Elsevier

Journal of Pediatric Nursing

Volume 46, May–June 2019, Pages 6-11
Journal of Pediatric Nursing

Delirium Knowledge, Self-Confidence, and Attitude in Pediatric Intensive Care Nurses

https://doi.org/10.1016/j.pedn.2019.01.013Get rights and content

Highlights

  • Didactic education significantly increased delirium knowledge in PICU nurses.

  • A significant increase in delirium self-confidence and attitude among PICU nurses was associated with education.

  • Improvement science provides a framework to translate science to clinical care.

Abstract

Purpose

A diagnosis of delirium places a critically ill child at risk of increased morbidity/mortality. Although delirium is common in critically ill children, only 2% of pediatric intensive care units (PICU) screen for delirium. The impediments to screening include knowledge deficits regarding delirium and delirium screening tools. The purpose of this improvement science project was two-fold. The first was to implement delirium screening in a PICU. The second was to evaluate the impact of multifaceted education on PICU nurses' delirium knowledge, self-confidence and attitude towards delirium.

Design & method

A series of three plan-do-study-act cycles (PDSA) were used to implement this practice change. Multifaceted education was provided during the PDSA cycles. Two questionnaires were used to assess for changes in delirium knowledge, self-confidence and attitude towards delirium among PICU nurses. Analysis of variance (ANOVA) was used for data analysis.

Results

Forty-two PICU nurses completed a questionnaire measuring delirium knowledge, self-confidence, and attitude during each PDSA cycle. A significant increase in delirium knowledge, self-confidence, and attitude towards delirium was found after education (p = .003; p < .001; p = .036) and 3 months post implementation of delirium screening (p = .023; p < .001; p = .027) as compared to pre-education.

Conclusion & practice implications

Multifaceted education is a successful tool in improving nurses' knowledge, self-confidence and attitude regarding delirium. The use of PDSA cycles is a practical systematic method to improve quality of care. Improving knowledge, self-confidence and attitude have the potential to mitigate adverse effects of delirium in the critically ill child.

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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  • Cited by (0)

    1

    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.

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