Level of Knowledge and Attitude towards Recognition of Delirium among Nurses Working in Critical Care Units at Kenyatta National Hospital, Kenya

Abstract

Delirium is a major barrier to the care of patients admitted in the intensive care units globally. The Society of Critical Care Medicine recommends regular delirium monitoring among patients admitted in ICU. Additionally, empirical research has documented a prevalence of up to 80% in all patients admitted in critical care units. Delirium has been linked to poor clinical outcomes such as higher mortality rates, longer mechanical ventilation periods and longer stays in ICU and hospital in general. The aim of the study was to assess the knowledge and attitude towards recognition of delirium among nurses working in critical care unit, KNH. A descriptive cross-sectional study design with both quantitative and qualitative approaches was utilized in the study. Census was used to recruit a sample of 166 nurses who participated in the study. Data was collected using a self-administered questionnaire. Quantitative data were analyzed with aid of SPSS version 24 using descriptive statistics and summarized in frequency tables, while qualitative data were analyzed using content analysis approach. Chi-square was used to test the factors associated with recognition of delirium. Results revealed that 80% of the studied nurses had high knowledge on recognition of delirium. While, 20% of them had low level of total knowledge on recognition of delirium. Majority (73.3%) of the critical care nurses had positive attitude towards recognition of delirium compared to 26.7% who had negative opinion towards the same. Binary logistics regression results revealed that critical care nurses aged between 41-50 years were likely to have high knowledge on delirium recognition than those aged below 30 years (AOR=2.462, CI 2.623-44.612, P-value<0.001). Critical care nurses with master degrees were likely to have higher knowledge on recognition of delirium compared to those with diplomas while nurses with between 20-24 years of experience were likely to have high knowledge compared to those with less than 6years of experience. critical care nurses who had received some professional training in critical care were more likely to have high level of knowledge compared to those whom had not (AOR=6.834, CI 4.271-26.091, P-value<0.001). Also, nurses aged above 41 years were less likely to develop negative attitude towards delirium recognition compared to those aged below 30 years (AOR=0.681, CI 0.036-0.983, P-value<0.001). Nurses with master’s degrees were less likely to develop negative attitude towards recognition of delirium compared to those with diploma as the highest academic level (AOR=0.802, CI 0.027-0.892, P-value<0.001). The unit was also noted to lack guidelines on assessment/management of delirium by nurses. In conclusion, delirium is a common problem in CCU at KNH and that recognition of delirium bycritical care nurses is associated with some social demographic factors. High degree of clinical expertise is crucial to detect any acute change in patient's mental status presenting as the early sign of delirium.