The Literature Review And Searching For Evidence
The Literature Review And Searching For Evidence
Click here 
to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS
The Literature Review And Searching For Evidence
D elirium : W hy Are Nurses Confused? Nidsa D. Baker
Helen M. Taggart Anita Nivens
Paula Tillman
Nurses have a key role in detection of delirium, yet this condition remains under recognized and poorly managed. The aim of this study was to explore nurses’ knowledge of delirium-related infor mation as well as their perception of their level o f knowledge.
D elirium is a serious, costly, potentially preventable complication for hospitalized patients age 65 and older (Wofford & Vacchiano, 2011). This acute, short term disturbance of consciousness may last from a few hours to as long as a few months. It is characterized by an acute onset of inattention, dis organized thinking, and/or altered level of consciousness.
Delirium can be categorized as hyperactive, hypoactive, or mixed based on symptoms that can fluctu ate and change during the course of the disorder. Hyperactive or excited delirium involves agitation and hal lucinations (American Psychiatric Association, 2011; Holly, Cantwell, & Jadotte, 2012). Patients with hyperactive delirium are more likely to receive earlier treatment than patients who exhibit the less easily recognized signs of hypoactive deliri um: lethargy, drowsiness, and inat tention. In addition, patients may show signs of both hyperactive and hypoactive delirium in a condition described as mixed variant delirium (Holly et al., 2012). Health care providers often confuse delirium with depression and/or dementia (Fick, Hodo, & Lawrence, 2007; Holly et al., 2012; Voyer, Richard, Doucet, Danjou, & Carmichael, 2008). Unlike delirium, which hap pens suddenly over a few hours or days, dementia usually develops gradually over months or years, while depression generally develops over weeks or months, or, less often, after a sudden event (Holly et al., 2012; Young & Inouye, 2007) (see Table 1).
Delirium is a common multifac torial disorder that involves a vul nerable patient with predisposing
factors and exposure to precipitat ing factors (Sendelbach & Guthrie, 2009). It can occur at various ages. However, older adults are particu larly vulnerable to delirium, espec ially when they are ill (Featherstone & Hopton, 2010) (see Table 2). Underlying risk factors are often contributory to delirium in older adults. Common triggers are infec tion, medications, general pain, constipation, dehydration, and environmental factors (Dahlke & Phinney, 2008; Quinlan et al., 2011). Although delirium occurs commonly in acute care settings, older adult residents of long-term care and assisted living homes are vulnerable as well. Rates of delirium in long-term care settings range from 1% to 60% (Lee, Ha, Lee, Kang, & Koo, 2011; Siddiqi, Young, & Cheater, 2008). Delirium is asso ciated with poor patient outcomes that include longer hospital stays, increased costs, increased need for
post-acute care, and significant stress for patients and families (O’Mahony, Murthy, Akunne, & Young, 2011). At least 20% of the 12.5 million patients age 65 or older hospitalized each year have deliri um as a complication, causing a $9,000 to $15,000 increase depend ing on the severity in hospital costs per patient. Delirium attributes to annual estimated cost of $38 – $152 billion (Kalish, Gillham, & Unwin, 2014; Young & Inouye, 2007).
The prevalence of delirium varies from 1% to 80% depending on pop ulation, the time of delirium assess ment, and the assessment method. In addition, the documented inci dence of delirium extended from 3% to 61% (Kalish et al., 2014; Young & Inouye, 2007). Addition ally, the prevalence of this condi tion reported in medical and surgi cal intensive care unit cohort stud ies varied from 20% to 80% (Girard, Panharipande, & Ely, 2008; Kalish
Nidsa D. Baker, MSN, RN, ANP-BC, is Adult Nurse Practitioner, St. Joseph’s/Candler Health System St. Mary’s Health Center, Savannah, GA.
Helen M. Taggart, PhD, RN, ACNS-BC, is Professor, Department of Nursing, College of Health Professions, Armstrong Atlantic State University, Savannah, GA.
Anita Nivens, PhD, RN, FNP-BC, is Graduate Nursing Program Coordinator and Professor, Department of Nursing, College of Health Professions, Armstrong Atlantic State University, Savannah, GA.
Paula Tillman, DNP RN, ACNS-BC, is Assistant Professor, Armstrong Atlantic State University, Savannah, GA, and Informatics Specialist, Memorial Health University Medical Center, Savannah, GA.
Acknowledgments: The authors thank Malcolm Hare, Fremantle Hospital and Health Service and Curtin University School of Nursing in Australia, for granting permission to utilize the ques tionnaire.
