Browsing by Author "Owens, Robert L."

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    A Multisite Study of Nurse-Reported Perceptions and Practice of ABCDEF Bundle Components
    (Elsevier, 2020-10) Boehm, Leanne M.; Pun, Brenda T.; Stollings, Joanna L.; Girard, Timothy D.; Rock, Peter; Hough, Catherine L.; Hsieh, S. Jean; Khan, Babar A.; Owens, Robert L.; Schmidt, Gregory A.; Smith, Susan; Ely, E. Wesley; Medicine, School of Medicine
    Objectives: ABCDEF bundle implementation in the Intensive Care Unit (ICU) is associated with dose dependent improvements in patient outcomes. The objective was to compare nurse attitudes about the ABCDEF bundle to self-reported adherence to bundle components. Research methodology/design: Cross-sectional study. Setting: Nurses providing direct patient care in 28 ICUs within 18 hospitals across the United States. Main outcome measures: 53-item survey of attitudes and practice of the ABCDEF bundle components was administered between November 2011 and August 2015 (n = 1661). Results: We did not find clinically significant correlations between nurse attitudes and adherence to Awakening trials, Breathing trials, and sedation protocol adherence (rs = 0.05-0.28) or sedation plan discussion during rounds and Awakening and Breathing trial Coordination (rs = 0.19). Delirium is more likely to be discussed during rounds when ICU physicians and nurse managers facilitate delirium reduction (rs = 0.27-0.36). Early mobilization is more likely to occur when ICU physicians, nurse managers, staffing, equipment, and the ICU environment facilitate early mobility (rs = 0.36-0.47). Physician leadership had the strongest correlation with reporting an ICU environment that facilitates ABCDEF bundle implementation (rs = 0.63-0.74). Conclusions: Nurse attitudes about bundle implementation did not predict bundle adherence. Nurse manager and physician leadership played a large role in creating a supportive ICU environment.
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    Post-Intensive Care Syndrome and Caregiver Burden: A Post Hoc Analysis of a Randomized Clinical Trial
    (American Medical Association, 2025-04-01) Ahn, Soojung; LaNoue, Marianna; Su, Han; Moale, Amanda C.; Scheunemann, Leslie P.; Kiehl, Amy L.; Douglas, Ivor S.; Exline, Matthew C.; Gong, Michelle N.; Khan, Babar A.; Owens, Robert L.; Pisani, Margaret A.; Rock, Peter; Jackson, James C.; Ely, E. Wesley; Girard, Timothy D.; Boehm, Leanne M.; Medicine, School of Medicine
    Importance: Understanding the reciprocal association between post-intensive care syndrome (PICS) and caregiver burden is crucial for optimal care of patients and caregivers following critical illness. Objective: To evaluate the associations between patient post-intensive care impairments and caregiver burden. Design, setting, and participants: This secondary analysis of the MIND-USA study, a multicenter randomized clinical trial, which enrolled patients admitted to intensive care units (ICU) from 16 academic medical centers across the US (December 2011 to August 2017), included 148 patient-caregiver dyads. Patients were adults aged 18 years or older with ICU delirium randomized to receive haloperidol, ziprasidone, or placebo. A caregiver who provided unpaid assistance to the patient was identified at enrollment. PICS and caregiver burden were assessed at 3 months and 12 months after randomization. Statistical analysis was performed from March 2023 to April 2024. Main outcomes and measures: ICU survivors were assessed for PICS domains, including physical and cognitive function, and posttraumatic stress disorder using the Katz Activities of Daily Living, the Functional Activities Questionnaire, the Telephone Interview for Cognitive Status, and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively. Caregiver burden was assessed using the Zarit Burden Interview. The associations between patient PICS and caregiver burden at 3 and 12 months were examined using structural equation modeling. Results: Of 148 patients included in this study with a median (IQR) age of 58 (48-65) years, the majority identified as male (79 patients [53.4%]), and there were 16 (10.8%) Black, 139 (93.9%) non-Hispanic, and 127 (85.8%) White patients. PICS and caregiver burden at 3-month follow-up was positively associated with these outcomes at 12-month follow-up (PICS: β = 0.69; 95% CI, 0.50 to 0.88; P < .001; caregiver burden: β = 0.68; 95% CI, 0.53 to 0.82; P < .001). However, contrary to the study hypotheses, significant associations between 3-month PICS and 12-month caregiver burden and between 3-month caregiver burden and 12-month PICS were not observed (PICS→caregiver burden: β = 0.82; 95% CI, -0.02 to 1.66; P = .09; caregiver burden→PICS: β = 0.00; 95% CI, -0.03 to 0.03; P = .95). There was significant covariance between PICS and caregiver burden at each time point. Conclusions and relevance: In this secondary analysis of a randomized clinical trial of ICU survivors and their caregivers, patient PICS and caregiver burden were associated at concurrent time points but were not associated with each other longitudinally.