Nurses Opinions Regarding Delirium Care in the Older General Hospital Population and in Older Cardiac Surgery Patients Specifically

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. The start of delirium is usually rapid — within hours or a few days. It is also a high prevalent postoperative complication in older cardiac surgery patients. An occurring delirium can have drastic long term consequences for the patient, like prolonged (months) functional (activity of daily live) dependency, an enormous fear because of occurring hallucinations, increased morbidity and mortality. Consequently, a delirium increases patient burden, healthcare demand and healthcare costs.

Preventive interventions, diagnosis and treatment of delirium require specialized knowledge and skills. Since nurses play a key role in hospital care, a successful implementation of nursing interventions for prevention, early and accurate diagnosis and treatment of delirium in older surgery patients is important. In this study, the authors aimed to gain insight in opinions and beliefs of nurses in hospitals concerning prevention, diagnosis and treatment of delirium in older hospital patients in general and specifically in older cardiac surgery patients.

In a cross-sectional study from February to July 2010, the authors distributed a survey on beliefs on delirium care among 368 nurses in three hospitals in the Netherlands, in one hospital in all wards with older patients and in two hospitals in the cardiac surgery wards only.

The results revealed that although in literature incidence rates up to 54.9% in cardiac surgery patients in hospitals were reported, with a response rate of 68% (250), half of the nurses believed that the incidence of delirium was not even 10%. Two thirds think that delirium in patients was preventable. Although, the Delirium Observation Scale was most often used for screening delirium, nearly all nurses did not routinely screen patients for delirium. Opinions on delirium of nurses working in cardiac surgery wards did not differ from nurses caring for older patients in other hospital wards.

In summary, although nurses in the hospitals do have knowledge on prevention, diagnosis and treatment of delirium, they underestimate the occurrence of delirium in patients. As a consequence, they do not screen patients on a routine basis. And because they do not screen patients on a routine basis they underestimate the incidence of delirium in older patients during their hospital admission.

Article by Roelof Ettema, et al, from The Netherlands.

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