Miscellaneous
Is the research design appropriate to answer the research question?
Yes, we believe that this research design is appropriate to answer the research question As it allows assessment of delirium rates before and after workflow was implemented.
What are the characteristics of the sample?
Hospitalized patients over 65 years old on the ACE unit
Explain why the study was done (problem/concern)?
The study was done to discover non-pharmacological ways to reduce hospital-acquired delirium.
Do you think the researchers accomplished what they set out to accomplish as they described it in the introduction?
Yes, delirium rates were reduced. However, there was not a significant impact on length of hospital stay for patients and the effectiveness of the workflow was reduced after COVID-19
What are the major limitations of the study?
-Nu-DESC tool does not provide a formal diagnosis of delirium, which may lead to inaccuracies in identifying patients with the condition
-a RCT would have been more rigorous study design
-The study was conducted within one hybrid ACE and general medical unit at one academic medical center meaning results may not be generalizable to other settings
How was the sample recruited? Discuss any possible ethical issues?
They were recruited at the University of California San Francisco Medical Center. Patients admitted to the hybrid Acute Care for Elders (ACE) and general medicine units were chosen.
What is the research question that the investigator is trying to answer?
Does the implementation of a nurse-driven delirium reduction workflow, consisting of evidence-based daytime and nighttime interventions, significantly reduce delirium rates and average length of stay for hospitalized adults
Was the article easy to read? Do you think anything needs to change to make it more clear?
The article was moderately easy to read. It would be easier to understand if the methods of statistical analysis and data tables were further explained
What were the main findings of the study?
The significant findings of this study showed a positive effect on hospital-acquired delirium. It decreased the number of cases - unfortunately, it was not sustainable because of the COVID-19 pandemic.
What methods were used to analyze the data? Discuss one strength and one weakness.
Rates of delirium and hospital stays were compared from before and after the workflow was implemented using chi-square and Fisher’s exact tests, and one-way ANOVAs. One strength is that it allows for change over time, accounting for potential confounding factors. One weakness is that only one delirium screening tool was used (Nu-DESC).
What is the research design?
Interrupted time series study design
Based on your clinical experience, how could you apply the findings from this article to your practice?
It is in our scope of practice as student nurses to implement the workflow study which includes:
During the day:
- Lights on in patient room
- blinds open >50%
- water within reach
- minimize naps to <1 hour
- out of bed for meals/ambulate >2x/day
What were the major strengths of the study?
High fidelity rates in the intervention phase indicate effective implementation of workflow, supporting its potential efficacy
What are the implications for practice?
If the workflow demonstrates significant efficacy, it could be implemented into standard practice at other hospitals
What is the independent variable?
Nurse-driven delirium reduction workflow
How strong are the references at the end of the article? Do you have any concerns?
We believe that the references are relatively strong for this article. There are multiple primary, quantitative, and peer-reviewed articles. The only downside to some articles is that they are over 5 years old.
Was there an underlying theory or conceptual framework?
This study explored behavior change principles and quality improvement strategies.
What were the strategies used for data collection?
Nurses screened patients with the Nu-DESC delirium screening tool and used information from the EHR in audit and feedback processes
What is the dependent variable?
Rates of hospital-acquired delirium and lengths of stay