Impact of a Delirium Screening Tool and Multifaceted Education on Nurses’ Knowledge of Delirium and Ability to Evaluate It Correctly (original) (raw)
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Intensive & critical care nursing, 2017
To determine the impact of education on nurses' knowledge of delirium, knowledge and perception of a validated screening tool, and delirium screening in the ICU. A quasi-experimental single group pretest-post-test design. A 16 bed ICU in a Canadian urban tertiary care centre. Nursing knowledge and perception were measured at baseline, 3-month and 18-month periods. Delirium screening was then assessed over 24-months. During the study period, 197 surveys were returned; 84 at baseline, 53 at 3-months post education, and 60 at the final assessment period 18-months post intervention. The significant improvements in mean knowledge scores at 3-months post intervention (7.2, SD 1.3) were not maintained at 18-months (5.3, SD 1.1). Screening tool perception scores remained unchanged. Improvements in the perception of utility were significant at both time periods (p=0.03, 0.02 respectively). Physician value significantly improved at 18-months (p=0.01). Delirium screening frequency improved...
ICU nurses’ perception, knowledge, and barriers on delirium assessment
Journal of Nursing Education and Practice, 2022
Background and objective: Despite the availability of assessment tools for identifying and managing delirium in clinical settings, most cases remain undiagnosed, which demands the importance of conducting educational sessions. There is a necessity to understand why ICU nurses are unable to assess delirium in ICU patients, and there is a need to establish the best practice to promote patient safety. The descriptive cross-sectional research design aimed to assess the ICU nurses' perception, knowledge, and Perceived barriers to delirium assessment, assess the association between qualifications and previous education regarding delirium to their knowledge and perception, and evaluate the association between ICU nurses' experience and total scores of knowledge and perception. Methods: A total 105 ICU nurses were selected from one of the tertiary hospitals in the Sultanate of Oman. Socio-demographics about ICU nurses' knowledge, perception of delirium, and barriers to proper delirium assessment were collected by using an online self-administrative survey after obtaining consent. Data were statistically analyzed for central tendencies and level of dispersion (mean, range, and standard deviation). Results: The result of this study illustrated that 60.2% of ICU staff nurses have a moderate perception of the importance of delirium assessment in ICU. The majority of the nurses are females who held bachelor's degrees with experience of six to ten years in the critical care field. Conclusions: The finding in this study illustrated that most of the staff nurses have previous training regarding delirium. However, there are gaps in delirium assessment, perception, and knowledge in ICU. Therefore, appropriate education is required to increase delirium identification, skill, and knowledge.
Australian Critical Care
Background: Delirium is common in critically ill patients with detrimental effects in terms of increased morbidity, mortality, costs, and human suffering. Delirium detection and management depends on systematic screening for delirium, which can be challenging to implement in clinical practice. Objectives: The aim of this study was to explore how nurses in the intensive care unit perceived the use of Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Confusion Assessment Method for the Intensive Care Unit-7 (CAM-ICU-7), and Intensive Care Delirium Screening Checklist (ICDSC) for delirium screening of patients in the intensive care unit. Methods: This was a cross-sectional, electronic-based survey of nurses' perceptions of delirium screening with the three different instruments for delirium screening. Nurses were asked to grade their perception of the usability of the three instruments and how well they were perceived to detect delirium and delirium symptom changes on a 1-to 6-point Likert scale. Open questions about perceived advantages and disadvantages of each instrument were analysed using the framework method. Results: One hundred twenty-seven of 167 invited nurses completed the survey and rated the CAM-ICU-7 as faster and easier than the ICDSC, which was more nuanced and reflected changes in the patient's delirium better. Despite being rated as the fastest, easiest, and most used, the CAM-ICU provided less information and was considered inferior to the CAM-ICU-7 and ICDSC. Using familiar instruments made delirium screening easier, but being able to grade and nuance the delirium assessment was experienced as important for clinical practice.
Journal of Clinical Nursing, 2018
Aims and objectives: The primary objective was 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 Accepted Article This article is protected by copyright. All rights reserved. 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 post-intervention 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 inter-professional 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 Accepted Article This article is protected by copyright. All rights reserved. management practice and improve ICU patient care. Thus, continuous efforts to improve and sustain nurses' knowledge become relevant in ICU settings.
