Eric Kai-Chung Wong1,2, Justin Yusen Lee2,3, Anasuiya Sherhee Surendran2, Kalpana Nair4, Nancy Della Maestra5, Marie Migliarini6, Joye Anne St Onge2,3,7, Christopher J Patterson2,3,8. 1. Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. 2. Department of Medicine, McMaster University, Hamilton, ON, Canada. 3. Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada. 4. School of Nursing, McMaster University, Hamilton, ON, Canada. 5. Musculoskeletal Unit and Fracture and Orthopedic Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. 6. Orthopedic Surgery, Hamilton Health Sciences Corporation, Hamilton, ON, Canada. 7. Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. 8. Department of Medicine, Hamilton Health Sciences Corporation, Hamilton, ON, Canada.
Abstract
Background: the Confusion Assessment Method (CAM) is commonly used to detect delirium. Although accurate when administered by trained researchers, its sensitivity is low when performed by nurses in clinical practice. We aimed to understand the perspectives of nurses who used the CAM on orthopaedic wards. Design: qualitative focus group study. Setting: two academic hospitals in Hamilton, Ontario, Canada. Participants: forty-three nurses who worked on orthopaedic inpatient units and used the CAM daily participated in one of eight focus group sessions. Measurements: structured focus groups explored nurses' perception of delirium and the use of the CAM. Each transcript was coded and sampling continued until theme saturation. Results: the participants (84% female, mean age 40 years, mean years in practice 12.8) had mixed feelings about the CAM. Some nurses praised its simplicity, while others preferred a narrative description of the delirium episode. Only 35% recalled receiving training to administer the CAM. Across the groups, disorientation was inappropriately used to evaluate level of consciousness and inattention. Objective testing was reportedly rarely used for assessing inattention. Most nurses retrospectively completed the CAM at the end of their shift by extrapolating from earlier observations rather than formally administering the tool. Reported challenges included differentiating delirium from dementia, assessing non-verbal patients and those with language barriers, time constraints, discrepancy with physicians' assessments and pressure to diagnose delirium. Conclusion: despite its widespread use, the CAM was poorly understood by orthopaedic nurses at two academic institutions. The CAM may be difficult to implement in practice.
Background: the Confusion Assessment Method (CAM) is commonly used to detect delirium. Although accurate when administered by trained researchers, its sensitivity is low when performed by nurses in clinical practice. We aimed to understand the perspectives of nurses who used the CAM on orthopaedic wards. Design: qualitative focus group study. Setting: two academic hospitals in Hamilton, Ontario, Canada. Participants: forty-three nurses who worked on orthopaedic inpatient units and used the CAM daily participated in one of eight focus group sessions. Measurements: structured focus groups explored nurses' perception of delirium and the use of the CAM. Each transcript was coded and sampling continued until theme saturation. Results: the participants (84% female, mean age 40 years, mean years in practice 12.8) had mixed feelings about the CAM. Some nurses praised its simplicity, while others preferred a narrative description of the delirium episode. Only 35% recalled receiving training to administer the CAM. Across the groups, disorientation was inappropriately used to evaluate level of consciousness and inattention. Objective testing was reportedly rarely used for assessing inattention. Most nurses retrospectively completed the CAM at the end of their shift by extrapolating from earlier observations rather than formally administering the tool. Reported challenges included differentiating delirium from dementia, assessing non-verbal patients and those with language barriers, time constraints, discrepancy with physicians' assessments and pressure to diagnose delirium. Conclusion: despite its widespread use, the CAM was poorly understood by orthopaedic nurses at two academic institutions. The CAM may be difficult to implement in practice.
Authors: Erica K Husser; Donna M Fick; Marie Boltz; Priyanka Shrestha; Jonathan Siuta; Shannon Malloy; Abigail Overstreet; Douglas L Leslie; Long Ngo; Yoojin Jung; Sharon K Inouye; Edward R Marcantonio Journal: J Am Geriatr Soc Date: 2021-01-20 Impact factor: 5.562