Validation of Finnish Neecham Confusion Scale and Nursing Delirium Screening Scale using Confusion Assessment Method algorithm as a comparison scale

Abstract

BackgroundDelirium is a common clinical problem with acute and fluctuating onset. Early notification of its symptoms can lead to earlier detection and management of this state. Valid and reliable instruments are required for successful nursing practice. The purpose of the study was to psychometrically test the Finnish versions of the Neecham Confusion Scale (NEECHAM) and the Nursing Delirium Screening Scale (Nu-DESC) in surgical nursing care, utilizing the Confusion Assessment Method (CAM) algorithm as a comparison scale.MethodsThis randomized, blinded, instrument testing study was conducted at one university hospital in one surgical unit. Study patients (n = 112) meeting the pre-set criteria were assessed by the principal investigator (PI) and a registered nurse (RN, n = 18). Internal consistency, inter-rater reliability, and concurrent validity of the scales were calculated and face validity and usability evaluated.ResultsInternal consistency was from .76 to .86 for all three scales. Inter-rater reliability between PI and RNs was .87 with NEECHAM, .60 with CAM and .47 with Nu-DESC. Concurrent validity was .56 and .59 between CAM and NEECHAM, and .68 and .72 between NEECHAM and Nu-DESC. In the PI group, the correlation between CAM and Nu-DESC was .91, in the RN’s group .42. Nu-DESC was evaluated as the most usable scale.ConclusionThe findings strengthen the earlier research on the scales and indicate that the Finnish NEECHAM and Nu-DESC correlates with CAM algorithm and with each other. They seem to be clinically viable in assessing patients’ delirium in surgical wards but more validity testing is needed.

Delirium screening instruments administered by nurses for hospitalized patients - literature review

“…According to van Velthuijsen et al (2016), as the NEECHAM is a tool combining interactive and observational aspects, it takes longer to administer and is therefore more time-consuming, and training is required for nurses. Finnish authors Poikajärvi et al (2017) tested and compared the properties of the NEECHAM and the NU-DESC and confirmed that both tools are reliable and practical for use by nurses. In terms of validity of both tools, they suggest further testing.…”

“…AUC and ROC ranged between 0.76 (Lingehall et al, 2012) and 0.99 (Radtke et al, 2010). Reliability ranged from 0.47 (Poikajärvi et al, 2017) to 0.94 (Spedale et al, 2016). Cut off score ranged from 2 to 3 (Table 2).…”

“…Two of the included studies tested the NEECHAM Delirium Detection Scale (DDS) (Sörensen Duppils, Johansson, 2011; Poikajärvi et al, 2017). NEECHAM is a nine-item measuring tool intended for use by general nurses.…”

“…The studies were conducted in Finland and Sweden at surgical and orthopaedic departments, with samples of 112 and 147 participants, respectively. Only Poikajärvi et al (2017) included the duration (20 months) of the study (Table 3), while only Sörensen Duppils, Johansson (2011) provided values for sensitivity (100%) and specificity (91%). Positive and negative predictive values and reliability were included only in the study by Poikajärvi et al (2017) (Table 2).…”

“…No reliability values were provided in either study. AUC was provided only in Poikajärvi et al (2017) at 0.87. The cut-off score was 25 points (Sörensen Duppils, Johansson, 2011).…”