Evaluating the efficacy of a delirium educational program for medical-surgical nurses
Abstract
The prevalence of delirium in general medical settings varies between 23% and 42%. The populations at significant risk for delirium include hospitalized adults aged 65 years and older. Delirium is associated with falls, functional decline, cognitive impairment, and high medical costs. A SWOT (strengths, weaknesses, opportunities, and threats) analysis of Vassar Brothers Medical Center’s strengths included adopting the Short-CAM delirium screening tool for patients aged 18 years and older. However, delirium remained underrecognized. Nurses have a significantly higher rate of patient interaction than any other healthcare professional. A literature review found that nurses lacked theoretical knowledge of delirium, and multimodal education effectively increased knowledge. The Iowa model framework was used due to its practicality and adaptability in the clinical setting. A practice change project consisting of a pre-and post-assessment method for 30 seasoned and novice nurses in the 30-bed neuroscience medical-surgical unit was developed. It included a 50-minute web-based module sent via email and eight 10-minute in-person sessions. The expected outcomes were to improve nurses’ knowledge of delirium and improve nurses’ recognition of delirium risk factors by 20% within 5 weeks. There was a statistically significant increase in mean percentage scores from the pre-assessment to the post-assessment surveys (z=-3.77, p≤0.001). Nurses’ post-assessment scores increased in knowledge of delirium, tools used for delirium assessments, and recognition of delirium risk factors. There was a limitation in the small sample size of 22. Delirium education should be part of the annual education of nurses and should be available to new nurses during orientation.
Ethics Approval
This study was approved by the University of Saint Joseph (Approval No. 23-038) and Brany IRB (Approval No. 23-12-667-337).
References
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Arlington (VA), USA: American Psychiatric Association; 2022. DOI: https://doi.org/10.1176/appi.books.9780890425787
- National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and management in hospital and long-term care (NICE Clinical Guideline CG103). London, UK: National Institute for Health and Care Excellence (NICE); 2023.
- Dixon M. Assessment and management of older patients with delirium in acute settings. Nurs Older People 2018;30:35-42. DOI: https://doi.org/10.7748/nop.2018.e969
- Bennett C. Caring for patients with delirium. Nursing 2019;49:17-20. DOI: https://doi.org/10.1097/01.NURSE.0000577772.92256.8a
- Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers 2020;6:90. DOI: https://doi.org/10.1038/s41572-020-00223-4
- Bauernfreund Y, Butler M, Ragavan S, Sampson EL. TIME to think about delirium: improving detection and management in the acute medical unit. BMJ Open Qual 2018;7:e000200. DOI: https://doi.org/10.1136/bmjoq-2017-000200
- Gibb K, Seeley A, Quinn T, et al. The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study. Age Ageing 2020;49:352-60. DOI: https://doi.org/10.1093/ageing/afaa040
- Thom RP, Levy-Carrick NC, Bui M, Silbersweig D. Delirium. Am J Psychiatry 2019;176:785-93. DOI: https://doi.org/10.1176/appi.ajp.2018.18070893
- Qu J, Chen Y, Luo G, et al. Delirium in the acute phase of ischemic stroke: incidence, risk factors, and effects on functional outcome. J Stroke Cerebrovasc Dis 2018;27:2641-7. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.034
- Shaw RC, Walker G, Elliott E, Quinn TJ. Occurrence rate of delirium in acute stroke settings: systematic review and meta-analysis. Stroke 2019;50:3028-36. DOI: https://doi.org/10.1161/STROKEAHA.119.025015
- Byrnes T. Impact of delirium education on medical-surgical nurses’ knowledge. J Nurs Care Qual 2021;36:291-3. DOI: https://doi.org/10.1097/NCQ.0000000000000551
- Ewens B, Seaman K, Whitehead L, et al. A delirium prevalence audit and a pre- and post-evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults. BMC Nurs 2021;20:202. DOI: https://doi.org/10.1186/s12912-021-00692-2
- Francisco MA, Gesell T, Meletis S, et al. Nurse-driven assessment, prevention, and management of delirium on an acute inpatient neurology unit. J Nurs Care Qual 2022;37:334-41. DOI: https://doi.org/10.1097/NCQ.0000000000000628
- Thomas N, Coleman M, Terry D. Nurses’ experience of caring for patients with delirium: systematic review and qualitative evidence synthesis. Nurs Rep 2021;11:164-74. DOI: https://doi.org/10.3390/nursrep11010016
