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The objective of this systematic review is to synthesize the best available evidence on the effects of motivational interviewing (MI) interventions (including adaptions of motivational interviewing [AMIs]) on the improvement of glycemic control in adults with type 2 diabetes.Worldwide, 346 million people have diabetes. With the growing prevalence of diabetes, controlling modifiable risk factors is essential to preventing complications and disease progression. The prevalence of type 2 diabetes is estimated to be double the present rate and by the year 2034 nearly 44 million Americans will have this preventable disease. In the United States (US), nearly 13 percent of adults aged 20 years and older have diabetes; this includes 25.8 million people, adults and children . Type 2 diabetes is more common in ethnic groups inclusive of African Americans, Latinos, Native Americans, and Asian Americans, Native Hawaiians and other Pacific Islanders. Diabetes is especially common in the elderly, 10.9 million or 26.9% of those aged 65 years and older have the disease. The US Centers for Disease Control and Prevention (CDC) estimates that 26% of US adults have impaired fasting glucose (IFG) of 100-125mg/dl and that 34% of adults meet the criteria for metabolic syndrome. An additional 35 % of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range.Type 2 diabetes occurs when people have insulin resistance and insulin cannot be appropriately utilized for blood sugar regulation. Type 2 diabetes is characterised by impaired glucose tolerance. It can be defined by the criteria derived from the World Health Organization [WHO] that uses a single fasting glucose value of ≥ 126mg/dl or a single two hour glucose value of ≥ 200mg/dl. A laboratory blood test examining levels of glycosylated haemoglobin (HgbA1c) provides an estimated average blood glucose level over the past two-three months. An HbA1C level of 6.5% or higher can indicate diabetes.Serious complications and premature death can ensue if type 2 diabetes is not treated. Collaboratively, the health care team and people with type 2 diabetes aim to manage this disease process, and lessen the risk of complications to the heart, blood vessels, nerves, eyes and kidneys. Comprehensive support, knowledge, multidisciplinary therapy and treatment modalities will enhance health outcomes and slow disease progression.The Healthy People 2020 initiative outlines several objectives to achieve these changes and cover a comprehensive assortment of disease specific management accountabilities including regular medical care and self-management education/training. Many behaviour change techniques and strategies are known to be successful, yet are seldom implemented in today's health care arena. Dieticians, diabetes educators, and nurse practitioners are in an excellent position to serve as change agents to assist patients with diabetes in making necessary lifestyle changes.Motivational interviewing (MI) is a well-known, scientifically tested method of counseling clients first described by Miller and further developed by Miller and Rollnick. Motivational interviewing is a useful intervention strategy in the treatment of lifestyle problems and diseases such as diabetes . MI is a client-oriented, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The four guiding principles of MI are: express empathy, develop discrepancies, roll with resistance, and support self-efficacy. Adaptation of motivational interviewing (AMI) utilises the basic elements of motivational interviewing and also includes a feedback component. In clinical research, most empirical studies have dealt with the efficacy of AMIs and no studies have addressed the efficacy of MI in its relatively pure form.In clinical practice, health care providers utilise AMIs solely or in combination with other approaches such as the transtheoretical model (TTM) to promote behavioural change. These techniques are often used in brief sessions to maximise time, cost and efficiency.Motivational interviewing has been shown to be effective in counseling patients towards behaviour change in smoking cessation , increasing exercise, and reducing alcohol consumption. While combined effect estimates including body mass index (BMI) show a significant effect for MI, combined effect estimates for cigarettes per day and glycosylated haemoglobin (HA1c) were not significant . Isolated effects of MI on BMI and/or HbA1c have not been identified. Strong clinical evidence suggests that patients with diabetes should achieve certain clinical goals such as lowering HbA1c to reduce morbidity and mortality. Motivational interviewing is a technique that is effective in behaviour change and could potentially be effective with achieving these goals. MI may lead to improved quality of life, health status and clinical outcomes for persons with type 2 diabetes through empowerment and supporting informed decision-making, self-care behaviors, and problem-solving, with active participation and collaboration with the interdisciplinary health care team.A search of the MEDLINE, DARE, CINHAHL, PROSPERO, Joanna Briggs and Cochrane Libraries of Systematic Reviews failed to locate a review conducted on this topic.

