Turkish Adaptation and Psychometric Evaluation of the Caregiver Intensive Care Unit Delirium Knowledge Questionnaire

Year 2024, Issue: 8, 9 - 17, 29.04.2024

Öznur Erbay Dallı Nermin Kelebek Girgin

https://doi.org/10.58252/artukluhealth.1475122

Abstract

Introduction: Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU) patients. Family caregivers of critically ill patients can support healthcare professionals in the early recognition, prevention and management of delirium. Valid and reliable tools are needed to assess family caregivers' knowledge about delirium. This study aimed to adapt the “Caregiver ICU Delirium Knowledge Questionnaire” into Turkish and evaluate its psychometric properties.
Methods: The cross-sectional and methodological study was conducted between June 2023 and September 2023 with 144 family caregivers of patients who were followed in the four ICU of a hospital. Data were collected using the “Caregiver Characteristics Form” and the “Caregiver ICU Delirium Knowledge Questionnaire-Turkish Version (CIDKQ-T)”. Language, face, content, and item validity were used for the validity stages of the test; internal consistency and the test-retest method were used for the reliability stages.
Results: The CIDKQ-T showed acceptable psychometric properties: (a) item-level content validity index (I-CVI) between 0.80-1.00, scale-level CVI (S-CVI/Ave) 0.93, (b) correlation between the total score of the test and its sub-themes between 0.63-0.75, (c) item difficulties between 0.32-0.67, (d) item discrimination index between 0.36-0.72, (e) Cronbach's alpha 0.77, (f) test-retest reliability 0.81.
Conclusion: The results of the study showed that the CIDKQ-T is a valid and reliable tool for measuring ICU related delirium knowledge level in caregivers of critically ill patients.

Keywords

Delirium, Caregiver, Critical care, Nursing

Bakım Verici için Yoğun Bakım Deliryumu Bilgi Düzeyi Testinin Türkçeye Uyarlanması ve Psikometrik Özelliklerinin Değerlendirilmesi

Abstract

Giriş: Deliryum, akut beyin hasarının bir belirtisi olarak tanımlanır ve yoğun bakım ünitesi (YBÜ) hastalarında en sık görülen komplikasyonlardan biridir. Kritik hastaların aile üyeleri/bakım vericileri; deliryumun erken tanınması, önlenmesi ve yönetimi konusunda sağlık profesyonellerine destek olabilir. Aile üyelerinin, deliryum hakkındaki bilgi düzeylerini değerlendirmek için geçerli ve güvenilir araçlara ihtiyaç vardır. Bu araştırmanın amacı; “Bakım Verici için Yoğun Bakım Deliryumu Bilgi Düzeyi Testini’’ Türkçeye uyarlamak ve psikometrik özelliklerini değerlendirmektir.
Yöntem: Araştırma; kesitsel ve metodolojik tipte Haziran 2023-Eylül 2023 tarihleri arasında, bir hastanenin dört YBÜ’sünde izlenen hastaların 144 aile üyesi/bakım vericisi ile yürütüldü. Araştırmanın verileri “Bakım Verici Özellikleri Formu” ve “Bakım Verici için Yoğun Bakım Deliryumu Bilgi Düzeyi Testi-Türkçe Versiyonu (CIDKQ-T)” ile toplandı. Testin geçerlilik aşamaları için dil, görünüş, kapsam ve madde geçerliliğinden; güvenilirlik aşamaları için iç tutarlılık ve test-tekrar test yönteminden yararlanıldı.
Bulgular: Testin Türkçe versiyonu; (a) madde düzeyinde kapsam geçerliliği indeksi (I-CVI) 0.80-1.00 arası, test düzeyinde kapsam geçerlik indeksi (S-CVI/Ave) 0.93, (b) test toplam puanı ile alt boyutlar/konular arasında 0.63-0.75 arasında korelasyon, (c) madde güçlükleri 0.32-0.67 arası, (d) madde ayırt edicilik indeksi 0.36-0.72 arası, (e) iç tutarlılık (Cronbach alfa) değeri 0.77 ve (f) test-tekrar test güvenilirliği 0.81 olarak kabul edilebilir psikometrik özellikler göstermiştir.
Sonuç: Araştırmanın sonuçları, kritik hastaların bakım vericilerinde YBÜ ile ilişkili deliryum bilgisinin bir ölçüsü olarak CIDKQ-T'nin geçerli ve güvenilir bir ölçüm aracı olduğunu göstermiştir.

