Aurora West Allis Medical Center

Presentation Notes

Poster presented at: 2019 Advocate Aurora Health Nursing Science Conference; September 18, 2019; Wheeling, IL.


INTRODUCTION: Delirium is an acute brain failure commonly experienced by hospitalized patients with serious consequences when it is not recognized and treated (Maldonado, 2017). Little is known about why difficulties occur or what can be done improve delirium detection.

PURPOSE: To increase our understanding of how experienced nurses use clinical reasoning to detect, diagnose, and respond to delirium symptoms and identify improvement opportunities.

METHODS: Ten focus groups were conducted with experienced staff nurses employed by three diverse medical centers in the Midwest. Sessions were audio-recorded, transcribed, reviewed, and coded using NVIVO-12 software. Inductive tools derived from dimensional analysis were used to identify concepts, conditions, and processes.

RESULTS: Participants (N=39) ranged in age from 18-65 (59%yrs), female (97%), Caucasian (87%), BSN or higher (81%), certified (28%), and worked on medical (42%), surgical (31%), and intensive care (28%) units. Many (51%) worked 12-hour shifts (51%), day-shift (64%) and managed delirium more than 1-2 times/week (84%). Nurses describe being able to detect and manage delirium symptoms with a range of knowledge and confidence. They report symptoms as subjective with limited use of diagnostic terminology. Nonpharmacological strategies and work arounds were used to address changes in patient status and keep patient safe. Clinical reasoning and subsequent actions were impacted by the knowledge, skills, and communication between members of the care team and the time of day. Nurses report that the diagnosis of delirium is not necessary to manage symptoms and that making a diagnosis of delirium may be associated with negative consequences. Both the clinical and social aspects of the nurse’s approach are related to the nature of delirium and their experience with delirium, the environment, the family, and interprofessional communication. Navigating both the clinical and social aspects of delirium is essential for successful management.

CONCLUSIONS: Nurses use clinical reasoning processes to manage delirium symptoms. The detection of delirium is influenced by clinical and social factors within the care environment. The nurse work within social structures that impact their thinking and actions. A larger study examining social factors that influence staff nurse clinical reasoning regarding delirium is recommended.


Caron, C. D., & Bowers, B. J. (2000). Methods and applications of dimensional analysis: a contribution to concept and knowledge development in nursing. In Beth L. Rodgers & K. A. Knafl (Eds.), Concept Development in Nursing: Foundations, Techniques, and Applications (2nd ed., pp. 285-319). Philadelphia, PA: Saunders.

Maldonado J.R. (2017). Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. International Journal Geriatric Psychiatry. 33(11), p. 1428-1457

Oh, W.A., Dong, T.G., Hshieh, T.T., & Inouye, S.K. (2017). Delirium in older persons Advances in diagnosis and treatment. Journal American Medical Association, 318(12):1161-1174

Simmons B. (2010). Clinical reasoning: concept analysis. Journal of Advanced Nursing. 66(5), p 1151-8.

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