Nurses’ Knowledge, Confidence, Detection and Actions Related to Delirium Care in the Post-Acute Setting

Abstract

Background Delirium is a common and under-recognized condition affecting patients during times of illness or injury and is associated with poor short and long- term outcomes. Although primarily considered a complication during hospitalization, delirium can persist, recur, or initially present during a post-acute stay in a skilled nursing facility. Little is known about delirium care knowledge, confidence, and practices by nurses in post-acute facilities. Objectives Measure post-acute care nurses’ knowledge and confidence levels related to delirium prevention, identification and management Describe post-acute care nurses’ documented assessments and actions related to delirious patients. Methods Nursing knowledge and confidence data was obtained from a query of 114 nurses working in three post-acute facilities. Documentation of nursing assessment and actions were analyzed from records of 22 patients determined to have experienced post-acute delirium using CHART-DEL methodology. Results Nurses averaged 75% correct on a written delirium knowledge test, with most deficits in identifying the key features of delirium and the assessment of delirium superimposed upon dementia. Most (89%) nurses accurately applied the Confusion Assessment Method Short Form to a video of an individual displaying hypoactive delirium with visual hallucinations, while only 49% did the same with the video depicting hypoactive delirium superimposed on mild cognitive impairment. The majority (85%) of nurses reported lack of confidence in performing delirium screening, specifically surrounding the identification of an acute change in mental status from baseline and the presence of inattention and 56% lacked confidence discussing results of a positive delirium screen with a provider. The term “confusion” was the most documented descriptor in records of patients experiencing delirium with nurses recognizing 40% of verified delirious cases and acting upon 83% of cases they recognized. Conclusion Nurses working in the post-acute care setting displayed gaps in knowledge, confidence and skills related to delirium prevention, assessment and management.