Critical Care, 2008
Background While nurses play a key role in identifying delirium, several authors have noted variability in their ability to recognize delirium. We sought to measure the impact of a simple educational intervention on the ability of intensive care unit (ICU) nurses to clinically identify delirium and to use a standardized delirium scale correctly. Methods Fifty ICU nurses from two different hospitals (university medical and community teaching) evaluated an ICU patient for pain, level of sedation and presence of delirium before and after an educational intervention. The same patient was concomitantly, but independently, evaluated by a validated judge (ρ = 0.98) who acted as the reference standard in all cases. The education consisted of two script concordance case scenarios, a slide presentation regarding scale-based delirium assessment, and two further cases. Results Nurses' clinical recognition of delirium was poor in the before-education period as only 24% of nurses reported the presence or absence of delirium and only 16% were correct compared with the judge. After education, the number of nurses able to evaluate delirium using any scale (12% vs 82%, P < 0.0005) and use it correctly (8% vs 62%, P < 0.0005) increased significantly. While judge-nurse agreement (Spearman ρ) for the presence of delirium was relatively high for both the before-education period (r = 0.74, P = 0.262) and after-education period (r = 0.71, P < 0.0005), the low number of nurses evaluating delirium before education lead to statistical significance only after education. Education did not alter nurses' self-reported evaluation of delirium (before 76% vs after 100%, P = 0.125). Conclusion A simple composite educational intervention incorporating script concordance theory improves the capacity for ICU nurses to screen for delirium nearly as well as experts. Self-reporting by nurses of completion of delirium screening may not constitute an adequate quality assurance process.
Journal of Client-Centered Nursing Care, 2023
Background: Timely diagnosis and effective treatment of delirium, a clinical syndrome, significantly impact the outcomes of patients in intensive care units (ICUs). Despite its significance and prevalence, delirium continues to be underdiagnosed. This study aims to determine the knowledge and capability of ICU nurses in Iraq in recognizing delirium syndrome. Methods: This descriptive cross-sectional study was conducted on 154 nurses working in the ICUs of hospitals in Babylon, Al-Diwaniyah, and Karbala cities, Iraq, in 2022. The subjects were recruited by the census. The study data were collected using a demographic questionnaire, case vignettes, and the delirium knowledge questionnaire (DKQ) to assess participants’ characteristics, delirium recognition, and delirium knowledge. The data were analyzed using an independent t-test and Pearson correlation coefficient in SPSS software, version 22. The significance level was set at P<0.05. Results: The Mean±SD score of nurses’ overall knowledge was 46.73±14.34. The Mean±SD score for their understanding of delirium’s incidence, symptoms, signs, and effects was 43.57±17.70, whereas the Mean±SD score for knowledge of its risk factors and causes was 49.7±18.74. Their overall ability to recognize delirium had a Mean±SD score of 1.44±1.13. There was a significant relationship between knowledge of delirium, participation in a delirium training course (P=0.008), and work experience in ICUs (P=0.046). Conclusion: Given the results of our study, it is crucial to develop plans for increasing the knowledge and recognition ability of ICU nurses in Iraq regarding delirium.
