Cognitive Stimulation in an Intensive Care Unit: A Qualitative Evaluation of Barriers to and Facilitators of Implementation.

Cognition Humans Intensive Care Units Quality Improvement

Journal

Critical care nurse
ISSN: 1940-8250
Titre abrégé: Crit Care Nurse
Pays: United States
ID NLM: 8207799

Informations de publication

Date de publication:
01 Apr 2021
Historique:
entrez: 1 4 2021
pubmed: 2 4 2021
medline: 26 11 2021
Statut: ppublish

Résumé

Delirium in the intensive care unit is associated with poor patient outcomes. Recent studies support nonpharmacological therapy, including cognitive stimulation, to address delirium. Understanding barriers to cognitive stimulation implemented by nurses during clinical care is essential to translating evidence into practice. To use qualitative methods through a structured quality improvement project to understand nurses' perceived barriers to implementing a cognitive stimulation intervention in a medical intensive care unit. Data were collected through semistructured interviews with nurses in a medical intensive care unit. Data were categorized into themes by using thematic analysis and the Consolidated Framework for Implementation Research. During cognitive stimulation, nurses reviewed with patients a workbook of evidence-based tasks (focused on math, alertness, motor skills, visual perception, memory, problem-solving, and language). The 23 nurses identified 62 barriers to and 26 facilitators of cognitive stimulation. These data were summarized into 12 barrier and 9 facilitator themes corresponding to the following Consolidated Framework for Implementation Research domains: Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals. Nurses also identified several facilitators within the Process domain. Patient-specific variables, including sedation, were the most frequently reported barriers. Other barriers included cognitive stimulation not being prioritized, nursing staff-related issues, documentation burden, and a lack of understanding of, or appreciation for, the evidence supporting cognitive stimulation. Implementation of cognitive stimulation requires a multidisciplinary approach to address perceived barriers arising from the organization, context, and individuals associated with the intervention, as well as the intervention itself.

Sections du résumé

BACKGROUND BACKGROUND
Delirium in the intensive care unit is associated with poor patient outcomes. Recent studies support nonpharmacological therapy, including cognitive stimulation, to address delirium. Understanding barriers to cognitive stimulation implemented by nurses during clinical care is essential to translating evidence into practice.
OBJECTIVE OBJECTIVE
To use qualitative methods through a structured quality improvement project to understand nurses' perceived barriers to implementing a cognitive stimulation intervention in a medical intensive care unit.
METHODS METHODS
Data were collected through semistructured interviews with nurses in a medical intensive care unit. Data were categorized into themes by using thematic analysis and the Consolidated Framework for Implementation Research. During cognitive stimulation, nurses reviewed with patients a workbook of evidence-based tasks (focused on math, alertness, motor skills, visual perception, memory, problem-solving, and language).
RESULTS RESULTS
The 23 nurses identified 62 barriers to and 26 facilitators of cognitive stimulation. These data were summarized into 12 barrier and 9 facilitator themes corresponding to the following Consolidated Framework for Implementation Research domains: Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals. Nurses also identified several facilitators within the Process domain. Patient-specific variables, including sedation, were the most frequently reported barriers. Other barriers included cognitive stimulation not being prioritized, nursing staff-related issues, documentation burden, and a lack of understanding of, or appreciation for, the evidence supporting cognitive stimulation.
CONCLUSIONS CONCLUSIONS
Implementation of cognitive stimulation requires a multidisciplinary approach to address perceived barriers arising from the organization, context, and individuals associated with the intervention, as well as the intervention itself.

Identifiants

DOI: 10.4037/ccn2021551 PMID: 33791762 PMC: PMC9528998
pubmed: 33791762
pii: 31409
doi: 10.4037/ccn2021551
pmc: PMC9528998
mid: NIHMS1817064
doi:

Types de publication

Journal Article

Langues

eng

Pagination

51-60

Subventions

Organisme : NHLBI NIH HHS
ID : K23 HL138206
Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

©2021 American Association of Critical-Care Nurses.

