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Original Article

The Effects of Delirium Care Training Program for Nurses in Hospital Nursing Units

Moonja Kim, Haejung Lee
Korean Journal of Adult Nursing 2014;26(5):489-499.
Published online: October 31, 2014

College of Nursing, Pusan National University, Yangsan, Korea

Corresponding author: Lee, Haejung College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 626-770, Korea. Tel: +82-51-510-8344, Fax: +82-51-510-8308, E-mail: haejung@pusan.ac.kr
• Received: July 6, 2014   • Accepted: September 24, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to examine the effects of delirium care training program on the nurses’ knowledge of delirium, self-confidence and performance levels in caring patients with delirium.
  • Methods
    The study was used a quasi-experimental design. The participants were 131 nurses in general nursing units in B and J hospitals. Sixty four nurses in B hospital were allocated into the experimental group and 67 nurses from J hospital into the control group. The delirium care training program was composed of lecture and clinical practice. Clinical practice of delirium care was applied everyday for 4 consecutive weeks starting from the admission day of the older adults(≥70 years old), using ‘short CAM' and ‘nursing checklist for delirium prevention’.
  • Results
    The knowledge of delirium, self-confidence in caring patients, and performance levels of nursing care were significantly increased in the experimental group compared to the control group.
  • Conclusion
    The findings of this study provided the evidence for the potential utility of the delirium care training program and underscored the needs of broader application of the training program of delirium care for nurses in general nursing units.
  • Key Words: Education; Nurses; Delirium
Table 1.
Components and Contents of The Delirium Care Training Program
Components Contents
Education (1 hour) ․ Provide one hour lecture about the definition, prevalence, characteristics, categories, possible causes, assessment tools, and intervention of delirium.
․ Introduce 'delirium assessment tools' and 'checklist for nursing intervention of patients with delirium' and educate how to use the tools and checklists.
․ Questions and answers.
Practical training (4 weeks) Delirium assessment tool ․ Perform the short CAM for every older patient (≥70) who admitted to the floor from the admission date to 7 days after admission.
․ Get feedback from charge nurses about the accurate usage of the delirium assessment tool.
Checklist for preventive nursing care of delirium ․ Perform 'checklist for preventive nursing of delirium' for every older patient (≥70) who admitted to the floor from the admission date to 7 days after admission.
․ Share the experience with the principle investigator about the difficulties to perform the checklist, missing items and reasons. Get feedback from the principle investigator about the accurate usage of the checklist.
Table 2.
Homogeneity of General Characteristics between the Experimental and Control Groups (N=131)
Characteristics Categories Exp. (n=64) Cont. (n=67) x2 p
n (%) n (%)
Age (year) ＜25 34 (53.1) 28 (41.8) 4.78 .092
25~29 25 (39.1) 25 (37.3)
≥30 5 (7.8) 14 (20.9)
Marital status Unmarried 60 (93.8) 57 (85.1) 2.58 .108
Married 4 (6.3) 10 (14.9)
Religion Christian 5 (7.8) 7 (10.4) 0.90 .825
Catholic 2 (3.1) 3 (4.5)
Buddhist 15 (23.4) 12 (17.9)
None 42 (65.6) 45 (67.2)
Educational level Junior college 53 (82.8) 52 (77.6) 0.56 .456
≥University 11 (17.2) 15 (22.4)
Clinical career (year) ≥1~＜5 47 (73.4) 50 (74.6) 0.02 .877
≥5 17 (26.6) 17 (25.4)
Department Internal medicine 17 (26.6) 24 (35.8) 8.72 .069
Orthopedics 34 (53.1) 20 (29.9)
General surgery 8 (12.5) 11 (16.4)
Neurology or neurosurgery 4 (6.3) 7 (10.4)
Other 1 (1.6) 5 (7.5)
Necessity of delirium education Urgently needed 15 (23.4) 13 (19.4) 4.58 .102
Needed 47 (73.4) 45 (67.2)
So so 2 (3.1) 9 (13.4)
Experience of delirium education Yes 22 (34.4) 29 (43.3) 1.09 .296
No 42 (65.6) 38 (56.7)
Ways to get delirium education In hospital 4 (18.2) 4 (13.8) 0.18 .670
In college 18 (81.8) 25 (86.2)
Number of education 1 16 (72.7) 18 (66.7) 1.83 .609
2 3 (13.6) 6 (22.2)
≥3 3 (13.6) 3 (11.1)
Had manuals for delirium care Yes 4 (6.3) 4 (6.0) 0.00 .947
No 60 (93.8) 63 (94.0)

Exp.=experimental group; Cont.=control group.