Keywords

Deliryum, Bakım verici, Yoğun bakım, Hemşirelik

References

• Altman, D. G. (1991). Practical statistics for medical research. Chapman & Hall, London.
• Assa, A. H., Wicks, M. N. and Umberger, R. A. (2021). Family Caregivers' Experience of Patients With Delirium in Critical Care Units: A State-of-the-Science Integrative Review, American Association of Critical-Care Nurses, 30(6), 471–478. https://doi.org/10.4037/ajcc2021394
• Beaton, D. E., Bombardier, C., Guillemin, F. and Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014
• Bohart, S., Møller, A. M., Andreasen, A. S., Waldau, T., Lamprecht, C. and Thomsen, T. (2022). Effect of Patient and Family Centred Care interventions for adult intensive care unit patients and their families: A systematic review and meta-analysis. Intensive & Critical Care Nursing, 69, 103156. https://doi.org/10.1016/j.iccn.2021.103156
• Brooke, J. (2018). Differentiation of delirium, dementia and delirium superimposed on dementia in the older person. British Journal of Nursing, 27(7), 363–367. https://doi.org/10.12968/bjon.2018.27.7.363
• Bull, M. J. (2011). Delirium in older adults attending adult day care and family caregiver distress. International Journal of Older People Nursing, 6(2), 85–92. https://doi.org/10.1111/j.1748-3743.2010.00260.x
• Bull, M. J., Boaz, L. and Jermé, M. (2016). Educating Family Caregivers for Older Adults About Delirium: A Systematic Review. Worldviews on Evidence-Based Nursing, 13(3), 232–240. https://doi.org/10.1111/wvn.12154
• Carbone, M. K. and Gugliucci, M. R. (2015). Delirium and the Family Caregiver: The Need for Evidence-based Education Interventions. The Gerontologist, 55(3), 345–352. https://doi.org/10.1093/geront/gnu035
• Carneiro, A. V. (2003). Estimating sample size in clinical studies: basic methodological principles. Revista Portuguesa de Cardiologia, 22(12), 1513–1521.
• Cavallazzi, R., Saad, M. and Marik, P. E. (2012). Delirium in the ICU: an overview. Annals of Intensive Care, 2(1), 49. https://doi.org/10.1186/2110-5820-2-49
• Cliff, N. (1984). An Improved Internal Consistency Reliability Estimate. Journal of Educational Statistics, 9(2), 151-161. https://doi.org/10.3102/10769986009002151
• Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., … Alhazzani, W. (2018). Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine, 46(9), e825–e873. https://doi.org/10.1097/CCM.0000000000003299
• Eghbali-Babadi, M., Shokrollahi, N. and Mehrabi, T. (2017). Effect of Family-Patient Communication on the Incidence of Delirium in Hospitalized Patients in Cardiovascular Surgery ICU. Iranian Journal of Nursing and Midwifery Research, 22(4), 327–331. https://doi.org/10.4103/1735-9066.212985
• Fauzie, M., Pada, A. and Supriatno, S. (2021). Analysis of the difficulty index of item bank according to cognitive aspects during the Covid-19 pandemic. Jurnal Penelitian dan Evaluasi Pendidikan, 25(2), 162-169. https://doi.org/10.21831/pep.v25i2.42603
• Fiest, K. M., Soo, A., Hee Lee, C., Niven, D. J., Ely, E. W., Doig, C. J. and Stelfox, H. T. (2021). Long-Term Outcomes in ICU Patients with Delirium: A Population-based Cohort Study. American Journal of Respiratory and Critical Care Medicine, 204(4), 412–420. https://doi.org/10.1164/rccm.202002-0320OC
• Fong, T. G. and Inouye, S. K. (2022). The inter-relationship between delirium and dementia: the importance of delirium prevention. Nature Reviews Neurology, 18(10), 579–596. https://doi.org/10.1038/s41582-022-00698-7
• Gogia, B. and Fang, X. (2023). Differentiating Delirium Versus Dementia in the Elderly. StatPearls Publishing, Treasure Island.
• Guilford, J. P. (1956). Fundamental statistics in psychology and education. McGraw-Hill, New York.
• Hayhurst, C. J., Pandharipande, P. P. and Hughes, C. G. (2016). Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment. Anesthesiology, 125(6), 1229–1241. https://doi.org/10.1097/ALN.0000000000001378
• Keyser, S. E., Buchanan, D. and Edge, D. (2012). Providing delirium education for family caregivers of older adults. Journal of Gerontological Nursing, 38(8), 24–31. https://doi.org/10.3928/00989134-20120703-03
• Khatri Chhetri, I. and Thulung, B. (2018). Perception of Nurses on Needs of Family Members of Patient Admitted to Critical Care Units of Teaching Hospital, Chitwan Nepal: A Cross-Sectional Institutional Based Study. Nursing Research and Practice, 2018, 1369164. https://doi.org/10.1155/2018/1369164
• Krewulak, K. D., Bull, M. J., Wesley Ely, E., Davidson, J. E., Stelfox, H. T. and Fiest, K. M. (2020). Effectiveness of an intensive care unit family education intervention on delirium knowledge: a pre-test post-test quasi-experimental study. Canadian Journal of Anaesthesia, 67(12), 1761–1774. https://doi.org/10.1007/s12630-020-01810-5
