The primary objective of this project is the development and implementation of an educational program for the staff nurses for the effective management of Acute Confusion (AC), Delirium among hospitalized patients at Kaiser Hospital in Fontana.

abstract: Aortic aneurysms and dissections are life threatening conditions addressed by replacing damaged sections of the aorta. Blood circulation must be halted to facilitate repairs. Ischemia places the body, especially the brain, at risk of damage. Deep hypothermia circulatory arrest (DHCA) is employed to protect patients and provide time for surgeons to complete repairs on the basis that reducing body temperature suppresses the metabolic rate. Supplementary surgical techniques can be employed to reinforce the brain's protection and increase the duration circulation can be suspended. Even then, protection is not completely guaranteed though. A medical condition that can arise early in recovery is postoperative delirium, which is correlated with poor long term outcome. This study develops a methodology to intraoperatively monitor neurophysiology through electroencephalography (EEG) and anticipate postoperative delirium. The earliest opportunity to detect occurrences of complications through EEG is immediately following DHCA during warming. The first observable electrophysiological activity after being completely suppressed is a phenomenon known as burst suppression, which is related to the brain's metabolic state and recovery of nominal neurological function. A metric termed burst suppression duty cycle (BSDC) is developed to characterize the changing electrophysiological dynamics. Predictions of postoperative delirium incidences are made by identifying deviations in the way these dynamics evolve. Sixteen cases are examined in this study. Accurate predictions can be made, where on average 89.74% of cases are correctly classified when burst suppression concludes and 78.10% when burst suppression begins. The best case receiver operating characteristic curve has an area under its convex hull of 0.8988, whereas the worst case area under the hull is 0.7889. These results demonstrate the feasibility of monitoring BSDC to anticipate postoperative delirium during burst suppression. They also motivate a further analysis on identifying footprints of causal mechanisms of neural injury within BSDC. Being able to raise warning signs of postoperative delirium early provides an opportunity to intervene and potentially avert neurological complications. Doing so would improve the success rate and quality of life after surgery. / Dissertation/Thesis / Doctoral Dissertation Electrical Engineering 2020

Bakgrund: Konfusion är en vanlig företeelse hos äldre personer inneliggande på sjukhus. Så många som hälften kan vara drabbade, men det upptäcks sällan och kunskapen hos sjuksköterskor behöver öka. Eftersom patienterna ofta har svårt att kommunicera, så kan närståendes kunskap om patienten hjälpa vårdpersonalen samt förmedla lugn till patienten. Familjefokuserad omvårdnadsteori valdes därför som teoretisk utgångspunkt. Syfte: Den här studien syftade till att undersöka, äldre patienters, närståendes och sjuksköterskors upplevelse av konfusion på sjukhus, samt huruvida familjefokuserad omvårdnad kunde verka främjande vid konfusion. Metod: Litteraturöversikt med systematisk ansats baserad på femton artiklar från åren 2010–2019, från databasen PubMed. Åtta av artiklarna hade en kvalitativ metod, fyra hade en kvantitativ ansats medan tre artiklar använde mixad metod. Resultat: Litteraturöversikten resulterade i fyra teman: Upplevelsen av konfusion, kunskapsbrist, interaktion samt familjefokuserad omvårdnad. Dessa återspeglades utifrån patienten, de närstående samt sjuksköterskan. Utifrån temat Upplevelse av konfusion sågs att patienten ofta hade en skrämmande upplevelse under konfusionen. Temat Kunskapsbrist visade att närstående var frustrerade över att de inte fick någon bra förklaring till patientens tillstånd. I temat Interaktion sågs att hallucinationer och aggressivt beteende hos patienterna ledde till att sjuksköterskor ibland var tvungna att ta till tvångsåtgärder. Temat Familjefokuserad omvårdnad visade att genom att lyfta fram närståendes kunskap om patienten, kunde tidiga tecken på konfusion upptäckas och patienterna kände sig också i regel lugnare. Slutsats: Konfusion är en komplex åkomma som upplevs svår för både patienten, närstående och sjuksköterskan. Genom en ökad kunskap om konfusion både för sjuksköterskor och närstående kan samarbete förbättra omvårdnaden för patienten. / Background: Delirium is a common phenomenon for elderly people during hospitalization. As many as 50% might be affected by this severe condition. Due to poor knowledge among nurses in general, many patients neither get the proper diagnosis nor care. By enhancing the understanding of the lived experience of delirium by patients, their families and the caregiving nurses, it is possible to create a good foundation for cooperation among all parts. Since the patients often have trouble with communication, the family’s knowledge of the patient can help health professionals and calm the patient. Family-centered care theory was therefore chosen as nursing theory. Aim: To examine the lived experience of delirium at a hospital from the perspective of the elderly patient, the significant other and the nurse. It is also to explore if family-centered care can serve as prevention or positive impact on the patient with delirium. Method: A literature review with systematic approach based on fifteen articles from the years 2010–2019, from the PubMed database. Of the articles, eight had a qualitative method, four had a quantitative approach while three articles used the mixed method. Result: The literature review resulted in four themes: Experience of the confusion, Lack of knowledge, Interaction and Family-centered nursing. These were reflected according to the patient, the significant other and the nurse. The theme Experience of the confusion showed that the patients often had a terrifying experience during the delirium episode. The theme Lack of knowledge showed that significant others were frustrated that they did not receive a clear explanation for the patient’s condition. In the theme of Interaction, hallucinations and an aggressive behaviour in patients led to nurses sometimes having to use coercive methods. The theme of family-centered nursing showed that by highlighting significant others knowledge of the patient, early signs of confusion could be detected, and patients also felt calmer. Conclusion: Delirium is a complex state that is difficult for the patient as well as the family and the nurse. If the knowledge of delirium increases for the nurse and the significant other, the cooperation can improve the care of the patient.

