Knowledge, attitude and practice regarding hypoactive delirium among ICU nurses: A nationwide cross-sectional study

Knowledge, attitude, and practice of frailty management among clinical nurses: a cross-sectional study

BACKGROUND

Frailty is a leading risk factor of falls, incapacitation, functional decline, and even death in aging populations globally. Clinical nurses play pivotal roles in screening, prevention, and intervention to reverse or slow the progression of frailty. The present study aimed to (1) understand the extent and influencing factors of knowledge, attitudes, and practices of clinical nurses for managing frailty, (2) elucidate the relationships of the knowledge, attitudes, and practices of clinical nurses for frailty management.

METHODS

This cross-sectional study was conducted from March to April 2024 on 524 clinical nurses in a tertiary hospital in Zhejiang Province, China. The survey instruments included a questionnaire inquiring about the knowledge, attitudes, and practices of nurses in terms of frailty management, a demographic data form, and a self-designed frailty educational information questionnaire. Data were analyzed by descriptive statistics, univariate analysis, multiple linear regression, and structural equation modeling.

RESULTS

Of 524 nurses, Only 37.2% were rated as good in terms of knowledge, attitude, and practice of frailty management, while 55.7% were rated as moderate. Among them, the proportion of nurses with good knowledge (10.3%) and practical skills (13.4%) is much lower than their attitude (65.3%). Structural equation modeling found that knowledge and attitudes were related to frailty management practices, with significant associations between knowledge and practices(β = 0.499, p < 0.001). Of the total effect size of knowledge influencing practice (total effect = 0.624, 95% CI: 0.455,0.791), approximately 20.0% was mediated by attitudes (indirect effect = 0.125, 95% CI: 0.076,0.187). Multiple linear regression analysis showed that age, organizational support, familiarity with relevant guidelines, familiar with the term frailty, and department all had a significant effect on the total score(adjusted R2 = 0.264, p < 0.001).

CONCLUSIONS

Despite inadequate knowledge and limited experience in frailty management, clinical nurses' attitudes towards frailty management were positive, indicating potential for improvement. The model was useful to explain practices in frailty management, thereby providing a theoretical basis for development of targeted training programs.

CLINICAL TRIAL NUMBER

Not applicable.

Comparative effectiveness of delirium recognition with and without a clinical decision assessment system on outcomes of hospitalized older adults: Cluster randomized controlled trial

BACKGROUND

Early recognition of delirium is essential for effective management, but it often goes unrecognized, resulting in adverse outcomes. Clinical decision support systems can enhance adherence to guidelines and improve patient outcomes. We developed a mobile-based clinical decision assessment tool (3D-DST) based on the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM). Implementing the 3D-DST may enhance delirium recognition and adherence to interventions among healthcare professionals, potentially improving outcomes in older adults.

OBJECTIVE

To test whether improved recognition of delirium could lead to better clinical outcomes in older adults.

DESIGN

A cluster randomized controlled trial with pair-matching.

SETTING

A tertiary geriatric hospital.

PARTICIPANTS

Patients aged ≥65 years.

METHODS

Four general wards were paired and randomly assigned to the intervention group (two wards) or the control group (two wards). The intervention included routine delirium assessments by nurses using either the 3D-DST or the 3D-CAM, along with delirium prevention and intervention measures carried out by a multidisciplinary team. Outcomes measured included delirium incidence, duration, severity, length of stay, and adherence to the delirium assessment, prevention, and treatment protocol. A trained nursing researcher collected data on demographics, clinical characteristics, and primary and secondary outcomes.

RESULTS

211 eligible patients participated (106 in the intervention group and 105 in the control group), with 21 identified as delirium-positive using the 3D-DST. The median Charlson comorbidity index score among older adults in the intervention group was 1 (1-2), compared to 2 (1-3) in the control group (P = 0.032). Nurses' adherence to delirium assessment was significantly higher in the intervention group than in the control group (73 % vs. 31 %). The recognition rate of delirium among nurses was 89 % in the intervention group and 42 % in the control group. There were no statistically significant differences in delirium duration (6 [3-9] vs. 7 [2-14], P = 0.967), incidence (8.5 % vs. 11.4 %, P = 0.500), severity (2 [1-3] vs. 2 [1-4], P = 0.891) or length of hospital stay (15 [14-18] vs. 18 [13-22], P = 0.568) between the intervention and control groups.

CONCLUSIONS

The 3D-DST enhanced adherence to routine delirium recognition by nurses. However, effective strategies are urgently needed to strengthen multidisciplinary collaboration and enhance adherence to delirium management among healthcare professionals.

REGISTRATION

Chinese Clinical Trial Registry, Identifier: ChiCTR1900028402.

Self-efficacy of ICU nurses in delirium care: an analysis of the current status and influencing factors

OBJECTIVE

The aim of this study was to assess the current status of delirium care self-efficacy among nurses in the intensive care unit (ICU) and the level of their knowledge about delirium in the ICU, more importantly, to analyze factors influencing the delirium care self-efficacy of ICU nurses and to provide a theoretical basis for ICU nursing managers to develop strategies for effective delirium care and management.

