Emergency Nurses' Perspectives on Adopting Geriatric Screenings for Cognitive Impairment: A Qualitative Study

Cognitive impairment in older adults is underrecognized in emergency departments. Despite emergency nurses' central role in facilitating ED screening for clinical and social needs, little is known about their perspectives on implementing delirium and dementia screenings. Nurses can provide insights to promote the uptake of these screenings.

Using a case study approach, we conducted qualitative interviews with emergency nurses at a public safety net hospital about their perspectives on implementing screening for delirium and dementia. Interview topics were derived from an implementation science framework (Consolidated Framework for Implementation Research). We performed a combined deductive-inductive analysis.

Eleven nurses participated in interviews. Four overarching themes were identified. Emergency nurses viewed safety as the core function of screening. Emergency nurses identified adequate staffing, private care spaces, and electronic medical record support as important resources required to support screening implementation. Nurses perceived benefits of screening ED patients for cognitive impairment specifically related to hazards of ED boarding. However, they simultaneously found screenings complex and incompatible with their workflows and available health system resources.

Emergency nurses conceptualize screenings in terms of patient safety, which may be the best way to frame initiatives to implement screenings for cognitive impairment. In light of ED crowding and boarding's impacts on patient safety, nurses highlighted screening for cognitive impairment as increasingly relevant. However, they found current working conditions of delivering patient care in waiting rooms and hallways not conducive to implementing screenings. Using the Consolidated Framework for Implementation Research framework helped identify workflow limitations that are barriers to ED screening.