A questionnaire to determine nurses' knowledge of delirium and its risk factors

Assessing delirium knowledge among health care professionals: findings from a scoping review

BACKGROUND

Delirium is highly prevalent among older adults in various healthcare settings. Healthcare professionals' knowledge is crucial for preventing, recognizing, and managing delirium and delirium-related adverse outcomes. Despite its importance, little is known about how delirium knowledge is assessed.

OBJECTIVES

To map instruments and items used to assess delirium knowledge among healthcare professionals.

DESIGN

A scoping review based on the methodological framework of Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005).

MATERIALS AND METHODS

A systematic literature search was performed in Medline, Embase, CINAHL, Scopus, and PsycINFO to include studies that assessed delirium knowledge among healthcare professionals.

RESULTS

After removing duplicates, 760 studies were assessed for eligibility and 98 studies were included. Delirium knowledge was mainly assessed among nurses (57/98, 58.8%) and physicians (12/98, 12.4%) with a focus on critical care (32/98, 33.0%) over long-term care settings (4/98, 4.1%). Most studies used self-developed instruments (50/93, 53%), followed by original or modified versions of the Delirium Knowledge Questionnaire (14/93, 15%). Among the 32 identified instruments, limited evidence of validity and reliability was reported for six (18.8%). Analysis at the item level (n = 392 items) revealed five domains: (a) definition, signs and symptoms (81 items); (b) risk factors, incidence, and prevention (139 items); (c) detection and tools (89 items); (d) management and therapy (64 items); and (e) outcomes, prognosis and consequences (19 items).

CONCLUSIONS

Delirium poses a significant burden on patients and on the healthcare system. This scoping review provides a comprehensive overview on how healthcare professionals' delirium knowledge has been assessed. Further research in this field is needed to provide stronger evidence of instruments' validity and reliability and to explore delirium knowledge among healthcare professionals in long-term care settings.

Factors Influencing Nurses' Knowledge About Delirium in Acute Care Settings in Hail Region, Saudi Arabia: A Cross-Sectional Study

Background

The factors influencing nurses' knowledge of delirium in acute care settings have not been fully investigated in Saudi Arabia. Therefore, this study aimed to investigate these factors among nurses in acute care settings in the northern region of Saudi Arabia.

Methodology

A cross-sectional study was conducted using a convenience sample of 234 acute care nurses at the main public hospitals in the Hail region of Saudi Arabia. Data were collected using a structured, self-administered questionnaire, from November 2023 to February 2024. Multiple linear regression was used to identify factors of knowledge about delirium.

Results

Of the acute care nurses, 7.3% had a good level of overall knowledge about delirium, while 66.1% and 26.6% showed poor and moderate levels, respectively. Most nurses (78.2%) had poor knowledge of delirium assessment. Significantly higher scores on delirium assessment were observed for nurses who reported receiving in-service training on delirium (P = 0.006) and when a clear job description was applied (P = 0.031), whereas significantly higher scores on knowledge about risk factors were observed for those who had previous experience in caring for delirious patients (P <0.001), received educational sessions on delirium (P = 0.001), and participated in training on delirium care (P <0.001). Lack of previous experience in caring for delirious patients and participation in delirium care training were significant factors for lower knowledge about delirium scores (CI=-5.750 --1.200, P <0.001).

Conclusion

In-service training, daily clinical discussion, availability of instructional materials, and specific training on delirium significantly influence nurses' knowledge about delirium, particularly regarding delirium assessment and early recognition. Enhancing these factors could improve nurses' knowledge and the care and management of patients complaining of delirium in acute care settings.

Knowledge of Delirium Among ICU Nursing Staff: A Cross-sectional Study

Background

Delirium is a reversible state that, if ignored, can result in increased morbidity and mortality. Studies from across the world have shown that nurses' knowledge regarding delirium is inadequate. This study is one of the very few Indian studies addressing this issue. The study aims to infer an intensive care unit (ICU) nurse's knowledge regarding delirium.

Materials and Methods

This is a descriptive study carried out in the ICUs of a multispecialty general hospital. A convenient sample of 220 nurses was recruited after obtaining written informed consent. Knowledge regarding delirium was ascertained using the Delirium Knowledge Questionnaire; this, along with the sociodemographic variables, was circulated as Google Forms through WhatsApp groups. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26, and results were presented as means and percentages.

Results

The present study reveals that out of 211 nurses 130 (61.6%) had an average knowledge about delirium. Out of the 211 nurses 108 (51.2%) had average knowledge about clinical features of delirium and 105(49.8%) had average knowledge about etiology of delirium. More than half of the nurses (53.1%) had awareness regarding the medical management of delirium. In the domain of knowledge regarding non-medical management, 81 (38.4%) had excellent knowledge and 114 (54%) respondents had average knowledge regarding the prevention of delirium.

Conclusion

The study calls for the need to provide educational interventions to the nursing staff for prevention, prompt recognition, and treatment of delirium.

Barriers to healthcare professionals recognizing and managing delirium in older adults during a hospital stay: A mixed-methods systematic review

AIM

To investigate barriers to healthcare professionals recognizing and managing delirium in hospitalized older people.

DESIGN

A mixed-methods systematic review.

PROSPERO ID

CRD42020187932.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO and CINAHL were searched (2007 to February 2023).

REVIEW METHODS

Included studies focused on healthcare professionals' recognition and management of delirium for patients aged 65 years and over in a hospital ward or emergency department. Enhancing rigour, screening of results was conducted independently by two researchers. Qualitative and quantitative data were tabulated separately and grouped. Data were compared to identify similarities and differences. All studies were quality appraised.

RESULTS

43 studies were included; 24 quantitative, 16 qualitative and three mixed-methods. Data synthesis highlighted synergy between qualitative and quantitative findings. Barriers were reflected in six themes: (1) healthcare professionals' knowledge and understanding; (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints.

CONCLUSIONS

Of significance, for older adults in hospital experiencing delirium, there is variability in whether and how well it is recognized and managed. To prevent adverse outcomes best practice guidance for screening, recognizing, diagnosing and managing delirium in older people needs to be agreed and disseminated widely. Supporting healthcare professionals to care for this patient population using an integrated approach is essential, how to involve and communicate with patients and their family and friends, how to recognize and manage delirium for patients with additional needs, e.g., those living with dementia and/or a learning disability. Hospitals need to have policy and guidance in place for the recognition and management of delirium in older adults presenting to a ward or to an emergency department. An IT infrastructure is needed that integrates assessments and care management plans in patient electronic records and makes them accessible within and across teams in hospital, primary and community care settings.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution to this systematic review.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Healthcare professionals can be better supported to be able to recognize and manage delirium during an acute hospital stay for older adults. This includes maximizing best care for those patients living with dementia, involving families and friends to help understand patients' baseline status and changes and supporting families and friends during this process. Of significance, attention to hospital IT infrastructures is warranted, integrating screening, assessment and care management plans in patients' electronic records and making these accessible to healthcare professionals caring for this patient population across care settings.

