Factors Affecting Nurses' Ability to Identify Delirium in Acute Care Settings

Delirium is a serious underrecognized health condition in hospitalized older adults. The current qualitative study used dimensional analysis to increase understanding of the clinical reasoning processes used by acute care nurses to assess for delirium.

Ten focus groups with experienced medical, surgical, and intensive care nurses (N = 39) from quaternary, community, and academic medical centers discussed their application of clinical reasoning processes to assess/detect delirium symptoms. Transcripts were inductively analyzed. Trustworthiness was checked with a subset of participants (n = 12).

Findings illustrate how nurses apply clinical reasoning to recognize and respond to delirium symptoms and navigate clinical and social structures to maintain patient safety. Clinical context and social structures are important conditions influencing nurse reasoning and judgment.

Further process improvement and research efforts should explore strategies to enhance interdisciplinary shared knowledge within a supportive environment to improve the detection and care to lessen the severity and duration of delirium for vulnerable patients.