Utilisation of a rapid response team (RRT) in a hospital setting has been documented in the literature. RRTs were formed to intervene quickly when the hospitalised patient first shows signs of deterioration. The purpose was to prevent failure to rescue, leading to intensive care unit transfers, cardiac arrest and mortality. To date, however, there is a lack of evidence to support the effectiveness of this intervention. The focused question, subsequent systematic review and data analysis are presented.To synthesise the best available research evidence on the impact of rapid response team composition on cardiopulmonary arrest outside the intensive care unit (ICU), unplanned transfers to ICU, in-hospital mortality, length of hospital stay in hospitalised non-ICU adult medical-surgical patients and staff satisfaction.Published and unpublished literature were searched. The databases searched for studies from 1989 to 2010 were CINAHL, EMBASE, Google Scholar, Mednar, New York Academy of Medicine, Proquest and PubMed. Reference lists of included studies were hand searched. Initial keywords searched were rapid response team, rapid response system, medical emergency team, medical emergency system and team composition.The studies included in the systematic review were randomized controlled trials (RCTs). In absence of sufficient RCTs, quasi-experimental studies, cohort studies, observational and control trials without randomization were included. Types of participants were adults (18 years and older) hospitalised in an acute care setting, not requiring the specialized care and management of an ICU. Hospitalised paediatric patients, ICU patients, hospice or palliative care patients were excluded.JBI MAStARI Critical Appraisal Tools were used for the methodological assessment of identified studies. Data were collected specifically related to RRT intervention, study methods and design, randomization, length of intervention, data collection points and inclusion criteria. Significant variables of interest included in the data collection were team composition, cardiopulmonary arrest outside the ICU, unplanned transfers to the ICU, in-hospital mortality, length of hospital stay and staff satisfaction. Data were extracted and analysed using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The findings were presented in narrative form as statistical meta-analysis was not possible.A total of 26 articles were included. The types of studies included in this systematic review were one cluster randomized control trial and one controlled trial without randomization. The remaining 24 studies were quasi-experimental cohort control design with two being retrospective studies and 22 prospective before-and-after intervention studies. Of those included, 10 were physician led, 13 were critical care registered nurse led and three nurse practitioner led. No association was found between team composition and patient outcomes.This systematic review found no correlation between team composition and patient outcomes. Teams that were mature, dedicated, made rounds and required mandatory activation had statistically significant results. These teams were more effective in decreasing cardiopulmonary arrest outside of the ICU, unplanned ICU transfer, in-hospital mortality, length of hospital stay and increased staff satisfaction.RRT activation was either mandatory or voluntary. Mandatory activation directed the RRT to be called if specific predetermined criteria were observed. Voluntary activation of the team was at the discretion of the staff regardless of guidelines. In these instances, concerns were reported about initiating "inappropriate" activation. Dedicated RRTs making proactive rounds and educating staff led to improved outcomes and staff satisfaction.Short study periods after team implementation may not accurately reflect the effectiveness of the RRT. Evidence points to significant results with team maturation. Further research should be directed toward more rigorous studies on team maturation, mandatory versus voluntary team activations, use of dedicated teams making rounds and staff satisfaction.

Hospital readmission soon after discharge is common and costly. To date, published studies of effectiveness of structured discharge process addressing reduction of hospital readmission have focused on patients with chronic conditions and complex needs, but not in adult patients with community acquired pneumonia.To examine and synthesise the best available evidence related to effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.This review considered studies that included hospitalised adult patients diagnosed with community acquired pneumonia regardless of gender, ethnicity, severity, and co-morbidities.Structured discharge process related to early patient engagement, patient-caregiver dyad intervention, transitional care, coordinated care, and multidisciplinary team approach.The outcome measures included in this review were hospital readmission, emergency room visits, and unscheduled visits to healthcare provider.Randomised controlled trials (RCTs) and quasi-experimental studies were considered for inclusion.The search strategy aimed to find both published and unpublished studies in English language without date limits. A search of PubMed/MEDLINE, CINAHL, CINAHL Plus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Academic Search Premier, Health Source Nursing/Academic Edition and seven other databases was conducted.Studies were critically appraised by two independent reviewers using the Joanna Briggs Institute's standardised critical appraisal tool.Data were extracted using the standardised Joanna Briggs Institute's data extraction instruments.Statistical pooling in meta-analysis was not appropriate. Findings are presented in a narrative form.Three articles were included in the review, two RCTs and one pseudo-randomised controlled clinical trial. Structured discharge process did not have a positive impact in reducing hospital readmission at 30, 90, and 180 days and in reducing emergency room visit at 30 days. The outcome measure of unscheduled visit to healthcare provider was not measured in any of the three studies. The incorporation of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist were effective strategies in reducing hospital readmission in all three studies and in reducing emergency room visits in one of the studies.Medication reconciliation with the addition of follow-up telephone calls and incorporation of either an advanced practice nurse, care coordinator, or a clinical pharmacist using a multidisciplinary team approach may have implications in existing coordination of care of adult patients with community acquired pneumonia.This review recommends use of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist as part of the structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.Further research is needed in examining the effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.

Background Nurse managers play an important role in implementing patient safety practices in hospitals. However, the influence of their professional background on their clinical leadership behaviour remains unclear. Research has demonstrated that concepts of Bourdieu (dispositions of habitus, capital and field) help to describe this influence. It revealed various configurations of dispositions of the habitus in which a caring disposition plays a crucial role. Objectives We explore how the caring disposition of nurse middle managers' habitus influences their clinical leadership behaviour in patient safety practices. Design Our paper reports the findings of a Bourdieusian, multi-site, ethnographic case study. Settings Two Dutch and two American acute care, mid-sized, non-profit hospitals. Participants A total of 16 nurse middle managers of adult care units. Methods Observations were made over 560h of shadowing nurse middle managers, semi-structured interviews and member check meetings with the participants. Results We observed three distinct configurations of dispositions of the habitus which influenced the clinical leadership of nurse middle managers in patient safety practices; they all include a caring disposition: (1) a configuration with a dominant caring disposition that was helpful (via solving urgent matters) and hindering (via ad hoc and reactive actions, leading to quick fixes and ‘compensatory modes'); (2) a configuration with an interaction of caring and collegial dispositions that led to an absence of clinical involvement and discouraged patient safety practices; and (3) a configuration with a dominant scientific disposition showing an investigative, non-judging, analytic stance, a focus on evidence-based practice that curbs the ad hoc repertoire of the caring disposition. Conclusions The dispositions of the nurse middle managers' habitus influenced their clinical leadership in patient safety practices. A dominance of the caring disposition, which meant ‘always' answering calls for help and reactive and ad hoc reactions, did not support the clinical leadership role of nurse middle managers. By perceiving the team of staff nurses as pseudo-patients, patient safety practice was jeopardized because of erosion of the clinical disposition. The nurse middle managers' clinical leadership was enhanced by leadership behaviour based on the clinical and scientific dispositions that was manifested through an investigative, non-judging, analytic stance, a focus on evidence-based practice and a curbed caring disposition.

