Publications (2)0 Total impact
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Article: Detection of delirium by nurses among long-term care residents with dementia.
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ABSTRACT: Delirium is a prevalent problem in long-term care (LTC) facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected among demented older residents in LTC settings. The goals of this study were to determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium. In this prospective study (N = 156), nurse ratings of delirium were compared to researcher ratings of delirium. This procedure was repeated for 6 delirium symptoms. Sensitivity, specificity, positive and negative predictive values were computed. Logistic regressions were conducted to identify factors associated with delirium that is undetected by nurses. Despite a high prevalence of delirium in this cohort (71.5%), nurses were able to detect the delirium in only a minority of cases (13%). Of the 134 residents not identified by nurses as having delirium, only 29.9% of them were correctly classified. Detection rates for the 6 delirium symptoms varied between 39.1% and 58.1%, indicating an overall under-recognition of symptoms of delirium. Only the age of the residents (>/= 85 yrs) was associated with undetected delirium (OR: 4.1; 90% CI: [1.5-11.0]). Detection of delirium is a major issue for nurses that clearly needs to be addressed. Strategies to improve recognition of delirium could result in a reduction of adverse outcomes for this very vulnerable population.BMC Nursing 01/2008; 7:4. -
Article: [Detection of delirium by nurses].
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ABSTRACT: The purpose of this study was to determine to what extent nurses practising in long-term care settings are able to detect delirium among elderly clients. This was a prospective clinical study, with two measurements taken seven days apart. The population studied consisted of 156 elderly people with dementia, and 32 nurses. The findings showed that these nurses had difficulty detecting delirium in this clientele. Their detection sensitivity varied from 7.3% to 15.5% and its specificity ranged from 95.2% to 100%. The probability of detection was higher when the elderly person experienced pain accompanied by delirium. For clients' well-being and the credibility of the profession, it appears crucial that steps be taken immediately to enable nurses to become fully competent in assessing seniors' mental states. Training in the clinical examination of mental states, clinical mentoring and the integration of an assessment tool into nursing practice are among the means suggested.Perspective infirmière: revue officielle de l'Ordre des infirmières et infirmiers du Québec 5(2):12-20.
