By Subhashni D.

Singh Joy

unrealistic expectations; and the need for more education for nurses who care for terminally ill patients. Nurses also identified five major areas of internal conflict: feeling relief when the care they provide is switched from curative to palliative; wanting dying patients to be comfortable and fam ilies to have good final memories of their loved ones; feeling abandoned while carry ing out physicians orders to stop care and powerless because theyre unable to save the patient; conflicted about administering medication to keep patients comfortable that may also cause them harm; and disturbed by younger terminal pa tients who re mind them of their own mortality. Five coping strategies were highlighted: building trust with family members, crying, humor, talking to others about termi nalcare, and avoiding caring forterminally ill patients. Some nurses also talked about having acrusty attitude as a coping mechanism. Nurses also suggested that improved education, increased staff support, and better communication would be helpful.
Espinosa L, et al. Crit Care Nurs Q 2010; 33(3):273-81.

PRENATAL AND POSTPARTUM DEPRESSION IN FATHERS

According to this study: Health care providers should be aware that fathers-to-be and new fathers experience depression.

the others used an interview. There was a wide range in sample size, from 23 to 10,975, for a total of 28,004 mothers and fathers included in the analysis. The overall rate of paternal depression between the first trimester of pregnancy and one year postpartum was 10%, with the lowest rates observed between birth and three months postpartum and the highest rates between three and six months postpartum. A higher rate was observed in the United States (14%) than interna tionally (8%). Lower prevalence was seen when interviews rather than rating scales were used to define cases; however, since only a few studies used interviews, fur ther research is needed to verify this finding. Mothers had an overall de pression rate of 24%, with the highest rates occurring three to six months after giving birth. As with fathers, a higher rate of ma ternal depression was also observed in the United States (30%) than in other countries (20%). Depression in fathers also showed a moderate positive corre lation with depression in mothers. The authors concluded that because the rate of depression in fathers in these trials (10%) was twice as high as that in men in general (5%), according to national prevalence data, prenatal and postpartum depression do occur in this population.
Paulson JF, Bazemore SD. JAMA 2010; 303(19):1961-9.

a thers may experience pre na tal and postpartum depression just as mothers do. A meta-analysis by Paulson and Bazemore included 43 international studies (17 were U.S. stud ies) published between January 1980 and October 2009. All butthree of the trials used self- reporting scales to define cases;
ajn@wolterskluwer.com

DELIRIUM DIRECTLY RELATED TO COGNITIVE IMPAIRMENT

According to this study: Longer delirium during critical illness may predict cognitive decline.

his prospective cohort study examined the effect of de lirium duration on long-term cognitive impairment in patients

re ceiving mechanical ventila tion in an ICU. The cohort was drawn from the Awakening and Breath ing Controlled (ABC) randomized trial and included adults me chan ically ventilated for more than 12 hours and later discharged. A total of 77 patients (median age, 61) were included in the analysis. Patients were severely illat hospital admission, and 9% showed signs of preexisting cognitive impairment. Eighty-four percent had delirium while hospitalized, for a median of two days, with half the patients de lirious for at least two days, and one in four for at least five days. Patients cognitive outcomes were determined by a neuropsychologist three and 12 months after study enrollment. A total of 80% and 72% of patients were cognitively impaired at three and 12 months, respectively. Cogni tive impairment wasdirectly related to the duration of delirium, with longer delirium associated with more severe impairment at both three and 12 months. Five days of delirium was associated with a 5-point lower cognitive battery mean score than one day of delirium when assessed three months after enrollment. Simi larly, at the 12-month assessment, an increase from one to five days of delirium resulted ina decrease of almost 7 points in the cognitive battery mean score. The authors noted that duration of mechanical ventilation wasnt related to cognitive impairment when evaluated at three or 12 months. While the study has drawbacks, such as limited generalizability and possible confounding factors, the authors suggest that theres enough evidence to show that cognitive decline occurred in most patients during their illness. Thus, delirium may predict cognitive impairment.
Girard TD, et al. Crit Care Med 2010;38(7): 1513-20. t

AJN t January 2011

Vol. 111, No. 1

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