Impact of a Multimodal Educational Delirium Program on Nurses’ Knowledge, Confidence and Clinical Practice in the Post-Acute Care Setting

Background Delirium is a serious and under-recognized condition affecting individuals during episodes of illness or injury and is associated with poor short and long- term outcomes. Delirium occurs in up to 25% of patients during hospitalization and post-acute recovery. Most published reports of delirium educational programs for nurses have taken place in the acute care setting and have demonstrated increased knowledge and confidence, while few measured the impact on nurses’ ability to accurately recognize delirium and respond to it in clinical practice. Objectives This study aimed to describe and compare the changes in (1) nurses’ knowledge and confidence levels related to delirium prevention, detection and intervention (2) nurse detection of delirium during patient care and (3) nurse action taken in identified cases of delirium prior to and following a multimodal simulation-based educational intervention in post-acute care. Methods Nursing knowledge and confidence data was obtained from a query of 114 nurses working in three post-acute facilities. The nurses participated in a multimodal delirium educational program featuring a simulation experience. Documentation of nursing delirium assessment and actions were analyzed from records of 41 (22 pre and 19 post-intervention) patients determined to have experienced post-acute delirium using CHART-DEL methodology. Scores on a knowledge test, confidence survey, and clinical documentation were compared pre-to-post intervention. Results Following the educational intervention, nurses demonstrated an increase in knowledge and confidence. In clinical practice, nurse recognition of confirmed delirium cases decreased from 40% pre-intervention to 33% post-intervention. Appropriate action taken by the nurse in response to a new recognized delirium decreased from 83% to 80%, but prompt notification of a provider increased from 40% to 75% following education. Conclusion The educational intervention yielded an increase in nursing knowledge and confidence in the classroom but had limited impact on improving the accuracy of delirium recognition and related actions.