IMPACT

What problem did the study address? Delirium is a common condition experienced by older hospitalized patients, but it is consistently under-recognized which has implications for patient and organization outcomes. To help address this, understanding barriers to healthcare professionals recognizing and managing delirium for this patient population is paramount. What were the main findings? Barriers to healthcare professionals recognizing and managing delirium for this patient population were synthesized in six themes: (1) healthcare professionals' knowledge and understanding, (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints. Where and on whom will the research have an impact? The findings of this original systematic review can contribute to hospital policy and protocol for the recognition and management of delirium in older patients. The findings can meaningfully contribute to workforce professional development for practitioners caring for older people during an acute hospital stay and for practitioners in primary and community settings involved in the follow-up of patients post hospital discharge. For researchers, the findings indicate several research recommendations including investigating the impact of an education programme for nurses and other healthcare professionals on the recognition and management of the condition and understanding and investigating how best to support delirium-related distress experienced by patients and their families and practitioners.

REPORTING METHOD

This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021).

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.

Nurses' Knowledge and Subjective Strain in Delirium Care: Impact of a Web-based Instructional Module on Nurses Competence

Background

Delirium, a prevalent condition among elderly individuals admitted to hospitals, particularly in intensive care settings, necessitates specialized medical intervention. The present study assessed the proficiency of nurses in the management of delirium and their subjective experience of stress while providing care for patients with delirium in emergency rooms and critical care units.

Materials and methods

The study adopted a quantitative descriptive approach, utilizing standardized self-reporting measures that assessed the nurses' expertise and perceived burden of care. A cohort of 86 nurses from a tertiary care hospital in North India participated in the study. Additionally, the impact of the web-based instructional module in enhancing the nurses' knowledge in delirium management was assessed by one group pretest-posttest quasi-experimental study.

Findings

The research revealed that nurses exhibited significant deficiencies in their knowledge, particularly in relation to the symptoms and causes of delirium. The most significant source of subjective stress was attributed to hyperactive delirium-associated behaviors, characterized by uncooperative and aggressive conduct. The utilization of the web-based instructional program significantly enhanced the comprehension of nurses about the management of delirium.

Conclusion

This study revealed a significant knowledge gap among nurses in delirium management and emphasizes the considerable subjective stress, particularly in dealing with hyperactive delirium-associated behaviors. The positive impact of the web-based instructional program underscores its potential as a valuable tool for enhancing nurses' knowledge and addressing these challenges in healthcare settings.

How to cite this article

Jose S, Cyriac MC, Dhandapani M. Nurses' Knowledge and Subjective Strain in Delirium Care: Impact of a Web-based Instructional Module on Nurses Competence. Indian J Crit Care Med 2024;28(2):111-119.

Knowledge, barriers, and training needs of nurses working in delirium care

BACKGROUND

Nurses' competency in delirium care is important because delirium can extend hospitalization and increase patient mortality.

AIM

This study aimed at identifying and comparing the perceived knowledge, barriers, importance, performance, and training priorities between the intensive care unit (ICU) and ward nurses working in delirium care.

STUDY DESIGN

This cross-sectional descriptive study included 71 ICU nurses and 149 ward nurses at one university hospital. Nurses' self-reported knowledge, barriers, importance, and performance of delirium care were surveyed. Data were analysed using descriptive statistics, chi-squared test or Fisher's exact test, Wilcoxon signed-rank tests, Mann-Whitney U tests, and the importance-performance analysis matrix.

RESULTS

Compared to ward nurses, ICU nurses reported lower overall knowledge level (57.1% vs 60.7%, z = -2.005, P = .045) but higher overall gap between the importance and performance of delirium care (0.5 vs 0.2, z = -4.008, P < .001). The level of overall barriers to delirium care was similar between the two groups (3.8 vs 3.8, z = -1.190, P = .234). The highest training priority, showing high importance but low performance in the importance-performance matrix, was "family involvement and education" for ICU nurses and "non-pharmacological management" for ward nurses.

CONCLUSIONS

The highest training priority for delirium care was different between ICU and ward nurses. To enhance the delirium care competency of hospital nurses, the nurse educator should develop training programs that target knowledge deficits, perceived barriers, and training priorities.

RELEVANCE TO CLINICAL PRACTICE

Acute cognitive disturbances are common in patients hospitalized in wards and ICUs and can lead to adverse patient outcomes if not properly assessed and managed. Nurse educators need to develop and implement a training program based on the needs assessment and priorities identified in this study so that ICU and ward nurses can obtain the optimal level of delirium care competency.

Managing delirium in acute inpatient units: A cross-sectional study of nursing teams' knowledge and perceived limitations

AIM

The aim of the study was to describe nursing teams' theoretical knowledge of delirium and their perceptions of the way in which it is handled in acute inpatient units.

DESIGN

This is a descriptive cross-sectional study using a questionnaire comprising ten questions on knowledge and seven on perception.

METHODS

The sample consisted of 216 professionals working at a hospital complex in Madrid, Spain. Descriptive and non-parametric bivariate analyses were performed for a p < .05.

RESULTS

Fifty-three point two per cent of staff possessed sufficient theoretical knowledge, and this figure rose significantly among professionals with more years of experience. Areas for improvement in theoretical knowledge included the use of therapeutic immobilization, screening scale, subtypes of delirium and precipitating factors. Sixty-eight point five per cent of staff perceived their knowledge as fair, 50% agreed that delirium was underdiagnosed and 48.1% agreed that preventive measures were only occasionally taken. Perceived barriers included lack of training, work overload, ineffective coordination and lack of standardized protocols.

[Development and content validity of a questionnaire to assess knowledge about delirium]

BACKGROUND

Delirium is a neuropsychiatric syndrome that can have serious consequences and is often overlooked by healthcare professionals. The level of knowledge about delirium is often insufficient among nursing and medical staff. At the current time there is no suitable questionnaire to record the level of knowledge in German-speaking countries.

AIM

Development of a questionnaire and evaluation of content validity.

METHODS

Following a literature search to identify current best practice, several questionnaires were identified. An already published questionnaire with the dimensions of basic knowledge of delirium and risk factors has been translated, adapted and extended by the dimension of nonpharmacological delirium prevention. Delirium experts assessed the relevance of the questionnaire items in two rounds of reviews. Content validity was calculated using the Content Validity Index (CVI) at item (I-CVI) and scale (S-CVI) level. Additionally, the modified Kappa (k*) was calculated using a lower 95% confidence interval (CI).

RESULTS

The original 30-item questionnaire was expanded to include 18 delirium prevention items. After the first round of scoring 30 out of 48 items showed good to excellent I‑CVI scores. Considering the comments, 6 items were discarded and 12 were adapted in terms of language and content. In the final version of the questionnaire 41 items with excellent scores remained. The total scale score increased from 0.88 in the first version to 1.0 in the final version. Nurses were identified as the target group, potentially also therapists and medical personnel.

CONCLUSION

The delirium knowledge questionnaire is content-valid.

Investigating nurses' knowledge and attitudes about delirium in older persons: a cross-sectional study

INTRODUCTION

Delirium is the most common emergency for older hospitalized patients that demands urgent treatment, otherwise it can lead to more severe health conditions. Nurses play a crucial part in diagnosing delirium and their competencies facilitate the appropriate treatment and management of the condition.

AIM

This study aims to enhance the understanding of delirium care by exploring both knowledge and attitudes of nurses toward patients in acute care hospital wards and the possible association between these two variables.

METHOD

The Nurses Knowledge of Delirium Questionnaire (NKD) and the Attitude Tool of Delirium (ATOD) that were created for the said inquiry, were disseminated to 835 nurses in the four largest Public Hospitals of the Republic. These tools focused particularly on departments with increased frequency of delirium (response rate = 67%).