Background The Knowledge about Older Patients-Quiz (KOP-Q) is designed as a unidimensional scale measuring knowledge of hospital nurses about older patients. Furthermore, the KOP-Q measures a second unidimensional construct, certainty of hospital nurses about their knowledge. The KOP-Q is developed and validated in the Netherlands. Whether the KOP-Q can be used in other countries is unknown given the cultural and language differences. Objectives Investigate the level of measurement invariance of the KOP-Q between the Netherlands and United States of America (USA). Design A multicenter international cross-sectional design. Settings Four general hospitals in the Netherlands and four general hospitals in the USA. Participants Nurses from the Netherlands (n = 201) and the USA (n = 130) were invited to participate by email from the ward manager, distributing flyers and present messages on the online hospital communication boards. Questions of the KOP-Q were completed online. Method The level of measurement invariance (configural, metric or scalar invariance) across countries was tested by running increasingly constrained structural equation models, and testing whether these models fitted the data. Results Both the knowledge and certainty construct of the KOP-Q proved unidimensional in the Netherlands and USA sample. Test results of the measurement invariance across the Netherlands and USA indicated a stable, partial scalar invariance (15 items full scalar invariance) for the knowledge items and full scalar invariance for the certainty items. Conclusions The KOP-Q shows to function uniformly across both language groups and can therefore be used to assess nurses' knowledge and their certainty about this knowledge which can be important for educational and/or quality improvement programs in the USA. Furthermore, the KOP-Q is suitable to make comparisons between the Netherlands and the USA using latent variable models. Before the KOP-Q can be used in other countries, cross-cultural tests should again be performed.

Delirium has been a recognised syndrome in the intensive care unit for some years. This systematic review reports risk factors for delirium studied in the intensive care unit. Four predisposing and 21 precipitating factors, including nine laboratory blood values and seven items relating to the use or the administration of medication, were found to influence the onset of delirium in the intensive care unit in six publications. The APACHE II score and hypertension were the only factors reported twice. Risk factors for the development of intensive care delirium were understudied and underreported in the literature.

The purpose of this study was to translate the Diabetes Management Self-Efficacy Scale (DMSES) into Chinese and test the validity and reliability of the instrument within a Taiwanese population.A two-stage design was used for this study. Stage I consisted of a multi-stepped process of forward and backward translation, using focus groups and consensus meetings to translate the 20-item Australia/English version DMSES to Chinese and test content validity. Stage II established the psychometric properties of the Chinese version DMSES (C-DMSES) by examining the criterion, convergent and construct validity, internal consistency and stability testing. The sample for Stage II comprised 230 patients with type 2 diabetes aged 30 years or more from a diabetes outpatient clinic in Taiwan.Three items were modified to better reflect Chinese practice. The C-DMSES obtained a total average CVI score of .86. The convergent validity of the C-DMSES correlated well with the validated measure of the General Self-Efficacy Scale in measuring self-efficacy (r=.55; p.01). Criterion-related validity showed that the C-DMSES was a significant predictor of the Summary of Diabetes Self-Care Activities scores (Beta=.58; t=10.75, p.01). Factor analysis supported the C-DMSES being composed of four subscales. Good internal consistency (Cronbach's alpha=.77 to .93) and test-retest reliability (Pearson correlation coefficient r=.86, p.01) were found.The C-DMSES is a brief and psychometrically sound measure for evaluation of self-efficacy towards management of diabetes by persons with type 2 diabetes in Chinese populations.

Objectives: Systematic reviews on complex interventions like self-management interventions often do not explicitly state an operational definition of the intervention studied, which may impact the reviews conclusions. This study aimed to propose an operational definition of self-management interventions and determine its discriminative performance compared with other operational definitions. Study Design and Setting: Systematic review of definitions of self-management interventions and consensus meetings with self management research experts and practitioners. Results: Self-management interventions were defined as interventions that aim to equip patients with skills to actively participate and take responsibility in the management of their chronic condition in order to function optimally through at least knowledge acquisition and a combination of at least two of the following: stimulation of independent sign/symptom monitoring, medication management, enhancing problem-solving and decision-making skills for medical treatment management, and changing their physical activity, dietary, and/or smoking behavior. This definition substantially reduced the number of selected studies (255 of 750). In two preliminary expert meetings (n = 6), the proposed definition was identifiable for self-management research experts and practitioners (80% and 60% agreement, respectively). Conclusion: Future systematic reviews must carefully consider the operational definition of the intervention studied because the definition influences the selection of studies on which conclusions and recommendations for clinical practice are based. (C) 2016 Elsevier Inc. All rights reserved. Funding Agencies|Dutch Ministry of Health, Welfare and Sports, ZonMw [520001002]

