Critical Care Nurses' Beliefs about Management Practices of Adult Patients

Critical Care Nurses' Beliefs about Management Practices of Adult Patients Kimberly J. Oosterhouse, Ph.D. Department of Nursing University of Illinois at Chicago Chicago, Illinois (2013) Dissertation Chairperson: Catherine Vincent, R.N., Ph.D. Delirium is the most frequent complication of hospitalized older adults leading to increased mortality rates, length of stay, functional decline, and decreased quality of life. Delirium is prevalent in intensive care units, but is underrecognized and undermanaged. Using a qualitative descriptive design with methodology informed by the Theory of Planned Behavior, we explored a convenience sample of 30 critical care nurses’ recognition of delirium; perceived barriers; ageist beliefs; and behavioral, normative, and control beliefs about assessment and management of delirium. After reviewing vignettes as a measure in research, we developed four delirium vignettes reflecting the three subtypes of delirium (hyperactive, hypoactive, mixed) with an older adult depicted as the patient in each vignette. We duplicated the mixed delirium vignette depicting a young adult as the patient. Information on nurses’ recognition of delirium, intention to act, and prioritization of patients was obtained in response to the written vignettes, followed by open ended questions from our structured interview guide addressing the aims of the study. We used content analysis and descriptive statistics to analyze the data. Nurses recognized assessment findings associated with delirium, but did not use the term “delirium.” The majority of nurses made management of the older adult with hypoactive delirium their lowest priority, and prioritized management of the young adult with mixed delirium over the older adult with the same scenario. Nurses identified behavioral beliefs that focused on the advantages of delirium assessment and management, including prevention, safety and improved patient outcomes. Related to normative beliefs, nurses believed delirium assessment and management was primarily their role. Nurses expressed control beliefs that hindered their ability to assess for delirium and act on delirium findings including time, staffing, and support. Nurses’ control beliefs about enabling delirium assessment and management included incorporating a delirium assessment tool into their usual charting, and having a delirium policy and protocol in place. In addition, nurses expressed ageist beliefs towards the older adult.