基于谵妄危险因素构建预防住院老年患者发生谵妄的照护方案

Delirium risk factor based care plan for prevention of delirium in elderly patients

目的构建适合预防住院老年患者发生谵妄的照护方案,为临床开展谵妄预防提供依据。方法基于谵妄危险因素,在综述文献基础上结合临床经验拟定照护方案初稿。遴选全国22名专家进行三轮德尔菲专家函询,构建预防住院老年患者发生谵妄的照护方案。结果三轮专家函询表有效回收率分别为92.31%、91.67%和100.00%;三轮专家函询权威程度(authority coefficient,Cr)分别为0.800、0.802和0.802;三轮函询各条目的变异系数(coefficient of variation,CV)范围分别为0.000~0.184、0.000~0.192与0.000~0.243;三轮总Kendall’s协调系数分别为0.062、0.104和0.482(χ^(2)值分别为17.573、135.892和223.479,均P<0.05);第一轮函询各条目重要性评分为3.65~4.96,标准差为0.21~1.56,第二轮函询各条目重要性评分为4.55~5.00,标准差为0.00~0.84,第三轮函询各条目的重要性评分为4.50~4.95,标准差为0.21~1.03。构建了包括4个一级指标(急性状态照护、认知情感照护、活动照护、老年综合征照护)、14个二级指标和70个三级指标的预防住院老年患者发生谵妄的照护方案。结论基于谵妄危险因素构建的预防住院老年患者发生谵妄的照护方案,可为临床护理实践提供参考。

Objective To make a care plan to prevent delirium in hospitalised elderly patients so as to provide a basis for prevention of delirium in clinical practice. Methods Based on the risk factors of delirium, the first draft of care plan was formulated on the basis of literatures review and clinical experiences. Twenty-two experts across the country were invited to conduct a threeround Delphi expert inquiries via letters to make a care plan for prevention of delirium. Results The effective recovery rates of the three rounds of expert inquiry form were 92.3%, 91.7%, and 100.0%, respectively. The authority coefficient(Cr) of the three rounds were 0.800, 0.802, and 0.802, respectively. The coefficients of variation(CV) for each item in the three rounds ranged 0.000-0.184,0.000-0.192 and 0.000-0.243. The total Kendall’s coordination coefficients of the three rounds were 0.062, 0.104 and 0.482, with χ^(2)values at 17.573, 135.892 and 223.479, respectively(P<0.05). The average importance and standard deviation of each item in the first,second and third rounds were 3.65-4.96, 0.21-1.56;4.55-5.00, 0.00-0.84;4.50-4.95, 0.21-1.03, respectively. A care plan was made to prevent delirium in the hospitalised elderly patients and it composed of 4 Level-1 indicators(acute state care, basic state emotional care, activity care, and elderly syndrome care), 14 Level-2 indicators and 70 Level-3 indicators. Conclusions A care plan based on the risk factors of delirium to prevent delirium in hospitalised elderly patients may provide reference for clinical nursing practice.