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Bedside Coaching to Improve Nurses’ Recognition of Delirium

Gordon, Susan Jean; Melillo, Karen Devereaux; Nannini, Angela; Lakatos, Barbara E.

Journal of Neuroscience Nursing: October 2013 - Volume 45 - Issue 5 - p 288–293
doi: 10.1097/JNN.0b013e31829d8c8b

ABSTRACT Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses’ knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses’ recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse’s Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.

Questions or comments about this article may be directed to Susan Jean Gordon, DNP ACNP-BC GNP-BC, at She is the NICHE Program Leader and Nursing Director of the Neuroscience Intermediate Care Unit, Brigham and Women’s Hospital, Boston, MA.

Karen Devereaux Melillo, PhD GNP ANP-BC FAANP FGSA, is the Professor, Director and Chair, School of Nursing at the University of Massachusetts Lowell.

Angela Nannini, PhD FNP, is an Associate Professor of Nursing at the University of Massachusetts Lowell.

Barbara E. Lakatos, DNP PMHCNS-BC APRN, is the Program Director, Psychiatric Nurse Resource Service at the Brigham and Women’s Hospital, Boston, MA.

The authors declare no conflicts of interest.

© 2013 American Association of Neuroscience Nurses