Rice Karen L, Bennett Marsha, Gomez Maureen, Theall Katherine P, Knight Michael, Foreman Marquis D
Center for Nursing Research, Ochsner Medical Center, New Orleans, Louisiana 70112, USA.
Clin Nurse Spec. 2011 Nov-Dec;25(6):299-311. doi: 10.1097/NUR.0b013e318234897b.
Delirium is the most frequent complication associated with hospitalization of older adults, responsible for 17.5 million additional hospital days in the United States each year; yet, nurses fail to recognize it more than 30% of the time.
The specific aim of the study was to measure staff nurses' recognition of delirium in hospitalized older adults by comparing nurse and expert diagnostician ratings for delirium using the Confusion Assessment Method (CAM).
This study investigated the rate of agreement/disagreement between researchers and a convenience sample of 167 nurses caring for 170 medical surgical patients (>65 years) in detecting delirium. Paired (nurse vs researcher) CAM ratings were completed at least every other day until either discharge or delirium was detected by the researcher.
The researcher detected delirium in 7% (12/170) of patients. Nurses failed to recognize delirium 75% (9/12) of the time, with poor agreement between nurse/researcher for all observations (κ = 0.34). A generalized estimating equation logistic regression model identified independent predictors of nurses' underrecognition of delirium that included increasing age and length of stay, dementia, and hypoactive delirium.
Findings provide further support for the significance of nurses' underrecognition of delirium in the hospitalized older adult when using the CAM. Additional research is warranted regarding the clinical decision-making processes that nurses use in assessing acute cognitive changes and in identifying strategies to improve delirium recognition.
谵妄是与老年人住院相关的最常见并发症，在美国每年导致额外1750万个住院日；然而，护士超过30%的时间未能识别出谵妄。
本研究的具体目的是通过使用谵妄评定法（CAM）比较护士和专家诊断医师对谵妄的评定，来衡量在职护士对住院老年人谵妄的识别情况。
本研究调查了研究人员与一个便利样本中的167名护士在检测170名内科和外科患者（年龄>65岁）谵妄时的一致/不一致率。至少每隔一天完成一次配对（护士与研究人员）的CAM评定，直至患者出院或研究人员检测到谵妄。
研究人员在7%（12/170）的患者中检测到谵妄。护士在75%（9/12）的时间里未能识别出谵妄，护士/研究人员之间对所有观察结果的一致性较差（κ = 0.34）。一个广义估计方程逻辑回归模型确定了护士对谵妄识别不足的独立预测因素，包括年龄增长、住院时间延长、痴呆和活动减退型谵妄。
研究结果进一步支持了在使用CAM时护士对住院老年人谵妄识别不足的重要性。有必要针对护士在评估急性认知变化和确定改善谵妄识别策略时所使用的临床决策过程开展更多研究。
