중환자실 노인환자에서 주관적·객관적 섬망 평가의 불일치에 영향을 미치는 요인: 환자와 간호사 특성과 섬망지식
Factors Influencing Discrepancy between Objective and Subjective Delirium Assessment in Elderly Patients in Intensive Care Unit: Patients and Nurses’ Characteristics and Delirium Knowledge
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Purpose: The purpose of this study was to identify the rate of discrepancy between nurses’ subjective and objective assessment of delirium in elderly patients in intensive care units (ICUs) and to explore factors influencing the discrepancy. Methods: Using a survey design, a total of 91 elderly patients and 47 nurses were recruited from three ICUs in C Hospital. While ICU nurses subjectively assessed prevalence of delirium in their patients, the researcher used the Confusion Assessment Method in the ICU (CAM-ICU) tool at the same time. Medical records were reviewed for participants’ demographic and disease-related characteristics. The nurses’ level of knowledge about delirium assessment was examined. Results: Twenty-seven percent of patients had delirium according to CAM-ICU assessment and the discrepancy rate between CAM-ICU and subjective assessments was 18.7% (χ2=21.648, p<.001): 2.2% for false positives, and 16.5% for false negatives. Patient factors influencing the discrepancy between delirium assessment methods were using restraints, as well as lower Glasgow Coma Scale (GCS) scores and Richmond Agitation and Sedation Scale (RASS) scores, while a nurse factor was shorter length of time working in an ICU. Conclusion: The discrepancy rate was 18.7% with 16.5% for false negatives. An education program is necessary for nurses to improve their knowledge of symptom assessment for delirium and to receive training in the use of objective tools for delirium assessment.
Abstract
Purpose: The purpose of this study was to identify the rate of discrepancy between nurses’ subjective and objective assessment of delirium in elderly patients in intensive care units (ICUs) and to explore factors influencing the discrepancy. Methods: Using a survey design, a total of 91 elderly patients and 47 nurses were recruited from three ICUs in C Hospital. While ICU nurses subjectively assessed prevalence of delirium in their patients, the researcher used the Confusion Assessment Method in the ICU (CAM-ICU) tool at the same time. Medical records were reviewed for participants’ demographic and disease-related characteristics. The nurses’ level of knowledge about delirium assessment was examined. Results: Twenty-seven percent of patients had delirium according to CAM-ICU assessment and the discrepancy rate between CAM-ICU and subjective assessments was 18.7% (χ2=21.648, p<.001): 2.2% for false positives, and 16.5% for false negatives. Patient factors influencing the discrepancy between delirium assessment methods were using restraints, as well as lower Glasgow Coma Scale (GCS) scores and Richmond Agitation and Sedation Scale (RASS) scores, while a nurse factor was shorter length of time working in an ICU. Conclusion: The discrepancy rate was 18.7% with 16.5% for false negatives. An education program is necessary for nurses to improve their knowledge of symptom assessment for delirium and to receive training in the use of objective tools for delirium assessment.
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