A Survey of Nurses' Perspectives on Delirium Screening in Older Adult Medical Inpatients With Limited English Proficiency

Abstract

The Confusion Assessment Method (CAM) is commonly used to detect delirium but its utility in patients with limited English proficiency (LEP) is not well-established. In the current study, internal medicine nurses at an acute care hospital in Canada were surveyed on the use of the CAM in older adults with LEP. Nurses' perspectives were explored with a focus on barriers to administration. Fifty participants were enrolled (response rate = 47.6%). Twenty-eight (56%) participants stated they could not confidently and accurately assess delirium in patients with LEP. Twenty-nine (58%) participants believed the CAM is not an effective delirium screening tool in the LEP population. Barriers to screening included: challenges with interpretation services, dependence on family members, and fear that the assessment itself may worsen confusion. Our study is the first to describe specific barriers to administering the CAM in patients with LEP. Strategies are required to address these barriers and optimize delirium screening for patients with LEP. [ Journal of Gerontological Nursing, 47 (4), 29–34.]

Language discordance in emergency department delirium screening: Results from a qualitative interview‐based study

“…An interactive electronic device‐based game that relies on patient reaction times has shown promise in detecting clinically unrecognized ED delirium, 9 and could potentially be used with instructions delivered in a patient's primary language. Finally, as our participants and other studies suggest, in situations of language discordance, collateral information can be crucial in determining the presence of acute confusion 4 . The Single Question in Delirium is a simple collateral‐based delirium assessment tool that can be used in these situations 10 …”

“…Finally, as our participants and other studies suggest, in situations of language discordance, collateral information can be crucial in determining the presence of acute confusion. 4 The Single Question in Delirium is a simple collateral-based delirium assessment tool that can be used in these situations.…”

“…A small but growing number of EDs is adopting delirium screening 3 . In a recent study, inpatient healthcare providers reported difficulty using delirium screening tools when there is language discordance with patients, that is, a difference between the primary language spoken by clinicians and patients 4 . Patients whose primary language differs from the language of healthcare delivery may be more likely to develop delirium.…”

“…3 In a recent study, inpatient healthcare providers reported difficulty using delirium screening tools when there is language discordance with patients, that is, a difference between the primary language spoken by clinicians and patients. 4 Patients whose primary language differs from the language of healthcare delivery may be more likely to develop delirium. We aimed to determine current practices and identify concerns about ED delirium screening in situations of language discordance among early adopter EDs.…”

Reply to: Expanding options to include language barriers for predicting postoperative delirium in geriatric patients

“…One study in the inpatient setting described how in situations of patient-clinician language discordance, healthcare providers reported difficulty using delirium screening tools and recognizing delirium. 3 Little is known about best practices for identifying inattention or disorganized thinking, key features of delirium, through an interpreter; verbal and non-verbal cues that clue a clinician into a patient's acute confusion may be lost in translation, particularly via remote interpretation. Only one validation study has used professional interpreters to administer a delirium screening tool (4AT) to inpatients in the setting of patient-clinician language discordance, that is, to non-English speaking patients in Australia.…”