Références

Int J Nurs Stud. 2009 Jun;46(6):804-12
pubmed: 19249782
BMJ. 2008 Oct 06;337:a1714
pubmed: 18838424
N Engl J Med. 1999 Mar 4;340(9):669-76
pubmed: 10053175
Crit Care Med. 2018 Sep;46(9):e825-e873
pubmed: 30113379
Med Educ. 2006 Apr;40(4):314-21
pubmed: 16573666
Intensive Care Med. 2001 Dec;27(12):1892-900
pubmed: 11797025
JAMA. 2004 Apr 14;291(14):1753-62
pubmed: 15082703
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
Crit Care Nurse. 2019 Feb;39(1):46-60
pubmed: 30710036
Cochrane Database Syst Rev. 2018 Nov 23;11:CD009783
pubmed: 30484283
JAMA Intern Med. 2015 Apr;175(4):512-20
pubmed: 25643002
Am J Respir Crit Care Med. 2002 Nov 15;166(10):1338-44
pubmed: 12421743
J Crit Care. 2019 Apr;50:280-286
pubmed: 30665181
Crit Care Med. 2013 Jun;41(6):1435-42
pubmed: 23507716
Intensive Care Med. 2009 Jul;35(7):1276-80
pubmed: 19350214
Crit Care Med. 2016 Mar;44(3):583-91
pubmed: 26540397
JAMA. 2001 Dec 5;286(21):2703-10
pubmed: 11730446
BMJ. 2014 Nov 24;349:g6652
pubmed: 25422275
J Crit Care. 2016 Feb;31(1):206-11
pubmed: 26596509
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
Am J Respir Crit Care Med. 2009 Dec 1;180(11):1092-7
pubmed: 19745202
Lancet Respir Med. 2018 Mar;6(3):213-222
pubmed: 29508705
J Crit Care. 2017 Aug;40:265
pubmed: 28385485
Am J Crit Care. 2016 Nov;25(6):535-544
pubmed: 27802955
Ann Am Thorac Soc. 2016 May;13(5):724-30
pubmed: 27144796
Crit Care. 2014 Jun 18;18(3):R125
pubmed: 24942154
N Engl J Med. 2013 Oct 3;369(14):1306-16
pubmed: 24088092
Am J Crit Care. 2008 Nov;17(6):555-65; quiz 566
pubmed: 18978240
J Crit Care. 2018 Dec;48:372-384
pubmed: 30300863
Intensive Care Med. 2019 Jan;45(1):1-12
pubmed: 30506354
N Engl J Med. 2018 Dec 27;379(26):2506-2516
pubmed: 30346242
Am J Crit Care. 2018 May;27(3):186-193
pubmed: 29716904

Auteurs

Ann M Parker (AM)

Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and a member of the Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland.

Louay Aldabain (L)

Louay Aldabain is an internal medicine resident, Medstar Health, Baltimore, Maryland.

Narges Akhlaghi (N)

Narges Akhlaghi is a postdoctoral research fellow, Division of Pulmonary and Critical Care Medicine, and a member of the OACIS Research Group, Johns Hopkins University.

Mary Glover (M)

Mary Glover is a lead clinical nurse in the medical intensive care unit, Johns Hopkins Hospital, Baltimore, Maryland.

Stephanie Yost (S)

Stephanie Yost is a bedside nurse in the intensive care unit, University of Vermont Medical Center in Burlington, Vermont.

Michael Velaetis (M)

Michael Velaetis is a critical care physician assistant in the medical intensive care unit, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.

Annette Lavezza (A)

Annette Lavezza is the acute care therapy manager, Johns Hopkins Hospital, and a member of the OACIS Research Group, Johns Hopkins University.

Earl Mantheiy (E)

Earl Mantheiy is a senior clinical program coordinator, Critical Care Physical Medicine and Rehabilitation Program, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.

Kelsey Albert (K)

Kelsey Albert is a research program assistant, Critical Care Physical Medicine and Rehabilitation Program, and a member of the OACIS Research Group, Johns Hopkins University.

Dale M Needham (DM)

Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, School of Nursing, and a member of the OACIS Research Group, Johns Hopkins University.

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Classifications MeSH

questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Cognition › Cognitive Stimulation in an Intensive Care...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Cognitive Stimulation in an Intensive Care...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Cognitive Stimulation in an Intensive Care...
questionsmedicales.fr › Administration des services de santé › Amélioration de la qualité › Cognitive Stimulation in an Intensive Care...