RESULTS

Overall nurses have limited knowledge of acute confusion/delirium. The average of correct answers was 42.2%. Only 38% of the participants reported a correct definition of delirium, 41.6 correctly reported the tools to identify delirium and 42.5 answered correctly on the factors leading to delirium development. The results of the attitudes' questionnaire confirmed that attitudes towards patients with delirium may not be supportive enough. A correlation between the level of nurses' knowledge and their attitude was also found. The main factors influencing the level of knowledge and attitudes were gender, education, and workplace.

CONCLUSION

The findings of this study are useful for the international audience since they can be used to develop and modify educational programmes in order to rectify the knowledge deficits and uninformed attitudes towards patients with delirium. The development of a valid and reliable instrument for the evaluation of attitudes will help to further assess nurses' attitudes. Furthermore, the results are even more important and useful on a national level since there is no prior data on the subject area, making this study the first of its kind.

Nurses' knowledge, barriers and practice in the care of patients with delirium in the intensive care unit in Poland-A cross-sectional study

Background

Delirium is a cognitive disorder that occurs with high frequency in patients in intensive care units and affects patient outcomes. Despite recommendations for monitoring and assessing delirium in the ICU, studies show that it is still not routinely assessed and often remains undiagnosed or misinterpreted as dementia or depression.

Aim

The aim of this study was (1) to assess nurses' knowledge and clinical practices regarding delirium, (2) to identify the factors associated with nurses' knowledge, and (3) to define barriers to effective control of delirium.

Methods

A cross-sectional study was conducted among 371 ICU nurses in Poland.

Results

53.1% of nurses had never been educated on delirium control resulting in a deficit in knowledge of delirium symptoms, risk factors and complications associated with delirium in ICU patients. Master's degree in nursing (vs. Registered nurses + Bachelor's), female gender, and working in university hospital (vs. other) were positively correlated with nurse's knowledge, while age had a negative impact on knowledge. Delirium is a marginalized state in ICU patients, only 16.4% of nurses assessed delirium routinely and 35.8% assessed delirium occasionally, rarely using validated scales. Barriers to effective delirium control were primarily the lack of a requirement to assess delirium, the difficulty of assessing delirium in intubated patients and nurses' lack of confidence in their ability to use delirium assessment tools.

Conclusions

There is an urgent need to educate nurses about delirium and to make delirium assessment obligatory in clinical practice. The area of change should also include a hospital policy on delirium monitoring and management. The study was registered on ClinicalTrials.gov (NCT05384964).

Self-efficacy of caring for patients in the intensive care unit with delirium: Development and validation of a scale for intensive care unit nurses

BACKGROUND

Improving the self-efficacy of intensive care unit nurses for delirium care could help them adapt to the changing situation of delirium patients. Validated measures of nurses' self-efficacy of delirium care are lacking OBJECTIVES: The objective of this study was to develop a Delirium Care Self-Efficacy Scale for assessing nurses' confidence about caring for patients in the intensive care unit and to examine the scale's psychometric properties.

METHODS

Draft scale items were generated from a review of relevant literature and face-to-face interviews with intensive care unit nurses; content validity was conducted with a panel of five experts in delirium. A group of nurses were recruited by convenience sampling from intensive care units (N = 299) for item analysis of the questionnaire, assessment of validity, and reliability of the scale. Nurse participants were recruited from nine adult critical care units affiliated with a hospital in Taiwan. Data were collected from August 2020 to July 2021.

RESULTS

Content validity index was 0.98 for the initial 26 items, indicating good validity. The critical ratio for item discrimination was 14.47-19.29, and item-to-total correlations ranged from 0.67 to 0.81. Principal component analysis reduced items to 13 and extracted two factors, confidence in delirium assessment and confidence in delirium management, which explained 66.82% of the total variance. Cronbach's alpha for internal consistency was 0.94 with good test-retest reliability (r = 0.92). High scale scores among participants were significantly associated with age (≥40 years), work experience in an intensive care unit (≥10 years), delirium education, and willingness to use delirium assessment tools.

CONCLUSIONS

The newly developed Delirium Care Self-Efficacy Scale demonstrated acceptable reliability and validity as a measure of confidence for intensive care nurses caring for and managing patients with delirium in the intensive care unit.

Nurse-Driven Assessment, Prevention, and Management of Delirium on an Acute Inpatient Neurology Unit

BACKGROUND

Delirium commonly affects hospitalized patients and is associated with increased hospital length of stay, discharge to skilled care, cost, morbidity, and mortality.

LOCAL PROBLEM

At our organization, there was no formal delirium assessment performed by the nursing staff outside of the intensive care unit.

METHODS

Assessment of nurses' knowledge about delirium, a nurse-driven delirium screening protocol, and patient education were implemented on an adult inpatient neurology unit. Knowledge change, protocol implementation, and patient-level outcomes were assessed.

INTERVENTIONS

Staff nurse delirium education and a nurse-driven delirium screening protocol were implemented.

RESULTS

No change in nursing knowledge occurred pre/postintervention. Falls, falls with injury, and restraint and sitter usage decreased. Changes in length of stay varied over the intervention period. The trend to discharge to home increased, while the trend to discharge to skilled nursing care decreased.

CONCLUSIONS

Formal delirium screening protocols may add organizational value by positively impacting patient outcomes.

Effect of an evidence-based poster on the knowledge of delirium and its prevention in student nurses: A quasi-experimental study

BACKGROUND

A major barrier to nurses adopting evidence-based practice (EBP) has been the limited awareness of evidence underpinning clinical practice, often due to poor access and understanding of the literature base. To address this, we piloted the development of educational posters summarizing the evidence base around clinical practices to see if they help nurses better understand the rationale behind their care. Our first poster focused on the evidence supporting the management of delirium in older persons, specifically delirium identification and its prevention.

OBJECTIVE

To examine the effect of an evidence-based poster education on the delirium knowledge of student nurses.

DESIGN

A prospective two-armed quasi-experimental study.

METHODS

188 student nurses were recruited in December 2017. Participants were alternated to receive either an evidence-based poster education session or a reflective education session as a control. Both groups were assessed on their general knowledge on delirium, knowledge on delirium detection and knowledge on delirium prevention. This was conducted both before exposure to either the intervention or control, and one week after exposure. Unpaired t-tests with 95% confidence intervals (CI) were applied to compare the mean change in pre-test and post-test delirium knowledge. We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist to report our methods and findings.

RESULTS

Students in the poster education group reported greater improvements in mean scores of delirium identification (Mean increase =1.0, p = 0.007, 95% CI: 0.3-1.6), delirium prevention (Mean increase =1.6, p < 0.001, 9% CI: 1.0-2.2) and overall delirium knowledge (Mean increase = 2.7, p < 0.001, 95% CI: 1.5-3.8) than students in the control.

CONCLUSION

Summarised research evidence within a poster format can increase student nurses' access to the evidence base. This has shown to increase their knowledge to guide their clinical practice.

IMPACT STATEMENT

Exposure to poster summaries of research evidence underpinning delirium care increases student nurses' clinical knowledge of delirium identification and prevention.

A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults

Background

Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge of delirium amongst clinicians caring for patients at high risk of developing delirium and to determine whether education can improve clinical assessment of delirium.

Methods

Two hundred and forty-six case notes were audited before and 149 were reviewed after the education intervention and implementation of a delirium screening tool. Clinicians at the hospital were invited to complete a questionnaire on knowledge of delirium. The questionnaire was based on a validated tool which contained 39 questions about delirium. The questionnaire also contained 28 questions on delirium knowledge. Additional questions were included to gather demographic information specific to the hospital. Descriptive statistics, chi square and independent t-tests were conducted to test for differences in knowledge between the pre and post periods. The Squire Checklist Reporting Guidelines for Quality Improvement Studies informed the preparation of the manuscript.