Table 3.
Homogeneity of Knowledge of Delirium, Self-confidence of Nursing, and Nursing Performance (N=131)
Variables Exp. (n=64) Cont. (n=67) t p
M±SD M±SD
Total Knowledge of delirium 33.58±3.47 33.30±3.47 0.46 .646
   Etiology 9.19±0.97 8.96±1.15 1.25 .215
   Symptoms 13.64±1.98 13.61±1.85 0.09 .932
   Management 10.75±2.20 10.73±2.24 0.05 .962
Self-confidence of nursing 49.58±11.44 53.65±14.28 -1.80 .075
Nursing performance 2.79±0.28 2.89±0.38 -1.56 .121

Exp.=experimental group; Cont.=control group.

Table 4.
Comparison of Knowledge of Delirium, Self-confidence of Nursing, and Nursing Performance between the Experimental and Control Groups (N=131)
Variables Exp. (n=64) Paired t-test (p) Cont. (n=67) Paired t-test (p) Group differences at posttests (p)
Pretest Posttest Pretest Posttest
M±SD M±SD M±SD M±SD
Total Knowledge of delirium e 33.58±3.47 38.77±2.75 11.62 33.30±3.47 32.84±3.63 -1.06 10.49
    (＜.001)     (.295) (＜.001)
  Etiology 9.19±0.97 9.63±0.55 3.72 8.96±1.15 8.97±1.13 0.86 4.25
    (＜.001)     (.932) (＜.001)
  Symptoms 13.64±1.98 15.83±2.03 8.13 13.61±1.85 12.87±1.87 -1.85 8.69
    (＜.001)     (.069) (＜.001)
  Management t 10.75±2.20 13.31±1.14 9.98 10.73±2.24 11.00±2.15 0.98 7.73
    (＜.001)     (.331) (＜.001)
Self-confidence of nursing 49.58±11.44 72.31±7.33 16.67 53.65±14.28   -0.39 9.73
    (＜.001)   53.05±14.36 (.695) (＜.001)
Nursing performance 2.79±0.28 3.34±0.35 11.66 2.89±0.38 2.82±0.42 -1.41 7.77
    (＜.001)     (.163) (＜.001)

Exp.=experimental group; Cont.=control group.

Table 5.
Differences in Item by Item Nursing Performance in the Experimental Group (N =64)
Item Nursing performance Pretest Post-test Differences (Post-Pre) p
M±SD M±SD
1 Assess potential risks of delirium 2.19±0.91 2.80±0.89 0.61 ＜.001
2 Assess the patient's mental status accurately 3.28±0.68 3.42±0.59 0.14 .151
3 Talk to the patient repeatedly about date, time, place, people 2.47±0.69 3.38±0.68 0.91 ＜.001
4 Explain to the patient before providing nursing care (or treatment) 3.55±0.64 3.72±0.49 0.17 .047
5 Listen to the words of the patient 3.42±0.66 3.77±0.43 0.34 ＜.001
6 Communicate softly in the patient room 3.22±0.72 3.50±0.59 0.28 .013
7 Perform all nursing activities (or treatment) at the same time during the night 2.81±0.87 3.41±0.60 0.59 ＜.001
8 Keep Machines' alarm sounds at minimum 2.78±0.98 3.17±0.63 0.39 .005
9 Encourage to use eye glasses if visual acuity is impaired 2.88±0.92 3.47±0.59 0.59 ＜.001
10 Remove catheters as soon as possible 2.70±0.79 3.08±0.60 0.38 .002
11 Encourage to use hearing aid and communication tools if needed (ex: word cards) 2.66±0.91 3.31±0.75 0.66 ＜.001
12 Perform cognitive stimulation activities (ex: word games, repeated information, provide a clock or calendar) 1.92±0.76 3.14±0.79 1.22 ＜.001
13 Avoid restraints 2.16±1.04 3.27±0.93 1.11 ＜.001
14 Check the signs of dehydration 2.47±0.69 3.27±0.67 0.80 ＜.001
15 Check the triggers, if delirium occurs 2.61±0.66 3.17±0.61 0.56 ＜.001
16 Control pain 3.53±0.50 3.78±0.42 0.25 .001
17 Encourage family members to be with patients at bed side 3.34±0.62 3.61±0.49 0.27 .006
18 Provide safe environment keeping soft light during the night 3.19±0.61 3.64±0.48 0.45 ＜.001
19 Educate the family and caregivers about delirium 2.70±0.85 3.36±0.68 0.66 ＜.001
20 Keep the environment clean removing unnecessary objects 2.80±0.72 3.22±0.63 0.42 ＜.001
21 Encourage to bring familiar objects or family photos, etc. 1.98±0.85 2.88±0.83 0.89 ＜.001
22 Encourage early ambulation 2.67±0.76 3.53±0.59 0.86 ＜.001
23 Consult with doctors to reduce the number of medication 2.56±0.91 2.98±0.70 0.42 .001
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    The Effects of Delirium Care Training Program for Nurses in Hospital Nursing Units
    Korean J Adult Nurs. 2014;26(5):489-499.   Published online October 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.5.489
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    The Effects of Delirium Care Training Program for Nurses in Hospital Nursing Units
    Korean J Adult Nurs. 2014;26(5):489-499.   Published online October 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.5.489
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    The Effects of Delirium Care Training Program for Nurses in Hospital Nursing Units
    The Effects of Delirium Care Training Program for Nurses in Hospital Nursing Units

