| Delirium and depression in general medical-surgical hospitalized patients have been shown to be prevalent, under-recognized, undertreated, and associated with adverse events both within and out of the Intensive Care Unit (ICU). Delirium and depression are common phenomenon among patients in the ICU, with subsequent multiple adverse outcomes, including increased fear, anxiety, falls, restraint use, and use of anti-psychosis and anti-depression medications. In addition, delirium and depression have been associated with increased burdens to the patient, family and staff. Accurate detection and effective treatment are critical strategies to ameliorate the effects of delirium and depression.; The purpose of the study was to assess the accuracy of critical care nurses' clinical bedside assessment of delirium and depression. The American Association of Critical Care Nurses' Synergy Model guided this study. This model suggests that synergy results from the actions of nurse competencies and patient characteristics. This study specifically examined the nurse competencies of clinical judgment and the patient characteristics of vulnerability and stability.; This descriptive study assessed 126 post-operative patients in the Surgical Intensive Care Unit of a large teaching hospital. This was done by comparing bedside nursing assessment with standardized assessment tools, the Confusion Assessment Method-ICU (CAM-ICU) to detect delirium, and the Hospital Anxiety and Depression Scale (HADS-D, depression subscale) to screen for depression. Concordance was assessed and variables were examined in a logistic regression model for nurse accuracy. Recognition of these cognitive impairments is a critical first step that will serve as a foundation for future studies to test interventions to manage delirium and depression. |
