Evaluation of a Web-Based Educational Model to Improve Nurse Detection of Delirium: An RCT

Wednesday, 1 August 2012

Judy M. McCrow, RN, BS, Grad, Dip:acutecare
School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Australia
Elizabeth R. Beattie, PhD, RN
Dementia Collaborative Research Centre, School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Australia
Karen Sullivan, PhD, MAPS, MAPS, CCN
School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Australia

Learning Objective 1: Identify delirium in older persons admitted to an acute care facility.

Learning Objective 2: understand the profound consequences associated with failure to identify and manage a person with delirium

Purpose: Delirium is a serious issue associated with high morbidity and mortality in older hospitalised people however, accurate nurse recognition is poor. This RCT evaluated the usability and effectiveness in terms of improving nurse recognition and knowledge of delirium using a specifically developed web-based learning site.

Methods: An RCT design study recruited 175 Registered Nurses from 3 acute healthcare facilities in Brisbane, Australia. At baseline (T1) participants completed a battery of questionnaires including delirium recognition (DR) and knowledge (DK) tests. Next participants were randomised to a control and intervention group. Intervention participants were provided with website access for a five-week period. Following this period DR and DK were assessed together with evaluation of the website (T2). Further assessments of DR and DK were assessed two months later (T3). An intention-to-treat analysis of participants who completed baseline assessments was undertaken using linear mixed-modeling (LMM) to determine differences in DR and DK between both groups at three different time-points.

 Results: Final sample (n=147) analysis showed participants reported high levels of satisfaction and site usability. There were no statistically significant effects of any baseline characteristics on final outcome scores. When compared with the control groups’ mean DK results the intervention groups’ change score results were higher over time [T3-T1 (t=3.390 p=<0.001) and T2-T1 baseline (t=5.04 p=<0.001)]. Statistically significant differences were also seen for DR when comparing T2-T1 results (t=2.55 p=0.012) but not for T3-T1 (t=1.84 p=0.068) comparisons.

 Conclusion: Findings support the concept that online learning is an effective and satisfying method of information delivery. Results showed that the website improved DK and DR scores and this website should be utilised to provide information to nurses about delirium. A critical next step is demonstrating the effect of the intervention in improving health outcomes for people with delirium.