- Hasemann W, Tolson D, Godwin J, et al. Nurses’ recognition of hospitalized older patients with delirium and cognitive impairment using the delirium observation screening scale: a prospective comparison study. J Gerontol Nurs 2018;44:35-43. DOI: https://doi.org/10.3928/00989134-20181018-02
- Mulkey MA, Olson DM, Misrahi S, Hardin SR. Delirium screening of patients on a neuroscience step-down unit. Medsurg Nurs 2021;30:414-8. DOI: https://doi.org/10.62116/MSJ.2021.30.6.414
- Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advances in diagnosis and treatment. JAMA 2017;318:1161-74. DOI: https://doi.org/10.1001/jama.2017.12067
- Eeles EM, England R, Armstrong A, et al. Understanding our patients better will lead to better recognition of delirium: an opinion piece. Australas J Ageing 2018;37:241-2. DOI: https://doi.org/10.1111/ajag.12585
- Fick DM, Shrestha P. Delirium in persons with dementia: integrating the 4Ms of age-friendly care as a set into the care of older people. J Gerontol Nurs 2022;48:3-6. DOI: https://doi.org/10.3928/00989134-20220909-01
- Wong EK, Lee JY, Surendran AS, et al. Nursing perspectives on the confusion assessment method: a qualitative focus group study. Age Ageing 2018;47:880-6. DOI: https://doi.org/10.1093/ageing/afy107
- Cechinel C, Lenardt MH, Rodrigues JAM, et al. Frailty and delirium in hospitalized older adults: a systematic review with meta-analysis. Rev Lat Am Enfermagem 2022;30:e3687. DOI: https://doi.org/10.1590/1518-8345.6120.3687
- Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113:941-8. DOI: https://doi.org/10.7326/0003-4819-113-12-941
- Edwards N. Differentiating the three D’s: delirium, dementia, and depression. Medsurg Nurs 2003;12:347-57.
- van Lieshout C, Schuit E, Hermes C, et al. Hospitalization costs and health-related quality of life in delirious patients: a scoping review. Health Econ 2022;169:28-38. DOI: https://doi.org/10.1016/j.zefq.2022.02.001
- Kinchin I, Mitchell E, Agar M, Trépel D. The economic cost of delirium: a systematic review and quality assessment. Alzheimers Dement 2021;17:1026-41. DOI: https://doi.org/10.1002/alz.12262
- American Geriatrics Society. What is delirium? 2019. Available from: https://help.agscocare.org/what_Is_help
- Weir E, O’Brien AJ. Don’t go there—it’s not a nice place: older adults’ experiences of delirium. Int J Ment Health Nurs 2019;28:582-91. DOI: https://doi.org/10.1111/inm.12563
- Solberg LM, Campbell CS, Jones K, et al. Training hospital inpatient nursing to know (THINK) delirium: a nursing educational program. Geriatr Nursing 2021;42:16-20. DOI: https://doi.org/10.1016/j.gerinurse.2020.10.018
- Ching J, Darwish S, Siegel K, et al. Positive outcomes following a multidisciplinary approach in the diagnosis and prevention of hospital delirium. J Clin Outcomes Manag 2021;28:272-6. DOI: https://doi.org/10.12788/jcom.0071
- Carey E, Furlong E, Smith R. The management of delirium in the older adult in advanced nursing practice. Br J Nurs 2022;31:76-84. DOI: https://doi.org/10.12968/bjon.2022.31.2.76
- Choi M, DeGennaro R, Blevins C. Multi-modal education program to improve nurses’ knowledge and confidence on delirium recognition in a surgical-trauma intermediate-care setting. J Doctoral Nurs Pract 2020;13:31-41. DOI: https://doi.org/10.1891/2380-9418.JDNP-D-19-00030
- Coyle MA, Chang HC, Burns P, Traynor V. Impact of interactive education on health care practitioners and older adults at risk of delirium: a literature review. J Gerontol Nurs 2018;44:41-8. DOI: https://doi.org/10.3928/00989134-20180626-02
- Detroyer E, Dobbels F, Teodorczuk A, et al. 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. BMC Geriatr 2018;18:19. DOI: https://doi.org/10.1186/s12877-018-0715-5
- Grealish L, Todd JA, Krug M, Teodorczuk A. Education for delirium prevention: knowing, meaning, and doing. Nurse Educ Pract 2019;40:102622. DOI: https://doi.org/10.1016/j.nepr.2019.102622
- Herrera E, Rutherford W, Plume T, et al. Evaluation of education and patient screening for delirium among patients with stroke: knowledge, confidence, and patient outcomes. J Contin Educ Nurs 2023;54:61-70. DOI: https://doi.org/10.3928/00220124-20230113-05
- Johnson CB. Evidence-based practice initiative: the educational reinforcement on delirium assessment. Medsurg Nurs 2021;30:383-8. DOI: https://doi.org/10.62116/MSJ.2021.30.6.383
- Jones L, Taylor T. Identifying acute delirium in acute care units. Medsurg Nurs. 2019;28:172-5.
