Confusion Assessment Method Accuracy and Nurse Competency in the Face of Delirium: A Scoping Review

Abstract Background: Delirium is a common and critical condition seen among hospitalized adults that frequently goes underrecognized. The Confusion Assessment Method (CAM) is a validated tool utilized by registered nurses to help identify delirium. However, variability in nurses’ knowledge and application may affect its effectiveness. The purpose of this scoping review was to evaluate nurses’ competency with CAM, identify barriers to its use, and examine educational strategies to improve delirium recognition. Methods: A scoping review was conducted using systematic search strategies across various databases. Studies published within the last ten years were included to reflect current clinical practice. Fourteen studies met the inclusion criteria and were analyzed using thematic synthesis. Results: Findings highlighted that CAM and CAM-ICU are reliable tools for delirium detection, with sensitivity ranging from 75% to 85% and specificity exceeding 95%. Across the selected studies, a variability in nurses’ knowledge and inconsistent applications was identified. Educational interventions improved nurses’ knowledge, confidence, and assessment accuracy. Quality improvement initiatives also improved screening compliance. Discussion: The effectiveness of CAM-based tools in clinical practice is limited by inconsistent nursing competency and variability in use. Findings in this scoping review suggest continuous training and system-level support are crucial to increasing nurses' delirium screening accuracy. Conclusion: While CAM-based tools are effective for delirium screening, their accuracy in practice depends on nurses’ competency and consistent use. Educational interventions and organizational support play a key role in improving delirium recognition. Further research is needed to evaluate long-term skill retention and the impact of improved CAM use on patient outcomes.