title: Factors that contribute to underrecognition of delirium by registered nurses in acute care settings: a scoping review of the literature to explain this phenomenon.
abstract: OBJECTIVE
  In order to obtain more information regarding this phenomenon, a scoping review of the literature was undertaken to analyse current research on the recognition of delirium by registered nurses in acute care settings.
  
  
  BACKGROUND
  Delirium is often manifested as a sign of an underlying undiagnosed condition that requires immediate intervention and is frequently manifested in acute care settings. Unfortunately, registered nurses often do not recognise delirium and its occurrence goes under-reported.
  
  
  METHODS
  Based on six inclusion criteria, a search in numerous databases using terms such as delirium detection, recognition and diagnosis by registered nurses was undertaken. Eight quantitative studies were deemed relevant and analysed for this scoping review.
  
  
  RESULTS
  Seven major categories emerged: the fluctuating nature of delirium, the impact of delirium education on its recognition, communication barriers, inadequate use of delirium assessment tools, lack of conceptual understanding of delirium, delirium as a burden and the likeness of delirium and dementia. A brief summary of the findings in each category is reported here.
  
  
  CONCLUSIONS
  The scoping review revealed that delirium remains underrecognised by registered nurses, which potentially contributes to reduced quality of nursing care for clients experiencing this condition. Further research on delirium and the processes that registered nurses use to recognise it is timely and will facilitate the development of evidence-based interventions to manage it.
  
  
  CONCLUSIONS
  While acute care registered nurses have historically reported dramatic changes in cognitive and neuro-biological functions in ill older adults, the literature highlighted in this scoping review revealed the following: (1) the need for further research to validate delirium assessment tools and, (2) the need for education and training for registered nurses on the use of these assessment tools to promote early recognition and thereby decrease the incidence of delirium in older adults.
authors.affiliation: School of Nursing and Midwifery, Mount Royal University, Calgary, AB, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Hussein
authors.forename: Sandra
authors.initials: S
authors.lastname: Hirst
authors.forename: Vincent
authors.initials: V
authors.lastname: Salyers
mesh_terms: D000368:Aged; D064648:Critical Care Nursing; D003693:Delirium / Q000175:diagnosis* / Q000451:nursing* / Q000523:psychology; D003704:Dementia / Q000150:complications / Q000175:diagnosis; D006801:Humans
keywords: acute care; clinical; education; elder care