Nurses In ICU Require Training To Spot Delirium

Main Category: Nursing / Midwifery
Also Included In: Medical Students / Training
Article Date: 23 Feb 2008 - 8:00 PDT

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ICU nurses are poor at spotting delirious patients in their care according to previous research, but a simple educational programme could soon remedy this serious failing. Reporting in the open access journal Critical Care, investigators showed that a basic training workshop quickly brings nurses up to the same standard as 'experts' in recognising the symptoms of delirium.

The programme consists of a traditional 30-45 minute slide presentation that covers the use of different scales for assessing aspects of delirium. The lecture is sandwiched between two practical exercises to assess delirium, working through questions and using clinical descriptions of patient symptoms.

It seems that this programme was enough to significantly improve nurses' ability to screen for delirium in ICU patients. The results the nurses achieved in the workshop were comparable to 'experts' undertaking the same tasks.

Fifty nurses were put through the educational programme. Prior to this training, only a quarter of nurses reported the presence or absence of delirium and only 16% made the same assessment as an expert judge. This is despite most nurses perceiving they were currently doing an adequate job in screening for delirium. Completion of the educational workshop led to a nearly eight-fold increase in the number of nurses who correctly used a recognised method for screening delirium.

"Training in the ICU often focuses on how to assess levels of pain and sedation in patients," says John Devlin, from the School of Pharmacy at Northeastern University in Boston, USA. "However, educational initiatives to improve the ability of bedside clinicians to assess delirium are at least as important and should be part of any ICU patient improvement effort. A rapid response to delirious patients in the ICU setting is important, as delirium is associated with higher mortality and longer stays in hospital."

This is the first time that researchers have studied the impact of a training programme, incorporating both traditional teaching and clinical reasoning tasks, on the assessment of delirium. "A clinical reasoning approach matches the day-to-day experiences of most ICU nurses," says Devlin, "where insufficient information is common and symptoms like pain and agitation often mask conditions like delirium . The combination of a lecture and case scenario exercises appears to rapidly improve the capacity for ICU nurses to perform delirium assessments in a standardised fashion without any detrimental effect on accuracy."

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Article adapted by Medical News Today from original press release.
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1. Combined Didactic and Scenario-Based Education Improves the Ability of ICU Staff to Recognize Delirium at the Bedside
John W Devlin, Francois Marquis, Richard R Riker, Tracey Robbins, Erik Garpestad, Jeffrey J Fong, Dorothy Didomenico and Yoanna Skrobik
Critical Care (in press)

Article available at journal website: http://ccforum.com/

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2. Critical Care is a high quality, peer-reviewed, international clinical medical journal. Critical Care aims to improve the care of critically ill patients by acquiring, discussing, distributing, and promoting evidence-based information relevant to intensivists. The journal is edited by Prof Jean-Louis Vincent (Belgium) and has an Impact Factor of 3.12

3. BioMed Central (http://www.biomedcentral.com/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

Source: Charlotte Webber
BioMed Central