Improving Intensive Care Unit Nurses' Delirium Assessment Performance Through a Multimodal Educational Intervention.

Area of Science:

• Critical Care Medicine
• Nursing
• Geriatric Medicine

Background:

• Delirium is a common and serious complication in intensive care units (ICUs), affecting elderly and ventilated patients.
• Accurate delirium assessment is critical but often inconsistent.
• Intensive care unit (ICU) nurses' use of the Intensive Care Delirium Screening Checklist (ICDSC) may be limited without structured training.

Purpose of the Study:

• To evaluate the delirium assessment performance of ICU nurses using the Intensive Care Delirium Screening Checklist (ICDSC).
• To assess the effectiveness of a multimodal educational intervention for improving delirium assessment performance.

Main Methods:

• A pre- and post-intervention study was conducted in three medical ICUs in Northern Taiwan.
• Nurses' performance using the ICDSC was compared with assessments by a trained expert nurse.
• A 3-month multimodal educational intervention including lectures, scenario reviews, and bedside mentoring was implemented.
• Inter-rater agreement was assessed using Cohen's kappa and Gwet's AC1 statistics.

Main Results:

• Baseline agreement between ICU nurses and expert assessment was suboptimal (kappa = 0.63).
• The multimodal educational intervention significantly improved agreement (kappa = 0.74).
• Notable improvements were seen in assessing consciousness, attention, orientation, psychomotor activity, and sleep-wake cycles.
• Agreement remained poor for patients over 85 years and those under physical restraint.

Conclusions:

• A structured, multimodal educational intervention significantly enhanced ICU nurses' delirium assessment performance using the ICDSC.
• One-to-one coaching and scenario-based learning were particularly effective.
• Additional strategies are needed for assessing very elderly patients and those under physical restraint.