Aims. To explore differences in self-care behaviour according to demographic and illness characteristics; and relationships among self-care behaviour and demographic and illness characteristics, efficacy expectations and outcome expectations of people with type 2 diabetes in Taiwan. Background. Most people with diabetes do not control their disease appropriately in Taiwan. Enhanced self-efficacy towards managing diseases can be an effective way of improving disease control as proposed by the self-efficacy model which provides a useful framework for understanding adherence to self-care behaviours. Design and methods. The sample comprised 145 patients with type 2 diabetes aged 30 years or more from diabetes outpatient clinics in Taipei. Data were collected using a self-administered questionnaire for this study. One-way anova, t-tests, Pearson product moment correlation and hierarchical regression were analysed for the study. Results. Significant differences were found: between self-care behaviour and complications (t = −2·52, p

Objectives. The aims of this study were to perform a cultural translation of the DMSES and evaluate the psychometric properties of the translated scale in a Korean population with type 2 diabetics.Methods. This study was conducted in patients with diabetes recruited from university hospitals. The first stage of this study involved translating the DMSES into Korean using a forward- and backward-translation technique. The content validity was assessed by an expert group. In the second stage, the psychometric properties of the Korean version of the DMSES (K-DMSES) were evaluated.Results. The content validity of the K-DMSES was satisfactory. Sixteen-items clustered into four-subscales were extracted by exploratory factor analysis, and supported by confirmatory factor analysis. The construct validity of the K-DMSES with the Summary of Diabetes Self-Care Activities scale was satisfactory (r=0.50,P<0.001). The Cronbach’s alpha and intraclass correlation coefficient were 0.92 and 0.85 (P<0.001; 95%CI=0.75–0.91), respectively, which indicate excellent internal consistency reliability and test-retest reliability.Conclusions. The K-DMSES is a brief instrument that has demonstrated good psychometric properties. It is therefore feasible to use in practice, and is ready for use in clinical research involving Korean patients with type 2 diabetes.

In clinical practice, identifying positive and negative attitudes toward older patients is very important to improve quality of care provided to them. The Older People in Acute Care Survey - United States (OPACS-US) is an instrument measuring hospital nurses attitudes regarding older patients. However, psychometrics have never been assessed. Furthermore, knowledge being related to attitude and behavior should also be measured complementing the OPACS-US. The purpose of this study was to assess structural validity and reliability of the OPACS-US and assess whether the OPACS-US can be complemented with the Knowledge about Older Patients-Quiz (KOP-Q). A multicenter cross sectional design was conducted. Registered nurses (n = 130, mean age 39,9 years; working experience 14,6 years) working in four general hospitals were included in the study. Nurses completed the OPACS-US section A: practice experiences, B: general opinion and the KOP-Q online. Findings demonstrated that the OPACS-US is a valid and reliable survey instrument that measures practice experiences and general opinion. Furthermore, the OPACS-US can be combined with the KOP-Q adding a knowledge construct, and is ready for use within education and/or quality improvement programs in the USA.

This review focuses on delirium and early recognition of symptoms by nurses. Delirium is a transient organic mental syndrome characterized by disturbances in consciousness, thinking and memory. The incidence in older hospitalized patients is about 25%. The causes of delirium are multi-factorial; risk factors include high age, cognitive impairment and severity of illness. The consequences of delirium include high morbidity and mortality, lengthened hospital stay and nursing home placement. Delirium develops in a short period and symptoms fluctuate, therefore nurses are in a key position to recognize symptoms. Delirium is often overlooked or misdiagnosed due to lack of knowledge and awareness in nurses and doctors. To improve early recognition of delirium, emphasis should be given to terminology, vision and knowledge regarding health in ageing and delirium as a potential medical emergency, and to instruments for systematic screening of symptoms.

This article summarizes the development and validation of a scale to measure the level of self-efficacy of patients with type 2 diabetes mellitus. Self-efficacy is described as people's belief in their capability to organize and execute the course of action required to deal with prospective situations. This self-efficacy scale was developed based on the self-care activities these patients have to carry out in order to manage their diabetes. The following psychometric properties of this scale were established: content validity, construct validity, internal consistency and stability. The original scale contained 42 items. A panel of five experts in diabetes and four self-efficacy experts evaluated the original scale two times for relevance and clarity. This content validity procedure resulted in a final scale which consisted of 20 items. Subsequently, patients with type 2 diabetes were asked to complete this 20-item scale and further tests were done with the 94 usable responses. Factor analysis identified four factors, all of which were related to clusters of self-care activities used to manage diabetes which comprised this scale. The internal consistency of the total scale was alpha=0.81 and the test-retest reliability with a 5-week time interval was r=0.79 (P < 0.001).

