Factors that contribute to underrecognition of delirium by registered nurses in acute care settings: a scoping review of the literature to explain this phenomenon

Abstract

While acute care registered nurses have historically reported dramatic changes in cognitive and neuro-biological functions in ill older adults, the literature highlighted in this scoping review revealed the following: (1) the need for further research to validate delirium assessment tools and, (2) the need for education and training for registered nurses on the use of these assessment tools to promote early recognition and thereby decrease the incidence of delirium in older adults.

Barriers and carriers: a multicenter survey of nurses’ barriers and facilitators to monitoring of nurse-sensitive outcomes in intensive care units

“…A major strength of this study is that we determined barriers and facilitators with regard to a wide range of NSOs, in contrast to previous studies focusing on one single NSO (El Hussein et al., 2014; Leistra et al., 2014; Strand & Lindgren, 2010; Wang & Tsai, 2010). As a result, we were able to draw more comprehensive conclusions about NSO monitoring by ICU nurses.…”

“…Lack of time, inadequacy of measurement tools, and workload were demonstrated to be important barriers. These factors have been linked to specific NSOs, such as pressure ulcers (Strand & Lindgren, 2010), malnutrition (Leistra et al., 2014), delirium (El Hussein, Hirst & Salyers, 2014), and pain (Wang & Tsai, 2010). However, there is limited evidence of barriers to the overall use and monitoring of NSOs.…”

Integrate Literature Review of Delirium on the Elders

“…Furthermore, delirium occurs in a short period accompanied by daily changes in cognitive behavior and psychological symptoms such as inattention, short memory, insomnia, sleep disturbances, irritable behavior, delusion, and illusion [10]. Finally, clear consciousness toward the environment might decrease along with consistent or transferred attention, altered perception of orientation and memory, verbal disturbances, and perceptual confusion manifesting as delusion; these symptoms could develop in a short period and disappear for 1 day [4,11]. The fluctuating processes of consciousness, cognition, memory, orientation, and verbalization lasting from a few hours to a few days can be divided into four types of delirium: overacted (irritable and aggressive), low reacted (delayed response and low psychomotor), combined (both symptoms), and unspecific [1,12].…”

“…Demographic and physical factors are age, gender, hospitalized days, institutionalization, trauma history, surgery, heart and lung illness, hypertension, diabetes, chronic kidney failure, gastrointestinal diseases, urinary and genital illness, metabolic disorders, central nervous system illness, peripheral vascular disease, stroke, dementia, malnutrition, fever, low albumin, low oxygen, dehydration, electronic imbalance, azotemia, infection, convulsion, and multiple or pain medications [1,2,4,5,[7][8][9][11][12][13][14][15][16][17][18]. Specifically, 3% to 5% of elderly people who have had hip and knee surgeries would experience acute confusion or delirium for a specific period.…”

“…Nevertheless, 65% of doctors and 43% of nurses could not identify the delirium problems of hospitalized elderly people [3]. Factors contributing to the under-recognition of delirium by registered nurses in acute care settings were determined to include the fluctuating nature of delirium, the effect of delirium education on its recognition, communication barriers, inadequate use of delirium assessment tools, lack of conceptual understanding of delirium, delirium as a burden, and the similarity of delirium and dementia [4]. Therefore, the purpose of this article is to provide an integrated review of the available literature on delirium in elderly populations.…”