Plain English Summary
Background and study aims
Delirium is a disturbance in mental capabilities and attention that commonly occurs in older patients who are hospitalised. Nurses can play an important role in preventing and detecting this syndrome, however they have a lack of knowledge and skills to manage it. This results in patients declining in their function and health outcomes. Education of healthcare providers is a key component of multicomponent delirium strategies to improve delirium management and patient outcomes. Traditional educational initiatives are difficult to implement in daily practice. E-learning might be easier. Studies evaluating the impact of delirium education through e-learning on daily delirium care are scarce. The study aim is to evaluate the effect of a delirium e-learning tool for nurses on in-hospital prevalence, duration and severity of delirium or mortality in hospitalized geriatric patients, and geriatric nurses’ delirium recognition and knowledge.
Who can participate?
Patients who were 70 years or older and admitted to the geriatric ward and nurses working on the participating geriatric ward.
What does the study involve?
The effect of nursing education about delirium through e-learning was evaluated on patient and nursing outcomes. A delirium e-learning tool - including 11 modules about delirium prevention, detection and management - was developed. All nurses of the participating ward receive the intervention, which includes a one-hour life information session about using the e-learning tool and the completion of six compulsory modules during a three-month learning period. The five other modules may be completed on a voluntary basis. This e-learning tool is implemented over three months between two periods of data collection in patients i.e. the non-intervention patient cohort (before group, consisting of usual care; 4 months) and the intervention patient cohort (after group; 4 months). In those patient cohorts, in-hospital prevalence, duration and severity of delirium and mortality up to 12 months after hospital admission were measured. Nurses’ delirium-related knowledge and their ability to recognize delirium are assessed immediately before the educational period and four months after the implementation period.
What are the possible benefits and risks of participating?
Participating nurses may benefit from improved levels of delirium-related knowledge and recognition skills. Participating patients may have decreased risk for developing delirium or may have a lower delirium severity or shorter duration of delirium. There are no notable risks involved for participating patients or nurses.
Where is the study run from?
UZ Leuven (Belgium)
When is study starting and how long is it expected to run for?
January 2010 to December 2011
Who is funding the study?
PWO Flanders (Belgium)
Who is the main contact?
Professor Koen Milisen
Prof Koen Milisen
Department of Public Health and Primary Care
Academic Centre for Nursing and Midwifery (KU Leuven)
Federal Agency for Medicines and Health Products (B32220097550, 09/12/2009).
Effect of an Interactive E-learning Tool for Delirium on Patient and Nursing Outcomes in a Geriatric Hospital Setting: Findings of a Before-After study
A delirium e-learning tool for nurses has beneficial effects on the in-hospital prevalence, duration and severity of delirium and mortality in older patients, and on geriatric nurses’ delirium knowledge and their ability to recognize delirium.
Medical Ethics Committee of the University Hospitals Leuven (Federal Agency for Medicines and Health Products, 09/12/2009, ref: B32220097550
Single-centre non randomised study
Primary study design
Secondary study design
Non randomised study
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Delirium and staff education
An online self-directed delirium educational (e-learning) tool for nurses was developed by the research team.
This tool consists of 11 modules (e.g. information about delirium specifics, delirium prevention/treatment strategies, use of screening instruments for delirium detection).
The intervention includes:
1. A one-hour live information session to offer nurses oral and written information about the use of the e-learning tool
2. The completion of six compulsory modules (e.g. ‘occurrence and consequences’, ‘clinical presentation’, ‘exercises in delirium recognition’, ‘predisposing and precipitating risk factors’, ‘screening for delirium, and ‘prevention of delirium’) during a 3-month learning period.
The five other modules can be completed on a voluntary basis. The tool remains available until the end of the study. Nurses can access the modules at any time using their personal log-in code. It takes between five and 15 min to complete one module. Nurses who do not complete the six compulsory modules within two months are encouraged by the head nurse to complete the tool. Additionally, a poster was displayed at the geriatric ward.
Participants are followed up to assess their knowledge of delirium and ability to diagnose delirium at four months to evaluate how well the programme works.
Primary outcome measure
1. In-hospital prevalence of delirium is measured using the Confusion Assessment Method (CAM) at days one, three, five, seven, 14 and 21 after admission to the geriatric ward. If the patient had delirium on one of the measurement points (positive CAM score), the patient was followed up daily until a negative CAM score was obtained
2. Duration and severity of delirium in patients is measured using the 7-item delirium index at days one, three, five, seven, 14, and 21 after admission to the geriatric ward
3. Duration of delirium in patients is measured as the number of days on which a positive CAM score was obtained
Secondary outcome measures
1. Mortality in patients is measured by the number of deaths while being hospitalised at the geriatric unit
2. Twelve-month mortality is measured as the number of deaths occurring within 12 months after admission, including cases of in-hospital mortality
3. Geriatric nurses' delirium-related knowledge is assessed with the 35-item true-false Delirium Knowledge Questionnaire (DKQ) at baseline and at the end of the 4 month after study
4. Geriatric nurses’ ability to recognize delirium is assessed with standardized ‘case vignettes’ at baseline and at the end of the 4 month after study
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Dutch speaking
2. 70 years or older
3. Consecutively admitted to the geriatric ward
All geriatric nurses of the participating unit.
Target number of participants
142 patients, 71 in each patient cohort
Participant exclusion criteria
1. Severe hearing or visual problems
2. Very poor health condition (e.g. palliative patients, patients with unstable cardiac or respiratory problems)
3. Isolation because of infectious disease
4. Unable to hold a conversation
5. Readmitted during the study period
6. Expected discharge within 24 hours after admission
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Planned publications in a high-impact peer reviewed journal
IPD sharing statement:
The datasets generated during and/or analysed during the current study will be available upon request from firstname.lastname@example.org
Intention to publish date
Participant level data
Available on request
Basic results (scientific)
2018 results in: https://www.ncbi.nlm.nih.gov/pubmed/29351772