What is the Nursing Delirium Screening Scale (Nu-DESC)?
The Nursing Delirium Screening Scale (Nu-DESC) is an observational tool used by nurses to screen patients for delirium. It is designed to be quick and easy to integrate into routine patient care, relying on a nurse's observations over a period, often a shift, rather than direct questioning or cognitive testing. This makes it practical for various clinical settings.
The five components of the Nu-DESC
The Nu-DESC evaluates five specific signs of delirium, with each item scored from 0 (absent) to 2 (severe). A total score of 2 or more suggests a positive screen requiring further assessment. The five items are:
- Disorientation: Assessing awareness of person, place, and time.
- Inappropriate Behavior: Observing for restlessness, agitation, or inappropriate actions.
- Inappropriate Communication: Evaluating speech and thought processes.
- Illusions or Hallucinations: Checking for perceptual disturbances.
- Psychomotor Retardation: Identifying significant slowing of movement and speech.
How nurses implement the Nu-DESC in practice
Nurses incorporate the observation of these five criteria into their regular interactions with patients throughout their shift. At the end of the shift, the scores are totaled. A positive score typically triggers further investigation and the implementation of a delirium care plan. This proactive approach facilitates early intervention.
Benefits and limitations of the Nu-DESC
Benefits
- Ease and speed: The Nu-DESC can be completed quickly, fitting easily into a nurse's workflow.
- Increased accuracy: It can improve delirium identification, particularly for hyperactive delirium, compared to clinical judgment alone.
- Standardized approach: Provides a consistent method for screening across nursing staff.
- Early detection: Facilitates prompt identification and intervention, improving outcomes.
Limitations
- Observational bias: Less sensitive to subtle or hypoactive delirium where symptoms are less overt.
- Absence of baseline comparison: Does not explicitly assess acute change from a patient's normal cognitive state.
- Need for training: Proper training is required for consistent and accurate use.
A comparison of delirium screening tools
The Nu-DESC is one of several tools available. Here is a comparison with the Confusion Assessment Method (CAM) and the Intensive Care Delirium Screening Checklist (ICDSC):
| Feature | Nu-DESC | CAM-ICU | ICDSC |
|---|---|---|---|
| Screening Context | General hospital wards | Intensive Care Unit (ICU) | Intensive Care Unit (ICU) |
| Patient Type | Non-intubated patients | Ventilated and non-ventilated patients | Ventilated and non-ventilated patients |
| Assessment Type | Observational | Interactive (requires patient testing) | Observational over 8-24 hours |
| Assessment Time | <2 minutes (based on 12-hour observation) | 1-2 minutes for interactive test | <5 minutes (based on 8-12 hour observation) |
| Key Items | Disorientation, inappropriate behavior, inappropriate communication, hallucinations/illusions, psychomotor changes | Acute mental status change, inattention, altered consciousness, disorganized thinking | Altered consciousness, inattention, disorientation, hallucinations, psychomotor changes, inappropriate speech/mood, sleep-wake disturbance, symptom fluctuation |
| Scoring | Score $\ge$2 is positive (max 10) | Requires specific combination of features | Score $\ge$4 is positive (max 8) |
The crucial role of early detection
Early detection of delirium is vital because it is linked to increased illness, longer hospital stays, and lasting cognitive problems. Timely identification using tools like the Nu-DESC allows healthcare teams to quickly address underlying causes such as infection or dehydration. Screening tools provide objective data for the care team, supporting prompt interventions to minimize patient suffering and promote recovery. For more information on delirium detection and management, you can consult the National Institutes of Health through their article on implementing screening tools in the ICU.
Conclusion
The Nu-DESC is a valuable nurse delirium screening checklist for identifying delirium in hospitalized patients. Its ease of use and observational nature make it practical for busy environments, contributing to early detection and intervention. While it has limitations, particularly with less overt forms of delirium, its use is a key element in patient-centered care, helping to mitigate the serious consequences of this condition.
