Multimodal Education Program to Improve Nurses' Knowledge and Confidence on Delirium Recognition in a Surgical-Trauma Intermediate-Care Setting

Background: High incidences of delirium in hospitalized patients have been reported in the United States, causing an economic burden in healthcare. Delirium is significantly associated with increased morbidity and mortality in hospitalized patients. The lack of knowledge about and confidence in performing delirium assessments has led to significant under-recognition of delirium by nurses. Evidence-based educational strategies have demonstrated improvement in nurses’ knowledge of delirium and confidence in delirium recognition. A lack of literature exists regarding consistent outcomes of educational methodologies affecting the measurement of nurses’ performance of delirium screening.
Purpose: The purpose of the project was to determine the effectiveness of a multimodal educational program to enhance nurses’ knowledge and confidence in performing the delirium screening assessment in a surgical-trauma intermediate-care unit in an academic setting.
Methods: A quasi-experimental pre and post-test design was used. The fundamental elements of Bandura’s Self-Efficacy theory were used to develop the educational intervention. Multimodal education included an online didactic session with a video-recorded simulation and 1:1 bedside coaching with return demonstration in using the Nursing Delirium Screening Scale (NU-DESC). The Nursing Delirium Knowledge Questionnaire (NDKQ) and the Confidence Scale (C-Scale) were used to measure nurses’ knowledge and confidence before and after the education. Direct observation in performing the Nu-DESC assessment was conducted before and after the education.
Results: Twenty-three nurses participated in the study from September to October 2018. The majority of nurses were less than 41 years old (73.9%) and had a BSN degree (78.3%) with less than six years of nursing experience (60.9%). There was a statistically significant improvement in the overall NDKQ scores and C-Scale from the pre-assessment to the post-assessment (p < .001). The performance in using the Nu-DESC was significantly improved after the 1:1 bedside coaching (p < .001). The pre-post change in the knowledge assessment was positively associated with the pre-post change in the confidence assessment (p = .009).
Discussion: This study demonstrated that the multimodal educational intervention with the use of the Nu-DESC instrument is crucial to improve nurses’ knowledge and confidence for delirium recognition. The results validated the consistency of the evidence regarding merits of a multimodal educational intervention. The educational intervention should focus on an individualized learning approach with a specific targeted patient population and currently used delirium screening tool in practice. Future research is warranted to investigate the knowledge and confidence retention after education and patient outcomes affected by the accurate delirium assessment.