Confusion Assessment Method in Intensive Care Unit

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Table of Contents

Aim of the Study
Proposed Method
References

Aim of the Study

Delirium is a significant bother for intensive care unit (ICU) personnel in Saudi Arabia. According to Rasheed et al. (2019), the prevalence of delirium among ICU patients is more than 17%. Alamri et al. (2018) also suggest that the condition can be found in 80% of older ICU patients. The condition is underdiagnosed, and a reliable screening method is required to address the problem. Research demonstrates that Confusion Assessment Method – Intensive Care Unit (CAM-ICU) can be an effective screening method for nurses that can be used to assess delirium in ICU patients (Aljuaid et al., 2018; Khan et al., 2017; Ramoo et al., 2018; Selim et al., 2018). However, it is unclear if the Arabic version of CAM-ICU is reliable when administered by non-Arabic-speaking nurses in Saudi Arabian ICUs. Thus, the aim of the present paper is to provide evidence that the Arabic version of CAM-ICU is an effective tool for delirium screening in Saudi Arabian ICUs even when administered by non-Arabic-speaking nurses.

Proposed Method

Proposed Design

Validation of a screening tool has a standard procedure that should be followed to avoid inconsistencies. According to Richardson et al. (2015), the reliability of a screening tool is confirmed by comparing the results to the gold standard of diagnosis. In particular, every patient should be examined at least twice: by the nurse with a screening tool and by a psychiatrist using DSM-V criteria. After that, a correlation analysis is to be conducted using Pearson’s R (Richardson et al., 2015). If the coefficient is 0.95 or above, the tool is considered highly reliable (Richardson et al., 2015). At the same time, any coefficient above 0.80 is deemed to be acceptable for confirming the reliability of the tests (Richardson et al., 2015). While the process of assessing the reliability of a screening test is well-designed, it requires significant resources to accomplish.

CAM-ICU was translated and validated by many researchers worldwide. Salim et al. (2018) and Aljuaid et al. (2018) utilized the process described above to validate the Arabic version of CAM-ICU. Ben Saida et al. (2020) used the method to validate Tunisian version of CAM-ICU, while Arbabi et al. (2019) used the process to assess validity and reliability of the Persian version of the test. Ewers et al. (2020) went through similar steps confirm the reliability of CAM-ICU in Australian patients, and Van de Meeberg (2017) used a similar approach to validating the tool for European geriatric patients. Thus, the research suggests that the method of assessing reliability described by Richerdson et al. (2015) should become the core of the present study.

However, it should be considered that the method can be modified if required. For instance, Ben Saida et al. (2020) screened every patient twice to assess inter-rater reliability and then juxtaposed the results to the diagnosis of a psychiatrist. Van de Meeberg (2017) conducted a cross-sectional compare prevalence of delirium before and after implementation of CAM-ICU. The results revealed that there was a significant increase in the diagnosis of delirium among elderly ICU patients (Van de Meeberg, 2017). Thus, there is a possibility to employ other methods to confirm the reliability of the test.

It should be noticed that the purpose of the present paper is not to assess the reliability of the Arabic version of CAM-ICU. The reliability of the Arabic version of the screening tool was confirmed previously by previous research (Aljuaid et al., 2018; Salim et al., 2018) Instead, the central purpose is to answer the question if non-Arabic-speaking nurses. Thus, there is no need to utilize the method described by Richardson et al. (2015). A cross-sectional correlational study is appropriate to answer the research question and accomplish the aim. A sample of nurses needs to be divided into Arabic speakers and non-Arabic speakers. After that, every group needs to utilize the test for three months. When the experiment is over, chi-square analysis should be conducted if the proportion of positive screenings is similar in both groups. Chi-square analysis is a method used to identify if two variables are related, which is appropriate for the purpose of the present paper (Pyrczak, 2016). The results of the statistical analysis will demonstrate if non-Arabic speakers performed differently for Arabic speakers.

Sampling and Data Collection Approaches

The population of interest is non-Arabic-speaking ICU nurses with more five years of experience in King Saud Medical Unit. The experience level was chosen to avoid biases connected with insufficient experience in the nursing profession. Non-Arabic-speakers are to be matched with Arabic speakers with a similar experience level. Instead of applying sampling methods, it is appropriate to conduct a census. In other words, it is convenient to assess all nurses of the population of interest. According to Etikan (2017), all types of sampling are associated with biases. A census helps to avoid such biases, and since the population is rather small, a census is possible.