- Martínez-García M, Sánchez-López E, Fernández-Trinidad M. Managing delirium in acute inpatient units: a cross-sectional study of nursing teams’ knowledge and perceived limitations. Nurs Open 2023;10:2213-21. DOI: https://doi.org/10.1002/nop2.1471
- Papaioannou M, Papastavrou E, Kouta C, et al. Investigating nurses’ knowledge and attitudes about delirium in older persons: a cross-sectional study. BMC Nurs 2023;22:10. DOI: https://doi.org/10.1186/s12912-022-01158-9
- Reppas-Rindlisbacher C, Siddhpuria S, Wong EK, et al. Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project. BMJ Open Qual 2021;10:e001186. DOI: https://doi.org/10.1136/bmjoq-2020-001186
- Rohatgi N, Weng Y, Bentley J, et al. Initiative for prevention and early identification of delirium in medical-surgical units: lessons learned in the past five years. Am J Med 2019;132:1421-30.e8. DOI: https://doi.org/10.1016/j.amjmed.2019.05.035
- Schnitker L, Nović A, Arendts G, et al. Prevention of delirium in older adults with dementia: a systematic literature review. J Gerontol Nurs 2020;46:43-54. DOI: https://doi.org/10.3928/00989134-20200820-02
- Travers C, Henderson A, Graham F, Beattie E. Turning education into action: impact of a collective social education approach to improve nurses’ ability to recognize and accurately assess delirium in hospitalized older patients. Nurse Educ Today 2018;62:91-7. DOI: https://doi.org/10.1016/j.nedt.2017.12.026
- van Velthuijsen EL, Zwakhalen SMG, Warnier RMJ, et al. Can education improve clinical practice concerning delirium in older hospitalised patients? Results of a pre-test post-test study on an educational intervention for nursing staff. BMC Med Educ 2018;18:59. DOI: https://doi.org/10.1186/s12909-018-1177-3
- Vonnes C, Tofthagen C. Impacting outcomes in the hospitalized oncology patient: evidence-informed quality and safety project to implement routine screening for delirium. Patient Saf 2022;4:20-9. DOI: https://doi.org/10.33940/med/2022.9.4
- Byrnes T, McMillan-Queen T, Weaver KJ, et al. Leveraging e-learning to improve nurses’ knowledge of delirium assessment. Medsurg Nurs 2023;32:57-61. DOI: https://doi.org/10.62116/MSJ.2023.32.1.57
- American Nurses Association/American Delirium Society. Delirium prevention strategies. 2016. Available from: https://www.nursingworld.org/practice-policy/work-environment/health-safety/delirium/
- Iowa Model Collaborative. Iowa model of evidence-based practice: Revisions and validation. Worldviews Evid Based Nurs 2017;14:175-82. DOI: https://doi.org/10.1111/wvn.12223
- Hare M, Wynaden D, McGowan S, et al. A questionnaire to determine nurses’ knowledge of delirium and its risk factors. Contemp Nurs 2008;29:23-31. DOI: https://doi.org/10.5172/conu.673.29.1.23
- Khachaturian AS, Hayden KM, Devlin JW, et al. International drive to illuminate delirium: a developing public health blueprint for action. Alzheimers Dement 2020;16:711-25. DOI: https://doi.org/10.1002/alz.12075
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