Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Carol Thompson

Clinical Mentor

Dr. Komal Pandya

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

Background: Delirium is a serious condition that affects critically ill adult patients in the intensive care unit. Bedside nursing delirium measurements are considered a dependable source of information that can be used for clinical decision-making. Nurse education and assessment of perceptions is important when building a framework for successful delirium assessment. However, few data exist about nursing perceptions and practices associated with delirium screening instruments. The overall purpose of this project is to examine nurse perceptions and knowledge about delirium and delirium screening instruments at the University of Kentucky (UK) Hospital’s Cardiovascular Intensive Care Unit (CVICU).

Objectives: The aims of the project were: (i) to describe current sedation and delirium practice using a 11-item survey completed by registered nurses who practice full time in the CVICU; (ii) to compare knowledge and perception about sedation and delirium screening score before the receipt of a 20-minute education program with those obtained immediately following the program in registered nurses who practice full time in CVICU; (iii) to describe registered nurse evaluation of 2 delirium screening instruments, the Confusion Assessment Methods-Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) , using a 10-item instrument.

Methods: A descriptive pre- and post- design was used for this study. The data was analyzed using descriptive statistics. Paired t-tests were conducted to compare the differences in mean pre- and post-test scores.

Findings: Overall, there were 40 nurse participants. All nurses in the study assessed sedation and delirium more than once per shift with 97.5% of nurses used the CAM-ICU validated screening instrument. Perceived barriers of delirium screening included (i) difficult to interpret intubated patients; (ii) nurses do not feel confident in their ability to use delirium assessment instruments; and (iii) inability to complete assessment in sedated patient. Overall, education on delirium screening can change nurse perception and improve nursing knowledge. After receiving education on both instruments, nurse participants preferred the ICDSC to the CAM-ICU regarding performance confidence and time consumption. The nurses also chose the ICDSC to be implemented into bedside practice.