Results

The audit demonstrated that the use of a cognitive assessment tool overall increased from 8.5% in pre education to 43% in the post education period. One hundred and fifty-nine staff completed the questionnaire in total, 118 the pre and 41 post. The knowledge subscale score was high pre and post education and no statistically significant difference was observed. The greatest increase in knowledge was related to knowledge of the risk factors subscale. The increase in knowledge (6.8%) was statistically significant.

Conclusion

An interprofessional approach to delirium education was effective in not only increasing awareness of the factors associated with this syndrome but also increased the use of a delirium assessment tool.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00692-2.

Preoperative Delirium Nursing Model Initiatives to Determine the Incidence of Postoperative Delirium Among Elderly Orthopaedic Patients

Delirium is a common neurocognitive disorder prevalent in hospitalized older adults. The development of delirium is associated with adverse health outcomes, including functional decline and mortality. This study aimed to investigate the incidence and risk factors of postoperative delirium in older adults (≥60 years) who underwent orthopaedic surgery. Elderly orthopaedic patients were recruited from a large urban hospital over 12 months. Patients were preoperatively screened for delirium and followed up at least once daily postoperatively until discharge. Of the 124 patients in the sample, 21 (16.9%) had postoperative delirium. There were no significant differences in any of the baseline characteristics between the delirious and nondelirious patients. Patients using antidepressants were more likely to develop postoperative delirium compared with those not using antidepressants (odds ratio: 2.72, p = .05). Postoperative delirium was common in this sample of older adults who underwent orthopaedic surgery. Aiming prevention strategies toward patients using antidepressants may help reduce the incidence of delirium in this population.

Improving delirium detection in intensive care units: Multicomponent education and training program

BACKGROUND

Delirium is a common, devastating, and underrecognized syndrome in the intensive care unit (ICU). The study aimed to describe and evaluate a multicomponent education and training program utilizing a "Train-The-Trainer" (TTT) model, to improve delirium detection across a large health system.

METHODS

Fourteen ICUs across nine hospitals participated in a multicomponent delirium program consisting of a 1-day workshop that included: (1) patient testimonials, (2) small group discussions, (3) didactics, and (4) role-playing. Additionally, four ICUs received direct observation/training via telehealth (tele-delirium training). The Kirkpatrick model was used for program evaluation in a pre/post-test design.

RESULTS

A 1-day delirium workshop was held at two time points and included 73 ICU nurses. Of the 65 nurses completing the post-workshop satisfaction survey, most (46.2) had >10 years of clinical experience, and no or minimal delirium training (69.2%). All nurses (100%) identified lack of knowledge as a barrier to delirium detection, while time constraints and lack of importance accounted for only 25%. Overall, nurses rated the workshop positively (excellent 66.7%, and very good 23.3%), and likely to change practice (definitely 73.3% and very likely 15.0%). All validated Confusion Assessment Method for the ICU (CAM-ICU) cases demonstrated improvement in number of correct responses. Delirium detection across the health system improved from 9.1% at baseline to 21.2% in ICUs that participated in the workshop and 30.1% in those ICUs that also participated in the tele-delirium training (p = 0.005).

CONCLUSION

A multicomponent delirium education and training program using a TTT model was rated positively, improved CAM-ICU knowledge, and increased delirium detection.

Can multifaceted educational intervention improve clinical practice and patient outcomes regarding delirium in nursing homes?

AIM

We aimed to develop and evaluate a multifaceted and evidence-based delirium educational program for practitioners in nursing home settings.

METHODS

A pre- and posttest comparison group design was employed. The recruited practitioners included nurses and care workers from two nursing homes. The intervention group (n = 51) received the developed delirium educational program for 3 weeks, whereas the control group (n = 23) received a delirium handbook. We examined pre- and posttest differences in the scores for delirium knowledge and confidence in providing delirium care. We also examined the nurses' ability to clinically detect delirium in patients and delirium incidence for 8-week periods both before and after the intervention.

RESULTS

There were significant improvements in the participants' aptitudes (delirium knowledge and confidence in providing delirium care) and clinical practice (ability to clinically detect delirium in the patients) only in the intervention group; however, there were no significant differences in patient outcomes (incidence of delirium) between either group. Additionally, it was observed that the nurses' improved understanding of distinct clinical features of delirium, such as acute change or fluctuation, was the key factor that directly affected the success of delirium screening.

CONCLUSIONS

This study revealed that implementation of a multifaceted and evidence-based delirium educational program for practitioners in nursing home settings was effective in promoting the knowledge, confidence, and ability to detect delirium. The developed program can also be implemented in settings where most patients are older individuals, such as geriatric care units, or long-term care hospitals.

The effect of an educational intervention to improve orthopaedic nurses' knowledge of delirium: A quasi-experimental study

BACKGROUND

Lack of delirium knowledge and its clinical repercussions contributes to the absence of delirium prevention activities in routine clinical practice.

AIM

The aim of this study was to investigate the effectiveness of a delirium awareness educational program on nurses' knowledge about delirium prevention and management.

METHODS

A quasi-experimental (pre-intervention, post-intervention test) design was used to test the effectiveness of an educational intervention using a knowledge survey.

RESULTS

There was no difference in the knowledge scores between the 2 periods for domains 1, 2 3 and 4. However, the median (IQR) knowledge scores for domain 5 (risk factors) and domain 6 (recognising delirium) was higher at post-intervention compared to pre-intervention.

CONCLUSION

A multi-step educational intervention had a positive but small impact on nurses' knowledge of delirium. However, the training was not mandatory and uptake of the training was not as high as hoped. Most nurses preferred ward-based education - combination of formal knowledge delivery and informal practice discussion. Future studies should focus on programs which are ward-based including various of teaching styles.

Evaluation of a delirium awareness podcast for undergraduate nursing students in Northern Ireland: a pre-/post-test study

BACKGROUND

Delirium is a common disorder affecting several people in primary, secondary, and tertiary settings. The condition is frequently under-diagnosed leading to long-lasting physical and cognitive impairment or premature death. Despite this, there has been limited research on the impact of innovative approaches to delirium education amongst undergraduate nursing students. The aim of this study was to evaluate the effect of a delirium awareness podcast on undergraduate nursing student knowledge and confidence related to the condition in Northern Ireland.

METHODS

The intervention was a 60-min delirium awareness podcast, available throughout May 2020, to a convenience sample of year one undergraduate nursing students (n = 320) completing a BSc Honours Nursing degree programme in a Northern Ireland University. The podcast focused on how nursing students could effectively recognise, manage, and prevent delirium. Participants had a period of 4 weeks to listen to the podcast and complete the pre and post questionnaires. The questionnaires were comprised of a 35-item true-false Delirium Knowledge Questionnaire (DKQ), a 3-item questionnaire about professional confidence and a 7-item questionnaire evaluating the use of podcasting as an approach to promote knowledge and confidence about delirium. Data were analysed using paired t-tests and descriptive statistics.