Comparing Two Training Methods on the Level of Delirium Awareness in Intensive Care Unit Nurses
Jundishapur Journal of Health Sciences, 2016
Background: Lack of correct diagnosis of delirium and considering it as an iatrogenic disease are the most important reasons for lack of correct detection of delirium by health care team. Appropriate training of the nurses on delirium can play an important role in its early diagnosis and prevention. Objectives: The current study aimed to compare the effects of two training methods on the level of delirium awareness in nurses in the intensive care units (ICUs). Patients and Methods: The present study was a pretest-posttest clinical trial on two groups conducted in the hospitals affiliated to Tehran University of Medical Sciences in 2014. The qualified subjects were divided into two groups (n = 35 for each) of workshop training and continuous electronic training by random number tabulation. The four-hour workshop training was applied in two days and training content was uploaded on Tehran University of Medical Sciences website for continuous electronic training. The data were collected by a questionnaire containing demographic characteristics and multiple-choice questions on delirium awareness including delirium definition, epidemiology, causes and risk factors, complications, diagnosis and diagnostic means, prevention and treatment with reliability coefficient of r = 0.85. The data were collected before and after the intervention as self-reporting. After collecting the data, the level of awareness of nurses was analyzed through descriptive and analytical statistics of paired and independent T-tests using SPSS ver. 16. Results: The results showed that 88.1% of the subjects were female. Comparison of mean ± SD showed a significant difference in the electronic training group before and after the intervention (P < 0.002) (before: 5.16 ± 4.6; after: 5.33 ± 5.1). However, there was no significant difference before and after the intervention in the workshop training group (before: 5.16 ± 3.4; after: 5.23 ± 5.1). Comparing the mean ± SD of the results in both groups of workshop and electronic training, there was no significant difference between them before the intervention. However, comparison of mean ± SD of the results after the intervention showed a significant difference between these two groups (P = 0.035). Conclusions: Given the results of the study, it can be concluded that electronic training had a more effective role in training the nurses regarding the awareness of delirium and can be recommended as a helpful training method in retraining courses targeting the nurses.
Assessment of delirium in the intensive care unit: nursing practices and perceptions
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2008
Despite practice guidelines promoting delirium assessment in intensive care, few data exist regarding current delirium assessment practices among nurses and how these practices compare with those for sedation assessment. To identify current practices and perceptions of intensive care nurses regarding delirium assessment and to compare practices for assessing delirium with practices for assessing sedation. A paper/Web-based survey was administered to 601 staff nurses working in 16 intensive care units at 5 acute care hospitals with sedation guidelines specifying delirium assessment in the Boston, Massachusetts area. Overall, 331 nurses (55%) responded. Only 3% ranked delirium as the most important condition to evaluate, compared with altered level of consciousness (44%), presence of pain (23%), or improper placement of an invasive device (21%). Delirium assessment was less common than sedation assessment (47% vs 98%, P < .001) and was more common among nurses who worked in medical...
Indian Journal of Critical Care Medicine
Background: Nursing Delirium Screening Scale (Nu-DESC) is a new instrument for determining delirium by nurses. The study aimed to investigate the psychometric properties of Nu-DESC and determined the sensitivity and specificity of it. Methods: Two evaluators assessed delirium by Nu-DESC in nonintubated patients admitted to intensive care unit (ICU) wards of Ardabil educational and medical centers. For determining psychometric properties of the instrument, the methods of determining content validity, structural validity, criterion validity (the DSM-5 criteria was used as a standard tool), internal consistency, and inter-rater reliability were used. Results: Ninety-six participants were assessed two times using the Nu-DESC. The mean age of the participants was 58.84, and 51 (53.1%) of them were male. Due to the high correlation of the Nu-DESC with the study criterion (DSM-5), the criterion validity of the instrument is confirmed. By using DSM-5 instrument, the cutoff score of 2 shows the best sensitivity and specificity. The kappa and alpha coefficients were obtained as r = 0.96 and α = 0.86, which indicate a good agreement between the evaluators and acceptable consistency. Conclusion: Nu-DESC can be used as an efficient and reliable instrument by nurses in the ICU. It was also found that taking medical history can help nurses to better interpret the Nu-DESC score at diagnosing delirium.
2019
In critically ill patients, delirium is a serious and frequent disorder that is associated with a prolonged intensive care and hospital stay and an increased morbidity and mortality. The lack of education, knowledge of delirium and the lack of a delirium screening instrument makes delirium often overlooked by critical care nurses and physicians. The aim of this study was to examine the effect of Confusion Assessment Method-Intensive Care Unit (CAM-ICU) tool implementation on the recognition of delirium by critical care nurses. A Pre-Posttest research design was implemented; 40 critical care nurses at Clemenceau Medical Center at three critical care units participated in the study. The participants were surveyed regarding recognition of delirium before and after the application of CAM-ICU tool and after a CAM-ICU education program was implemented. Highly significant difference in the test scores of the nurses between pre and post intervention were noted. The training concerning delirium and the application of validated assessment tools CAM-ICU increases the knowledge of critical care nurses and effective in recognizing patients with delirium.