Various methods for diabetes risk assessment have been developed over a decade, but they were not evaluated in patients with mental illness. This study examined the feasibility and utility of a self-assessment score for type 2 diabetes mellitus (DM2) risk among patients with mental illness. DM2 risk was assessed by patients with mental illness as well as clinicians via a self-assessment questionnaire, and the resulting scores were compared to each other as well as with actual diagnosis. Of 100 patients, nine patients were newly revealed to have DM2 and 34 patients have pre-DM2. Patients tended to underreport risk factors - obesity and physical activity - so perceived to have lower risk. Sensitivity of the self-assessment score was different when used by patients and by clinicians despite correlation coefficient of 0.82. Based on positive predictive values, we may expect one out of two patients who have high scores actually have DM2 or pre-DM2. Also, the discrimination capability was reasonably high (AUC=0.79), comparable to its performance observed in general populations. The self-assessment score has potential as a simple and adjunct tool to identify a high risk group of DM2/pre-DM2 among persons with mental illness, especially, when used together with health care providers.

Malnutrition is a serious problem in older adults, particularly for those at risk of hospital readmission. The essential step in managing malnutrition is early identification using a valid nutrition screening tool. The purpose of this study was to validate the Malnutrition Screening Tool (MST) in older adults at high risk of hospital readmission. Two RNs administered the MST to identify malnutrition risk and compared it with the comprehensive Subjective Global Assessment (SGA) to assess nutritional status for patients 65 and older who had at least one risk factor for hospital readmission. The MST demonstrates substantial sensitivity, specificity, and agreement with the SGA. These findings indicate that nursing staff can use the MST as a valid tool for routine screening and rescreening to identify patients at risk of malnutrition. Use of the MST may prevent hospital-acquired malnutrition in acute hospitalized older adults at high risk of readmission.

Background: People with cardiac disease and type 2 diabetes have higher hospital readmission rates (22%) compared to those without diabetes (6%). Self-management is an effective approach to achieve better health outcomes; however there is a lack of specifically designed programs for patients with these dual conditions. This project aims to extend the development and pilot test of a Cardiac-Diabetes Self-Management Program incorporating user-friendly technologies and the preparation of lay personnel to provide follow-up support. Methods/Design: A randomised controlled trial will be used to explore the feasibility and acceptability of the Cardiac-Diabetes Self-Management Program incorporating DVD case studies and trained peers to provide follow-up support by telephone and text-messaging. A total of 30 cardiac patients with type 2 diabetes will be randomised, either to the usual care group, or to the intervention group. Participants in the intervention group will received the Cardiac-Diabetes Self-Management Program in addition to their usual care. The intervention consists of three face-to-face sessions as well as telephone and text-messaging follow up. The face-to-face sessions will be provided by a trained Research Nurse, commencing in the Coronary Care Unit, and continuing after discharge by trained peers. Peers will follow up patients for up to one month after discharge using text messages and telephone support. Data collection will be conducted at baseline (Time 1) and at one month (Time 2). The primary outcomes include self-efficacy, self-care behaviour and knowledge, measured by well established reliable tools. Discussion: This paper presents the study protocol of a randomised controlled trial to pilot evaluates a Cardiac-Diabetes Self-Management program, and the feasibility of incorporating peers in the follow-ups. Results of this study will provide directions for using such mode in delivering a self-management program for patients with both cardiac condition and diabetes. Furthermore, it will provide valuable information of refinement of the intervention program. Trial Registration Number ACTRN12611000086965

Introduction Delirium is a common complication in the intensive care unit. The attention of researchers has shifted from the treatment to the prevention of the syndrome necessitating the study of associated risk factors. Methods In a multicenter study at one university hospital, two community hospitals and one private hospital, all consecutive newly admitted adult patients were screened and included when reaching a Glasgow Coma Scale greater than 10. Nurse researchers assessed the patients for delirium using the NEECHAM Confusion Scale. Risk factors covered four domains: patient characteristics, chronic pathology, acute illness and environmental factors. Odds ratios were calculated using univariate binary logistic regression. Results A total population of 523 patients was screened for delirium. The studied factors showed some variability according to the participating hospitals. The overall delirium incidence was 30%. Age was not a significant risk factor. Intensive smoking (OR 2.04), daily use of more than three units of alcohol (OR 3.23), and living alone at home (OR 1.94), however, contributed to the development of delirium. In the domain of chronic pathology a pre-existing cognitive impairment was an important risk factor (OR 2.41). In the domain of factors related to acute illness the use of drains, tubes and catheters, acute illness scores, the use of psychoactive medication, a preceding period of sedation, coma or mechanical ventilation showed significant risk with odds ratios ranging from 1.04 to 13.66. Environmental risk factors were isolation (OR 2.89), the absence of visit (OR 3.73), the absence of visible daylight (OR 2.39), a transfer from another ward (OR 1.98), and the use of physical restraints (OR 33.84). Conclusions This multicenter study indicated risk factors for delirium in the intensive care unit related to patient characteristics, chronic pathology, acute illness, and the environment. Particularly among those related to the acute illness and the environment, several factors are suitable for preventive action.

