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Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients

INTRODUCTION: Delirium in critically-ill patients is a common multifactorial disorder that is associated with various negative outcomes. It is assumed that sleep disturbances can result in an increased risk of delirium. This study hypothesized that implementing a protocol that reduces overall nocturnal sound levels improves quality of sleep and reduces the incidence of delirium in Intensive Care Unit (ICU) patients.METHODS: This interrupted time series study was performed in an adult mixed medical and surgical 24-bed ICU. A pre-intervention group of 211 patients was compared with a post-intervention group of 210 patients after implementation of a nocturnal sound-reduction protocol. Primary outcome measures were incidence of delirium, measured by the Intensive Care Delirium Screening Checklist (ICDSC) and quality of sleep, measured by the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcome measures were use of sleep-inducing medication, delirium treatment medication, and patient-perceived nocturnal noise.RESULTS: A significant difference in slope in the percentage of delirium was observed between the pre- and post-intervention periods (-3.7% per time period, p=0.02). Quality of sleep was unaffected (0.3 per time period, p=0.85). The post-intervention group used significantly less sleep-inducing medication (p<0.001). Nocturnal noise rating improved after intervention (median: 65, IQR: 50-80 versus 70, IQR: 60-80, p=0.02).CONCLUSIONS: The incidence of delirium in ICU patients was significantly reduced after implementation of a nocturnal sound-reduction protocol. However, reported sleep quality did not improve.

Safe and effective nursing shift handover with NURSEPASS

AIM: Implementation of a locally developed evidence based nursing shift handover blueprint with a bedside-safety-check to determine the effect size on quality of handover.METHODS: A mixed methods design with: (1) an interrupted time series analysis to determine the effect on handover quality in six domains; (2) descriptive statistics to analyze the intercepted discrepancies by the bedside-safety-check; (3) evaluation sessions to gather experiences with the new handover process.RESULTS: We observed a continued trend of improvement in handover quality and a significant improvement in two domains of handover: organization/efficiency and contents. The bedside-safety-check successfully identified discrepancies on drains, intravenous medications, bandages or general condition and was highly appreciated.CONCLUSION: Use of the nursing shift handover blueprint showed promising results on effectiveness as well as on feasibility and acceptability. However, to enable long term measurement on effectiveness, evaluation with large scale interrupted times series or statistical process control is needed.

Quiet Please! Drug Round Tabards: Are They Effective and Accepted? A Mixed Method Study

BACKGROUND: The use of drug round tabards is a widespread intervention that is implemented to reduce the number of interruptions and medication administration errors (MAEs) by nurses; however, evidence for their effectiveness is scarce.PURPOSE: Evaluation of the effect of drug round tabards on the frequency and type of interruptions, MAEs, the linearity between interruptions and MAEs, as well as to explore nurses' experiences with the tabards.STUDY DESIGN: A mixed methods before-after study, with three observation periods on three wards of a Dutch university hospital, combined with personal inquiry and a focus group with nurses.METHODS: In one pre-implementation period and two post-implementation periods at 2 weeks and 4 months, interruptions and MAEs were observed during drug rounds. Descriptive statistics and univariable linear regression were used to determine the effects of the tabard, combined with personal inquiry and a focus group to find out experiences with the tabard.FINDINGS: A total of 313 medication administrations were observed. Significant reductions in both interruptions and MAEs were found after implementation of the tabards. In the third period, a decrease of 75% in interruptions and 66% in MAEs was found. Linear regression analysis revealed a model R2 of 10.4%. The implementation topics that emerged can be classified into three themes: personal considerations, patient perceptions, and considerations regarding tabard effectiveness.CONCLUSIONS: Our study indicates that this intervention contributes to a reduction in interruptions and MAEs. However, the reduction in MAEs cannot be fully explained by the decrease in interruptions alone; other factors may have also influenced the effect on MAEs. We advocate for further research on complementary interventions that contribute to a further reduction of MAEs.CLINICAL RELEVANCE: We can conclude that drug round tabards are effective to improve medication safety and are therefore important for the quality of nursing care and the reduction of MAEs.

The art of interruption: concepts of art as a cooperative citizen practice driving cultural innovation and social change

The research studies informal learning in cooperative art practices. It describes the way artists and artistically skilled amateurs get together to produce culture and in that way give shape and meaning to their own public lives. In many ways the "cooperative art practices" of these "communities of creative citizens" interrupt the habits of seeing, thinking and doing in our formal society that is based on economic functionalism, technologic reasoning and mediazation of public relations. These interruptions challenge further questioning of these habits developing a repertoire of alternative action that is based on subjective relations between people, things and the world. But above all these interruptions offer an opportunity for the participants to manifest themselves publicly, discuss their subjective human being and ultimately learn from that.First the dissertation explores literature on the power of imagination and a progressive force is contributed to art and the role of esthetics, symbolism and drama in our contemporary western society. Next it treats art as a social practice that creates opportunities for human growth and development. After an explanation of the methodological matters of the research the study continues with a report of three cases of learning and culture producing communities that are initiated and guided by artists. The social settings of these cases are analyzed according to their social features and subsequently investigated through the lens of pedagogical theory. The dissertation concludes with recommendations for artists, art institutions and policy makers who strive to promote the developmental quality of art.

Effects of advertisements and questionnaire interruptions on the player experience

Effects of advertisements and questionnaire interruptions on the player experience

New online stores and digital distribution methods have led to the development of alternative monetization models for video-games, such as free-to-play games with advertisements. Although there are many games using such models, until now the effect on the player experience from such interruptions has not been studied. In this controlled experiment, we requested that participants (N=236) play one of three different versions of a platformer game with: 1) no interruptions, 2) 30-second video advertisements, and 3) a multiple-choice questionnaire. We then evaluated the effects on the player experience. The study shows differences in their experiences, namely in: competence, immersion, annoyance, affects, and the reliability of the questionnaire answers. The contribution of this work is to identify which player experience variables are affected by interruptions, which can be valuable for selecting the business model and guiding the game design process.