¶ … Recognition of Delirium: Literature Review
The objective of this study is to conduct a review of the literature on the assessment and recognition of delirium. The study, which follows reviews literature, related to the recognition of delirium in older patients by nurses and examines the variations of recognition of delirium by nurses as it relates to their own personal views of age and aging related symptoms.
Devline et al. (2013)
There are few data in existence relating to the current assessment practices used by nurses for delirium. (Devline, et al., 2013, p.555) Delirium is reported to be characterized by "an acutely changing or fluctuating mental status, inattention, disorganized thinking and altered level of consciousness." (Devline, et al., 2013, p.556) Devline et al. (2013) additionally reports that while it is believed by many that patients with delirium are hyperactive they are in fact more likely to be hypoactive or have a mixed pattern. (Devline, et al., 2013, p.556) Delirium in the ICU is reported to be associated "with higher mortality, prolonged stay, and greater health care costs." (Devline, et al., 2013, p.556) Preexisting cognitive impairment is reported as the primary risk factor for delirium as well as are factors of "higher age, the presence of acute systematic illnesses or medical comorbid diseases, and the use of certain medications." (Devline, et al., 2013, p.556)
Ramaswamy et al. (1993)
The work of Ramaswamy, et al. (1993) reports a study that involved a "comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium. The study design and methods reported include "a 2-day CSI program that consisted of progressive 4-part didactic series, including evidence-based reviews of delirium recognition, prevention and management, interspersed with interactive and small group sessions and practical case conferences " which were reported to have been "conceptualized in a consultation with a leading expert on delirium." (Ramaswamy, et al., 1993, p.122) It is reported that the design of pre- and post-tests were focused on testing the participants in their knowledge and confidence around delirium identification. Study results state that there were an average attendance of 71 individuals at each didactic session. Specifically reported is "…Among all responses, 50 pretests and posttests were matched based on numeric coding (6 MD/DOs, 34 RNs, and 10 others). Mean pretest and posttest scores were 7.9 and 10.8 points, respectively (maximum: 17), showing a positive change in knowledge scores after the intervention (2.9 points, p < .001). Improvement in knowledge scores was higher in the cohort attending 2 or more lectures (3.8 points, p < .001)." (Ramaswamy, et al., 1993, p.122)
Tabet et al. (2005)
The work of Tabet, et al. (2005) reports a study that examined an educational intervention for preventing delirium on acute medical wards and states that delirium is a common disorder is older people who are hospitalized and that intervention may not improve such cases. The study reports the objective of testing the hypothesis "that an educational package for medical and nursing staff would both reduce the number of incident cases of delirium and increase recognition of cases of delirium within an acute medical admissions ward." (p.152) The study reported was a single-blind case control study in two acute admissions wards in a busy inner-city teaching hospital involving 250 participants over the age of 70 years of age. The state methodology was use of an educational package for staff on one ward of the hospital comprised by a one-hour presentation that was formal in nature accompanied by a group discussion, written management guidelines, and follow-up sessions. It is reported that the follow-up sessions "were based on one-to-one and group" and had the objective of making the provision of "continuous support of staff through emphasizing learning and testing knowledge. Diagnosis and management of some discharged delirium patients were also discussed to allow staff to learn from previous experience. The main outcome measures are point prevalence of delirium established by researchers, and recognition and case-note documentation of delirium by clinical staff." (Tabet, et al., 2005, p.152) Study results state that the point prevalence of delirium "…was significantly reduced on the intervention compared to the control ward (9.8% versus 19.5%, P < 0.05) and clinical staff recognized significantly more delirium cases that had been detected by research staff on the ward where the educational package had been delivered." (Tabet, et al., 2005, p.152)
Inoyue et al. (2001)
The work of Inouye et al. (2001) reports that nurses "play a key role in recognition of delirium, yet delirium is often unrecognized by nurses." (p.2467) Inouye (2004) reports a prospective study involving 797 patients ages 70 and older who underwent 2721 paired delirium rating...
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