Designing a nurse-delivered delirium bundle: what ICU staff, survivors and their families think

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Abstract

Background
Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation.

Objective
The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation.

Methods
Nine focus group interviews were conducted with ICU staff (n = 68) in 12 UK ICUs. Three focus group interviews were conducted with ICU survivors (n = 12) and their family members (n = 2). Interviews were digitally recorded, transcribed, and thematically analysed using the Braun and Clarke framework.

Results
Overall, staff, survivors, and their families agreed the bundle was acceptable. Facilitating factors for delivering the bundle were staff and relatives' education about potential benefits and encouraging family presence. Facilitating factors for sedation minimisation were evening ward rounds, using non-verbal pain scores, and targeting sedation scores. Barriers identified by staff were inadequate resources, poor education, relatives' anxiety, safety concerns, and ICU culture. Concerns were raised about patient confidentiality when displaying orientation materials and managing resources for early mobility. Survivors cited that flexible visiting and re-establishing normality were important factors; and staff workload, lack of awareness, and poor communication were factors that needed to be considered before implementation.

Conclusion
Generally, the bundle was deemed acceptable and deliverable. However, like any complex intervention, component adaptations will be required depending on resources available to the ICU; in particular, involvement of pharmacists in the ward round and physiotherapists in mobilising intubated patients.
LanguageEnglish
Pages174-179
JournalAustralian Critical Care
Volume31
Early online date23 Mar 2018
DOIs
Publication statusPublished - 01 May 2018

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Delirium
Intensive Care Units
Survivors
Nurses
Interviews
Focus Groups
Education
Communication
Pain
Early Ambulation
Physical Therapists
Confidentiality
Quality Improvement
Workload
Pharmacists
Critical Illness
Sleep
Anxiety
Safety

Cite this

@article{3ebdbe28c350479bbf09f225def93e77,
title = "Designing a nurse-delivered delirium bundle: what ICU staff, survivors and their families think",
abstract = "BackgroundImplementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation.ObjectiveThe objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation.MethodsNine focus group interviews were conducted with ICU staff (n = 68) in 12 UK ICUs. Three focus group interviews were conducted with ICU survivors (n = 12) and their family members (n = 2). Interviews were digitally recorded, transcribed, and thematically analysed using the Braun and Clarke framework.ResultsOverall, staff, survivors, and their families agreed the bundle was acceptable. Facilitating factors for delivering the bundle were staff and relatives' education about potential benefits and encouraging family presence. Facilitating factors for sedation minimisation were evening ward rounds, using non-verbal pain scores, and targeting sedation scores. Barriers identified by staff were inadequate resources, poor education, relatives' anxiety, safety concerns, and ICU culture. Concerns were raised about patient confidentiality when displaying orientation materials and managing resources for early mobility. Survivors cited that flexible visiting and re-establishing normality were important factors; and staff workload, lack of awareness, and poor communication were factors that needed to be considered before implementation.ConclusionGenerally, the bundle was deemed acceptable and deliverable. However, like any complex intervention, component adaptations will be required depending on resources available to the ICU; in particular, involvement of pharmacists in the ward round and physiotherapists in mobilising intubated patients.",
author = "Leona Bannon and Jennifer McGaughey and Danny McAuley and Michael Clarke and Bronagh Blackwood",
year = "2018",
month = "5",
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doi = "10.1016/j.aucc.2018.02.007",
language = "English",
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journal = "Australian Critical Care",
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TY - JOUR

T1 - Designing a nurse-delivered delirium bundle: what ICU staff, survivors and their families think

AU - Bannon, Leona

AU - McGaughey, Jennifer

AU - McAuley, Danny

AU - Clarke, Michael

AU - Blackwood, Bronagh

PY - 2018/5/1

Y1 - 2018/5/1

N2 - BackgroundImplementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation.ObjectiveThe objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation.MethodsNine focus group interviews were conducted with ICU staff (n = 68) in 12 UK ICUs. Three focus group interviews were conducted with ICU survivors (n = 12) and their family members (n = 2). Interviews were digitally recorded, transcribed, and thematically analysed using the Braun and Clarke framework.ResultsOverall, staff, survivors, and their families agreed the bundle was acceptable. Facilitating factors for delivering the bundle were staff and relatives' education about potential benefits and encouraging family presence. Facilitating factors for sedation minimisation were evening ward rounds, using non-verbal pain scores, and targeting sedation scores. Barriers identified by staff were inadequate resources, poor education, relatives' anxiety, safety concerns, and ICU culture. Concerns were raised about patient confidentiality when displaying orientation materials and managing resources for early mobility. Survivors cited that flexible visiting and re-establishing normality were important factors; and staff workload, lack of awareness, and poor communication were factors that needed to be considered before implementation.ConclusionGenerally, the bundle was deemed acceptable and deliverable. However, like any complex intervention, component adaptations will be required depending on resources available to the ICU; in particular, involvement of pharmacists in the ward round and physiotherapists in mobilising intubated patients.

AB - BackgroundImplementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation.ObjectiveThe objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation.MethodsNine focus group interviews were conducted with ICU staff (n = 68) in 12 UK ICUs. Three focus group interviews were conducted with ICU survivors (n = 12) and their family members (n = 2). Interviews were digitally recorded, transcribed, and thematically analysed using the Braun and Clarke framework.ResultsOverall, staff, survivors, and their families agreed the bundle was acceptable. Facilitating factors for delivering the bundle were staff and relatives' education about potential benefits and encouraging family presence. Facilitating factors for sedation minimisation were evening ward rounds, using non-verbal pain scores, and targeting sedation scores. Barriers identified by staff were inadequate resources, poor education, relatives' anxiety, safety concerns, and ICU culture. Concerns were raised about patient confidentiality when displaying orientation materials and managing resources for early mobility. Survivors cited that flexible visiting and re-establishing normality were important factors; and staff workload, lack of awareness, and poor communication were factors that needed to be considered before implementation.ConclusionGenerally, the bundle was deemed acceptable and deliverable. However, like any complex intervention, component adaptations will be required depending on resources available to the ICU; in particular, involvement of pharmacists in the ward round and physiotherapists in mobilising intubated patients.

U2 - 10.1016/j.aucc.2018.02.007

DO - 10.1016/j.aucc.2018.02.007

M3 - Article

VL - 31

SP - 174

EP - 179

JO - Australian Critical Care

T2 - Australian Critical Care

JF - Australian Critical Care

SN - 1036-7314

ER -