title: Strategies to improve nurse knowledge of delirium: a call to the adult-gerontology clinical nurse specialist.
abstract: OBJECTIVE
  The purpose of this article is to discuss the role of the adult-gerontology clinical nurse specialist in addressing the problem of delirium in hospitalized older adults through strategies to improve nurse knowledge.
  
  
  BACKGROUND
  Delirium is a significant issue in hospitalized older adults. This acute confusional state can adversely impact older adults in various ways. Delirium has been implicated in (1) poor physical, cognitive, and psychological outcomes, (2) prolonged hospitalizations, (3) increased costs of care, (4) need for continued postacute care, and (5) patient and provider stress. To prevent delirium, nurses must possess the knowledge to identify risk factors and institute preventive strategies. Once a change in mental status occurs, it is critical that nurses recognize delirium and the steps necessary to provide safe, effective care. Nurses are the major providers of bedside care; however, multiple studies have identified a lack of nurse knowledge regarding delirium. The adult-gerontology clinical nurse specialist can be instrumental in fostering knowledge on this important issue.
  
  
  METHODS
  Multiple interventions can be conducted by the adult-gerontology clinical nurse specialist with acute care nurses to increase delirium knowledge. A review of the literature revealed strategies that might be used in the hospital setting. Before educational endeavors, it is crucial to assess baseline nurse knowledge of delirium. Educational strategies can then include use of standardized delirium assessment tools, implementation of the Geriatric Resource Nurse model, fostering geriatric case studies and simulations, conducting geriatric grand rounds, and development of structured delirium educational programs. Exploring the patient experience, post delirium, can provide an invaluable, first-hand account of the acute confusional state. This information can impact nurse knowledge as well as patient safety and well-being. Geriatric certification and professional organizational involvement can be encouraged. Numerous online geriatric resources can be shared with nurses to enhance knowledge of delirium.
  
  
  RESULTS
  Improved nurse knowledge will assist in preventing/decreasing incidents of delirium and thwart the negative outcomes associated with delirium occurrence in hospitalized older adults.
  
  
  CONCLUSIONS
  Nurse knowledge can be measured and patient care assessed to determine the effectiveness of the proposed educational strategies.
  
  
  CONCLUSIONS
  The goal of the identified adult-gerontology clinical nurse specialist-led educational initiatives is to improve knowledge of delirium, which will assist nurses in providing evidence-based, safe, appropriate care to all hospitalized older adults.
authors.affiliation: Author Affiliations: Faculty (Dr Middle) and Assistant Professor (Dr Miklancie), School of Nursing, George Mason University, Fairfax, Virginia.
authors.forename: Beverly
authors.initials: B
authors.lastname: Middle
authors.forename: Margaret
authors.initials: M
authors.lastname: Miklancie
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003693:Delirium / Q000451:nursing*; D003695:Delivery of Health Care / Q000458:organization & administration; D004506:Education, Nursing / Q000379:methods*; D005851:Geriatric Nursing / Q000193:education*; D006801:Humans; D009720:Nurse Clinicians; D024802:Nurse's Role; D015402:Nursing Education Research; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research