Page 142 - Encyclopedia of Nursing Research

DELiRiUM n 109

analysis of nursing data and their usefulness Data stewardship poses challenges and
have to be further explored. responsibilities for nurses in building knowl-
Processing data implies the transfer edge bases. Standardization of terms of data D
of data in raw form to a structured, inter- is critical, and coordination and synthesis
preted information form. information has of current efforts are needed. Further study
characteristics of accuracy, timeliness, util- to focus on the following areas has been
ity, relevance, quality, and consistency. Data recommended and continues to be needed:
stewardship suggests that attention be paid (a) the definition and description of the data
to these characteristics. For example, accu- and information required for patent care,
racy is of concern at the level of judgment in (b) the use of data and knowledge to deliver
collecting data as well as at the level of the and manage patient care, and (c) how one
data collected. Quality of data and informa- acquires and delivers knowledge from and
tion is related to the ability and willingness for patient care (national Center for nursing
of clients to disclose information as well as to Research, 1993).
the nurse’s ability to observe, to collect, and
to record it. Reliability refers to random mea- Carol A. Romano
surement errors such as ambiguities in data
interpretation. These measurement errors
that affect clinically generated data can occur
at the point of care delivery, the time of doc- DeliriuM
umentation, and when data are retrieved or
abstracted for studies (hays, norris, Martin,
& Androwich, 1994). Delirium is an acute, fluctuating disturbance
With the advent of automated data pro- of attention with disorganized thinking
cessing and computerized information sys- and altered psychomotor activity (Meagher,
tems, decisions about data content, control, MacLullich, & Laurila, 2008). it frequently
and cost need careful consideration. The con- accompanies acute physical illness and
tent and design decisions concern format, is found in all care settings and all ages.
standardized languages, level of detail, data Estimates of the incidence of delirium range
entry and retrieval messages, and interfaces from 11% to 42% for all hospitalized adults
with nonclinical data systems. A primary and 10% of hospitalized children referred
concern of clinicians is the amount of time to psychiatry, up to 66% of pediatric inten-
invested in harvesting data and recording it. sive care patients referred to psychiatry,
Minimum time investment, with maximum 46% for older adults receiving home health
clarity and comprehensiveness of data col- care services, and 14% to 39% for residents
lected and recorded, is needed. Redundancy in long-term care settings. in a community-
must be eliminated. Decisions related to con- based adult sample, delirium was found to
tent of data demand stewardship to ensure be superimposed on dementia in 13% of the
privacy, confidentiality, and security, espe- cases (Fick, Kolanowski, Waller, & inouye,
cially when data are in electronic form. 2005; heatherill & Flisher, 2010).
Requirements for legitimate access to data Previously, delirium was thought to be
must be managed to facilitate the flow of clin- self-limiting and benign. Recent discover-
ical data while simultaneously restricting ies indicate that delirium is associated with
inappropriate access. There is a cost associated cognitive and functional impairments in
with the use and development of automated adults and children persisting for weeks
databases; however, accuracy, reliability, and to months after the index incident of delir-
comprehensiveness of information should ium. Moreover, delirium portends poorer
not be sacrificed because of cost. outcomes, greater costs of care, and greater