Educational Interventions to Improve Recognition of Delirium: A Systematic Review

Abstract

Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is warranted to better manage the disease and prevent the adverse outcomes associated with it. The purpose of this article is to review the literature concerning educational interventions focusing on recognition of delirium. The Medline and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases were searched for studies with specific educational focus in the recognition of delirium, and 26 studies with various designs were identified. The types of interventions used were classified according to the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, and outcomes were sorted according to Kirkpatrick's hierarchy. Educational strategies combining predisposing, enabling, and reinforcing factors achieved better results than strategies that included one or two of these components. Studies using predisposing, enabling, and reinforcing strategies together were more often effective in producing changes in staff behavior and participant outcomes. Based on this review, improvements in knowledge and skill alone seem insufficient to favorably influence recognition of delirium. Educational interventions to recognize delirium are most effective when formal teaching is interactive and is combined with strategies including engaging leadership and using clinical pathways and assessment tools. The goal of the current study was to systematically review the published literature to determine the effect of educational interventions on recognition of delirium.

Jordanian Intensive Care Unit Nurses’ Knowledge of Delirium Recognition

“…The results of this study showed three outcomes supporting this idea. ( Donahue, Kazer, Smith, & Fitzpatrick, 2011;Vargheseet al,2014;Yanamadala, Wieland, & Heflin, 2013) showed that educational programs and bedside coaching ( El Hussein, Hirst, &Salyers, 2015) were effective in increasing knowledge, and producing positive changes in staff behaviors, practices and participant outcomes. These educational programs included information about the eight topics mentioned above regarding delirium and the screening instruments.…”

The role of diagnosis in delirium

“…In the study by Davis and MacLullich (2009), 86% respondents were aware that acute onset was an essential criterion for delirium and almost all agreed that doctors working in acute medical settings should have a good working knowledge of delirium. Importantly, findings of a recent systematic review failed to show that improvement in skills and knowledge alone had a favorable influence on the recognition of delirium (Yanamadala et al, 2013).…”

“…While, changes to healthcare systems that facilitate the assessment and management of the elderly are important, we believe that deeper thinking into the nature of medical and nursing training is necessary for finding solutions for improved healthcare for the geriatric population. Yanamadala et al (2013) used the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model in their systematic review. They classified educational interventions into four types depending on the nature of the intervention, i.e., whether they were didactic; whether they facilitated change in performance by providing; reinforced learning through reminders and feedback or; were a combination of all three.…”

“…The narrative of delirium misdiagnosis is thus typically, though not universally, framed as one of under-recognition (Steis and Fick, 2008;Teodorczuk et al, 2012;Yanamadala et al, 2013;Inouye et al, 2014). The implication is that with improved knowledge, improved recognition will follow.…”

Post-Operative Delirium in the Elderly: Diagnosis, Risk Factors and Prevention

“…As recommended by AGS, multiple non-pharmacological interventions have been used to prevent and treat delirium including behavioral interventions, rehabilitation, environmental adaptation, psychological and social supports, medication reductions and system and process changes (60). Several programs including various nonpharmacological interventions have been studied (61,62).…”