    Components and Contents of The Delirium Care Training Program

    Components Contents
    Education (1 hour) ․ Provide one hour lecture about the definition, prevalence, characteristics, categories, possible causes, assessment tools, and intervention of delirium.
    ․ Introduce 'delirium assessment tools' and 'checklist for nursing intervention of patients with delirium' and educate how to use the tools and checklists.
    ․ Questions and answers.
    Practical training (4 weeks) Delirium assessment tool ․ Perform the short CAM for every older patient (≥70) who admitted to the floor from the admission date to 7 days after admission.
    ․ Get feedback from charge nurses about the accurate usage of the delirium assessment tool.
    Checklist for preventive nursing care of delirium ․ Perform 'checklist for preventive nursing of delirium' for every older patient (≥70) who admitted to the floor from the admission date to 7 days after admission.
    ․ Share the experience with the principle investigator about the difficulties to perform the checklist, missing items and reasons. Get feedback from the principle investigator about the accurate usage of the checklist.

    Homogeneity of General Characteristics between the Experimental and Control Groups (N=131)

    Characteristics Categories Exp. (n=64) Cont. (n=67) x2 p
    n (%) n (%)
    Age (year) ＜25 34 (53.1) 28 (41.8) 4.78 .092
    25~29 25 (39.1) 25 (37.3)
    ≥30 5 (7.8) 14 (20.9)
    Marital status Unmarried 60 (93.8) 57 (85.1) 2.58 .108
    Married 4 (6.3) 10 (14.9)
    Religion Christian 5 (7.8) 7 (10.4) 0.90 .825
    Catholic 2 (3.1) 3 (4.5)
    Buddhist 15 (23.4) 12 (17.9)
    None 42 (65.6) 45 (67.2)
    Educational level Junior college 53 (82.8) 52 (77.6) 0.56 .456
    ≥University 11 (17.2) 15 (22.4)
    Clinical career (year) ≥1~＜5 47 (73.4) 50 (74.6) 0.02 .877
    ≥5 17 (26.6) 17 (25.4)
    Department Internal medicine 17 (26.6) 24 (35.8) 8.72 .069
    Orthopedics 34 (53.1) 20 (29.9)
    General surgery 8 (12.5) 11 (16.4)
    Neurology or neurosurgery 4 (6.3) 7 (10.4)
    Other 1 (1.6) 5 (7.5)
    Necessity of delirium education Urgently needed 15 (23.4) 13 (19.4) 4.58 .102
    Needed 47 (73.4) 45 (67.2)
    So so 2 (3.1) 9 (13.4)
    Experience of delirium education Yes 22 (34.4) 29 (43.3) 1.09 .296
    No 42 (65.6) 38 (56.7)
    Ways to get delirium education In hospital 4 (18.2) 4 (13.8) 0.18 .670
    In college 18 (81.8) 25 (86.2)
    Number of education 1 16 (72.7) 18 (66.7) 1.83 .609
    2 3 (13.6) 6 (22.2)
    ≥3 3 (13.6) 3 (11.1)
    Had manuals for delirium care Yes 4 (6.3) 4 (6.0) 0.00 .947
    No 60 (93.8) 63 (94.0)

    Exp.=experimental group; Cont.=control group.

    Homogeneity of Knowledge of Delirium, Self-confidence of Nursing, and Nursing Performance (N=131)

    Variables Exp. (n=64) Cont. (n=67) t p
    M±SD M±SD
    Total Knowledge of delirium 33.58±3.47 33.30±3.47 0.46 .646
       Etiology 9.19±0.97 8.96±1.15 1.25 .215
       Symptoms 13.64±1.98 13.61±1.85 0.09 .932
       Management 10.75±2.20 10.73±2.24 0.05 .962
    Self-confidence of nursing 49.58±11.44 53.65±14.28 -1.80 .075
    Nursing performance 2.79±0.28 2.89±0.38 -1.56 .121

    Exp.=experimental group; Cont.=control group.

