A Toolkit for Delirium Identification and Promoting Partnerships Between Carers and Nurses: A Pilot Pre-Post Feasibility Study

Christina Aggar; Alison Craswell; Kasia Bail; Roslyn M Compton; Mark Hughes; Golam Sorwar; James Baker; Jennene Greenhill; Lucy Shinners; Belinda Nichols; Rachel Langheim; Allison Wallis; Karen Bowen; Hazel Bridgett

doi:10.1007/s11606-024-08734-6

A Toolkit for Delirium Identification and Promoting Partnerships Between Carers and Nurses: A Pilot Pre-Post Feasibility Study

J Gen Intern Med. 2024 Apr 22. doi: 10.1007/s11606-024-08734-6. Online ahead of print.

Authors

Christina Aggar^{1

2}, Alison Craswell³, Kasia Bail⁴, Roslyn M Compton⁵, Mark Hughes⁶, Golam Sorwar⁷, James Baker⁶, Jennene Greenhill⁶, Lucy Shinners⁶, Belinda Nichols^{6

8}, Rachel Langheim⁸, Allison Wallis⁸, Karen Bowen⁸, Hazel Bridgett⁸

Affiliations

¹ Faculty of Health, Southern Cross University, Bilinga, QLD, Australia. christina.aggar@scu.edu.au.
² Northern NSW Local Health District, Lismore, NSW, Australia. christina.aggar@scu.edu.au.
³ School of Health, University of the Sunshine Coast, Maroochydore BC, QLD, Australia.
⁴ Faculty of Health, University of Canberra, Bruce, ACT, Australia.
⁵ College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.
⁶ Faculty of Health, Southern Cross University, Bilinga, QLD, Australia.
⁷ Faculty of Business, Law and Arts, Southern Cross University, Bilinga, QLD, Australia.
⁸ Northern NSW Local Health District, Lismore, NSW, Australia.

PMID: 38647970
DOI: 10.1007/s11606-024-08734-6

Abstract

Background: Delirium is frightening for people experiencing it and their carers, and it is the most common hospital-acquired complication worldwide. Delirium is associated with higher rates of morbidity, mortality, residential care home admission, dementia, and carer stress and burden, yet strategies to embed the prevention and management of delirium as part of standard hospital care remain challenging. Carers are well placed to recognize subtle changes indicative of delirium, and partner with nurses in the prevention and management of delirium.

Objective: To evaluate a Prevention & Early Delirium Identification Carer Toolkit (PREDICT), to support partnerships between carers and nurses to prevent and manage delirium.

Design: A pre-post-test intervention and observation study.

Main measures: Changes in carer knowledge of delirium; beliefs about their role in partnering with nurses and intended and actual use of PREDICT; carer burden and psychological distress. Secondary measures were rates of delirium.

Participants: Participants were carers of Indigenous patients aged 45 years and older and non-Indigenous patients aged 65 years and older.

Intervention: Nurses implemented PREDICT, with a view to provide carers with information about delirium and strategies to address caregiving stress and burden.

Key results: Participants included 25 carers (43% response rate) (n = 17, 68% female) aged 29-88 (M = 65, SD = 17.7 years). Carer delirium knowledge increased significantly from pre-to-post intervention (p = < .001; CI 2.07-4.73). Carers' intent and actual use of PREDICT was (n = 18, 72%; and n = 17, 68%). Carer burden and psychological distress did not significantly change. The incidence of delirium in the intervention ward although not significant, decreased, indicating opportunity for scaling up.

Conclusion: The prevention and management of delirium are imperative for safe and quality care for patients, carers, and staff. Further comprehensive and in-depth research is required to better understand underlying mechanisms of change and explore facets of nursing practice influenced by this innovative approach.

Keywords: caregiving; carers; delirium; family.