• Krewulak, K.D., Bull, M.J., Ely, E.W., Stelfox, H. T. and Fiest, K. M. (2020). Psychometric evaluation of the family caregiver ICU delirium knowledge questionnaire. BMC Health Services Research, 20, 116. https://doi.org/10.1186/s12913-020-4892-5
• Lange, S., Mȩdrzycka-Da Browska, W., Friganović, A., Religa, D. and Krupa, S. (2022). Family experiences and attitudes toward care of ICU patients with delirium: A scoping review. Frontiers in Public Health, 10, 1060518. https://doi.org/10.3389/fpubh.2022.1060518
• Lee, J., Yeom, I., Yoo, S. and Hong, S. (2023). Educational intervention for family caregivers of older adults with delirium: An integrative review. Journal of Clinical Nursing, 32(19-20), 6987–6997. https://doi.org/10.1111/jocn.16816
• Liang, S., Chau, J. P. C., Lo, S. H. S., Zhao, J. and Liu, W. (2022). Non-pharmacological delirium prevention practices among critical care nurses: a qualitative study. BMC Nursing, 21(1), 235. https://doi.org/10.1186/s12912-022-01019-5
• Lin, L., Peng, Y., Zhang, H., Huang, X., Chen, L. and Lin, Y. (2022). Family-centred care interventions to reduce the delirium prevalence in critically ill patients: A systematic review and meta-analysis. Nursing Open, 9(4), 1933–1942. https://doi.org/10.1002/nop2.1214
• Nunnally, J. C. and Bernstein, I. H. (1994). Psychometric Theory (3rd ed.). McGraw Hill, New York.
• Palakshappa, J. A. and Hough, C. L. (2021). How We Prevent and Treat Delirium in the ICU. Chest, 160(4), 1326–1334. https://doi.org/10.1016/j.chest.2021.06.002
• Pandhal, J. K. and Van Der Wardt, V. (2022). Exploring perceptions regarding family-based delirium management in the intensive care unit. Journal of the Intensive Care Society, 23(4), 447–452. https://doi.org/10.1177/17511437211037928
• Polit, D. F. and Beck, C. T. (2006). The content validity index: are you sure you know what's being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489–497. https://doi.org/10.1002/nur.20147
• Poulin, T. G., Krewulak, K. D., Rosgen, B. K., Stelfox, H. T., Fiest, K. M. and Moss, S. J. (2021). The impact of patient delirium in the intensive care unit: patterns of anxiety symptoms in family caregivers. BMC Health Services Research, 21(1), 1202. https://doi.org/10.1186/s12913-021-07218-1
• Rosenbloom, D. A. and Fick, D. M. (2014). Nurse/family caregiver intervention for delirium increases delirium knowledge and improves attitudes toward partnership. Geriatric Nursing, 35(3), 175–181. https://doi.org/10.1016/j.gerinurse.2013.12.004
• Rosgen, B., Krewulak, K., Demiantschuk, D., Ely, E. W., Davidson, J. E., Stelfox, H. T. and Fiest, K. M. (2018). Validation of Caregiver-Centered Delirium Detection Tools: A Systematic Review. Journal of the American Geriatrics Society, 66(6), 1218–1225. https://doi.org/10.1111/jgs.15362
• Salluh, J. I., Wang, H., Schneider, E. B., Nagaraja, N., Yenokyan, G., Damluji, A., Serafim, R. B. and Stevens, R. D. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ, 350, h2538. https://doi.org/10.1136/bmj.h2538
• Schmitt, E. M., Gallagher, J., Albuquerque, A., Tabloski, P., Lee, H. J., Gleason, L., Weiner, L. S., Marcantonio, E. R., Jones, R. N., Inouye, S. K. and Schulman-Green, D. (2019). Perspectives on the Delirium Experience and Its Burden: Common Themes Among Older Patients, Their Family Caregivers, and Nurses. The Gerontologist, 59(2), 327–337. https://doi.org/10.1093/geront/gnx153
• Sousa, V. D. and Rojjanasrirat, W. (2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. Journal of Evaluation in Clinical Practice, 17(2), 268–274. https://doi.org/10.1111/j.1365-2753.2010.01434.x
• Stollings, J. L., Kotfis, K., Chanques, G., Pun, B. T., Pandharipande, P. P. and Ely, E. W. (2021). Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Medicine, 47(10), 1089–1103. https://doi.org/10.1007/s00134-021-06503-1
• Shrestha, P. and Fick, D. M. (2020). Family caregiver's experience of caring for an older adult with delirium: A systematic review. International Journal of Older People Nursing, 15(4), e12321. https://doi.org/10.1111/opn.12321
• Wheeler, A., Bloch, E., Blaylock, S., Root, J., Ibanez, K., Newman, K., Diarte, J. and Voigt, L. P. (2023). Delirium education for family caregivers of patients in the intensive care unit: A pilot study. PEC Innovation, 2, 100156. https://doi.org/10.1016/j.pecinn.2023.100156
• Xue, W., Li, S., Yuan, J. and Liang, S. (2022). Transcultural Adaptation and Psychometric Evaluation of the Chinese Version of the Family Caregiver ICU Delirium Knowledge Questionnaire. Psychology, 13, 908-921. https://doi.org/10.4236/psych.2022.136062