Nurse's Role
Conditions
Keywords
delirium, intensive care units, primary nursing, professional practice
Brief summary
After a one-year phase of development, primary nursing (process-responsible nursing; PP) has been practically implemented on a pilot ICU since January 2022 at the Heart and Diabetes Center NRW. PP plan, coordinate and evaluate the nursing carried out. In the further course, an examination between the project ICU and another ICU without PP with a focus on thoracic and cardiovascular surgery (surgical ICU) is to be carried out. The primary goal of this pilot study is to test the feasibility of a large-scale RCT with patient-related outcomes.
Detailed description
After a one-year phase of development, primary nursing (process-responsible nursing; PP) has been practically implemented on a pilot ICU since January 2022 at the Heart and Diabetes Center NRW. Previously, the system of room care (standard care) was carried out. PP plan, coordinate and evaluate the nursing carried out. In addition, they take on the care responsibility for a maximum of two patients and also carry out the care at the same time. In the further course, an examination between the project ICU and another ICU with a focus on thoracic and cardiovascular surgery (surgical ICU) is to be carried out. The primary goal of this pilot study is to test the feasibility of a large-scale RCT. For this purpose, the duration of delirium after the introduction of a PP on the project ICU should be compared with the previous care organization as standard care in a surgical ICU. Secondary goals e.g. include: the incidence of delirium, anxiety, as well as the satisfaction of the relatives and the effects of PP on nurses are shown.
Interventions
OTHERprimary nursing
The primary responsibility of one nurse for the planning, evaluation, and care of a patient throughout the course of illness, convalescence, and recovery.
Sponsors
Martin-Luther-Universität Halle-Wittenberg
Heart and Diabetes Center North-Rhine Westfalia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
RCT
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* All patients are included who are at least 65 years old, * understand German language, * whose health insurance company has concluded a quality contract with the Heart and Diabetes Center NRW (HDZ NRW), * Elective thoracic and cardiovascular surgery, * Intensive care for at least three days on ICU. Relatives: * at least 18 years old, * patients have to receive PP. Focus group interview with nurses of the intervention-ICU: * Nurses have to be at least 18 years old, * Nurses belong the the intervention-ICU.
Exclusion criteria
Patients who * are \< 65 years old, * whose health insurance company has not concluded a quality contract with the HDZ NRW, * cannot be admitted due to allocation by randomization and a lack of free bed on the destination ICU, * have not given their informed consent, * cannot participate in the CAM-ICU screening due to neurological diseases, * in whom the screening using CAM-ICU could not be carried out over the entire intensive care stay and/or * belong to the target group but stay less than three days after their elective operation in the ICU. Relatives: * not at least 18 years old and/or * the patients do not receive PP. Focus group interview with nurses of the intervention-ICU: * Nurses who are not at least 18 years old and * Nurses do not belong to the intervention-ICU.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| duration of delirium | 3 times per day over one year. | As a syndrome, delirium represents a serious brain-organic emergency situation with dangerous consequences. The incidence of delirium in cardiac surgery ranges from \<10% to \>25%. Data collection: Confusion Assessment Method for Intensive Care Unit (CAM-ICU). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| pain (incidence and strength of pain) | 3 times per day over one year. | An unpleasant sensation induced by noxious stimuli which are detected by nerve endings. Data collection: Numeric Rating Scale (NRS) or Critical Care Pain Observation Tool (CPOT). |
| incidence and risk of decubitus | Once per day over one year. | An ulceration caused by prolonged pressure on the skin and tissues when one stays in one position for a long period of time, such as lying in bed. Data collection: Braden-Scale and documentation. |
| anxiety | 3 times per day over one year. | Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Data collection: Numeric Rating Scale (NRS). |
| incidence of delirium | 3 times per day over one year. | As a syndrome, delirium represents a serious brain-organic emergency situation with dangerous consequences. The incidence of delirium in cardiac surgery ranges from \<10% to \>25%. Data collection: Confusion Assessment Method for Intensive Care Unit (CAM-ICU). |
| satisfaction of the relatives | Once during ICU-care over one year. | Satisfaction of relatives means the satisfaction with care of the relatives' patients trough nurses. Data collection: Data collection: standardized questionaire. |
| effects of PP on nurses (only intervention group) | Once during the study in one year. | Effects of PP on nurses means the effects of the new organizational system of nursing care on nurses. Data collection: focus group interview with nurses. |
| need of care (Barthel-Index) | Once per week over one year. | Need of care describes, how much time and extend of care a patient needs. Data-Collection: Barthel-Index. |
Countries
Germany
Outcome results
None listed