People with cognitive impairment in acute hospitals Mental and Behavioural Disorders
Conditions
Interventions
The complex intervention consists of a total of 14 components that reflect the role and tasks of expanded practice nurses in person-centred care:
1. Screening for cognitive impairment
2. Expanded nurs
Sponsors
University of Cologne
Eligibility
Sex/Gender
All
Age
65 Years to 120 Years
Inclusion criteria
Inclusion criteria: Ward level: 1. Prevalence of at least 30 people with cognitive impairment per month according to data from hospital controlling 2. Non-ICU wards Staff level: 1. Nurses, nurse assistants and physicians working on project wards during the intervention period Patient level: 1. Patients aged 65 years and above 2. Patients with cognitive impairment or a risk for cognitive impairment, identified by: 2.1. Pre-existing diagnosis, defined by the following ICD-10 codes: F00.*, F01.*, F02.3, F02.8, F03, F05*, U51* 2.2. Need for clarification of neurocognitive disorder, assessed by outcome-oriented nursing assessment AcuteCare (ePA-AC ©) 1. Risk for delirium, defined by a combination of predetermined risk factors
Exclusion criteria
Exclusion criteria: Ward level: 1. Intensive care units, intermediate care units, psychiatric wards, palliative care wards, paediatric wards Staff level: 1. Other healthcare professionals Patient level: 1. Patients with insufficient German language skills 2. Patients without capacity to give consent and without legal guardianship 3. Patients with a planned hospital stay of <48 hours 4. Patients in the terminal phase (end of life)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Length of hospital stay (from study inclusion to hospital discharge), obtained from medical records after patient discharge | — |
Secondary
| Measure | Time frame |
|---|---|
| Patient level: Measured at admission (t1), day 3 of hospital stay (t2), day 7 of hospital stay (t3), day 14 of hospital stay (t4), discharge (t5) and 30 days after discharge (t6): 1. Prevalence of delirium measured using the Confusion Assessment Method (CAM, short form), rated by the research team (t1, t2, t3, t4, t5) 2. Delirium subtype measured using the Delirium Motor Subtype Scale (DMSS-4), rated by nurses (t1, t2, t3, t4, t5) 3. Severity of delirium measured using the Confusion Assessment Method – Severity (CAM-S, short form), rated by the research team (t1, t2, t3, t4, t5) 4. Prevalence of pain measured using the Numeric Rating Scale (NRS), self-rated by patients. If the numeric rating scale is not feasible, the research team rates pain using the Pain Assessment in Advanced Dementia (PAINAD-G) (t1, t2, t3, t4, t5) 5. Undetected pain, defined as a discrepancy between the research team’s rating and nursing documentation of pain or administration of pain medication on demand (t1, t2, t3, t4, t5) 6. Prevalence of agitation measured using Cohen Mansfield Agitation Inventory (CMAI, hospital version), rated by nurses (t3, t4, t5) 7. Quality of sleep measured using Richards-Campbell-Sleep-Questionnaire (RCSQ), self-rated by patients (t2, t3, t4, t5) 8. Sleep problems measured using single items, obtained from medical records (t2, t3, t4, t5) 9. Anxiety, stress and depression measured using Depression Anxiety Stress Scales (DASS, short form), self-rated by patients (t1, t3, t4, t5) 10. Quality of Life – self-assessment using Bath Assessment of Subjective Quality of Life in Dementia (BASQID), self-rated by patients (t5) 11. Quality of Life – proxy assessment using QUALIDEM, rated by nurses (t5) 12. Person-centred care assessed using Individualised Care Scale (ICS), rated by patients (t5) 13. Falls assessed using single items, obtained from medical records (t5) 14. Physical restraints assessed using single items, reported by nurses (t2, t3, t4, t5) 15. Prescription of ps | — |
Countries
Germany
Outcome results
None listed