Mixed-methods approach to understanding nurses' clinical reasoning in recognizing delirium in hospitalized older adults.

Abstract:

:A mixed-methods study was conducted to enhance understanding of nurses' clinical reasoning in recognizing delirium in the hospitalized older adult. Paired nurse and researcher ratings of the confusion assessment method in 103 medical-surgical patients were analyzed to determine the rate of agreement in detecting delirium and to identify a purposive sample of nurses to be interviewed about the patients with delirium who were under their care. Nurses' clinical reasoning in recognizing and underrecognizing delirium was investigated using semistructured interviews. The incidence of delirium was 13%, with poor agreement (95% CI [0.05, 0.64], p < 0.05) between the researchers and the nurses in detecting delirium. Sixteen nurses were interviewed and transcripts were analyzed with grounded theory. Confusion was the primary causal factor for recognizing symptoms of delirium. The findings explicated a framework that forms the basis for generating testable assumptions to improve nurses' recognition of delirium.

journal_name

J Contin Educ Nurs

authors

Rice KL,Bennett MJ,Clesi T,Linville L

doi

10.3928/00220124-20140219-02

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

136-48

issue

3

eissn

0022-0124

issn

1938-2472

journal_volume

45

pub_type

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