Purpose: To identify, describe and evaluate the level of person-centeredness in non-pharmacologic delirium prevention measures (NDPMs). Evaluation was two- fold; a conceptual framework was applied and measures were ranked per the extent of person-centeredness.
Significance: Delirium is an acute form of brain dysfunction experienced by approximately 50% of hospitalized, older adult patients, impacting their future mortality, morbidity and quality of life(1). Delirium is preventable; a 44% decrease in occurrence was observed when nonpharmacologic prevention measures were combined and appropriately applied(2). Nonetheless, these measures have not been evaluated for person-centeredness. Person-centered interventions are shown to improve patient outcomes because they facilitate the individualization of interventions.
Conceptual Framework: Person-centeredness as authentic consciousness situates the continuation of the meaning of life through a holistic reflection of an individuals being and applies the imperfect duties of informed flexibility, mutuality, transparency, negotiations, and sympathetic presence. To categorize the extent of person-centeredness, the levels of Person-Centered Intervention (PCI) were applied. These four levels (from least to most) are personalized, targeted, tailored and individualized.
Method: A systematic review of literature was performed following PRISMA guidelines. CINAHL, PubMed, and Medline were searched using specific search terms and date parameters of January 1st, 1990 to May 1st, 2016. Studies were included if the following criteria was met: > 18 years of age, inpatient hospital setting, and developing and/or testing a NDPM. Studies were excluded using the following criteria: pediatric population, setting other than inpatient hospital, review study and did not test a NDPMs. Included studies were evaluated through the application of the conceptual framework then ranked per level of PCI.
Results: Three of the 23 included studies align with the applied conceptual framework. In order of PCI: three PC-NDPMs rank as personalized, eight rank as targeted, four rank as tailored and three rank as individualized. Nine studies were unable to be ranked into a level of PCI and were not considered person-centered. The following categories of NDPMs were identified: cognitive stimulation, early mobility, sleep, sensory impairment, nutrition/hydration, and family.
Conclusions: Several NDPMs were identified and demonstrate effectiveness in delirium prevention. Nonetheless, only three align with the applied conceptual framework and fourteen are rankable per level of PCI. The state of science in PC-NDPMs could be enhanced through the addition of person-centered measures.
This state-of-the-science research paper was initially developed as part of a course assignment for Nursing 818(N818) and guided by Drs. Diane Lauver and Lisa Bratzke. Following completion of N818, the paper was revised for publication under the guidance of Dr. Lisa Bratzke. As first author, I was responsible for the original idea of the paper, completing the literature review, synthesizing the identified studies and incorporating feedback from my faculty mentors.
Authorship:
1st: Heidi Lindroth BSN RN 2nd: Dr. Diane Lauver PhD RN 3rd: Dr. Lisa Bratzke PhD RN