NURS 6052: Essentials of Evidence-Based Practice

NURS 6052: Essentials of Evidence-Based Practice

Summary of Research Article

Guo and Fan (2016) report that the aim of this study was to determine the efficacy of a multi-disciplinary interventional program for the prevention of acute post-operative delirium. The intervention included the standard protocols, in addition to specialized education of nursing staff, systematic cognitive caring, maintaining a safe environment, social support, and measures to improve sleep quality. All patients were monitored for delirium using the Delirium Detection Score (DDS). The researchers found that patients in the interventional group had better outcomes than patients in the control group (Guo & Fan, 2016).

Data and Results

In this study, all participants underwent face to face assessment by a trained nurse using the DDS at scheduled intervals. The DDS measures eight criteria: agitation, anxiety, hallucination, orientation, seizures, tremor, paroxysmal sweating, and altered sleep-wake cycle. A score of 9 or less indicates no delirium, 10-14 indicates mild delirium, a score of 15-19 moderate delirium, and a score greater than 19 indicates severe delirium. Patients were assessed at regular intervals; 2,4,8,16, and 24 hours. Statistical analysis was performed utilizing SPSS software. Baseline characteristics, incidence, and severity of scores were between the intervention and control groups were compared using an independent t-test. Continuous variables were tested by the use of exact Man-Whitney U test due to the abnormal distribution of the data. A Wilcox test analysis was used to show a significant difference in the severity of delirium in the interventional and control groups. There were fewer delirious patients in the interventional group, and when delirium did occur, it was less severe (Guo & Fan, 2016).

Conclusion

The researchers asserted that lower scores on the DDS indicate that patients in the interventional group received better nursing care than patients in the control group; and that the pre-operative, nurse-led intervention program can improve patient outcomes. However, while the majority of interventions were carried out by nurses, the researchers failed to account for physician carry over. This would have tended to bias the results toward the null hypothesis. According to Polit and Beck (2017), the null hypothesis is when results were the result of chance factors, rather than the intervention. A type 1 error occurs when researchers reject a null hypothesis that is true, and a type 2 error occurs when the null hypothesis is accepted when it is, in fact, false (Polit & Beck, 2017). In this case, the researchers report that they rejected the null hypothesis, but also report that factors not attributed to nursing care could have impacted the final results, thus there was a potential type 1 error. Moreover, because the nurses administering the intervention knew they were being studied, the Hawthorne effect could have also impacted the results (Guo & Fan, 2016).