- reporting by nurses of completion of delirium screening may not constitute an adequate quality assurance process.