Abstract
BackgroundWhile 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.MethodsFifty 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.ResultsNurses' 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).ConclusionA 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.
Highlights
Delirium in the intensive care unit (ICU) is associated with an increased mortality and a longer ICU and hospital stay [1,2,3]
A simple composite educational intervention incorporating script concordance theory improves the capacity for ICU nurses to screen for delirium nearly as well as experts
A simple composite educational intervention incorporating script concordance theory rapidly improves the capacity for ICU nurses to perform delirium assessment in a standardized fashion without a detrimental effect on accuracy
Summary
Delirium in the intensive care unit (ICU) is associated with an increased mortality and a longer ICU and hospital stay [1,2,3]. While education plays a key role in boosting delirium screening efforts by ICU nurses, the optimal pedagogical strategy to educate clinicians regarding delirium assessment is currently unclear and several authors have pointed out the limitations of standard delirium teaching methods [6,9,10]. Sedation and pain scales at the bedside, these assessment tools only evaluate one dimension of an ICU patient's symptoms [11,12]. 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
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