Objective:The purpose of the project was to determine the effectiveness of a multifaceted educational program to enhance nurses’ knowledge and confidence in performing the delirium screening assessment in a surgical-trauma intermediate-care unit in an academic setting.
Methods: A quasi-experimental pre and post-test design was used. The fundamental elements of Bandura’s Self-Efficacy theory were used to develop the educational intervention. Multifaceted education included an online didactic session with a video simulation and 1:1 bedside coaching with the Nursing Delirium Screening Scale (NU-DESC). This was conducted in the surgical intermediate-care unit of an academic medical center. The Nursing Delirium Knowledge Questionnaire (NDKQ) and the Confidence Scale (C-Scale) were used to measure nurses’ knowledge and confidence before and after the education. Direct observation in performing the Nu-DESC assessment was conducted by the investigator and a unit delirium champion before and after the education.
Results: Twenty-three nurses participated in the study from September to October 2018. The majority were less than 41 years old (n= 17, 73.9%) and had at least a bachelor of science in nursing degree (n= 18, 78.3%) with up to five years of nursing experience (n= 14, 60.9%). Sixteen (69.6%) of the participants reported having received at least one delirium-related education training. For the 25-item NDKQ, the pre-assessment scores ranged between 11 and 25 with an overall mean score of 74.8% (M= 18.70, SD = 3.30) and the post-assessment scores ranged between 17 and 25 with an overall mean score of 91.5% (M= 22.87, SD= 2.42). Fourteen respondents (60.9%) scored greater than 75% on the overall pre-assessment, which increased to twenty-one (91.3%) on the overall post-assessment. The mean increase in the overall NDKQ was 4.17 (SD= 2.98) with a 95% confidence interval ranging between 2.98and 5.46. There was a statistically significant improvement in the overall NDKQ scores from the pre-assessment to the post-assessment, t (22) = 6.718, p< .001 (two-tailed), based on a paired t-test. For the five-item C-Scale, the mean scores were 16.43 (SD= 4.37, range 8-25) for the pre-assessment and 22.91 (SD= 2.70, range 16-25) for the post-assessment. Twelve (52.2%) of the participants reported having above an average level of confidence (> 16 out of 25 scores) in performing the Nu-DESC assessment and only one reported having the highest confidence (25 out of 25 scores) on the pre-assessment. After the educational intervention, all (100%) reported having above an average level of confidence and ten of those (43.5%) achieved the highest confidence level. The mean increase in confidence scores was 6.48 (SD= 3.68), which is a statistically significant improvement, t(22) = 8.445, p< 001 (two-tailed), based on a paired t-test. At the baseline observation, the majority of the nurses (n= 18, 78.3%) did not screen patients correctly using the Nu-DESC and were in disagreement with the evaluators. Of those (n= 12) who reported themselves having an above average level of confidence in performing the Nu-DESC assessment on the pre-assessment, ten of those (83.3%) failed to perform the assessment correctly. After the 1:1 bedside coaching, all nurses (n= 23, 100%) performed correctly in using a Nu-DESC and results were in agreement with the coaches. The performance in using the Nu-DESC was significantly improved after the 1:1 bedside coaching (p< .001). The pre-post change in the knowledge assessment was positively associated with the pre-post change in the confidence assessment (rho (22) = .529, p = .009).
Conclusion: Prompt nurse recognition of delirium allows the patient and caregiver to avoid additional healthcare costs and suffer from a preventable condition. Educational programs are needed to increase knowledge of delirium and confidence of nurses for delirium recognition. This study demonstrated that the multimodal educational intervention with the use of the Nu-DESC tool is crucial to improve nurses’ knowledge and confidence for delirium recognition. The results validated the consistency of the evidence regarding merits of a multimodal educational intervention. The educational intervention should focus on an individualized learning approach with a specific targeted patient population and currently used delirium screening tool in practice. Future research is warranted to investigate the knowledge and confidence retention after education and patient outcomes affected by the accurate delirium assessment.