Bakgrund: Konfusion är ett akut förvirringstillstånd som är vanligt förekommande efter kirurgi där en desorientering av tid, rum, situation eller person sker vilket kan leda till längre vårdtider, ett ökat behov av rehabilitering samt en ökad dödlighet. Detta innebär dels ett lidande för patienten, men även en ökad belastning på vården med ökade kostnader på grund av den längre vårdtiden. Genom att förebygga postoperativ konfusion skulle de negativa konsekvenserna kunna förhindras och patientens lidande därmed minska. Syfte: Syftet med studien var att identifiera vilka icke-farmakologiska åtgärder som beskrivs i vetenskaplig litteratur för att förebygga postoperativ konfusion på somatiska vårdavdelningar.  Metod: En deskriptiv litteraturstudie som baserats på tio kvantitativa originalartiklar publicerade år 2015–2020. Databaserna som användes var PubMed och Cinahl. Artiklarnas kvalitet granskades och de sammanställda artiklarnas resultat analyserades och resultatet delades in teman och kategorier för ge en bättre överblick inom området.  Resultat: Som förebyggande åtgärder för postoperativ konfusion identifierades i det sammanvägda resultatet fem teman. Dessa var kunskap, orientering, miljö, basal omvårdnad och smärta. Inom temana identifierades även kategorier där kommunikation, utbildning av personal samt ett nära samarbete med närstående visades vara en viktig del i att förebygga postoperativ konfusion på somatiska vårdavdelningar.  Slutsats: Med icke-farmakologiska förebyggande åtgärder riktade mot kunskap, orientering, miljö, basal omvårdnad och smärta kunde fler fall av postoperativ konfusion förebyggas. Genom detta kunde därmed även patientens lidande och belastningen på vården minskas. / Background: Delirium is an acute state of confusion that is common post surgery where a disorientation of time, situation and person occurs which can lead to longer length of stay, an increased need for rehabilitation and an increased mortality. This leads to suffering for the patient but also an increased burden on healthcare. By preventing postoperative delirium the negative consequences could be avoided and the suffering of the patient thereby decrease. Aim: The aim of this study was to identify non-pharmacological measures that are described in scientific literature to prevent postoperative delirium in somatic wards.    Methods: A descriptive literature study based on ten quantitative peer reviewed articles published between 2015–2020. The databases that were used were Pubmed and Cinahl. The compiled results were evaluated and the compiled results were analyzed and then categorized into themes to give a better overview of the field.  Results: As preventive measures for postoperative delirium five themes were identified in the result. These were knowledge, orientation, environment, nursing care and pain. Within these themes categories were also identified and communication, staff education and a close cooperation with relatives were an important part in preventing postoperative delirium in somatic wards.   Conclusion: With non-pharmacological preventive measures aimed towards knowledge, orientation, environment, nursing care and pain more cases of postoperative delirium could be prevented. These preventive measures could thereby decrease the patients suffering and the burden on healthcare.

