Zhou Wen, Zheng Qiulan, Huang Miao, Zhang Chuanlai, Zhang Huan, Yang Li, Wu Taiqin, Gan Xiuni
Department of Nursing, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.
Front Psychiatry. 2023 Feb 1;13:1017283. doi: 10.3389/fpsyt.2022.1017283. eCollection 2022.
Delirium, a confused transient state of consciousness, can be divided into hyperactive, hypoactive, mixed, and no motor subtypes, according to different clinical manifestations. Several studies have investigated delirium subtypes in the knowledge dimension, but few studies have investigated delirium subtype in the attitude and practice dimensions. The barriers, knowledge sources, and practice details regarding subtype assessment are unclear.
This study had three objectives. First, we planned to investigate the KAP status regarding delirium and subtypes for nurses. Second, we wanted to identify factors affecting clinical nurses' KAP scores. Third, this study expected to explore more details regarding delirium and subtypes assessment, including assessment barriers, assessment instruments, and knowledge sources.
This multicentre cross-section study was conducted in 10 tertiary hospitals in three provinces, China, from January to April 2022. We investigated 477 nurses from six departments with a high prevalence. The self-developed KAP questionnaire regarding delirium and subtypes assessment had four parts: knowledge, attitude, practice, and source. Its reliability and validity were verified effectively by 2-round Delphi expert consultation.
A total of 477 nurses from the general intensive care unit (ICU), specialty ICU, orthopedics, thoracic surgery, operating room, and geriatrics were 28.3, 22.4, 22.2, 10.5, and 5.2%, respectively. The total KAP score regarding delirium and subtypes assessment was 60.01 ± 6.98, and the scoring rate was 73.18%. The scoring rate for knowledge, attitude, and practice was 58.55, 83.94, and 51.70%, respectively. More than half (54.1%) were unaware of the delirium subtypes assessment instruments. A total of 451 (94.6%) participants recognized the importance of nursing work for delirium prevention. A total of 250 (52.4%) nurses occasionally or sometimes assessed delirium subtypes, and 143 (30.0%) never assessed for delirium subtypes. We found that age, department, technical title, familiarity with delirium, familiarity with delirium subtypes, delirium training, and subtype training affected the total KAP scores. ICU nurses achieved the highest scores.
Chinese nurses' KAP status regarding delirium and subtypes assessment were barely acceptable, and the attitude score was positive, but knowledge and practice needed improvement. Meanwhile, the department was one of the significant KAP factors, and ICU nurses did better in delirium and subtype assessment in knowledge and practice dimension than other departments. Systematic and scientific training processes including subtype content and assessment tools are required. Experience still drives nurses' assessments of delirium and subtype. Adding the delirium assessment into routine tasks should be considered.
谵妄是一种意识混乱的短暂状态，根据不同临床表现可分为多动型、少动型、混合型和无运动型亚型。多项研究在知识维度对谵妄亚型进行了调查，但在态度和实践维度对谵妄亚型的研究较少。关于亚型评估的障碍、知识来源和实践细节尚不清楚。
本研究有三个目标。第一，我们计划调查护士对谵妄及其亚型的知识、态度和实践（KAP）状况。第二，我们想确定影响临床护士KAP评分的因素。第三，本研究期望探索关于谵妄及其亚型评估的更多细节，包括评估障碍、评估工具和知识来源。
本多中心横断面研究于2022年1月至4月在中国三个省份的10家三级医院进行。我们调查了来自六个高患病率科室的477名护士。自行编制的关于谵妄及其亚型评估的KAP问卷有四个部分：知识、态度、实践和来源。通过两轮德尔菲专家咨询有效地验证了其信效度。
来自综合重症监护病房（ICU）、专科ICU、骨科、胸外科、手术室和老年医学科的477名护士分别占28.3%、22.4%、22.2%、10.5%和5.2%。关于谵妄及其亚型评估的KAP总分为60.01±6.98，得分率为73.18%。知识、态度和实践的得分率分别为58.55%、83.94%和51.70%。超过一半（54.1%）的人不知道谵妄亚型评估工具。共有451名（94.6%）参与者认识到护理工作对预防谵妄的重要性。共有250名（52.4%）护士偶尔或有时评估谵妄亚型，143名（30.0%）护士从未评估过谵妄亚型。我们发现年龄、科室、职称、对谵妄的熟悉程度、对谵妄亚型的熟悉程度、谵妄培训和亚型培训影响KAP总分。ICU护士得分最高。
中国护士对谵妄及其亚型评估的KAP状况勉强可以接受，态度得分呈阳性，但知识和实践方面需要改进。同时，科室是影响KAP的重要因素之一，ICU护士在谵妄及其亚型评估的知识和实践维度上比其他科室表现更好。需要系统科学的培训过程，包括亚型内容和评估工具。经验仍然主导护士对谵妄及其亚型的评估。应考虑将谵妄评估纳入日常工作。
