title: Detection of delirium and its symptoms by nurses working in a long term care facility.
abstract: OBJECTIVE
  To investigate the ability of nurses to recognize delirium and its symptoms and to investigate the factors associated with undetected delirium.
  
  
  METHODS
  A prospective, observational study with repeated measurements over a 6-month period.
  
  
  METHODS
  Seven long term care settings in Montreal and Quebec City, Canada.
  
  
  METHODS
  Residents aged 65 and older, with or without dementia, admitted to long term care (not respite care) and able to communicate in English or French.
  
  
  METHODS
  Delirium and its symptoms were assessed using the Confusion Assessment Method. Ratings of delirium by nurses based on their observations during routine care were compared with delirium ratings by trained research assistants based on a one-time formal structured evaluation (Confusion Assessment Method and Mini Mental State Examination). This procedure was repeated for 10 delirium symptoms. Sensitivity, specificity, and positive and negative predictive values were calculated. The method of generalized estimating equations was used to identify factors associated with undetected delirium.
  
  
  RESULTS
  Research assistants identified delirium in 43 (21.3%) of the 202 residents. Nurses identified delirium in 51% of the cases identified by the research assistants. However, for cases without delirium according to the research assistants, nurses identified 90% of them correctly. Detection rates for delirium symptoms ranged from 25% to 66.7%. Undetected delirium was associated with lower number of depressive symptoms manifested by the resident.
  
  
  CONCLUSIONS
  Detection of delirium is a major issue for nurses. Strategies to improve nurse recognition of delirium could well reduce adverse outcomes for this vulnerable population.
authors: Faculty of Nursing Sciences, Laval University, Quebec City, Canada. philippe.voyer@fsi.ulaval.ca
authors: Philippe
authors: P
authors: Voyer
authors: Sylvie
authors: S
authors: Richard
authors: Jane
authors: J
authors: McCusker
authors: Martin G
authors: MG
authors: Cole
authors: Johanne
authors: J
authors: Monette
authors: Nathalie
authors: N
authors: Champoux
authors: Antonio
authors: A
authors: Ciampi
authors: Eric
authors: E
authors: Belzile
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003693:Delirium / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D024802:Nurse's Role; D009735:Nursing Homes; D011446:Prospective Studies; D011792:Quebec