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Keywords

advance practice, bypass, cardiopulmonary, delirium, heart surgery, nurse assessment

 

Authors

  1. Colwill, Jennifer P. DNP, APRN-CNS, CCNS, PCCN
  2. Bena, James F. MS
  3. Morrison, Shannon L. MS
  4. Bakaeen, Faisal MD
  5. Albert, Nancy M. PhD, RN, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN

Abstract

Purpose: The aims of this study were to examine interrater agreement of delirium between clinical nurses and a clinical nurse specialist, determine delirium subtype prevalence, and examine associated patient, procedure, and hospital factors.

 

Design: A descriptive cross-sectional design and a convenience sample of nurses and patients on progressive care units were used in this study.

 

Methods: Clinical nurse specialist data were collected on a case report form, and clinician and patient data were obtained from electronic databases. Interrater agreement of delirium prevalence was assessed by [kappa] statistic, and logistic regression models were used to determine patient factors associated with delirium.

 

Results: Of 216 patients, 23 had delirium; clinical nurses identified fewer cases than the clinical nurse specialist: 1.8% versus 10.7%; [kappa] agreement, 0.27 (0.06, 0.49). By delirium subtype, hypoactive delirium was more frequent (n = 10). Factors associated with delirium were history of cerebrovascular disease (odds ratio [95% confidence interval], 2.8 [1.01-7.7]; P = .044), history of mitral valve disease (odds ratio [95% confidence interval], 0.31 [0.09-0.90]; P = .041), and longer perfusion time (odds ratio [95% confidence interval], 1.7 [1.1-2.7]; P = .016). One factor was associated with hypoactive delirium, longer perfusion time (odds ratio [95% confidence interval], 2.2 [1.3-4.2]; P = .008).

 

Conclusions: Because clinician-clinical nurse specialist delirium agreement was low and hypoactive delirium was common, clinical interventions are needed.