Resources From EBSCOhost Search Basic

Resourceshttpwebaebscohostcomehostsearchbasicvid0sid04898

Resourceshttpwebaebscohostcomehostsearchbasicvid0sid04898

Evaluate and analyze the research article by Guo and Fan (2016) regarding the effectiveness of a nurse-led intervention to prevent postoperative delirium. Summarize the purpose, methodology, results, and conclusions of the study. Discuss potential biases, limitations, and the reliability of the findings. Provide recommendations for future research based on identified weaknesses, including study design improvements and considerations for confounding variables. Reference current evidence-based practices and literature in nursing and medical research to support your analysis.

Paper For Above instruction

Postoperative delirium is a common and serious complication among older patients undergoing surgery, associated with increased morbidity, mortality, and extended hospital stays. Guo and Fan (2016) conducted a significant study to evaluate whether a multidisciplinary, nurse-led preoperative intervention could reduce the incidence and severity of delirium in postoperative patients. Their research aimed to assess the efficacy of a comprehensive educational and supportive nursing program in improving patient outcomes, which is crucial for advancing patient-centered care and reducing healthcare costs associated with delirium.

The study employed a quasi-experimental design involving two groups: an intervention group that received a structured, nurse-led preoperative program and a control group that received standard care. The intervention included patient education, systematic cognitive care, environmental safety measures, social support, and sleep improvement strategies. Data collection involved the use of the Delirium Detection Score (DDS), which assesses eight criteria: agitation, anxiety, hallucinations, orientation, seizures, tremors, sweating, and sleep patterns. Patients' delirium status was monitored at multiple intervals—2, 4, 8, 16, and 24 hours post-surgery—to track both occurrence and progression.

The findings demonstrated that patients in the intervention group experienced significantly fewer episodes of delirium and presented with less severe symptoms, as evidenced by lower DDS scores, compared to the control group. Statistical analysis using SPSS included independent t-tests for baseline comparisons and Mann-Whitney U tests for non-parametric data, in addition to Wilcoxon tests to evaluate changes in severity over time. The reduction in delirium incidence and severity suggests that comprehensive nursing interventions can positively influence postoperative cognitive outcomes. The authors concluded that preoperative nurse-led interventions could serve as an effective strategy to mitigate delirium, emphasizing the importance of targeted nursing care in surgical settings.

Despite the promising results, several potential biases and limitations weaken the interpretation of the study. Notably, the study did not control for physicians’ contributory actions or other non-nursing care components that might influence outcomes. This oversight introduces a confounding variable, which could bias the results toward the null hypothesis or amplify the perceived effect of nursing interventions. Additionally, the study's reliance on subjective criteria such as agitation and anxiety, measured through DDS, raises concerns about inter-rater reliability and measurement consistency, especially given that assessments occurred over 24 hours in variable environments. The potential influence of the Hawthorne effect cannot be discounted, as nurses and patients aware of being observed might alter their behavior, affecting delirium scores.

Another critical concern involves medication management, which was not detailed in the study. Many drugs—including anticholinergics, sedatives, or analgesics—are known to influence delirium risk, and their uncontrolled use could confound the findings. Variability in medication administration and other clinical interventions across groups could therefore bias results, making it difficult to attribute observed effects solely to the nurse-led intervention.

The researchers' decision to conduct a quasi-experimental study in a single hospital further limits the generalizability of the results. The relatively small sample size may have reduced statistical power and increased the risk of type I or type II errors. Moreover, without randomization, there is a greater chance that unmeasured variables influenced group assignment, potentially skewing the results.

In terms of enhancing future research, adopting a randomized controlled trial (RCT) design would significantly improve the scientific rigor and validity of findings. A double-blind approach, where feasible, could minimize biases introduced by participant and researcher awareness of group allocations. Comprehensive control over confounding factors, including medication management and other clinical care elements, is warranted. Implementing larger, multi-center studies with diverse patient populations would also improve external validity, ensuring that results are applicable across different settings.

Furthermore, employing objective measurement tools, such as neuropsychological testing, alongside standardized delirium assessments, could enhance reliability. Training for evaluators and inter-rater reliability testing should be incorporated to reduce subjectivity in data collection. Long-term follow-up assessments could provide insight into the sustained effects of nursing interventions on postoperative cognitive function. Ultimately, integrating these methodological improvements would strengthen the evidence base for nursing practices aimed at preventing delirium.

In conclusion, Guo and Fan’s (2016) study offers promising evidence regarding the role of preoperative nursing care in reducing postoperative delirium. However, addressing the identified biases and methodological limitations through rigorous study designs and comprehensive control of confounding variables is essential for establishing robust, generalizable evidence. Such advancements could lead to the development of standardized, evidence-based protocols for delirium prevention in clinical practice, ultimately improving patient outcomes and reducing the burden of postoperative complications.

References

  • Guo, Y., & Fan, Y. (2016). A preoperative, nurse-led intervention program reduces acute postoperative delirium. Journal of Neuroscience Nursing, 48(4). https://doi.org/10.1097/jnn
  • Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer.
  • Röhrig, B., Prel, J. D., & Blettner, M. (2009). Study design in medical research. Deutsches Ärzteblatt International, 106(2), 184-189. https://doi.org/10.3238/arztebl.2009.0184
  • Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.
  • Inouye, S. K., et al. (2016). Delirium in older persons: Advances in diagnosis and prevention. JAMA, 315(8), 842-853.
  • Marcantonio, E. R. (2017). Delirium in hospitalized older adults. New England Journal of Medicine, 377(15), 1456-1466.
  • Fick, D. M., et al. (2015). Delirium assessment in hospitalized older adults. Journal of the American Geriatrics Society, 63(2), 209-214.
  • Sampson, E. L., et al. (2018). Causes of delirium in hospitalized elderly: A systematic review. Geriatrics & Gerontology International, 18(8), 1225-1233.
  • Krismer, M., & De Bruin, J. (2019). Prevention strategies for postoperative delirium. Clinical Interventions in Aging, 14, 795-805.
  • Meagher, D. J., et al. (2020). Ethical considerations in delirium research. Research Ethics, 16(2), 104-117.

Related Assignments