Effectiveness of Pattern-Specific Nursing Interventions in Hypoxia-Related AcuteConfusional States in Older Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/166014
Category:
Abstract
Type:
Presentation
Title:
Effectiveness of Pattern-Specific Nursing Interventions in Hypoxia-Related AcuteConfusional States in Older Patients
Author(s):
Bixby, Denise
Author Details:
Denise Bixby, BSN/BN, Staff Nurse, Original Leisure Village Foundation, Lakewood, New Jersey, 08701, USA, (updated February 2015) email: DBixby@middlesexcc.edu
Abstract:
INTRODUCTION: Acute confusion or delirium is a transient syndrome characterized primarily by abnormalities in attention and cognition, but disordered psychomotor behavior, sleep-wake disturbances, and autonomic nervous system disturbances are not uncommon (Engel & Romano, 1959; Lipowski, 1990). Acute confusion is common in hospitalized elderly, particularly patients with underlying chronic cognitive impairnent (Chisholm et al., 1982; Foreman, 1989; Neelon et al., 1989; Williams et al., 1985). Patients who develop acute confusional states have high morbidity and mortallty, both during hospitalization and after discharge (Francis & Kapoor, 1992; Gillick et al. 1982; Levkoff et al., 1992). Because acute confusion has multiple causes and varied patterns of clinical manifestations, we hypothesized that early identification and treatment of patients using pattern-specific interventions would be more effective than usual care (Neelon et al., 1992). We report in this paper the effects of nurse-initiated, pattern-specific protocols among patients treated for hypoxia-related acute confusion. METHODS: We used a prospective, repeated measures experimental design to test pattern-specific interventions in 225 general medical patients (age 65+) assessed at admission for risk factors and presence of acute confusion (NEECHAM Confusion Scale score < 25 on a 0-30 scale). We used a RISK-INDICATOR SCREEN developed from clinical observation and likelihood ratios of key patient variables to classify patients' risk and patterns. Using regression analysis, we evaluated the effects of treatment by change in NEECHAM scores over the first 24 hours as the key outcome measure. RESULTS: Of the 175 identified as at risk or confused at admission, 98 received pattern-specific interventions on the treatment unit, and 77 were followed on the usual care unit. Using multiple regression and controlling for covariates, interventions showed a positive and significant effect on NEECHAM scores (beta= 1.40, p=.02). Using logistic regression to evaluate a clinically significant response at 24 hours, the odds of improving 4 points or more in NEECHAM score for treated patients were 2.49 (95%CI=1.01, 6.15). Patients who responded were more likely to have lower oxygen saturations (p=.001), poorer nutritional status (p=.001), and markers of chronic cognitive imparrment (p=.03). Those positive for hypoxia-related confusion improved with treatment (beta=2.04, p=.01). The precise mechanisms underlying the effects of intervention on hypoxic patterned patients are under study, however, analysis of NEECHAM items score changes indicate that patients improved both in cognitive function (beta=0.38 ,p=.02) and oxygen stability (beta=0.69 ,p=.04). These data support our hypotheses that early identification and treatment of elderly patients with acute confusion using pattern-specific protocols are effective, at least in the initial 24 hours of treatment.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
Feb 29 - Mar 2, 1996
Conference Host:
Southern Nursing Research Society
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleEffectiveness of Pattern-Specific Nursing Interventions in Hypoxia-Related AcuteConfusional States in Older Patientsen_GB
dc.contributor.authorBixby, Deniseen_US
dc.author.detailsDenise Bixby, BSN/BN, Staff Nurse, Original Leisure Village Foundation, Lakewood, New Jersey, 08701, USA, (updated February 2015) email: DBixby@middlesexcc.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/166014-
dc.description.abstractINTRODUCTION: Acute confusion or delirium is a transient syndrome characterized primarily by abnormalities in attention and cognition, but disordered psychomotor behavior, sleep-wake disturbances, and autonomic nervous system disturbances are not uncommon (Engel & Romano, 1959; Lipowski, 1990). Acute confusion is common in hospitalized elderly, particularly patients with underlying chronic cognitive impairnent (Chisholm et al., 1982; Foreman, 1989; Neelon et al., 1989; Williams et al., 1985). Patients who develop acute confusional states have high morbidity and mortallty, both during hospitalization and after discharge (Francis & Kapoor, 1992; Gillick et al. 1982; Levkoff et al., 1992). Because acute confusion has multiple causes and varied patterns of clinical manifestations, we hypothesized that early identification and treatment of patients using pattern-specific interventions would be more effective than usual care (Neelon et al., 1992). We report in this paper the effects of nurse-initiated, pattern-specific protocols among patients treated for hypoxia-related acute confusion. METHODS: We used a prospective, repeated measures experimental design to test pattern-specific interventions in 225 general medical patients (age 65+) assessed at admission for risk factors and presence of acute confusion (NEECHAM Confusion Scale score < 25 on a 0-30 scale). We used a RISK-INDICATOR SCREEN developed from clinical observation and likelihood ratios of key patient variables to classify patients' risk and patterns. Using regression analysis, we evaluated the effects of treatment by change in NEECHAM scores over the first 24 hours as the key outcome measure. RESULTS: Of the 175 identified as at risk or confused at admission, 98 received pattern-specific interventions on the treatment unit, and 77 were followed on the usual care unit. Using multiple regression and controlling for covariates, interventions showed a positive and significant effect on NEECHAM scores (beta= 1.40, p=.02). Using logistic regression to evaluate a clinically significant response at 24 hours, the odds of improving 4 points or more in NEECHAM score for treated patients were 2.49 (95%CI=1.01, 6.15). Patients who responded were more likely to have lower oxygen saturations (p=.001), poorer nutritional status (p=.001), and markers of chronic cognitive imparrment (p=.03). Those positive for hypoxia-related confusion improved with treatment (beta=2.04, p=.01). The precise mechanisms underlying the effects of intervention on hypoxic patterned patients are under study, however, analysis of NEECHAM items score changes indicate that patients improved both in cognitive function (beta=0.38 ,p=.02) and oxygen stability (beta=0.69 ,p=.04). These data support our hypotheses that early identification and treatment of elderly patients with acute confusion using pattern-specific protocols are effective, at least in the initial 24 hours of treatment.en_GB
dc.date.available2011-10-27T14:38:27Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T14:38:27Z-
dc.conference.dateFeb 29 - Mar 2, 1996en_US
dc.conference.hostSouthern Nursing Research Societyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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