RESUMEN
PURPOSE: Emergence delirium (EDL) is a psychomotor behavioral phenomenon that occurs immediately after emergence from general anesthesia. EDL is nearly 1.5 times more common among military than nonmilitary patients. Indirect delirium scales have precluded understanding of EDL in military patients. This quality improvement project assesses the feasibility of adopting a population-specific scale, the Emergence Delirium in the Wounded Warrior (ED-WW) Tool. DESIGN: Pre-post implementation design. METHODS: Postanesthesia care unit (PACU) nurses were surveyed on the clinical utility of the ED-WW Tool and its impact on their workload. The incidence of EDL behaviors in a Veterans Administration PACU was also recorded using the ED-WW Tool. FINDINGS: PACU nurses agreed the ED-WW Tool was of clinical value to military patients and had a very low workload impact. Twenty-one percent of patients demonstrated at least one behavior associated with EDL. CONCLUSIONS: ED-WW Tool adoption is clinically feasible and recommended for practice.
Asunto(s)
Delirio del Despertar/clasificación , Enfermeras y Enfermeros/psicología , Percepción , Estándares de Referencia , Carga de Trabajo/normas , Delirio del Despertar/enfermería , Humanos , Incidencia , Enfermeras y Enfermeros/estadística & datos numéricos , Enfermería Posanestésica/métodos , Mejoramiento de la Calidad , Factores de Riesgo , Estadísticas no Paramétricas , Carga de Trabajo/psicología , Carga de Trabajo/estadística & datos numéricosRESUMEN
Emergence delirium is a known phenomenon which occurs after general anesthesia in approximately 5% of the general population. However, individuals who have been diagnosed with post-traumatic stress disorder may present with symptoms refractory to conventional methods of reorientation. In the past several years, literature has begun to address the problem, but no standardized guidelines exist at present. The authors synthesize the available literature, combining data with evidence-driven principles from multiple disciplines, to submit an initial set of guidelines until research either supports or disproves these recommendations.
Asunto(s)
Anestesia General/efectos adversos , Delirio del Despertar/enfermería , Trastornos por Estrés Postraumático/complicaciones , Delirio del Despertar/etiología , HumanosRESUMEN
OBJECTIVES: This study developed and validated the Perceived Stigma of Delirium Scale(PSDS), which is designed to measure perceived stigma associated with delirium in patients suffering from that disorder. METHODS: Based on a literature review of scales assessing stigma, a preliminary scale comprising seven items was developed. After recovering from delirium, 128 patients completed the PSDS and the Distress Thermometer (DT). Factor analysis was used to examine construct validity, and internal consistency and test-retest reliability were examined to ensure reliability. Concurrent validity was assessed using the correlation between the total scores on the PSDS and the DT. RESULTS: Factor analysis yielded a single-factor structure from the seven candidate items. One item was excluded due to low factor loading. The internal consistency was computed and Cronbach's α was 0.85 for the total score. The overall test-retest reliability was 0.71, with items ranging from 0.58 to 0.83. The total score on the PSDS was significantly correlated with the DT score. CONCLUSIONS: The PSDS may be a reliable, valid instrument for evaluating perceived stigma in patients who have recovered from delirium. Further study of the perceived stigma by delirium patients is required to assess the implications of the PSDS for clinical practice and research.
Asunto(s)
Humanos , Delirio , Termómetros , Pesos y MedidasRESUMEN
Pediatric emergence delirium is a postoperative phenomenon characterized by aberrant cognitive and psychomotor behavior, which can place the patient and health care personnel at risk for injury. A common tool for identifying emergence delirium is the Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS), although it has not been validated for use in the pediatric population. The Pediatric Anesthesia Emergence Delirium Scale (PAED) is a newly validated tool to measure emergence delirium in children. We chose to implement and evaluate the effectiveness and fidelity of using the PAED Scale to identify pediatric emergence delirium in one eight-bed postanesthesia care unit in comparison with the traditional LOC-RASS. The overall incidence of pediatric emergence delirium found by using the LOC-RASS with a retrospective chart review (3%) was significantly lower than the incidence found by using the LOC-RASS (7.5%) and PAED Scale (11.5%) during the implementation period. Our findings suggest that the PAED Scale may be a more sensitive measure of pediatric emergence delirium, and, in the future, we recommend that health care personnel at our facility use the PAED Scale rather than the LOC-RASS.