RESULTS

Students improved across all three core areas in the post-test questionnaire, demonstrating improvements in knowledge about symptoms of delirium (7.78% increase), causes and risk factors of delirium (13.34% increase) and management of delirium (12.81% increase). In relation to perceived confidence, students reported a 46.50% increase in confidence related to recognition of delirium, a 48.32% increase in relation to delirium management and a 50.71% increase their ability to communicate about delirium. Both questionnaires were statistically significant (P < 0.001). The final questionnaire illustrated that nursing students positively evaluated the use of podcast for promoting their knowledge and confidence about delirium and 96.32% of nursing students believed that the podcast met their learning needs about delirium.

CONCLUSIONS

A 60-min podcast on delirium improved first year student nurse knowledge about delirium. Nursing students also expressed that this approach to delirium education was effective in their learning about the condition.

Perceptions of current occupational therapy practice with older adults experiencing delirium

OBJECTIVES

To describe the perceptions of Australian occupational therapists of their role, knowledge and skills in enabling older adults with delirium to participate in meaningful occupations.

METHODS

This is a mixed-methods cross-sectional study. Participants (n = 91) completed an online survey, with quantitative data analysed descriptively and qualitative data subjected to content analysis.

RESULTS

Occupational therapists had good general delirium knowledge, but less understanding of specific risk factors. Participants asserted the importance of occupational therapy assessment and treatment for older people experiencing delirium and generally felt confident or somewhat confident in their skills. While all participants provided collaborative care with multidisciplinary team members, only a minority thought colleagues had a satisfactory knowledge of the occupational therapy role with delirium.

CONCLUSION

Currently, the role of occupational therapy with older people experiencing delirium remains emerging rather than established, and there are many opportunities for further research and development in this practice area.

Evaluation of a co-produced delirium awareness programme for undergraduate nursing students in Northern Ireland: a pre-test/post-test study

BACKGROUND

Delirium is recognised internationally as a common disorder that causes acute deterioration in a person's cognitive abilities. Healthcare professionals play a key role in the early identification and management of delirium and effective education can support timely recognition and treatment. There is currently a lack of research exploring the delirium education provided to undergraduate nursing students. The aim of this study was to evaluate the effectiveness of a co-produced delirium awareness programme on undergraduate nursing students in Northern Ireland.

METHODS

The intervention was a 2-h delirium workshop, delivered in April 2019, to a convenience sample of year one undergraduate nursing students (n = 206) completing a BSc Honours Nursing degree programme in a Northern Ireland University. The workshop focused on four core elements: defining delirium, reflecting on practice, recognition of delirium and management of delirium. Participants completed a 35-item true-false Delirium Knowledge Questionnaire (DKQ) at baseline and post intervention using Socrative, a cloud-based student response system. In addition, students also completed a short questionnaire at baseline and post-workshop, designed by the authors, to ascertain perceived confidence about caring for people with delirium. Data were analysed using paired t-tests and descriptive statistics.

RESULTS

In the DKQ, Scores were normally distributed around the mean at baseline (71.89%) and post intervention (81.89%). Students improved across all three core areas in the post-test questionnaire, demonstrating improvements in knowledge about symptoms of delirium (7.32% increase), causes and risk factors of delirium (17.91% increase) and management of delirium (5.72% increase). In relation to perceived confidence, students reported a 60.20% increase in confidence related to recognition of delirium, a 49.51% increase in relation to delirium management and a 45.04% increase their ability to communicate about delirium. Both questionnaires were statistically significant (P < 0.01).

CONCLUSIONS

A 2-h workshop on delirium improved first year student nurse knowledge about delirium. Nursing students expressed that this approach to delirium education enabled collective thinking about how knowledge could be transferred into individual practises. Students also stated that learning incorporating the voice of the person who has experienced delirium, was an effective and powerful way to deliver education.

Multimodal Education Program to Improve Nurses' Knowledge and Confidence on Delirium Recognition in a Surgical-Trauma Intermediate-Care Setting

Background

High incidence of delirium in hospitalized patients has been reported in the United States and is significantly associated with increased morbidity and mortality. The lack of knowledge and confidence in performing delirium assessment (KCDA) has led to significant underrecognition of delirium by nurses regardless of evidence-based education intervention.

Objective

The purpose of this study was to determine the effectiveness of a multimodal educational program (MEP) to enhance nurses' KCDA.

Methods

A MEP including an online didactic with a video-simulation and 1:1 bedside coaching with delirium screening (DS) was conducted in the surgical intermediate-care unit of an academic medical center. A quasi-experimental pre- and post-test design was used.

Results

Of 23 nurses, the majority were <41 years old (73.9%) and had at least a bachelor of science in nursing degree (78.3%) with <6 years of experience (60.9%). The overall KCDA scores and the performance of DS improved significantly after the MEP (p < .001). A positive correlation was noted between the changes of the KCDA scores (p = .009).

Conclusions

The MEP demonstrated improvement in nurses' KCDA. The MEP should focus on an individualized learning approach with a targeted patient population, using current delirium screening tools.

Implications for Nursing

Educational programs are recommended in either an orientation or continuing education program on nursing units. This is also recommended for use in other academic centers that encompass similar clinical settings and could possibly be considered for use in other disease processes.

Development of a Tool for the Assessment of Nurses' Attitudes Toward Delirium

BACKGROUND AND PURPOSE

The prevalence of delirium during hospitalization is high in older patients and there is evidence of staff regarding them as unpopular or a burden. This study aims to develop an instrument examining nurses' attitudes toward patients with delirium.

METHODS

Stages included (a) content identification, (b) content development, (c) content critique, (e) pilot study with a test-retest reliability, (f) field study consisting of psychometric testing of the internal consistency and construct validity.

RESULTS

The Cronbach's alpha was 0.89 and the stability reliability was acceptable. The factor analysis resulted in three factors explaining a total of 56.5% of the variance. hese factors are "beliefs," "behavior," and "emotions," explaining 37.025%, 12.792%, and 5.652% of variance.

CONCLUSIONS

The Attitude Tool of Delirium (ATOD) is a reliable and valid instrument for the assessment of attitudes toward delirium.

"Just another piece of paperwork": perceptions of clinicians on delirium screening following hip fracture repair elicited in focus groups

ABSTRACTBackground:Delirium is a complex clinical syndrome characterized by disturbed consciousness, cognitive function, or perception and associated with serious adverse outcomes such as death, dementia, and the need for long-term care. However, recognition and management of delirium is poorly prioritized even though it is the most frequent complication among patients undergoing surgery following hip fracture. The aim of this study was to understand clinicians' from orthopedic speciality perceptions in relation to recognition, diagnosis, and management of delirium.

METHODS

This was a qualitative study using in-depth focus groups discussions with clinical staff of one orthopedic unit within a level 1 trauma center, south of Adelaide, South Australia.

RESULTS

A total number of 17 individuals (14 nurses, 1 geriatric registrar, 1 nursing manager, and 1 speech therapist) participated in the focus groups. Four major themes were identified: (1) Delirium is important but can be hard to recognize and validate; (2) ambiguity on the use of delirium screening tool; (3) need of designated delirium care pathway; and (4) vital role of the family. Despite the initial lack of agreement on use of the objective tool to screen delirium, nurses did propose a number of ways that formal delirium screening could be included in routine nursing duties and existing nursing documentation.

CONCLUSION

Although orthopedic nurses aim to provide effective care to patients experiencing delirium symptoms following hip fracture, they are doing so in the absence of structured screening, assessment, and multidisciplinary team approach. This study emphasizes the various barriers which need to be considered before attempting to change practice in this important area.

