Delirium Knowledge, Self-Confidence, and Attitude in Pediatric Intensive Care Nurses
Section snippets
Background
Routine screening for delirium provides for early recognition and alerts caregivers of the need to intervene (Patel, Bell, & Traube, 2017; Schieveld, Ista, Knoester, & Molag, 2015). Screening critically ill children for delirium is recommended by the European Society of Paediatric and Neonatal Intensive Care (Harris et al., 2016), the American Association of Critical-Care Nurses (Pun & Boehm, 2016), and the American Nurses Association (American Nurses Association, 2016). However in one study,
Design
The plan, do study, act (PDSA) quality improvement method was used as a framework for this project. PDSA uses a four-step approach to implementing changes to improve quality of care (Taylor et al., 2014). In the plan stage, the problem is identified, and a plan for change is developed. In the do stage, the change is implemented and observed, and unexpected problems are documented. In the study stage, the success of the change is evaluated including what was learned and what went wrong. In the
RN sample
Of the 60 nurses employed as dedicated PICU staff at the initiation of the project, 42 (70%) completed the two delirium questionnaires at all three time points, and their data are the ones analyzed. Ten nurses declined to complete the questionnaires or did not complete all questions at one of the time periods. There was attrition: two nurses resigned, three transferred to other positions within the system, and one retired. Other missing data could be attributed to two nurses on leave of absence
Discussion
The purpose of this project was to evaluate nurses' delirium knowledge, self-confidence, and attitude towards delirium post implementation of delirium screening as a standard of care. Delirium screening was implemented as standard of care for critically ill children in a community hospital following a series of interventions over 3 months. As part of the project, the screening tool was embedded in the EHR, providing a prompt to nurses to complete and document screening. Multiple educational
Limitations
Limitations to this project include use of a non-validated delirium knowledge questionnaire. This survey was developed at Johns Hopkins University and is the only published instrument on this topic. Another potential limitation is selection bias among the nurses who responded to the surveys and completed the three questionnaires. Those who had different baseline delirium knowledge and self-confidence and attitudes may have been motivated to respond to the survey differently than those who did
Implications for practice
This project utilizing multifaceted education demonstrated increased knowledge, self-confidence, and improved attitude towards delirium in PICU nurses. Based on our work and previous similar studies, multifaceted education has been shown to be the most effective in increasing nurses' knowledge of delirium. Education is only one component needed to reliably screen for delirium in critically ill children. Ongoing monitoring, reinforcement of delirium screening and discussion on interdisciplinary
Conclusion
Increasing PICU nurses' knowledge of delirium, improving self-confidence and attitude towards delirium is the first step to mitigating adverse outcomes from delirium for critically ill children. Multifaceted education increased delirium knowledge, self-confidence, and improved attitude towards delirium for PICU nurses. Ongoing monitoring is needed to ensure staff adherence to screening. Education is only one strategy to increase early recognition of delirium.
Sustainability of delirium screening
Conflict of interest
The authors declare no conflict of interest.
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Oregon Health & Science University, School of Nursing, Mail Code: SN-5S (569), 3455 SW US Veterans Hospital Rd., Portland, OR 97239, Doernbecher Children's Hospital.