Aims and objectives. This research studied the long term outcome of intensive care delirium defined as mortality and quality of life at three and six months after discharge of the intensive care unit. Background. Delirium in the intensive care unit is known to result in worse outcomes. Cognitive impairment, a longer stay in the hospital or in the intensive care unit and a raised mortality have been reported. Design. A prospective cohort study. Methods. A population of 105 consecutive patients was included during the stay at the intensive care unit in July–August 2006. The population was assessed once a day for delirium using the NEECHAM Confusion Scale and the CAM-ICU. Patients were visited at home by a nurse researcher to assess the quality of life using the Medical Outcomes Study Short-Form General Health Survey at three and six months after discharge of the intensive care unit. Delirious and non delirious patients were compared for mortality and quality of life. Results. Compared to the non delirious patients, more delirious patients died. The total study population discharged from the intensive care unit, scored lower for quality of life in all domains compared to the reference population. The domains showed lower results for the delirious patients compared to the non delirious patients. Conclusions. Mortality was higher in delirious patients. All patients showed lower values for the quality of life at three months. The delirious patients showed lower results than the non delirious patients. Relevance to clinical practice. Nurses are the first caregivers to observe patients. The fluctuating delirious process is often not noticed. Long term effects are not visible to the interdisciplinary team in the hospital. This paper would like to raise the awareness of professionals for long term outcomes for patients having experienced delirium in the intensive care unit.

Geriatric nursing competency in the acute care setting is a social mandate for the 21st century. This article reports on the content validation of an Australian research instrument, the Older Patients in Acute Care Survey (OPACS) that examines the attitudes, the knowledge, and the practices of nurses working with acute care patients. The OPACS tool was developed primarily to assist nurse educators to assess attitudes, knowledge, and practices of nursing staff in caring for older patients in the acute care setting; to evaluate the implementation of institution-specific educational interventions; and to improve quality of care given to older patients. An overall content validity index (CVI) for the OPACS was calculated (CVI = .918), revealing high content validity. Opinions (CVI = .92) and practices (CVI = .97) subconstructs revealed high content validity as well. Therefore, results indicate that the OPACS has high content validity in the U.S. acute care setting and could assist nurse educators in establishing and enhancing nurse competency in the care for geriatric patients in the future.

Background Several reports indicate a high incidence of intensive care delirium. To develop strategies to prevent this complication, validated instruments are needed. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is widely used. A binary result diagnoses delirium. The Neelon and Champagne (NEECHAM) Confusion Scale recently has been validated for use in the ICU and has a numeric assessment. This scale allows the patients to be classified in four categories: non-delirious, at risk, confused, and delirious. In this study, we investigated the results of the NEECHAM scale in comparison with the CAM-ICU. Methods A consecutive sample of 172 non-intubated patients in a mixed ICU was assessed after a stay in the ICU for at least 24 hours. All adult patients with a Glasgow Coma Scale score of greater than 9 were included. A nurse researcher simultaneously assessed both scales once daily in the morning. A total of 599 paired observations were made. Results The CAM-ICU showed a 19.8% incidence of delirium. The NEECHAM scale detected incidence rates of 20.3% for delirious, 24.4% for confused, 29.7% for at risk, and 25.6% for normal patients. The majority of the positive CAM-ICU patients were detected by the NEECHAM scale. The sensitivity of the NEECHAM scale was 87% and the specificity was 95%. The positive predictive value and the negative predictive value were 79% and 97%, respectively. The diagnostic capability in cardiac surgery patients proved to be lower than in other patients. Conclusion In non-intubated patients, the NEECHAM scale identified most cases of delirium which were detected by the CAM-ICU. Additional confused patients were identified in the categorical approach of the scale. The NEECHAM scale proved to be a valuable screening tool compared with the CAM-ICU in the early detection of intensive care delirium by nurses.

[Extract] This chapter provides an overview of the differentiation between the ‘nontaught’ and ‘taught’ doctorates, and examines why and how different doctoral approaches in nursing have evolved. The major forms of doctoral education examined are: professional doctoral programmes (mainly taught), doctorates by published work, and doctorates by portfolio; doctoral study via distance education is also explored. Within our discussion we draw out benefits and challenges of these diverse doctoral approaches in nursing, all of which are equally robust and aim to contribute to knowledge for practice. For the purpose of the chapter doctorates may be termed ‘non-traditional doctorates’; however, we acknowledge that it is difficult to define what is traditional and non-traditional1 in a global context. We suggest that because many different doctoral education systems have emerged over time in many countries with distinct postgraduate systems, no single definition is satisfactory, and mutually exclusive criteria to categorize doctorates are difficult to identify. While many countries have examples of ‘traditional’ PhDs by thesis, diverse new approaches to doctoral education are emerging worldwide, some based on the US Doctorate of Nursing Science (DNS) model, with others emerging within specific contexts such as practice and/or higher education policy, and are subsequently mixed in their structure and delivery. Therefore, we explore new forms of doctoral education as well as concepts that underpin current understandings of the non-taught (thesis-based PhD) and taught doctorates (professional doctorates such as DNS), and illustrate their key tenets.

Australians' use of the English language is influenced by a British educational curriculum, exposure to international television programmes and cultural backgrounds. Hence, adapting research instruments for use with Australian populations can be challenging. This study adapted the United Kingdom's version of the 20-item Diabetes Management Self-Efficacy Scale and tested it psychometrically with Australians. Face validity of the adapted instrument was established through consultation with diabetes educators and people with type 2 diabetes. Data from a convenience sample of 88 people with type 2 diabetes were analysed to determine the psychometric properties of the adapted instrument. The results indicate that the Australian/English version of the instrument is internally consistent, stable over time and it measures self-efficacy. However, there was evidence to show that there might be some redundant items in the scale. Further psychometric testing is warranted with a larger sample to determine whether the scale requires refinement.