Educational intervention on delirium assessment using confusion assessment method-ICU (CAM-ICU) in a general intensive care unit

AIMS AND OBJECTIVES

To assess intensive care unit nurses' knowledge of intensive care unit delirium and delirium assessment before and after an educational intervention. In addition, nurses' perception on the usefulness of a delirium assessment tool and barriers against delirium assessment were assessed as secondary objectives.

BACKGROUND

Early identification of delirium in intensive care units is crucial for patient care. Hence, nurses require adequate knowledge to enable appropriate evaluation of delirium using standardised practice and assessment tools.

DESIGN

This study, performed in Malaysia, used a single-group pretest-posttest study design to assess the effect of educational interventions and hands-on practices on nurses' knowledge of intensive care unit delirium and delirium assessment.

METHODS

Sixty-one nurses participated in educational intervention sessions, including classroom learning, demonstrations and hands-on practices on the Confusion Assessment Method-Intensive Care Unit. Data were collected using self-administered questionnaires for the pre- and postintervention assessments. Analysis to determine the effect of the educational intervention consisted of the repeated-measures analysis of covariance.

RESULTS

There were significant differences in the knowledge scores pre- and postintervention, after controlling for demographic characteristics. The two most common perceived barriers to the adoption of the intensive care unit delirium assessment tool were "physicians did not use nurses' delirium assessment in decision-making" and "difficult to interpret delirium in intubated patients".

CONCLUSIONS

Educational intervention and hands-on practices increased nurses' knowledge of delirium assessment. Teaching and interprofessional involvements are essential for a successful implementation of intensive care unit delirium assessment practice.

RELEVANCE TO CLINICAL PRACTICE

This study supports existing evidences, indicating that education and training could increase nurses' knowledge of delirium and delirium assessment. Improving nurses' knowledge could potentially lead to better delirium management practice and improve ICU patient care. Thus, continuous efforts to improve and sustain nurses' knowledge become relevant in ICU settings.

Educational Intervention to Improve Delirium Recognition by Nurses

BACKGROUND

Delirium poses increased morbidity and mortality risks for hospitalized patients. Underrecognition by health care providers contributes to poor outcomes for patients. Little has been published about methods used to teach health care providers how to screen for delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).

OBJECTIVE

To evaluate the effectiveness of a multimodal educational intervention for nurses in the medical intensive care unit to improve their knowledge and skills regarding delirium and delirium recognition.

METHODS

An educational intervention was done in the medical intensive care unit of an academic medical center. Effectiveness was evaluated via a quasi-experimental design and using preintervention and postintervention assessments. Procedural correctness of performing the CAM-ICU delirium screening also was measured.

RESULTS

Nurses participated in 1 small-group session (n = 34). Fifteen sessions were conducted from June to September 2016, and assessments were completed before and after the intervention. The sample consisted of predominantly nurses with a bachelor's degree (56%) who had 1 to 5 years' experience (59%). Mean scores overall and on the knowledge subscale differed significantly (P < .001) from before to after the intervention. No correlation was found between demographic groups and score differences. Seventy-nine percent of participants used the tool correctly after the intervention.

CONCLUSIONS

The educational intervention provided for these nurses further validated published reports of the benefits of an educational program about delirium. The content of the educational intervention should be targeted for the setting, the risk factors for the patient population in question, and the specific delirium screening tool used.

Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices

OBJECTIVES

The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery.

DESIGN

Descriptive self-report survey.

SETTING

A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society.

PATIENT OR SUBJECTS

Pediatric cardiac intensive care clinicians (physicians and nurses).

INTERVENTIONS

None.

MEASUREMENT AND MAIN RESULTS

One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia.

CONCLUSIONS

Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

Effect of an interactive E-learning tool for delirium on patient and nursing outcomes in a geriatric hospital setting: findings of a before-after study

BACKGROUND

Education of healthcare workers is a core element of multicomponent delirium strategies to improve delirium care and, consequently, patient outcomes. However, traditional educational strategies are notoriously difficult to implement. E-learning is hypothesised to be easier and more cost effective, but research evaluating effectiveness of delirium education through e-learning is scarce at present. Aim is to determine the effect of a nursing e-learning tool for delirium on: (1) in-hospital prevalence, duration and severity of delirium or mortality in hospitalized geriatric patients, and (2) geriatric nurses' knowledge and recognition regarding delirium.

METHODS

A before-after study in a sample of patients enrolled pre-intervention (non-intervention cohort (NIC); n = 81) and post-intervention (intervention cohort (IC); n = 79), and nurses (n = 17) of a geriatric ward (university hospital). The intervention included an information session about using the e-learning tool, which consisted of 11 e-modules incorporating development of knowledge and skills in the prevention, detection and management of delirium, and the completion of a delirium e-learning tool during a three-month period. Key patient outcomes included in-hospital prevalence and duration of delirium (Confusion Assessment Method), delirium severity (Delirium Index) and mortality (in-hospital; 12 months post-admission); key nurse outcomes included delirium knowledge (Delirium Knowledge Questionnaire) and recognition (Case vignettes). Logistic regression and linear mixed models were used to analyse patient data; Wilcoxon Signed Rank tests, McNemar's or paired t-tests for nursing data.

RESULTS

No significant difference was found between the IC and NIC for in-hospital prevalence (21.5% versus 25.9%; p = 0.51) and duration of delirium (mean 4.2 ± SD 4.8 days versus 4.9 ± SD 4.8 days; p = 0.38). A trend towards a statistically significant lower delirium severity (IC versus NIC: difference estimate - 1.59; p = 0.08) was noted for delirious IC patients in a linear mixed model. No effect on patient mortality and on nurses' delirium knowledge (p = 0.43) and recognition (p = 1.0) was found.

CONCLUSION

Our study, the first in its area to investigate effects of delirium e-learning on patient outcomes, demonstrated no benefits on both geriatric patients and nurses. Further research is needed to determine whether delirium e-learning nested within a larger educational approach inclusive of enabling and reinforcing strategies, would be effective.

TRIAL REGISTRATION

ISRCTN ( 82,293,702 , 27/06/2017).

Delirium in a residential care facility: An exploratory study of staff knowledge

OBJECTIVE

To explore staff knowledge of delirium by eliciting meaning through descriptions of their experiences within a residential aged care facility (RACF).

METHODS

Six staff from one RACF in Australia participated in this qualitative study. Semi-structured individual interviews were conducted and analysed using Colaizzi's analytical framework.

RESULTS

The analysis revealed four themes: (i) absence of the word delirium; (ii) care based on intuition and automated actions; (iii) reliance on teamwork; and (iv) confusing delirium, depression and dementia.

CONCLUSION

Delirium was absent from clinical discourse in the RACF. Although participants concluded that delirium was common, lack of knowledge led to under-assessment. Findings emphasise the need for staff education, informed assessment and clinical guidelines to better support staff care for residents.

CogChamps - a model of implementing evidence-based care in hospitals: study protocol

BACKGROUND

Delirium and dementia (cognitive impairment; CI), are common in older hospital patients, and both are associated with serious adverse outcomes. Despite delirium often being preventable, it is frequently not recognized in hospital settings, which may be because hospital nurses have not received adequate education or training in recognizing or caring for those with CI. However, the most effective way of increasing nurses' awareness about delirium and dementia, and initiating regular patient screening and monitoring to guide best practices for these patients in hospital settings is not known. Hence this current project, conducted in 2015-2017, aims to redress this situation by implementing a multi-component non-pharmacological evidence-based intervention for patients with CI, through educating and mentoring hospital nurses to change their practice.

