Initial development of a screening tool for postoperative deliriumprodrome

Managing postoperative delirium is challenging for nurses. Nurses encounter postoperative delirium cases in clinical, risk assessment, and preventive care situations and tend to rely on their individual experiences. AIMS: This study examines thefactorstructureunderlying postoperative delirium prodrome to develop an easily administered postoperative delirium screening tool for clinical nurses. METHODS: In Research I, we extracted prodrome concepts based on a literature review. We conducted an investigative survey with 20 nurses for prodrome in Survey II. Based on these, in Survey III, we developed the tool’s first draft, administering it to 725 nurses who had at least three years surgical experience at one of 19 National University hospitals across the country. RESULTS: We extracted 50 items from 12 studies on postoperative delirium prodrome in Research I. The nurses’ interviews yielded 82 items inSurveyII. Thus, a questionnaire comprising 126 items was developed and administered inSurvey III. The factor analysis yielded 10 factors with40 items. The important underlying factors included “mental function dominated by delusions,”“decreased cognitive function,”“appearance of arousal,”and “discomfort and confusion,” of which the latter two were unique to this screening tool. CONCLUSIONS: Ten postoperative delirium prodrome factors were extracted in survey III. Of these “decreased activity and motivation,” “physiological arousal” “discomfort and confusion,” were consistent with two existing tools, the CAM-ICU and ICDSC. Additionally, we observed that “physiological arousal” and “discomfort and confusion” were two unique factors.