An observational study of community health care nurses’ knowledge about delirium

Figures & data

Figure 1 Data collection procedure.

Abbreviation: CHN, community health care nurse.

Table 1 Sociodemographic and professional characteristics of the CHNs (N = 47)

Characteristics (n = 43)
Age, mean (SD)	39.4 (10.2)
Female, n (%)	37 (86.0)
Highest diploma obtained, n (%)
Swiss bachelor’s degree	7 (16.2)
UAS + registered nurses	5 (11.7)
Foreign registered nurses	31 (72.1)
Nurses with master’s degree	0 (0.0)
Delirium education, n (%)	4 (9.3)
Years of nursing experience, mean (SD)	14.4 (9.3)
Years of experience in CHC, mean (SD)	5.8 (4.7)
Years of geriatric experience, mean (SD)	4.6 (6.4)

Abbreviations: CHN, community health care nurse; UAS, University of Applied Sciences; CHC, community health care; SD, standard deviation.

Table 2 Responses on the definition and diagnostic criteria of delirium (N = 47)

n (%)
a. What is the definition of delirium? (N = 47)
Permanent mental disorder with a progressive onset of cognitive impairment, disorientation in time and space, dysfunction of attention, a decline of consciousness and perception disorders	1 (2.1)
Fluctuating temporary mental disorder with a sudden cognitive impairment onset, disorientation and dysfunction of the attention, a declining consciousness level and perception disorders	44 (93.6)
Chronic disease is becoming more common in older people. In general, it affects memory and mental faculties. Delirium evolves gradually and irreversibly due to a degeneration of brain tissue, leading to dementia	2 (4.2)
b. What are the diagnostic criteria used by physicians to make a delirium diagnosis? (N = 47)
Disturbance of consciousness (reduction of a clear awareness of the environment) with reduced ability to direct, focus, sustain or shift attention	43 (91.4)
Rapid symptoms onset (hours or days) and fluctuation during the day	42 (89.3)
Chronic disease is becoming more common in older people. In general, it affects memory and mental faculties. Delirium evolves gradually and irreversibly due to a degeneration of brain tissue, leading to dementia	4 (8.5)
Inability to learn new information, to remember information previously acquired	25 (53.1)
Change in cognition (memory deficit, disorientation or language difficulty), difficulty of perception not related to preexisting stabilised or evolving dementia	41 (87.2)
Markedly diminished interest or pleasure in all or almost all activities throughout the day, nearly every day (by subjective account or observation made by others)	13 (27.6)
Insomnia and hypersomnia nearly every day	14 (29.7)
Evidence from the history of the disease, physical examination or laboratory examinations, the symptoms are the direct physiological consequence of a general medical condition (physical cause, intoxication, medication, etc.)	20 (42.5)
c. Select the essential signs and symptoms of delirium (N = 47)
Loss of interest or pleasure in normal activities	10 (21.2)
Apraxia	8 (17.0)
Inattention	35 (74.4)
Aphasia	15 (31.9)
Fluctuating mental and/or motor symptoms	22 (46.8)
Significant weight loss or weight gain	1 (2.1)
Rapid onset of mental and/or motor symptoms	24 (51.0)
Continuous cognitive decline	8 (17.0)
Altered level of consciousness	33 (70.2)
Suicidal ideation	1 (2.1)
Disruption of long-term memory	4 (8.5)
Impaired cognition and/or perceptual disturbances	39 (82.9)

Table 3 Responses on detection tools for delirium (N = 47)

Tools	n (%)
MMSE	23 (48.9)
VAS	0 (0.0)
DRS	5 (10.6)
CGA	3 (6.4)
NCS	5 (10.6)
GDS	3 (6.4)
CAM	16 (34.0)

Abbreviations: MMSE, Mini-Mental State Examination; VAS, visual analogue scale; DRS, dementia rating scale; CGA, comprehensive geriatric assessment; NCS, Neecham confusion scale; GDS, geriatric depression scale; CAM, Confusion assessment method.

Table 4 Summary of questionnaire scores (N = 47)

Questionnaire variables	Mean	SD	Min	Max
Definition of delirium^a	0.9	0.2	0	1
Diagnostic criteria of delirium^b	3.1	0.6	2	4
Signs and symptoms of delirium^c	2.3	1.5	0	5
Definition of signs and symptoms of delirium^d	5.0	1.8	1	8
Delirium detection tools^e	0.9	0.5	0	3
Clinical vignette case studies^f	1.4	1.1	0	3
Total points for the questionnaire^g	12.7	3.2	6	19

Notes:

a Maximum score for the question 1.

b Maximum score 4.

c Maximum score 5.

d Maximum score 8.

e Maximum score 3.

f Maximum score 3.

g Maximum total questionnaire score 24.

Abbreviations: min, minimum; max, maximum; SD, standard deviation.

Table S1 Responses to the cases studies questions (N = 47)

Cases studies	n (%)
Case study 1 (N = 47)
Delirium	19 (40.4)
Dementia	2 (4.3)
Delirium superimposed on dementia	6 (12.8)
Depression	12 (25.5)
Cognitive impairment not attributable to any of these conditions	8 (17.0)
Normal state	0 (0.0)
Case study 2 (N = 47)
Delirium	3 (6.3)
Dementia	2 (4.2)
Delirium superimposed on dementia	1 (2.1)
Depression	36 (76.5)
Cognitive impairment not attributable to any of these conditions	5 (10.6)
Normal state	0 (0.0)
Case study 3 (N = 47)
Delirium	23 (48.9)
Dementia	6 (12.7)
Delirium superimposed on dementia	6 (12.7)
Depression	0 (0.0)
Cognitive impairment not attributable to any of these conditions	12 (25.5)
Normal state	0 (0.0)
Case study 4 (N = 47)
Dementia	13 (27.6)
Delirium	4 (8.5)
Delirium superimposed on dementia	20 (42.5)
Depression	0 (0.0)
Cognitive impairment not attributable to any of these conditions	10 (21.2)
Normal state	0 (0.0)
Case study 5 (N = 47)
Delirium	1 (2.1)
Dementia	24 (51.0)
Delirium superimposed on dementia	5 (10.6)
Depression	1 (2.1)
Cognitive impairment not attributable to any of these conditions	12 (25.5)
Normal state	4 (8.5)

Table S2 Correlation matrix by sociodemographic variable and total score for delirium knowledge

Variables	1	2	3	4	5	6	7
Age	0.32	0.16	0.06	0.14	0.15	0.04*	0.15
Nursing experience	0.31	0.13	0.12	0.09	0.19	0.15	0.12
Community Healthcare experience	0.22	0.16	0.27	0.06	0.02*	0.26	0.10
Geriatric experience	0.22	0.00*	0.07	0.05	0.14	0.10	0.03*
Diploma	0.42	0.49	0.61	0.28	0.74	0.14	0.41
Continuing training	0.13	0.19	0.10	0.17	0.11	0.29	0.24
Continuing training in aging	0.05	0.01*	0.27	0.09	0.10	0.09	0.05

Notes: 1) Delirium definition score; 2) delirium diagnostic criteria score; 3) signs and symptoms of delirium score; 4) definition of signs and symptoms of delirium score; 5) detection tools for delirium score; 6) cases studies score; 7) total score questionnaire.

* Correlation is significant at p = <0.05.