METHODS

The development of the practice change component is informed by recent findings from implementation science that focuses on facilitation as the active ingredient in knowledge uptake and utilization. This component focuses on educating and empowering experienced nurses to become Cognition Champions (CogChamps) across six wards in a large Australian tertiary referral hospital. The CogChamps will, in turn, educate other nursing team members to more effectively care for patients with CI. The hospital leadership team are supportive of the project and are directly involved in selecting the CogChamps. CogChamps will be provided with comprehensive education in evidence-based delirium assessment, prevention and management, and practice change management skills. They will receive continuing support from research and education staff about raising awareness, upskilling other staff in delirium assessment and in the adoption of best practices for preventing and managing delirium. Both qualitative and quantitative data are being collected at multiple time-points to evaluate process, impact and outcome, and to provide clarity regarding the most effective aspects of the intervention.

DISCUSSION

This paper describes the study protocol for the implementation of multi-component evidence-based non-pharmacological practices designed to improve the care of older hospital patients with CI. Findings will inform subsequent initiatives directed towards enhancing the capacity of the nursing workforce to implement best practices for providing high quality care for this growing patient population throughout their acute care hospital stay.

The psychotropic education and knowledge test for nurses in nursing homes: striving for PEAK performance

OBJECTIVES

The psychotropic education and knowledge test for nurses in acute geriatric care (PEAK-AC) measures knowledge of psychotropic indications, doses and adverse drug reactions in older inpatients. Given the low internal consistency and poor discrimination of certain items, this study aims to adapt the PEAK-AC, validate it in the nursing home setting and identify factors related to nurses' knowledge of psychotropics.

METHOD

This study included nurses and nurse assistants employed by nursing homes (n = 13) and nursing students at educational institutions (n = 5) in Belgium. A Delphi technique was used to establish content validity, the known groups technique for construct validity (n_respondents = 550) and the test-retest procedure for reliability (n_respondents = 42). Internal consistency and item analysis were determined.

RESULTS

The psychotropic education and knowledge test for nurses in nursing homes (PEAK-NH) (n_items = 19) demonstrated reliability (κ = 0.641) and internal consistency (Cronbach's α = 0.773). Significant differences between-group median scores were observed by function (p < 0.001), gender (p = 0.019), educational background (p < 0.001), work experience (p = 0.008) and continuing education (p < 0.001) for depression, delirium and pharmacotherapy topics. Items were acceptably difficult (n_items = 15) and well-functioning discriminators (n_items = 17). Median PEAK-NH score was 9/19 points (interquartile range 6-11 points). Respondents' own estimated knowledge was related to their PEAK-NH performance (p < 0.001).

CONCLUSION

The PEAK-NH is a valid and reliable instrument to measure nurses' knowledge of psychotropics. These results suggest that nurses have limited knowledge of psychotropic use in nursing homes and are aware of their knowledge deficits. The PEAK-NH enables educational initiatives to be targeted and their impact on nurses' knowledge to be tracked.

The impact of a delirium educational intervention with intensive care unit nurses

BACKGROUND

Delirium is a frequently encountered condition in critically ill patients that has significant clinical impacts. Associated costs for patients impacted by delirium are higher, including a 39% higher intensive care unit (ICU) cost and 31% higher hospital costs, yet delirium goes unnoticed in up to 72% of cases. If ICU nurses are not aware of risk factors and presentation of delirium, the condition may go unrecognized, allowing for development of negative sequelae.

OBJECTIVES

The purpose of this research study was to examine delirium knowledge levels of ICU nurses at a single level I trauma hospital both before and after a tailored educational intervention.

METHODS

A preintervention/postintervention research study design in conjunction with a tailored educational intervention was utilized. Preintervention/postintervention delirium knowledge testing was completed through the use of the Nurses' Knowledge of Delirium Questionnaire.

RESULTS

The results indicated a significant difference in preintervention scores (mean, 74.65 [SD, 8.68]) and postintervention scores (mean, 84.95 [SD, 5.73]); t23 = -5.256, P = .000. These results suggest that an educational intervention does have an impact on ICU nurses' knowledge level of delirium.

CONCLUSIONS

If ICU nurses are not aware of the fluctuating nature of delirium and its varied clinical presentations, they cannot be expected to consistently identify its development when providing care. Through educational activities, it is possible to increase team member knowledge levels, potentially resulting in increased identification of delirium and a reduction in negative sequelae.

Strategies to improve nurse knowledge of delirium: a call to the adult-gerontology clinical nurse specialist

PURPOSE/OBJECTIVES

The purpose of this article is to discuss the role of the adult-gerontology clinical nurse specialist in addressing the problem of delirium in hospitalized older adults through strategies to improve nurse knowledge.

BACKGROUND

Delirium is a significant issue in hospitalized older adults. This acute confusional state can adversely impact older adults in various ways. Delirium has been implicated in (1) poor physical, cognitive, and psychological outcomes, (2) prolonged hospitalizations, (3) increased costs of care, (4) need for continued postacute care, and (5) patient and provider stress. To prevent delirium, nurses must possess the knowledge to identify risk factors and institute preventive strategies. Once a change in mental status occurs, it is critical that nurses recognize delirium and the steps necessary to provide safe, effective care. Nurses are the major providers of bedside care; however, multiple studies have identified a lack of nurse knowledge regarding delirium. The adult-gerontology clinical nurse specialist can be instrumental in fostering knowledge on this important issue.

DESCRIPTION

Multiple interventions can be conducted by the adult-gerontology clinical nurse specialist with acute care nurses to increase delirium knowledge. A review of the literature revealed strategies that might be used in the hospital setting. Before educational endeavors, it is crucial to assess baseline nurse knowledge of delirium. Educational strategies can then include use of standardized delirium assessment tools, implementation of the Geriatric Resource Nurse model, fostering geriatric case studies and simulations, conducting geriatric grand rounds, and development of structured delirium educational programs. Exploring the patient experience, post delirium, can provide an invaluable, first-hand account of the acute confusional state. This information can impact nurse knowledge as well as patient safety and well-being. Geriatric certification and professional organizational involvement can be encouraged. Numerous online geriatric resources can be shared with nurses to enhance knowledge of delirium.

OUTCOME

Improved nurse knowledge will assist in preventing/decreasing incidents of delirium and thwart the negative outcomes associated with delirium occurrence in hospitalized older adults.

IMPLICATIONS

Nurse knowledge can be measured and patient care assessed to determine the effectiveness of the proposed educational strategies.

CONCLUSION

The goal of the identified adult-gerontology clinical nurse specialist-led educational initiatives is to improve knowledge of delirium, which will assist nurses in providing evidence-based, safe, appropriate care to all hospitalized older adults.

Nursing intervention versus usual care to improve delirium among home-dwelling older adults receiving homecare after hospitalization: feasibility and acceptability of a Randomized Controlled Trail

BACKGROUND

Delirium is an acute cognitive impairment among older hospitalized patients. It can persist until discharge and for months after that. Despite proof that evidence-based nursing interventions are effective in preventing delirium in acute hospitals, interventions among home-dwelling older patients is lacking. The aim was to assess feasibility and acceptability of a nursing intervention designed to detect and reduce delirium in older adults after discharge from hospital.