The data will be collected using the electronic health record (EHR) system of the ICU. According to Kim et al. (2019), utilization of EHRs for research purposes is a convenient way of collecting and storing data. The results of CAM-ICU tests of all the patients admitted to the ICU will be divided into three groups: administered by non-Arabic-speaking nurses with five or more years of experience, administered by Arabic-speaking nurses with five or more years of experience, and other. Gathering data using the EHR system is faster and less resource-dependent than collecting the data using non-digital methods.

The data collection procedure, however, can be associated with ethical and technical problems. In particular, data collection will be associated with access to protected health information, which may lead to privacy issues (Maher et al., 2019). Thus, data collection procedure should be conducted with the help of the IT personnel to avoid errors. After that, all the data should be cleared from personal information and stored with all the needed precautions.

References

Alamri, S. H., Ashanqity, O. A., Alshomrani, A. B., Elmasri, A. H., Saeed, M. B., Yahya, S. A.,… & Mukhtar, A. M. (2018). Delirium and correlates of delirium among newly admitted elderly patients: a cross-sectional study in a Saudi general hospital. Annals of Saudi Medicine, 38(1), 15-21.

Aljuaid, M. H., Deeb, A. M., Dbsawy, M., Alsayegh, D., Alotaibi, M., & Arabi, Y. M. (2018). Psychometric properties of the Arabic version of the confusion assessment method for the intensive care unit (CAM-ICU). BMC Psychiatry, 18(1), 1-9. Web.

Arbabi, M., Zolfaghari, M., Amirsardari, A., Fahimfar, N., & Eybpoosh, S. (2019). Validity and reliability of the Persian version of the confusion assessment method for intensive care units. Nursing Practice Today, 6(3), 123-132.

Ben Saida, I., Kortli, S., Amamou, B., Kacem, N., Ghardallou, M., Ely, E. W.,… & Boussarsar, M. (2020). A Tunisian version of the confusion assessment method for the intensive care unit (CAM-ICU): translation and validation. BMC Psychiatry, 20, 1-8.

Etikan, I., & Bala, K. (2017). Sampling and sampling methods. Biometrics & Biostatistics International Journal, 5(6), 00149.

Ewers, R., Bloomer, M. J., & Hutchinson, A. (2020). An exploration of the reliability and usability of two delirium screening tools in an Australian ICU: A pilot study. Intensive and Critical Care Nursing, 102919.

Khan, B. A., Perkins, A. J., Gao, S., Hui, S. L., Campbell, N. L., Farber, M. O., Chlan, L. L., & Boustani, M. A. (2017). The CAM-ICU-7 delirium severity scale: A novel delirium severity instrument for use in the intensive care unit. Critical Care Medicine, 45(5), 851-857. Web.

Kim, E., Rubinstein, S., Nead, K., Wojcieszynski, A., Gabriel, P., & Warner, J. (2019). The evolving use of electronic health records (EHR) for research.Seminars in Radiation Oncology, 29(4), 354-361. Web.

Maher, N. A., Senders, J. T., Hulsbergen, A. F., Lamba, N., Parker, M., Onnela, J. P.,… & Broekman, M. L. (2019). Passive data collection and use in healthcare: A systematic review of ethical issues. International journal of medical informatics, 129, 242-247.

Pyrczak, F. (2016). Success at statistics: A worktext with humor. Routledge.

Ramoo, V., Abu, H., Rai, V., Singh, S. K. S., Baharudin, A. A., Danaee, M., & Thinagaran, R. R. R. (2018). Educational intervention on delirium assessment using confusion assessment method‐ICU (CAM‐ICU) in a general intensive care unit. Journal of Clinical Nursing, 27, 4028-4039. Web.

Rasheed, A. M., Amirah, M., Abdallah, M., Awajeh, A. M., Parameaswari, P. J., & Al Harthy, A. (2019). Delirium incidence and risk factors in adult critically ill patients in Saudi Arabia. Journal of Emergencies, Trauma, and Shock, 12(1), 30-37.

Richardson, R., Trépel, D., Perry, A., Ali, S., Duffy, S., Gabe, R., … McMillan, D. (2015). Screening for psychological and mental health difficulties in young people who offend: a systematic review and decision model. Health Technology Assessment, 19(1), 1-128. Web.

Selim, A., Kandeel, N., Elokl, M., Khater, M. S., Saleh, A. N., Bustami, R., & Ely, E. W. (2018). The validity and reliability of the Arabic version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU): A prospective cohort study. International Journal of Nursing Studies, 80, 83-89. Web.

Van de Meeberg, E. K., Festen, S., Kwant, M., Georg, R. R., Izaks, G. J., & Ter Maaten, J. C. (2017). Improved detection of delirium, implementation and validation of the CAM-ICU in elderly Emergency Department patients. European Journal of Emergency Medicine, 24(6), 411-416.

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