Factors Influencing Nurses’ Perceptions and Practices Regarding Assessment of Delirium Among Intensive Care Unit Patients at Kenyatta National Hospital

Abstract

Background: Delirium is an acute loss of consciousness and cognitive ability which poses an impact on the patient, family and the hospital. It is associated with increased mortality rates, prolonged hours in mechanical ventilation, stress to the patient and family, increased need for nursing scrutiny and prolonged hospitalization. In order to manage delirium, it must be detected first by the Intensive Care Unit nurses who are in constant contact with patients. Broad objective: To establish factors influencing nurses’ perceptions and practices regarding assessment of delirium among ICU patients in KNH. Methodology: a descriptive cross- sectional design with qualitative study nested on quantitative study was used in this study. A simple random sampling method was used to select study participants. The study was conducted in the General Intensive Care Unit at Kenyatta National Hospital, Kenya. Ethical approval was sought from KNH and University of Nairobi ethics and Research Committee while authority to conduct the study was sought from the hospital administration. Data was obtained from consented nurses working in ICU. The sample size was 88 ICU nurses from whom quantitative data was collected while interview was conducted from 3 nurse in-charges. Quantitative data was collected using a questionnaire while the qualitative data was collected using an interview guide and audio recorded. Quantitative data was analyzed using statistical package for social sciences (SPSS) version 23. Descriptive and inferential statistics was used to examine the distribution of variables and statistical significance measured using chi square. Qualitative data was transcribed verbatim, coded and deductively analyzed into themes using content analysis method. The results were presented in graphs, tables, figures and in narrative form. Results: More than half of the nurses (71%) reported that their ICU lacked an established guideline to screen for delirium and that sedation protocol did not specify assessment of delirium. Preferred methods for assessing delirium in a 12-hour shift included assessing ability to follow commands (78.4%), checking for agitation-related events (48.9%). They also reported the unavailability of other reliable, specific, and validated delirium tools. Only 32.5% of the nurses reported using the Confusion Assessment Method for the Intensive Care Unit while 9.1% and 13.6% indicated using the Intensive Care Delirium Screening Checklist and psychiatric consultation respectively. This could be a leading cause of low frequency of delirium assessment among the studied sample as 38.6% of the nurses indicated that they never assessed delirium while 34.1% rarely assessed the patients for delirium. In addition, more than half (55.7%) respondents reported that they had never been trained on delirium assessment and monitoring. Conclusion: In conclusion, the study shows that majority of the nurses working in Kenyatta National Hospital ICU do not assess delirium among the critically ill patients. Nurses demographic factors such as age, years of experience and level of training do not influence assessment of delirium among the critically ill patients in ICU. Cultural factors of ICU nurses such as delirium is a ‘normal’ part of ICU environment, delirium is caused by depression of illness or associated with old age slightly influence assessment of delirium among ICU patients. Institutional factors such as unavailability of delirium guideline, appropriate assessment tool and training on assessment of delirium are significant contributors to lack of delirium assessment by majority of the nurses in ICU. The possible impact of this is under diagnosis of delirium requires intervention strategies on the part of ICU management