The Effects of Delirium Care Training Program for Nurses in Hospital Nursing Units

Moonja Kim; Haejung Lee

doi:10.7469/kjan.2014.26.5.489

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Kim and Lee: The Effects of Delirium Care Training Program for Nurses in Hospital Nursing Units

Original Article

Korean J Adult Nurs 2014;26(5):489-499.

Published online: NaN October 2014

DOI: https://doi.org/10.7469/kjan.2014.26.5.489

The Effects of Delirium Care Training Program for Nurses in Hospital Nursing Units

Moonja Kim, Haejung Lee

College of Nursing, Pusan National University, Yangsan, Korea

Corresponding author: Lee, Haejung College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 626-770, Korea. Tel: +82-51-510-8344, Fax: +82-51-510-8308, E-mail: haejung@pusan.ac.kr

Received 6 July 201420 September 2014 Accepted 24 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to examine the effects of delirium care training program on the nurses’ knowledge of delirium, self-confidence and performance levels in caring patients with delirium.

Methods

The study was used a quasi-experimental design. The participants were 131 nurses in general nursing units in B and J hospitals. Sixty four nurses in B hospital were allocated into the experimental group and 67 nurses from J hospital into the control group. The delirium care training program was composed of lecture and clinical practice. Clinical practice of delirium care was applied everyday for 4 consecutive weeks starting from the admission day of the older adults(≥70 years old), using ‘short CAM' and ‘nursing checklist for delirium prevention’.

Results

The knowledge of delirium, self-confidence in caring patients, and performance levels of nursing care were significantly increased in the experimental group compared to the control group.

Conclusion

The findings of this study provided the evidence for the potential utility of the delirium care training program and underscored the needs of broader application of the training program of delirium care for nurses in general nursing units.

Keywords: Education, Nurses, Delirium

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Table 1.

Components and Contents of The Delirium Care Training Program

Components		Contents
Education (1 hour)		․ Provide one hour lecture about the definition, prevalence, characteristics, categories, possible causes, assessment tools, and intervention of delirium.
		․ Introduce 'delirium assessment tools' and 'checklist for nursing intervention of patients with delirium' and educate how to use the tools and checklists.
		․ Questions and answers.
Practical training (4 weeks)	Delirium assessment tool	․ Perform the short CAM for every older patient (≥70) who admitted to the floor from the admission date to 7 days after admission.
	Delirium assessment tool	․ Get feedback from charge nurses about the accurate usage of the delirium assessment tool.
	Checklist for preventive nursing care of delirium	․ Perform 'checklist for preventive nursing of delirium' for every older patient (≥70) who admitted to the floor from the admission date to 7 days after admission.
	Checklist for preventive nursing care of delirium	․ Share the experience with the principle investigator about the difficulties to perform the checklist, missing items and reasons. Get feedback from the principle investigator about the accurate usage of the checklist.

Table 2.

Homogeneity of General Characteristics between the Experimental and Control Groups (N=131)

Characteristics	Categories	Exp. (n=64)	Cont. (n=67)	x²	p
Characteristics	Categories	n (%)	n (%)	x²	p
Age (year)	＜25	34 (53.1)	28 (41.8)	4.78	.092
	25~29	25 (39.1)	25 (37.3)
	≥30	5 (7.8)	14 (20.9)
Marital status	Unmarried	60 (93.8)	57 (85.1)	2.58	.108
Marital status	Married	4 (6.3)	10 (14.9)	2.58	.108
Religion	Christian	5 (7.8)	7 (10.4)	0.90	.825
	Catholic	2 (3.1)	3 (4.5)
	Buddhist	15 (23.4)	12 (17.9)
	None	42 (65.6)	45 (67.2)
Educational level	Junior college	53 (82.8)	52 (77.6)	0.56	.456
Educational level	≥University	11 (17.2)	15 (22.4)	0.56	.456
Clinical career (year)	≥1~＜5	47 (73.4)	50 (74.6)	0.02	.877
Clinical career (year)	≥5	17 (26.6)	17 (25.4)	0.02	.877
Department	Internal medicine	17 (26.6)	24 (35.8)	8.72	.069
	Orthopedics	34 (53.1)	20 (29.9)
	General surgery	8 (12.5)	11 (16.4)
	Neurology or neurosurgery	4 (6.3)	7 (10.4)
	Other	1 (1.6)	5 (7.5)
Necessity of delirium education	Urgently needed	15 (23.4)	13 (19.4)	4.58	.102
	Needed	47 (73.4)	45 (67.2)
	So so	2 (3.1)	9 (13.4)
Experience of delirium education	Yes	22 (34.4)	29 (43.3)	1.09	.296
Experience of delirium education	No	42 (65.6)	38 (56.7)	1.09	.296
Ways to get delirium education	In hospital	4 (18.2)	4 (13.8)	0.18	.670
Ways to get delirium education	In college	18 (81.8)	25 (86.2)	0.18	.670
Number of education	1	16 (72.7)	18 (66.7)	1.83	.609
	2	3 (13.6)	6 (22.2)
	≥3	3 (13.6)	3 (11.1)
Had manuals for delirium care	Yes	4 (6.3)	4 (6.0)	0.00	.947
Had manuals for delirium care	No	60 (93.8)	63 (94.0)	0.00	.947

Exp.=experimental group; Cont.=control group.

