Exploring facilitators and barriers to the implementation of routine delirium screening by nurses in acute geriatric wards: A survey using the theoretical domains framework

Abstract

AbstractBackgroundThe aim of this study was to assess barriers and facilitators to the performance of routine delirium screening by nurses in the inpatient acute geriatric wards of a tertiary general hospital.MethodCross‐sectional surveys of nurses employed in the inpatient acute geriatric wards of a tertiary general hospital in Singapore were undertaken. Survey items were developed based on 14 domains of the Theoretical Domains Framework. Mean domain scores (range: 1‐5) were examined to identify domains representing facilitators and barriers to delirium screening. Univariate analyses were performed to investigate the relationship of each domain with self‐reported likelihood of routinely performing delirium screening for geriatric inpatients upon admission, and significant variables were entered into a multivariable regression model.Result112 nurses completed the surveys. Domains with the highest mean values (representing facilitators to delirium screening) were “memory, attention and decision processes” (mean: 3.14, SD 0.62), “goals” (mean: 3.08, SD 0.61), and “behavioural regulation” (mean: 2.89, SD 0.63) while “optimism” (mean: 1.88, SD 0.71), “beliefs about consequences” (mean: 2.06, SD 0.64) and “knowledge” (mean: 2.15, SD 0.63) were the lowest scoring domains (representing barriers) [Table 1]. On average, nurses neither agreed nor disagreed that delirium screening in geriatric inpatients upon admission was something that they did routinely (mean: 2.42, SD 0.83). Age, clinical grade, number of years working in the clinical grade or with a geriatric population did not affect the likelihood of routinely performing delirium screening. In the multivariable regression model, the domains that were significantly associated with increased likelihood of routinely performing delirium screening included “intentions”, “goals”, “emotions” and “reinforcement” (adjusted R2 81.68%, F(13,98) = 39.07, p < .01) [Table 2].ConclusionMemory, attention, decision processes, goals, and behavioural regulation strategies were found to facilitate the performance of delirium screening by nurses. Intentions, goals, emotions, and reinforcement predicted self‐reported likelihood of routinely performing delirium screening. Interventions to support routine screening of delirium for geriatric inpatients should be designed to enhance these factors and target identified barriers of knowledge, beliefs about consequences, and (lack of) optimism.