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confusion assessment method, delirium, dementia, end of life, hospice, nurses, nursing



  1. Oligario, Grace Cullen DNP, APRN-BC, ACHPN
  2. Buch, Carrie PhD, RN
  3. Piscotty, Ronald PhD, RN-BC


Because of physical and metabolic changes during end of life, patients with dementia are very susceptible to develop delirium. The recognition of delirium with underlying dementia can be difficult because of their overlapping behavioral manifestations. Previous studies conducted among nurses caring for patients with delirium have shown that nurses are often not able to detect the presence of delirium using their subjective assessments. This study evaluated the nurses' ability to subjectively assess for delirium in patients with underlying dementia in end of life. Their findings were compared with the results of objective assessments performed by the researcher using Confusion Assessment Method. In 30 paired assessments, the objective and subjective assessments had the same findings. The remaining 20 paired assessments showed disagreement between the subjective and objective findings. A [kappa] measure of agreement was performed with a result of 0.074 and a significance of P > .05. This finding indicates no statistically significant agreement between the subjective nursing assessment for delirium and the objective assessment using Confusion Assessment Method. Accurate nursing assessment yields appropriate nursing interventions. The findings of this study support the need for improved subjective nursing assessment for delirium in patients with dementia at the end of life.