Bakgrund: Akut konfusion är ett vanligt tillstånd hos patienter som genomgått kirurgi och innebär att patientens kognitiva förmåga är nedsatt. Forskning visar att patienter som drabbas av akut konfusion efter ett kirurgiskt ingrepp har högre mortalitet och resulterar i ett lidande för patienten med allvarliga komplikationer. Syfte: Syftet med litteraturöversikten var att sammanfatta olika omvårdnadsinterventioner som förebygger akut konfusion hos patienter som genomgått kirurgi. Metod: Litteraturöversikt med deskriptiv design där resultatet grundar sig på 10 kvantitativa originalartiklar. Resultat: Resultatet visade att en användning av screeningverktyg, anpassning av omvårdnadsmiljön och en medverkan av närstående kunde förebygga utvecklingen av akut konfusion hos patienter som genomgått kirurgi. Slutsats: Effektiva screeningsverktyg och rätt omvårdnadsåtgärder i kombination med närståendes medverkan är avgörande preventionsfaktorer för akut konfusion hos patienter som genomgått kirurgi. Sjuksköterskan har en avgörande roll i det patientnära arbetet eftersom det är här som rätt åtgärder måste sättas in – på så vis kan akut konfusion förebyggas och minska lidandet för patienten. Tillståndet bör därför uppmärksammas och förebyggas med hjälp av sjuksköterskans kompetens och omvårdnad. / Background: Delirium is one of the most common postoperative complications and results in impaired cognitive function for the patient. It has been established from research that delirious patients had a higher risk for mortality, pathophysiological consequences and negative postoperative outcomes which can cause distress for the patient. Intention: The aim of this study was to survey nursing interventions that prevent delirium for patients who underwent surgery. Method: Quantitative literature review with a descriptive design, where the result is based on ten quantitative original articles. Results: The results show that use of clinical assessment tools for nurses, adaptation of the nursing environment and involvement of family members helped to prevent the development of delirium. Conclusion: Proper nursing assessment tools, adaptation of the nursing environment and involvement of family members helped prevent delirium. Nurses play a vital role in the patientcentered care as it is here warning signs needs to be identified – knowledge of this subject should therefore be studied. This helps to improve the quality of the nursing care, prevents delirium and reduces unnecessary suffering for the patients.

A Quality Improvement project to initiate the Confusion Assessment Method (CAM) delirium screening tool at a Skilled Nursing Facility and Rehabilitation Center in East Tennessee -- by S. Joseph Jadav, Doctor of Nursing Practice Candidate at East Tennessee State University. Purpose/Aims: The aim of this project is to implement a delirium screening protocol in a skilled nursing and rehabilitation facility which will aid in early detection of signs and symptoms of delirium in older adults. This early detection followed by an early intervention can help reduce costs and decrease mortality rates with better outcomes. Processes: A CAM screening is conducted on each patient (male & female) for delirium for a period of four weeks. Data collection will comprise of the number of patients assessed and the total number of positive and negative delirium cases. It was determined that the proposed activity is not research involving human subjects according to United States Department of Health and Human Services (DHHS) regulations by the university’s Institutional Review Board (IRB). Results: The project is currently in the data collection phase. Limitations: Refusal to participate either by the patient or family in the screening. Conclusions: While nearly 80% of delirium cases in an acute care setting go undetected or undiagnosed, this project to implement a delirium screening protocol in a skilled nursing facility is even more imperative in early detection and early intervention.