Background : As a profession, nurses are particularly concerned with cross-cultural influences that affect the health practices of populations. Although the international literature describes questionnaires and specific scales in health and disease behaviours, adequate Turkish-language instruments are scarce. Therefore, suitable Turkish-language instruments need to be developed or adapted for the Turkish population. Objectives : Study aim was to adapt a Dutch/English version of the diabetes management self-efficacy (SE) scale for use with a Turkish population and evaluate its psychometric properties. Design : Methodological research design. Settings : Attendants of an outpatient clinic of a university hospital in Turkey. Participants : A convenience sample of 110 patients with type 2 diabetes mellitus (DM). Methods : Translation and back-translation of the original English instrument and content validation through a expert panel were the first two steps of the study. Third step was the psychometric testing of the adapted instrument by establishing internal consistency (Cronbach's α ), stability (test–retest reliability), and construct validity (factor analysis). Results : Content validity procedure resulted in a final scale that consisted of 20 items. Internal consistency of the total scale was coefficient α = 0.88 , and test–retest reliability with a 4-week time interval was r = 0.91 ( p 0.001 ). Factor analysis yielded three factors related to diet, exercise and medical treatment. Two relevant items of the scale, weight control and blood sugar control, however, had low reliability and validity scores. Conclusions : Although acceptable levels of reliability and validity of the Turkish version of the diabetes management SE scale for people with type 2 DM were reached, cultural factors appeared to play a role in the applicability of some items of the scale.

A importância de instrumentos de avaliação para o praticante da prática clínica de família não tem tido a ênfase suficiente. Modelos são menos práticos do que seus instrumentos e inventários na prática clínica. Um método estruturado para avaliar instrumentos de avaliação é apresentado. O APGAR Famíliar é avaliado usando este método para demonstrar sua utilidade ao clínico da prática de família. A intenção do método estruturado de avaliar cada instrumento é facilitar a escolha de um instrumento para avaliação da família pelo clínico e no ensino da avaliação da família àquelas que usam a família como foco no cuidado clínico de seus pacientes.

This review describes the characteristics and evaluates the psychometric qualities (process of testing and the results) of thirteen delirium instruments. Delirium instruments differ in goal (diagnosis, screening symptoms severity), type of data on which the rating is based (observation, interview or test of patients), the rater qualities required, the number of items and the rating time needed. Most instruments are based on the Diagnostic Statistical Manual criteria and measure signs and symptoms as described by these criteria. Reliability of delirium instruments shows good to excellent results. Validity of the delirium instruments is overall fair to good. Differences exist, however, in the degree to which reliability and validity were tested and the quality of the testing procedures. Most instruments are not further developed and tested after the initial study. Conclusion of this review is that most delirium instruments show promising results but need further testing. Testing is needed in different samples and on a broader range of aspects with regard to reliability and validity. Much emphasis should be given to the procedures used in future studies. Ease of use is an aspect of testing that is so far not taken into account, however, is important for use of instruments in clinical practice.A minority of instruments can be seen as “ready to use” instruments meaning well tested in more than one sample with good results. For screening high-risk, elderly hospitalized patients, the NEECHAM Confusion Scale and the Delirium Observation Screening Scale are recommended. The Confusion Assessment Method is the best diagnostic tool and the Delirium Rating Scale shows best results in screening symptom severity. For ICU patients the CAM-ICU is recommended. The MDAS is well tested in cancer patients. Nurses, however, have not yet tested the DRS and MDAS in practice.

This prospective study investigated risk factors for delirium in elderly hip fracture patients that could be recognized by nurses. Data were collected on predisposing and precipitating factors for delirium from 92 elderly patients with a hip fracture. Predisposing factors included age, gender, sensory impairments, functional impairment before the hip fracture, residency before admission, pre-existing cognitive impairment, comorbidities, and medication use. Precipitating factors included factors related to surgery and to the postoperative period. Factors related to surgery included time between admission and surgery, type of surgery, type of anesthesia, duration of surgery and anesthesia, and complications during surgery. Factors studied in the postoperative period were slow recovery, malnutrition, dehydration, addition of three or more medications, introduction of bladder catheter, infections, complications and falls, and use of morphine. Eighteen patients developed delirium, as diagnosed by a geriatrician by using the Diagnostic Statistical Manual-IV criteria. Data on delirious patients were compared with the data on non-delirious patients. The findings confirm that elderly hip fracture patients with premorbid ADL dependency, psychiatric comorbidities (including dementia), and a high number of other comorbid problems are at risk for the development of delirium. Based on these findings, it is recommended that nurses should assess patients' pre-fracture functional and cognitive capacities in an early stage of the hospital stay. Nurses should also be alert to postoperative delirium in "healthy elderly" patients. Monitoring of symptoms postoperatively in all elderly patients is advised.