MEDSURG n u r s i n g . January-February 2015 • Vol. 24/No. 1 15
Research for Practice
TABLE 1. C o m p a ris o n o f D e liriu m , D e m e n tia , a n d D epression
Delirium Dementia Depression Onset Sudden: Hours or days Gradual over months or years
‘ Gradual over weeks or months, or after an event
Alertness/ Attention
Fluctuates: Sleepy or agitated, unable to concentrate
Generally stable Generally stable, some difficulty concentrating
Sleep Sudden changes in sleeping pattern, unusual confusion at night
Can be disturbed, with habitual night-time wandering
Early morning waking
Thinking Disorganized, rambling Specific, difficulty with short-term memory
Preoccupied with negative thoughts, hopelessness, help lessness, self-depreciation
Perception Delusions, hallucinations common Generally normal Generally normal
Source: Holly et al., 2012
TABLE 2. P redisposing a n d P re c ip ita tin g Factors fo r D e liriu m
Predisposing Factors Precipitating Factors
Age a 65 Use of sedative hypnotics, opioids, or Male sex anticholinergic drugs Co-existing dementia/cognitive Stroke
impairment Infections History of delirium Hypoxia Depression Shock Functional dependence Fever or hypothermia Immobility Anemia Low level of activity Poor nutritional status History of falls Recent surgery (major/minor) Visual impairment Admission to an intensive care unit Hearing impairment Use of physical restraints Dehydration Use of indwelling urinary catheter Malnutrition Multiple procedures Polypharmacy Pain Alcohol/drug abuse Emotional stress
Prolonged sleep deprivation
Source: Sendelbach & Guthrie, 2009
et al., 2014). Delirium is com m on am ong elders in long-term care (LTC) facilities, with its prevalence ranging from 9.6% to 89% (Voyer et al., 2008).
Although com m on, delirium often is under-recognized and under-diagnosed (O’Mahony et al., 2011). Because of the high incidence and costs associated with delirium, prevention should be a high priority for health care professionals, espe cially nurses (Harris, Chodosh, Vassar, Vickrey, & Shapiro, 2009).
Nurses spend more time with patients, allowing them to observe any changes in patients’ attention, level of consciousness, and cognitive function (Brixey & Mahon, 2010). As a result, frequent assessments by nurses are crucial for early detection of delirium (Girard et al., 2008).
Literature Review A comprehensive review of the
literature was conducted of all orig inal research published 2001-2014
using MEDLINE, CINAHL, and ProQuest Psychology Journals. Search terms included delirium or acute confusion and nurses, nurses’ recognition, nurses’ identification, or nurses’ knowledge. Exclusion criteria were studies not reporting primary data and studies th a t did n o t include m easurem ent of nurse recognition or knowledge of deliri um. A lthough now dated, the selected research specifically evalu ated nurses’ knowledge deficit for delirium in studies of various designs. In addition, fewer studies actually assessed th e levels of knowledge about delirium factors, such as definition, available and appropriate assessment scales/tools, and risks (Hare, Dianne, Sunita, Ian, & Gaye, 2008).
Many studies of delirium focused on th e advantages of educated intervention, such as prevention practices, increased early detection, and proper medical management (Bergmann, Murphy, Kiely, Jones, & Marcantonio, 2005; Featherstone & Hopton, 2010; Rapp, Mentes, & Titler, 2001). Researchers also found a positive correlation between use of an educational intervention for nursing and medical professionals and positive patient outcomes such as decreased length of hospital stay (Meako, Thompson, & Cochrane, 2011; Tabet et al., 2005). Fick and co-authors (2007) found using case vignettes could evaluate nurses’
16 la n u a ry -F e b ru a ry 2015 • Vol. 2 4 /N o . 1 MEDSURG N U R S IISTO
Delirium: Why Are Nurses Confused?
knowledge of delirium in patients with dementia.
Hare and colleagues (2008) tar geted 1,097 clinical nurses in a hos pital setting with a questionnaire to assess their knowledge of delirium and its associated risk factors. Of the 338 (30.8%) returned responses, 64% (n=217) scored 50% or better on the questionnaire. In addition, 36.3% (n=123) scored 50% or better for the risk factor questions while 81.9% («=227) scored 50% or better for the knowledge questions. Find ings indicated orthopedic nurses who had participated in a delirium education forum prior to the research scored better on the gener al facts portion of the questionnaire when compared to nurses having no pre-survey educational interven tion. However, the orthopedic nurs es did not score higher compared to other surveyed nurses on the risk factor questions. The researchers thus found nurses were n o t as knowledgeable about delirium risk factors as they were about general facts concerning delirium.