Bakgrund: Trots att delirium är något som känts till sedan år 480 f.Kr. är detta ett tillstånd som fortfarande är relativt outforskat och missförstått. Forskning ur anestesi- och intensivvårdssjuksköterskors samt anhörigas perspektiv visar att det saknas kunskap och insikt gällande deliriumtillståndet. Syfte: Undersöka patienters erfarenheter av att drabbas av delirium i samband med anestesi- och intensivvård. Metod: Allmän litteraturöversikt enligt Friberg. 24 studier ligger till grund för resultatet: sjutton kvalitativa, två kvantitativa och sex mixad metod. Resultat: Det finns både behagliga och obehagliga erfarenheter av att drabbas av delirium. Det var vanligt att patienterna konfronterades med döden i olika skepnader och att de befann sig i en alternativ verklighet. Patienter som drabbats av delirium i samband med anestesi- och intensivvård erfor ett stort emotionellt lidande, särskilt då anestesi- och intensivvårds-sjuksköterskor samt anhöriga bemötte dem respektlöst och skrattade åt dem när de försökte förklara vad de erfarit. När anestesi- och intensivvårdssjuksköterskor utförde omvårdnad i form av samtal och bekräftelse lindrades patienternas lidande avsevärt. Slutsats: Patienter som drabbats av delirium i samband med anestesi- och intensivvård utsätts för ett onödigt lidande på grund av bristande omvårdnad relaterat till delirium. Anestesi- och intensivvårdssjuksköterskorna fokuserar på det medicinska och har inte tid att se patienterna som individer med ett emotionellt lidande. Det är viktigt att dessa sjuksköterskor får en förståelse för vad patienter som drabbats av delirium erfar och hur omvårdnaden kan inverka på dessa erfarenheter.

No description available.

The rapid digitalization of the healthcare domain in recent years highlighted the need for advanced predictive methods particularly based upon deep learning methods. Deep learning methods which are capable of dealing with time- series data have recently emerged in various fields such as natural language processing, machine translation, and the Intensive Care Unit (ICU). The recent applications of deep learning in ICU have increasingly received attention, and it has shown promising results for different clinical tasks; however, there is still a need for the benchmark models as far as a handful of public datasets are available in ICU. In this thesis, a novel benchmark model of four clinical tasks on a multi-center publicly available dataset is presented; we employed deep learning models to predict clinical studies. We believe this benchmark model can facilitate and accelerate the research in ICU by allowing other researchers to build on top of it. Moreover, we investigated the effectiveness of the proposed method to predict the risk of delirium in the varying observation and prediction windows, the variable ranking is provided to ease the implementation of a screening tool for helping caregivers at the bedside. Ultimately, an attention-based interpretable neural network is proposed to predict the outcome and rank the most influential variables in the model predictions’ outcome. Our experimental findings show the effectiveness of the proposed approaches in improving the application of deep learning models in daily ICU practice.

Patients admitted to an adult intensive care unit (ICU) are at risk of developing an acute condition known as ICU delirium, which can impact patients’ length of hospital stay and increase short term and 6-month mortality. The cause of ICU delirium is multifactorial, and lack of quality sleep is a known risk factor. Patients’ sleep in the ICU is frequently interrupted by clinicians involved in their care and equipment alarms. Sleep hygiene interventions to minimize these interruptions for the patient are one strategy to reduce the risk of ICU delirium. Examples of sleep hygiene interventions include eye masks, earplugs, and grouping patient care to minimize nighttime interruptions. The primary purpose of this thesis was to review the available evidence on non-pharmacological sleeping interventions and how they can prevent the development of ICU delirium in adults hospitalized with a critical illness. A secondary aim of this thesis was to study the impact of non-pharmacological interventions on sleep quality. Seven studies conducted in critical care units were included in this scoping review, which examined how non-pharmacological sleep hygiene interventions impacted both the prevention of ICU delirium, and sleep quality. Study results were analyzed to determine their effectiveness in relation to the two outcome measures. Although this review identified many benefits of non-pharmacological sleep interventions, the results on which are most effective in preventing delirium and improving sleep quality are inconclusive. Future research needs to be done to evaluate which sleep-promoting intervention(s) will benefit critical care patients most in preventing or lowering their risk of delirium. The feasibility of both health care staff consistently and effectively executing the intervention(s) outside of research conditions, and patient compliance to the interventions needs to be further studied. Additionally, there is a need for future studies measuring sleep quality as a result of sleep promoting interventions to be measured by PSG rather than subjective written/oral reports in order to obtain objective, reliable results.