Nursing perspectives on the confusion assessment method: a qualitative focus group study

Area of Science:

• Geriatric Medicine
• Nursing Practice
• Psychiatry

Background:

• The Confusion Assessment Method (CAM) is a widely used tool for delirium detection.
• Its accuracy is high with trained researchers but limited when used by nurses in clinical settings.
• Understanding nurses' perspectives on CAM use in orthopaedic wards is crucial for improving delirium assessment.

Purpose of the Study:

• To explore the perceptions and experiences of orthopaedic nurses regarding the use of the Confusion Assessment Method (CAM).
• To identify challenges and facilitators in the daily clinical application of the CAM by nurses.

Main Methods:

• A qualitative focus group study was conducted with 43 orthopaedic nurses.
• Focus groups were held in two academic hospitals in Hamilton, Ontario, Canada.
• Data analysis involved coding transcripts until theme saturation was achieved.

Main Results:

• Nurses reported mixed feelings about the CAM, with some appreciating its simplicity and others preferring narrative descriptions.
• A significant barrier identified was the lack of adequate training, with only 35% recalling formal CAM administration training.
• Common challenges included differentiating delirium from dementia, assessing non-verbal patients, time constraints, and pressure to diagnose delirium.

Conclusions:

• Orthopaedic nurses at the institutions studied demonstrated a poor understanding of the CAM.
• The findings suggest that the CAM may present significant implementation challenges in routine clinical practice.
• Further research and improved training strategies are needed to enhance the effective use of the CAM by nurses.