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      Effectiveness of an intensive care unit family education intervention on delirium knowledge: a pre-test post-test quasi-experimental study Translated title: Efficacité d’une intervention de formation familiale à l’unité de soins intensifs sur les connaissances concernant le delirium : une étude quasi expérimentale pré-test post-test

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          Abstract

          Purpose

          To create, validate, and refine an intensive care unit (ICU) delirium education intervention to prepare family members to partner with the ICU care team to detect delirium symptoms and prevent and manage delirium using nonpharmacological strategies.

          Methods

          In this pre-test post-test quasi-experimental study, consecutive eligible family members of critically ill patients admitted to an ICU completed an ICU Family Education Delirium intervention in two parts: 1) six-minute video on ICU delirium (risk factors, prevention/management, symptoms, communication with the ICU care team), and 2) two case vignettes to practice detecting delirium using family-administered delirium detection questionnaires (Family Confusion Assessment Method [FAM-CAM] and Sour Seven). Family members’ delirium knowledge was measured before, immediately after, and two weeks following the intervention using the Caregiver ICU Delirium Knowledge Questionnaire (CIDKQ).

          Results

          Of 99 family members recruited over eight months, 81 (82%) completed the intervention and 63 (63/81, 78%) completed all follow-up questionnaires. Family members’ delirium knowledge improved significantly following the intervention (pre-CIDKQ, 14; 95% confidence interval [CI], 13 to 15; post-CIDKQ, 17; 95% CI, 16 to 17; P < 0.001) and was retained two weeks after the intervention (CIDKQ 16; 95% CI, 16 to 17; P < 0.001). This included increased knowledge regarding delirium risk factors (e.g., medication, mechanical ventilation), prevention/management (e.g., orientation, day/night routine), and symptoms of delirium. More family members correctly detected delirium symptoms in case vignettes using the Sour Seven (92%) compared with the FAM-CAM (78%).

          Conclusions

          A video-based ICU delirium education intervention is effective in educating family members about prevention, detection, and management of delirium.

          Résumé

          Objectif

          Notre objectif était de créer, valider et améliorer une intervention de formation sur le delirium à l’unité de soins intensifs (USI) afin de préparer les membres de la famille à coopérer avec l’équipe de soins de l’USI pour dépister les symptômes de delirium ainsi que prévenir et prendre en charge le delirium à l’aide de stratégies non pharmacologiques.

          Méthode

          Dans cette étude quasi expérimentale avant après, les membres éligibles consécutifs de familles de patients en état critique admis dans une USI ont pris part à une formation familiale sur le delirium à deux volets : 1) le visionnement d’une vidéo de six minutes sur le delirium à l’USI (facteurs de risque, prévention/prise en charge, symptômes, communication avec l’équipe de soins de l’USI), et 2) deux vignettes pour pratiquer le dépistage du delirium à l’aide de questionnaires de dépistage du delirium administrés par la famille (Méthode d’évaluation de la confusion par la famille [FAM-CAM] et Questionnaire de dépistage du delirium ‘ Sour Seven’). Les connaissances sur le delirium des membres de la famille étaient mesurées avant, immédiatement après et deux semaines après l’intervention à l’aide d’un Questionnaire sur les connaissances des aidants concernant le délirium à l’USI (CIDKQ).

          Résultats

          Parmi les 99 membres de famille recrutés au cours d’une période de huit mois, 81 (82 %) ont complété l’intervention et 63 (63/81, 78 %) ont complété tous les questionnaires de suivi. Les connaissances des membres de la famille sur le delirium se sont significativement améliorées après l’intervention (pré-questionnaire, 14; intervalle de confiance [IC] 95 %, 13 à 15; post-questionnaire, 17; IC 95 %, 16 à 17; P < 0,001) et étaient retenues deux semaines après l’intervention (questionnaire 16; IC 95 %, 16 à 17; P < 0,001). Cette amélioration était notable dans les catégories de connaissances en matière de facteurs de risque de delirium (par ex., la médication, la ventilation mécanique), de prévention et de prise en charge (par ex., l’orientation, la routine jour/nuit), et des symptômes de delirium. Un nombre plus élevé de membres des familles est parvenu à dépister correctement les symptômes de delirium dans les vignettes à l’aide du questionnaire Sour Seven (92 %) comparativement au FAM-CAM (78 %).

          Conclusion

          Le visionnement d’une vidéo de formation sur le delirium à l’USI est efficace pour former les membres des familles quant à la prévention, le dépistage et la prise en charge du delirium.

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          Most cited references48

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          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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                Author and article information

                Contributors
                kmfiest@ucalgary.ca
                Journal
                Can J Anaesth
                Can J Anaesth
                Canadian Journal of Anaesthesia
                Springer International Publishing (Cham )
                0832-610X
                1496-8975
                21 September 2020
                21 September 2020
                2020
                : 67
                : 12
                : 1761-1774
                Affiliations
                [1 ]GRID grid.413574.0, ISNI 0000 0001 0693 8815, Department of Critical Care Medicine, , Alberta Health Services& University of Calgary, ; Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB T2N 5A1 Canada
                [2 ]GRID grid.259670.f, ISNI 0000 0001 2369 3143, College of Nursing, , Marquette University, ; Milwaukee, WI USA
                [3 ]GRID grid.412807.8, ISNI 0000 0004 1936 9916, Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (VA GRECC), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, , Vanderbilt University Medical Center, ; Nashville, TN USA
                [4 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Department of Education, Development and Research, , University of California, San Diego Health, ; San Diego, CA USA
                [5 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Department of Community Health Sciences & O’Brien Institute for Public Health, , University of Calgary, ; Calgary, AB Canada
                [6 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, , University of Calgary, ; Calgary, AB Canada
                Author information
                http://orcid.org/0000-0002-7299-6594
                Article
                1810
                10.1007/s12630-020-01810-5
                7716844
                32959203
                d6838f87-42a8-4ec2-b643-cf5ce27e028b
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 5 March 2020
                : 3 June 2020
                : 23 June 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Categories
                Reports of Original Investigations
                Custom metadata
                © Canadian Anesthesiologists' Society 2020

                Anesthesiology & Pain management
                delirium education,family,critical care,intensive care unit
                Anesthesiology & Pain management
                delirium education, family, critical care, intensive care unit

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