    Comparison of Knowledge of Delirium, Self-confidence of Nursing, and Nursing Performance between the Experimental and Control Groups (N=131)

    Variables Exp. (n=64) Paired t-test (p) Cont. (n=67) Paired t-test (p) Group differences at posttests (p)
    Pretest Posttest Pretest Posttest
    M±SD M±SD M±SD M±SD
    Total Knowledge of delirium e 33.58±3.47 38.77±2.75 11.62 33.30±3.47 32.84±3.63 -1.06 10.49
        (＜.001)     (.295) (＜.001)
      Etiology 9.19±0.97 9.63±0.55 3.72 8.96±1.15 8.97±1.13 0.86 4.25
        (＜.001)     (.932) (＜.001)
      Symptoms 13.64±1.98 15.83±2.03 8.13 13.61±1.85 12.87±1.87 -1.85 8.69
        (＜.001)     (.069) (＜.001)
      Management t 10.75±2.20 13.31±1.14 9.98 10.73±2.24 11.00±2.15 0.98 7.73
        (＜.001)     (.331) (＜.001)
    Self-confidence of nursing 49.58±11.44 72.31±7.33 16.67 53.65±14.28   -0.39 9.73
        (＜.001)   53.05±14.36 (.695) (＜.001)
    Nursing performance 2.79±0.28 3.34±0.35 11.66 2.89±0.38 2.82±0.42 -1.41 7.77
        (＜.001)     (.163) (＜.001)

    Exp.=experimental group; Cont.=control group.

    Differences in Item by Item Nursing Performance in the Experimental Group (N =64)

    Item Nursing performance Pretest Post-test Differences (Post-Pre) p
    M±SD M±SD
    1 Assess potential risks of delirium 2.19±0.91 2.80±0.89 0.61 ＜.001
    2 Assess the patient's mental status accurately 3.28±0.68 3.42±0.59 0.14 .151
    3 Talk to the patient repeatedly about date, time, place, people 2.47±0.69 3.38±0.68 0.91 ＜.001
    4 Explain to the patient before providing nursing care (or treatment) 3.55±0.64 3.72±0.49 0.17 .047
    5 Listen to the words of the patient 3.42±0.66 3.77±0.43 0.34 ＜.001
    6 Communicate softly in the patient room 3.22±0.72 3.50±0.59 0.28 .013
    7 Perform all nursing activities (or treatment) at the same time during the night 2.81±0.87 3.41±0.60 0.59 ＜.001
    8 Keep Machines' alarm sounds at minimum 2.78±0.98 3.17±0.63 0.39 .005
    9 Encourage to use eye glasses if visual acuity is impaired 2.88±0.92 3.47±0.59 0.59 ＜.001
    10 Remove catheters as soon as possible 2.70±0.79 3.08±0.60 0.38 .002
    11 Encourage to use hearing aid and communication tools if needed (ex: word cards) 2.66±0.91 3.31±0.75 0.66 ＜.001
    12 Perform cognitive stimulation activities (ex: word games, repeated information, provide a clock or calendar) 1.92±0.76 3.14±0.79 1.22 ＜.001
    13 Avoid restraints 2.16±1.04 3.27±0.93 1.11 ＜.001
    14 Check the signs of dehydration 2.47±0.69 3.27±0.67 0.80 ＜.001
    15 Check the triggers, if delirium occurs 2.61±0.66 3.17±0.61 0.56 ＜.001
    16 Control pain 3.53±0.50 3.78±0.42 0.25 .001
    17 Encourage family members to be with patients at bed side 3.34±0.62 3.61±0.49 0.27 .006
    18 Provide safe environment keeping soft light during the night 3.19±0.61 3.64±0.48 0.45 ＜.001
    19 Educate the family and caregivers about delirium 2.70±0.85 3.36±0.68 0.66 ＜.001
    20 Keep the environment clean removing unnecessary objects 2.80±0.72 3.22±0.63 0.42 ＜.001
    21 Encourage to bring familiar objects or family photos, etc. 1.98±0.85 2.88±0.83 0.89 ＜.001
    22 Encourage early ambulation 2.67±0.76 3.53±0.59 0.86 ＜.001
    23 Consult with doctors to reduce the number of medication 2.56±0.91 2.98±0.70 0.42 .001
    Table 1. Components and Contents of The Delirium Care Training Program

    Table 2. Homogeneity of General Characteristics between the Experimental and Control Groups (N=131)

    Exp.=experimental group; Cont.=control group.

    Table 3. Homogeneity of Knowledge of Delirium, Self-confidence of Nursing, and Nursing Performance (N=131)

    Exp.=experimental group; Cont.=control group.

    Table 4. Comparison of Knowledge of Delirium, Self-confidence of Nursing, and Nursing Performance between the Experimental and Control Groups (N=131)

    Exp.=experimental group; Cont.=control group.

    Table 5. Differences in Item by Item Nursing Performance in the Experimental Group (N =64)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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