title: The effect of an interactive delirium e-learning tool on healthcare workers' delirium recognition, knowledge and strain in caring for delirious patients: a pilot pre-test/post-test study.
abstract: BACKGROUND
  Studies investigating the effectiveness of delirium e-learning tools in clinical practice are scarce. The aim of this study is to determine the effect of a delirium e-learning tool on healthcare workers' delirium recognition, delirium knowledge and care strain in delirium.
  
  
  METHODS
  A pilot pre-posttest study in a convenience sample of 59 healthcare workers recruited from medical, surgical, geronto-psychiatric and rehabilitation units of a university hospital. The intervention consisted of a live information session on how to use the e-learning tool and, a 2-month self-active learning program. The tool included 11 e-modules integrating knowledge and skill development in prevention, detection and management of delirium. Case vignettes, the Delirium Knowledge Questionnaire, and the Strain of Care for Delirium Index were used to measure delirium recognition, delirium knowledge and experienced care strain in delirium respectively. Subgroup analyses were performed for healthcare workers completing 0 to 6 versus 7 to 11 modules.
  
  
  RESULTS
  The delirium recognition score improved significantly (mean 3.1 ± SD 0.9 versus 2.7 ± 1.1; P = 0.04), and more healthcare workers identified hypoactive (P = 0.04) and hyperactive (P = 0.007) delirium in the posttest compared to the pretest phase. A significant difference in the change of recognition levels over time between the 0 to 6 and 7 to 11 module groups was demonstrated (P = 0.03), with an improved recognition level in the posttest phase within the 7 to 11 module group (P = 0.007). After adjustment for potential confounders, this difference in the change over time was not significant (P = 0.07) and no change in recognition levels within the 7 to 11 module group was noted (P = 0.19). The knowledge score significantly improved in the posttest compared to the pretest phase (mean 31.7 ± SD2.6 versus 28.3 ± 4.5; P < 0.001), with a significant increased level within the 7 to 11 module group (unadjusted P < 0.001/adjusted P = 0.02). Overall, no difference between posttest and pretest phases was documented for care strain (P = 0.46).
  
  
  CONCLUSIONS
  The e-learning tool improved healthcare workers' delirium recognition and knowledge. The effect of the tool is related to its level of completion, but was less explicit after controlling for potential confounders and warrants further investigation. The level of strain did not improve.
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, 3000, Leuven, Belgium. elke.detroyer@med.kuleuven.be.|Group Health and Welfare, UC Leuven-Limburg, Genk, Belgium. elke.detroyer@med.kuleuven.be.
authors.forename: Elke
authors.initials: E
authors.lastname: Detroyer
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, 3000, Leuven, Belgium. fabienne.dobbels@med.kuleuven.be.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Dobbels
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, 3000, Leuven, Belgium. bodebonnaire@hotmail.com.
authors.forename: Deborah
authors.initials: D
authors.lastname: Debonnaire
authors.affiliation: Department of Nursing, Dublin City University, Dublin, Ireland. Kate.Irving@dcu.ie.
authors.forename: Kate
authors.initials: K
authors.lastname: Irving
authors.affiliation: School of Medical Education, Newcastle University, Newcastle upon Tyne, UK. andrew.teodorczuk@newcastle.ac.uk.|Campus for Ageing and Vitality, Newcastle upon Tyne, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK. andrew.teodorczuk@newcastle.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Teodorczuk
authors.affiliation: College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA. dmf21@psu.edu.|Department of Psychiatry, College of Medicine, The Pennsylvania State University, University Park, Pennsylvania, USA. dmf21@psu.edu.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Fick
authors.affiliation: Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium. etienne.joosten@uzleuven.be.
authors.forename: Etienne
authors.initials: E
authors.lastname: Joosten
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, 3000, Leuven, Belgium. koen.milisen@med.kuleuven.be.|Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium. koen.milisen@med.kuleuven.be.
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
mesh_terms: D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods*; D003693:Delirium / Q000175:diagnosis* / Q000628:therapy*; D004517:Education, Professional / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D020407:Internet; D008297:Male; D010865:Pilot Projects; D012494:Sampling Studies