METHODS

The study was based on a sample of 283 ICU nurses from eight hospitals in Chongqing selected using a convenience sampling method between July 2023 and September 2023. The tools used included a general information questionnaire, the Chinese version of the Delirium Care Self-Efficacy of ICU Nurses Scale, and the Chinese version of the ICU Delirium Knowledge Level Questionnaire.

RESULTS

The self-efficacy score (47.84 ± 9.93) of ICU nurses was positively correlated with the delirium knowledge level score (12.32 ± 3.47, r = 0.591, P < 0.001). Multivariate linear regression analysis identified the gender of the nurse, hospital level (tier), duration of ICU work experience, whether the nurse was a specialized ICU nurse, whether the nurse received delirium-related training, and the level of knowledge about delirium (all P < 0.05) as the influencing factors for the delirium care self-efficacy of ICU nurses.

CONCLUSION

It is recommended that ICU nursing managers offer targeted interventions based on the influencing factors to improve the delirium care self-efficacy of ICU nurses and their delirium knowledge levels, thereby reducing the incidence of delirium and improving the quality of care provided for patients with delirium in the ICU.

Delirium Knowledge, Risk Factors, and Attitude Among the General Public in Saudi Arabia: A Cross-Sectional Study

Introduction Delirium is a common and serious neuropsychiatric disorder, of acute onset, present at any age, but more common in older adults, and very common in clinical practice. It combines mental and behavioral symptoms with a fluctuating course, with worsening of the condition in the afternoon and at night, with important repercussions on increased mortality, greater risk of cognitive impairment, and hospitalization costs. Delirium's impact extends to patients, families, and healthcare systems, emphasizing the need for public awareness and education in Saudi Arabia. Methodology It is a cross-sectional conducted in Saudi Arabia that aims to assess knowledge, risk factors, and attitudes regarding delirium among all Saudi and non-Saudi residents aged 18 and older. A 36 self-administered questionnaire, standardized Nordic, was used. Data were cleaned in Microsft Excel (Microsoft Corporation, USA) and analyzed using IBM SPSS Statistics (IBM Corp., Armonk, NY). This study was conducted in Saudi Arabia from May 2023 till March 2024. Results Our study involved 1,470 participants from Saudi Arabia, primarily females (79.1%), Saudi nationals (89.9%), and unmarried individuals (65.4%). Most participants were aged 18-24 (59.5%) and held bachelor's degrees (57.3%). Commonly recognized delirium risk factors included increasing age (63.3%), dementia (58.2%), and longer ICU stays (48.7%). The participants showed moderate knowledge of delirium symptoms and consequences. Attitudes varied, with many agreeing that delirium requires intervention (30.7%) but fewer considering it preventable (17.1%). Sociodemographic factors, including gender and age, significantly influenced knowledge and attitudes, while education levels did not. Conclusion Our study found that gender and age influenced knowledge and attitudes, highlighting the importance of targeted education. Future research should further investigate the effectiveness of such interventions in enhancing knowledge and awareness and promoting preventive actions.

Development and validation of nurse's assessment ability questionnaire in delirium subtypes: Based on Delphi expert consensus

BACKGROUND

Delirium, a common occurrence in clinical work, can be divided into three subtypes according to Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition (DSM-5). Each subtype has its special significance and focus. As the primary caregivers and observer of delirious patients, nurses should be able to quickly and accurately indentify each subtype. Therefore, it is necessary to clarify nurses' assessment ability of delirium subtypes. However, there is currently no suitable questionnaire available for investigating nurses' assessment ability of delirium subtypes.

OBJECTIVE

To develop a scientifically validated questionnaire for assessing nursing assessment ability of delirium subtypes based on Knowledge-Attitude-Practice(KAP) Model.

METHODS

The questionnaire was conducted from October 2021 to February 2022 to assess the KAP status of nurses the regarding delirium subtype. A two-round Delphi Method was employed to revise the draft questionnaire, ensuring the importance and rationality of each item. Ten experts specializing in critically ill patients, clinical nursing, and nursing management were invited from seven provinces in China for the Delphi process. Additionally, we validated the reliability and validity of the questionnaire.

RESULTS

The return rate in the first and second rounds were 83% and 100%, respectively. The individual authority coefficients for the two rounds of correspondence ranged from 0.787 to 0.987, while the overall authority coefficient of experts was 0.866. Kendall's coefficient of coordination for the importance scores were found to be 0.192 and 0.156, respectively, whereas those for rationality scores were calculated as 0.149 and 0.141, respectively. Notably, all mean values of importance and rationality scores in the two rounds were exceeded a threshold of 4.10 across both rounds of assessment with coefficient variations (CV) ranging from 0.00 to 0.19 for importance ratings and 0.00 to 0.16 for rationality ratings, both of which were <0.25. Experts proposed modifications to eleven items while introducing four new ones into consideration during this process; thus ensuring that reliability and validity standards were met by the final questionnaire design which consists of a total of thirty-seven items distributed across four dimensions: delirium subtype-related knowledge, assessment attitude, assessment practice, and knowledge source-thereby establishing its clinical relevance as a reliable scientific instrument.

CONCLUSION

The development process is both scientific and theoretical, encompassing reliable expert correspondence results and a diverse range of question formats. As thus, effectively captures the current landscape of delirium subtypes assessment among clinical nurses from multiple perspectives, including knowledge level and source, attitude, assessment behavior, and assessment barriers. It offers comprehensive and detailed insights.