The Delirium Observation Screening (DOS) scale, a 25-item scale, was developed to facilitate early recognition of delirium, according to the Diagnostic and Statistical Manual-IV criteria, based on nurses’ observations during regular care. The scale was tested for content validity by a group of seven experts in the field of delirium. Internal consistency, predictive validity, and concurrent and construct validity were tested in two prospective studies with high risk groups of patients: geriatric medicine patients and elderly hip fracture patients. Among the patients admitted to a geriatric department (N = 82), 4 became delirious; among the elderly hip fracture patients (N = 92), 18 became delirious. The DOS scale was determined to be content valid and showed high internal consistency, α = 0.93 and α = 0.96. Predictive validity against the Diagnostic and Statistical Manual-IV diagnosis of delirium made by a geriatrician was good in both studies. Correlations of the DOS scale with the Mini Mental State Examination (MMSE) were Rs -0.79 (p ≤ 0.001) in the hip fracture patients and Rs -0.66 (p ≤ 0.001) in the geriatric medicine patients. Concurrent validity, as tested by comparison of the research nurse’s ratings of the DOS scale and the Confusion Assessment Method (CAM), for the group of hip fracture patients was 0.63 (p ≤ 0.001). Construct validity of the DOS was tested against the Informant Questionnaire of Cognitive Decline in Elderly (IQCODE), a preexisting psychiatric diagnosis and the Barthel Index. Correlation with the IQCODE was 0.74 (p ≤ 0.001) in the study with the hip fracture patients and 0.33 (p ≤ 0.05) in the study with the geriatric medicine patients. Correlation with the Barthel Index was -0.26 (p ≤ 0.05) in the geriatric medicine patients and -0.55 (p ≤ 0.001) in the hip fracture patients. The overall conclusion of these studies is that the DOS scale shows satisfactory validity and reliability, to guide early recognition of delirium by nurses’ observation.

Objective: to perform the cultural adaptation and validation of the Diabetes Management Self-efficacy Scale for Patients with Type 2 Diabetes Mellitus with a Brazilian population sample. Method: cross-sectional methodological study in which the adaptation and validation process included the stages recommended in the literature. Construct validity and reliability were assessed with 200 adults with type 2 diabetes mellitus. Results: the items indicated by the panel of judges and by the target population were adjusted in the cultural adaptation to improve clarity and understanding. The instrument's four factors remained in the confirmatory factor analysis with factor loadings of items greater than 0.30, except for factor 4; convergent validity, verified by the multitrait-multimethod analysis, presented inter-item correlations from 0.37 to 0.92, while for discriminant validity, 100% of the items presented greater correlation in their own factors. Cronbach's coefficient alpha for the total scale was 0.78, ranging from 0.57 to 0.86 among factors. Conclusion: semantic, cultural, conceptual and idiomatic equivalences were achieved and the instrument's Brazilian version also presented psychometric properties that showed evidence of reliability and validity. Thus, it can be applied both in clinical practice and research. Self-efficacy is useful for planning and assessing educational interventions, as well as predicting behavior modification in self-care. Objetivo: realizar a adaptação cultural e validação da Diabetes Management Self-efficacy Scale for Patients with Type 2 Diabetes Mellitus para uma amostra populacional brasileira. Método: estudo metodológico transversal, cujo processo de adaptação e validação incluiu as etapas preconizadas pela literatura. A validade de construto e a confiabilidade foram avaliadas em 200 adultos com diabetes mellitus tipo 2. Resultados: na adaptação cultural, foram ajustados itens indicados pelo Comitê de Juízes e pela população alvo, para maior clareza e compreensão. Na análise fatorial confirmatória manteve-se os quatro fatores, com cargas fatoriais dos itens superiores a 0,30, exceto para o fator 4; a análise multitraço-multimétodo mostrou para a validade convergente, correlações inter-itens de 0,37 a 0,92, e para a discriminante, que 100% dos itens obtiveram maior valor de correlação em seu próprio fator. O coeficiente alfa de Cronbach para a escala total foi de 0,78, com variação de 0,57 a 0,86 entre os fatores. Conclusão: as equivalências semântica, cultural, conceitual e idiomática foram mantidas, e as propriedades psicométricas mostraram evidências de confiabilidade e de validade da versão brasileira do instrumento, portanto, poderá ter aplicação clínica e em pesquisas. A autoeficácia é útil para planejar e avaliar intervenções educativas e predizer mudanças comportamentais para o cuidado. Objetivo: realizar la adaptación cultural y validación de la Diabetes Management Self-efficacy Scale for Patients with Type 2 Diabetes Mellitus en una muestra poblacional brasileña. Método: estudio metodológico transversal, cuyo proceso de adaptación y validación incluyó las etapas preconizadas por la literatura. La validez de constructo y la confiabilidad fueron evaluadas en 200 adultos con diabetes mellitus tipo 2. Resultados: para mayor clareza y comprensión, en la adaptación cultural fueron ajustados los ítems indicados por el Comité de Jueces y por la población objetivo. En el análisis factorial confirmatorio se mantuvieron los cuatro factores, con cargas factoriales de los ítems superiores a 0,30, excepto para el factor 4; el análisis multirrasgo y multimétodo mostró para la validez convergente, correlaciones entre ítems de 0,37 a 0,92, y en el caso del discriminante que 100% de los ítems obtuvieron mayor valor de correlación en su propio factor. El coeficiente alfa de Cronbach para la escala total fue de 0,78, con variación de 0,57 a 0,86 entre los factores. Conclusión: las equivalencias semántica, cultural, conceptual e idiomática fueron mantenidas; las propiedades psicométricas mostraron evidencias de confiabilidad y de validez en la versión brasileña del instrumento; por tanto, la adaptación podrá tener aplicación en la clínica e investigaciones. La autoeficacia es útil para planificar y evaluar intervenciones educativas y predecir cambios comportamentales para el cuidado.