ICU nurses require training to spot delirium

Feb 21 2008

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.”