Date of Award

2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Graduate Studies

First Advisor

Teresa J.Kelechi

Second Advisor

Lynne S. Nemeth

Third Advisor

Martina Mueller

Fourth Advisor

Elaine J. Amella

Abstract

Delirium is a serious complication experienced by patients in the intensive care unit (ICU). Over the past 15 years, researchers have identified risk factors, assessment techniques, pharmacological, and nonpharmacological interventions. Despite the current literature, there is a gap regarding delirium bundle care provided by an interprofessional team. This dissertation, a compendium of three manuscripts, delineates delirium bundle care by the interprofessional team in the ICU. The first manuscript details Rodgers’ Evolutionary Concept Analysis to identify attributes, antecedents, consequences, surrogate concepts, and related terms of bundled delirium care in the ICU. The second manuscript utilized the Social Ecological Model to identify factors that prevent or facilitate delirium bundle care in the ICU based on behavioral determinants and environmental factors. The third manuscript details a convergent parallel mixed-­‐method study guided by Consolidated Framework for Implementation Research to explore clinical perceptions, roles, and practices of the surgical ICU interprofessional team regarding delirium bundle implementation. Findings from the first study used Rodgers’ Evolutionary View of Concept Analysis to identify attributes, antecedents, and consequences of delirium bundle care. Results from the second manuscript identify the facilitators and barriers based on the Social Ecological Model for implementing the ABCDEF bundle and PAD guidelines for managing delirium in the ICU. The findings from the convergent parallel mixed-­‐method study identified factors associated with domains from the Consolidated Framework for Implementation Research. Results from this study showed that structural and cultural elements of an ICU need to be considered when exploring how the interprofessional team of nurses, physicians, pharmacists, respiratory therapists, and physical therapists implements the ABCDEF bundle. The findings of the three manuscripts are integrated in the conclusion of this dissertation.

Rights

All rights reserved. Copyright is held by the author.

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