Development and review of vignettes representing older people with cognitive impairment

Abstract

This paper describes a process undertaken to develop and review five clinical vignettes to be used in geriatric nursing educational research. The purpose of this process was to provide valid depictions of delirium and its subtypes and distinguish delirium from dementia. Five vignettes depicting hospital bedside interactions between nursing staff, family, and an older patient who displayed signs of one of the following conditions: delirium (hyper and hypoactive types respectively), dementia, or delirium (both types) superimposed on dementia were constructed. Vignette accuracy and reliability were established using a multistage process that culminated in formal review by a group of ten international nursing and medical delirium experts. The final five vignettes accurately depicted the given scenario as agreed by the experts and were at an appropriate level of simplicity and clarity. Given the increased interest in vignettes for both nursing research and educational purposes, the described method of vignette development and review has the ability to assist other vignette developers in creating reliable representations of their desired clinical scenarios.

Evaluation of a method to estimate the point prevalence of cognitive impairment and delirium in a multi‐campus Australian health service

“…Initially surveyors completed a prereading pack that included the 4AT, the 3D‐CAM Training Manual, an article explaining the differences between delirium, depression and dementia, and validated web‐based videos which illustrated common presentations of cognitive impairment . Two weeks prior to the survey, all surveyors participated in a face‐to‐face workshop in which a mix of didactic instruction, group discussion and discussion of validated vignettes of cognitive impairment was used. The study protocol was described in detail.…”

Screening in delirium: A pilot study of two screening tools, the Simple Query for Easy Evaluation of Consciousness and Simple Question in Delirium

“…This method was deemed to be the reference standard for the purposes of comparison. Prior to commencing the study, the consultants independently categorised five clinical vignettes [13] as 'Delirium' or 'No Delirium' based on the DSM-IV criteria to ensure diagnostic consistency. A comparison of the results revealed 100% concordance, indicating high vignette diagnostic accuracy and inter-rater reliability.…”

Palliative care nurses’ recognition and assessment of patients with delirium symptoms: A qualitative study using critical incident technique

“…Vignettes are brief descriptions of clinical situations, used as an effective and economical means to explore or test clinician knowledge and/or decision-making (Veloski et al, 2005, Fick et al, 2007, Mc Crow et al, 2013. A vignette of a palliative care inpatient with unrecognised hypoactive delirium was developed and provided to participants shortly before their interview (Text Box 1).…”