• Mohamed El Hussein and Sandra Hirst.
• Faculty of Health & Community Studies, School of Nursing, Mount Royal University, Calgary, AB, Canada.
• J Clin Nurs. 2016 Feb 1; 25 (3-4): 381-91.

Aims And ObjectivesTo construct a grounded theory that explains the clinical reasoning processes that registered nurses use to recognise delirium while caring for older adults in acute care settings.BackgroundDelirium is often under-recognised in acute care settings; this may stem from underdeveloped clinical reasoning processes. Little is known about registered nurses' clinical reasoning processes in complex situations such as delirium recognition.DesignSeventeen registered nurses working in acute care settings were interviewed. Concurrent data collection and analysis, constant comparative analysis and theoretical sampling were conducted in 2013-2014.MethodsA grounded theory approach was used to analyse interview data about the clinical reasoning processes of registered nurse in acute hospital settings.ResultsThe core category that emerged from data was 'Tracking the footsteps'. This refers to the common clinical reasoning processes that registered nurses in this study used to recognise delirium in older adults in acute care settings. It depicted the process of continuously trying to catch the state of delirium in older adults.ConclusionsUnderstanding the clinical reasoning processes that contribute to delirium under-recognition provides a strategy by which this problem can be brought to the forefront of awareness and intervention by registered nurses.Relevance To Clinical PracticeRegistered nurses could draw from the various processes identified in this research to develop their clinical reasoning practice to enhance their effective assessment strategies. Delirium recognition by registered nurses will contribute to quality care to older adults.© 2016 John Wiley & Sons Ltd.

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