2019 Research and EBP projects
Building an Army of Nurses to Combat Delirium: Delirium Boot Camp
Authors: Mae Dizon DNP, RN, ANP-BC and Heather Roorda MSN, RN-BC
PICO/Clinical Question: For acute care nurses, how does a 4 hour intensive delirium education program (combined didactic and case study review) affect knowledge acquisition and retention?
Project Goal: To evaluate the effectiveness of comprehensive nurse education for best practice care of patients with delirium.
Background: Delirium is a serious medical syndrome commonly experienced by older adults. Delirium is associated has been linked to poor outcomes such as longer length of stay (Gleason, et al., 2015), higher rate of complications (Zhang et al., 2013), and even increased mortality (Pieralli et al. 2014). Research has found that nurses reported a lack of general understanding about delirium (Sinvani et al., 2016). Nurses also reported a significant amount of burden when caring for these patients (McDonnell & Timmins, 2012). With nurses playing a key role in managing delirium, it is pertinent to provide an educational curriculum with focused interventions to improve delirium prevention and management.
Methodology: Nurses attended a 4-hour class that covered the following delirium topics: definition, identification, and management. Before the class, attendees were asked to complete a modified delirium knowledge questionnaire created by Hare, Wynaden, & McGowan (2008). The same questionnaire was given after the class. After 6 months, the same knowledge questionnaire was sent to the attendees along with an 8-question survey to determine the participants’ level of confidence in managing delirium. The questionnaires are de-identified and then paired.
Results: Twenty nurses attended the class. Fifty percent reported having more than 20 years experience. There was an average 3.7 point increase between the pre and post-test using a paired t-test approach (n=10) – approaching marginal significance. There was not a significant decrease between the post and 6 months scores. Majority of the nurses (90%) reported feeling confident in knowing the topics covered 6 months after the class.
Conclusions: Creating a comprehensive and interactive delirium curriculum led to improved and retained knowledge. More importantly, the nurses felt more confident in managing delirium. Had there been a larger sample size and higher return rate, there may be more statistically significant results on knowledge acquisition and retention. Given the reports of confidence at 6 months post, it may warrant more focus on this topic for new hire nurses and on a continued basis.
Would the Use of Aromatherapy Improve Nausea During the First 24 Hours Post Surgery?
Authors: Winnie Sin, BSN, CMSRN, Kelli Lin, BSN, CMSRN, and Anna Marie Bentic, MSN, CCRN-CSC
PICO Question: In surgical patients, will the patients’ perception of the use of aromatherapy be useful in guiding practice change and implementation for relieving post-operative nausea?
Project Goal: This evidence based practice project will look to validate a patient's perceptions of the aromatherapy experiences as it relates to post-operative nausea and vomiting (PONV) to guide implementation of this best practice.
Background: The American Society of PeriAnesthesia Nurses (ASPAN) has recognized nausea and vomiting as one of the most commonly occurring post-operative complications. PONV can result to prolonged hospital stay, unanticipated admission, and increased healthcare cost. Some patients will need multiple antiemetic medications to address nausea and vomiting which can lead to unwanted side effects such as increased sleepiness and can potentially lead to delayed ambulation and aspiration pneumonia. The use of aromatherapy has already been proven to be an acceptable alternative and complementary therapy management for PONV.
Methodology: This evidence based practice will take a quantitative and qualitative approach. Participants will be identified through convenience sampling. Nurses in the oncology unit will be given training and educational material regarding the study protocol. Potential subjects will be identified after verbalizing nausea within 24 hours post-surgery. Staff will follow the existing anti-emetic physician orders for all patients requesting nausea treatment. As an adjunct, the patients will be offered aromatherapy to help determine interest in participating in the project. Patients will be given an information sheet about the aromatherapy product. Patients will be asked to rate their nausea at baseline using a 5-point Likert scale (0 = no nausea, 5 = worst possible nausea). After 30 minutes, the nurses will follow-up with the patients to rate their nausea using the same 5-point Likert scale. Additional questions will be asked to help determine level of satisfaction about the treatment, perceived effectiveness, and any general comments about their experience. Completed paper forms will be placed in a box in the main nursing station. Expected duration of the project is 1 year.
Results: This project is ongoing and results are pending.
Nursing research and innovation are supported by donations to El Camino Health Foundation.