Fick and co-authors (2007) also assessed nurses’ knowledge of deliri um but more narrowly focused on delirium superimposed on dementia (DSD), with the goal of determining if nurses were able to recognize these conditions using case vignettes. The case vignettes were designed to eval uate knowledge of delirium, its risk factors, and management. The study also assessed nurses’ geropsychiatric knowledge using the Mary Starke Harper Aging Knowledge Exam (MSHAKE), a tool that measures gen eral geropsychiatric knowledge. Of 29 participating nurses, 41% (n=12) were able to identify dementia cor rectly in the dementia vignette but had difficulty differentiating deliri um factors from DSD factors and specifically identifying hypoactive delirium. While this study had a small sample size, its findings sug gested nurses are more likely to dis tinguish dementia and hyperactive delirium than DSD and hypoactive delirium alone.
Dahlke and Phinney (2008) eval uated how nurses assess, prevent, and treat delirium in older hospital ized patients, and identified deliri
um-related challenges and barriers faced by nurses when caring for patients with delirium. This descrip tive qualitative study comprised interviews with nurses who worked in a hospital. A convenience sam pling included 12 registered nurses in a mid-sized regional hospital in western Canada who had manageri al, educational, and bedside roles and worked in various areas such as medical and surgical units. The nurs es in the study had 6-43 years of nursing experience. Level of profes sional education included diploma («=7), baccalaureate (n=4), and mas ter’s degree {n= 1). Each respondent was interviewed for approximately 1.5 hours with open-ended ques tions about his or her clinical and personal experience with delirium assessment, recognition, and inter vention. Analysis of the recorded interviews yielded three main deliri um-related strategies: Taking a Quick Look, Keeping an Eye on Them, and Controlling the Situation.
Taking a Quick Look suggested nurses quickly assess patients because of the limited time general ly available in a fast-paced acute care setting (Dahlke & Phinney, 2008). Keeping an Eye on Them rec om m ended frequent rounding and m onitoring of patients assessed to be at risk for delirium. Controlling the Situation focused on intervening as needed to prevent injury and provide appropriate therapy. Au thors found nurses repeatedly reported having little to no formal education about older adults and had sparse formal knowledge of delirium; they concluded nurses would benefit from increased deliri um-related educational support.
Additional research assessing nurses’ knowledge of delirium has been completed in LTC settings. Voyer and co-authors (2008) assessed nurse detection of delirium in older adults. This prospective study identified th e signs and symptoms m ost challenging to dis tinguish, as well as delirium factors most likely to go unnoticed. At three LTC facilities and a large regional hospital LTC unit over two 7-day periods, trained research assistants (nurses who had complet
ed 15 hours of instruction on delir ium and dementia detection) inter viewed 160 consenting patients age 65 and over with no history of psy chiatric illness. Investigators collect ed relevant dem ographic and health inform ation and assessed patients for delirium as part of their interviews. Nurses were questioned about their ability and experience in assessing delirium in patients. The incidence of delirium among patient participants was 71.5% (n=108); of those, nurses identified delirium in just 13% (n=14). Authors concluded nurses under recognize delirium in older adults in the LTC setting.
Purpose Nurses’ failure to differentiate and
recognize delirium early may be due to lack of knowledge about delirium, risk factors, preventive measures, and treatment. Therefore, the pur pose of this study was to assess nurs es’ knowledge of delirium and its risk factors, and correlate findings to demographic variables, such as nurs es’ years of experience, level of edu cation, and area of practice. The study also was designed to evaluate nurses’ perception of their own level of competency related to delirium recognition and management.
Research Questions Research questions addressed in
this study included the following: 1. W hat was nurses’ level of
knowledge of delirium? 2. What was nurses’ level of know
ledge of delirium risk factors? 3. Was there a correlation be
tween nurses’ years of experi ence, education, and practice area, and their knowledge of delirium and its risk factors?
Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS
WhatsAppWho We Are
We are a professional custom writing website. If you have searched a question and bumped into our website just know you are in the right place to get help in your coursework.
Do you handle any type of coursework?
Yes. We have posted over our previous orders to display our experience. Since we have done this question before, we can also do it for you. To make sure we do it perfectly, please fill our Order Form. Filling the order form correctly will assist our team in referencing, specifications and future communication.
Is it hard to Place an Order?
ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT
1. Click on the “Order Now” on the main Menu and a new page will appear with an order form to be filled.
2. Fill in your paper’s requirements in the “PAPER INFORMATION” section and the system will calculate your order price/cost.
3. Fill in your paper’s academic level, deadline and the required number of pages from the drop-down menus.
4. Click “FINAL STEP” to enter your registration details and get an account with us for record-keeping and then, click on “PROCEED TO CHECKOUT” at the bottom of the page.
100% Reliable Site. Make this your Home of Academic Papers.
 |
 |
Always Order High-Quality Academic Papers from HERE
5. From there, the payment sections will show, follow the guided payment process and your order will be available for our writing team to work on it.
SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS: ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT
We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so that it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.
Use the following coupon code :
Nursing25