Table 3.

Homogeneity of Knowledge of Delirium, Self-confidence of Nursing, and Nursing Performance (N=131)

Variables	Exp. (n=64)	Cont. (n=67)	t	p
Variables	M±SD	M±SD	t	p
Total Knowledge of delirium	33.58±3.47	33.30±3.47	0.46	.646
Etiology	9.19±0.97	8.96±1.15	1.25	.215
Symptoms	13.64±1.98	13.61±1.85	0.09	.932
Management	10.75±2.20	10.73±2.24	0.05	.962
Self-confidence of nursing	49.58±11.44	53.65±14.28	-1.80	.075
Nursing performance	2.79±0.28	2.89±0.38	-1.56	.121

Exp.=experimental group; Cont.=control group.

Table 4.

Comparison of Knowledge of Delirium, Self-confidence of Nursing, and Nursing Performance between the Experimental and Control Groups (N=131)

Variables	Exp. (n=64)		Paired t-test (p)	Cont. (n=67)		Paired t-test (p)	Group differences at posttests (p)
	Pretest	Posttest		Pretest	Posttest
	M±SD	M±SD		M±SD	M±SD
Total Knowledge of delirium	e 33.58±3.47	38.77±2.75	11.62	33.30±3.47	32.84±3.63	-1.06	10.49
Total Knowledge of delirium			(＜.001)			(.295)	(＜.001)
Etiology	9.19±0.97	9.63±0.55	3.72	8.96±1.15	8.97±1.13	0.86	4.25
Etiology			(＜.001)			(.932)	(＜.001)
Symptoms	13.64±1.98	15.83±2.03	8.13	13.61±1.85	12.87±1.87	-1.85	8.69
Symptoms			(＜.001)			(.069)	(＜.001)
Management	t 10.75±2.20	13.31±1.14	9.98	10.73±2.24	11.00±2.15	0.98	7.73
Management			(＜.001)			(.331)	(＜.001)
Self-confidence of nursing	49.58±11.44	72.31±7.33	16.67	53.65±14.28		-0.39	9.73
Self-confidence of nursing			(＜.001)		53.05±14.36	(.695)	(＜.001)
Nursing performance	2.79±0.28	3.34±0.35	11.66	2.89±0.38	2.82±0.42	-1.41	7.77
Nursing performance			(＜.001)			(.163)	(＜.001)

Exp.=experimental group; Cont.=control group.

Table 5.

Differences in Item by Item Nursing Performance in the Experimental Group (N =64)

Item	Nursing performance	Pretest	Post-test	Differences (Post-Pre)	p
Item	Nursing performance	M±SD	M±SD	Differences (Post-Pre)	p
1	Assess potential risks of delirium	2.19±0.91	2.80±0.89	0.61	＜.001
2	Assess the patient's mental status accurately	3.28±0.68	3.42±0.59	0.14	.151
3	Talk to the patient repeatedly about date, time, place, people	2.47±0.69	3.38±0.68	0.91	＜.001
4	Explain to the patient before providing nursing care (or treatment)	3.55±0.64	3.72±0.49	0.17	.047
5	Listen to the words of the patient	3.42±0.66	3.77±0.43	0.34	＜.001
6	Communicate softly in the patient room	3.22±0.72	3.50±0.59	0.28	.013
7	Perform all nursing activities (or treatment) at the same time during the night	2.81±0.87	3.41±0.60	0.59	＜.001
8	Keep Machines' alarm sounds at minimum	2.78±0.98	3.17±0.63	0.39	.005
9	Encourage to use eye glasses if visual acuity is impaired	2.88±0.92	3.47±0.59	0.59	＜.001
10	Remove catheters as soon as possible	2.70±0.79	3.08±0.60	0.38	.002
11	Encourage to use hearing aid and communication tools if needed (ex: word cards)	2.66±0.91	3.31±0.75	0.66	＜.001
12	Perform cognitive stimulation activities (ex: word games, repeated information, provide a clock or calendar)	1.92±0.76	3.14±0.79	1.22	＜.001
13	Avoid restraints	2.16±1.04	3.27±0.93	1.11	＜.001
14	Check the signs of dehydration	2.47±0.69	3.27±0.67	0.80	＜.001
15	Check the triggers, if delirium occurs	2.61±0.66	3.17±0.61	0.56	＜.001
16	Control pain	3.53±0.50	3.78±0.42	0.25	.001
17	Encourage family members to be with patients at bed side	3.34±0.62	3.61±0.49	0.27	.006
18	Provide safe environment keeping soft light during the night	3.19±0.61	3.64±0.48	0.45	＜.001
19	Educate the family and caregivers about delirium	2.70±0.85	3.36±0.68	0.66	＜.001
20	Keep the environment clean removing unnecessary objects	2.80±0.72	3.22±0.63	0.42	＜.001
21	Encourage to bring familiar objects or family photos, etc.	1.98±0.85	2.88±0.83	0.89	＜.001
22	Encourage early ambulation	2.67±0.76	3.53±0.59	0.86	＜.001
23	Consult with doctors to reduce the number of medication	2.56±0.91	2.98±0.70	0.42	.001

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