METHODS

Randomized clinical pilot trial with a before/after design was used. One hundred and three older adults were recruited in a home healthcare service in French-speaking Switzerland and randomized into an experimental group (EG, n = 51) and a control group (CG, n = 52). The CG received usual homecare. The EG received usual homecare plus five additional nursing interventions at 48 and 72 h and at 7, 14 and 21 days after discharge. These interventions were tailored for detecting and reducing delirium and were conducted by a geriatric clinical nurse (GCN). All patients were monitored at the start of the study (M1) and throughout the month for symptoms of delirium (M2). This was documented in patients' records after usual homecare using the Confusion Assessment Method (CAM). At one month (M2), symptoms of delirium were measured using the CAM, cognitive status was measured using the Mini-Mental State Examination (MMSE), and functional status was measured using Katz and Lawton Index of activities of daily living (ADL/IADL). At the end of the study, participants in the EG and homecare nurses were interviewed about the acceptability of the nursing interventions and the study itself.

RESULTS

Feasibility and acceptability indicators reported excellent results. Recruitment, retention, randomization, and other procedures were efficient, although some potentially issues were identified. Participants and nurses considered organizational procedures, data collection, intervention content, the dose-effect of the interventions, and methodology all to be feasible. Duration, patient adherence and fidelity were judged acceptable. Nurses, participants and informal caregivers were satisfied with the relevance and safety of the interventions.

CONCLUSIONS

Nursing interventions to detect/improve delirium at home are feasible and acceptable. These results confirm that developing a large-scale randomized controlled trial would be appropriate.

TRIAL REGESTRATION

ISRCTN registry no: 16103589 - 19 February 2016.

Impact of falls on mental health outcomes for older adult mental health patients: An Australian study

Sustaining a fall during hospitalization reduces a patient's ability to return home following discharge. It is well accepted that factors, such as alteration in balance, functional mobility, muscle strength, and fear of falling, are all factors that impact on the quality of life of elderly people following a fall. However, the impact that falls have on mental health outcomes in older adult mental health patients remains unexplored. The present study reports Health of the Nation Outcome Scale scores for people over the age of 65 (HoNOS65+), which were examined in a cohort of 65 patients who sustained a fall and 73 non-fallers admitted to an older adult mental health service (OAMHS). Results were compared with state and national HoNOS65+ data recorded in Australian National Outcome Casemix Collection data to explore the effect that sustaining a fall while hospitalized has on mental health outcomes. Australian state and national HoNOS65+ data indicate that older adults generally experience improved HoNOS65+ scores from admission to discharge. Mental health outcomes for patients who sustained a fall while admitted to an OAMHS did not follow this trend. Sustaining a fall while admitted to an OAMHS negatively affects discharge mental health outcomes.

The effect of an interactive delirium e-learning tool on healthcare workers' delirium recognition, knowledge and strain in caring for delirious patients: a pilot pre-test/post-test study

BACKGROUND

Studies investigating the effectiveness of delirium e-learning tools in clinical practice are scarce. The aim of this study is to determine the effect of a delirium e-learning tool on healthcare workers' delirium recognition, delirium knowledge and care strain in delirium.

METHODS

A pilot pre-posttest study in a convenience sample of 59 healthcare workers recruited from medical, surgical, geronto-psychiatric and rehabilitation units of a university hospital. The intervention consisted of a live information session on how to use the e-learning tool and, a 2-month self-active learning program. The tool included 11 e-modules integrating knowledge and skill development in prevention, detection and management of delirium. Case vignettes, the Delirium Knowledge Questionnaire, and the Strain of Care for Delirium Index were used to measure delirium recognition, delirium knowledge and experienced care strain in delirium respectively. Subgroup analyses were performed for healthcare workers completing 0 to 6 versus 7 to 11 modules.

RESULTS

The delirium recognition score improved significantly (mean 3.1 ± SD 0.9 versus 2.7 ± 1.1; P = 0.04), and more healthcare workers identified hypoactive (P = 0.04) and hyperactive (P = 0.007) delirium in the posttest compared to the pretest phase. A significant difference in the change of recognition levels over time between the 0 to 6 and 7 to 11 module groups was demonstrated (P = 0.03), with an improved recognition level in the posttest phase within the 7 to 11 module group (P = 0.007). After adjustment for potential confounders, this difference in the change over time was not significant (P = 0.07) and no change in recognition levels within the 7 to 11 module group was noted (P = 0.19). The knowledge score significantly improved in the posttest compared to the pretest phase (mean 31.7 ± SD2.6 versus 28.3 ± 4.5; P < 0.001), with a significant increased level within the 7 to 11 module group (unadjusted P < 0.001/adjusted P = 0.02). Overall, no difference between posttest and pretest phases was documented for care strain (P = 0.46).

CONCLUSION

The e-learning tool improved healthcare workers' delirium recognition and knowledge. The effect of the tool is related to its level of completion, but was less explicit after controlling for potential confounders and warrants further investigation. The level of strain did not improve.

Identifying Barriers to Delirium Screening and Prevention in the Pediatric ICU: Evaluation of PICU Staff Knowledge

Delirium in the pediatric intensive care unit (PICU) setting is often unrecognized and undertreated. The importance of screening and identification of ICU delirium has been identified in both adult and pediatric literature. Delirium increases ICU morbidity, length of mechanical ventilation and length of stay. The objective of this study was to determine the current knowledge level about delirium and its risk factors among pediatric critical care nurses through a short questionnaire. We hypothesized that before a targeted educational intervention, PICU care providers do not have an adequate knowledge base for accurate screening and diagnosis of delirium in critically ill children. A 17 question online survey was given to all nurses in a tertiary 36-bed PICU to assess current knowledge about delirium in children. The response rate was 73% (105/143). When asked to identify the correct way to diagnose pediatric delirium, 11.4% of nurses surveyed (12/105) incorrectly believed that Glasgow Coma Score is the appropriate screening tool. A large proportion of respondents (40/105) believed that benzodiazepines are helpful in treatment of delirium. The results of the survey identified specific knowledge gaps about risk factors and treatment of pediatric delirium in the critically ill child. There is a critical need for education about pediatric delirium and its risk factors among PICU staff prior to unit-wide implementation of a delirium screening and prevention program, specifically with regards to screening methods and pharmacologic risk factors. These results are likely generalizable to all physicians, nurses and staff who care for critically ill children.

A Multi-Method Study of the Geriatric Learning Needs of Acute Care Hospital Nurses in Ontario, Canada

Older people are at risk of experiencing functional decline and related complications during hospitalization. In countries with projected increases in age demographics, preventing these adverse consequences is a priority. Because most Canadian nurses have received little geriatrics content in their basic education, understanding their learning needs is fundamental to preparing them to respond to this priority. This two-phased multi-method study identified the geriatrics learning needs and strategies to address the learning needs of acute care registered nurses (RNs) and registered practical nurses (RPNs) in the province of Ontario, Canada. In Phase I, a survey that included a geriatric nursing knowledge scale was completed by a random sample of 2005 Ontario RNs and RPNs. Average scores on the geriatric nursing knowledge scale were in the "neither good nor bad" range, with RNs demonstrating slightly higher scores than RPNs. In Phase II, 33 RN and 24 RPN survey respondents participated in 13 focus group interviews to help confirm and expand survey findings. In thematic analysis, three major themes were identified that were the same in RNs and RPNs: (a) geriatric nursing is generally regarded as simple and custodial, (b) older people's care is more complex than is generally appreciated, and (c) in the current context, older people's care is best learned experientially and in brief on-site educational sessions. Healthcare providers, policy-makers, and educators can use the findings to develop educational initiatives to prepare RNs and RPNs to respond to the needs of an aging hospital population.