Delirium
The two nurses below are talking about situations that they regularly come across in the course of their work with older patients. If you have worked or currently work in an acute hospital, do these situations sound familiar to you too?
‘Yeah it can be obvious things like agitation, it can be you know undressing at inappropriate times or patients doing something odd like they’re moving things around or they’re continually trying to get up out of bed. Sometimes they’re calling out for people who are not there. And when it comes to things around them like drip stands or water jugs, it’s like they don’t appreciate them for what they’re actually there for and why they’re there, so they’ll try to pull them over or pull them down or throw them away.’ [Staff nurse, acute medical ward]
‘Very often it can just be subtle and it’s not until you sort of speak to a patient that you realise that they’re answering you inappropriately or they’re not answering you at all. It’s not until you talk to the person or sometimes even it’s not until you tell them something or speak to them about something and then you try to ascertain whether or not they’ve taken on board what you’ve said and that’s when you realise that they’re confused.’ [Staff nurse, elective orthopaedic ward]
Do you recognise that both nurses are talking about patients with delirium (nurses often call this acute confusion) and are you aware that delirium is the term used by international disease classification systems to describe acute illness related confusion that comes on with little warning?
Delirium occurs as a sudden and fluctuating impairment in a person’s mental status as a result of a medical condition or its clinical treatment. Many nurses associate delirium with alcohol withdrawal but it is important to be aware that delirium can occur as a result of any pathophysiological disturbance such as infection, dehydration or drug toxicity. The circumstances in which a person can develop delirium therefore are very varied. Although much of the published literature on delirium relates to hospital care, it is now being acknowledged that delirium is an important care issue for nurses working in primary care, in the community and in care homes.
- Essential features of delirium
- Why is it important to know about delirium?
- Which patients are at risk of developing delirium?
What is the nurses role in caring for patients with delirium?
Nurses have a major role in giving essential care to patients who become temporarily vulnerable as a result of delirium, and in working with medical colleagues to find out the root cause of the delirium. The best outcome though is that nurses prevent delirium in the first place by being aware of the risk factors and precipitating factors, such as dehydration and bladder catheterisation for example, and in trying to prevent them. If nurses suspect that a patient is developing delirium, there are formal screening instruments that can be used.
It might be helpful to share experiences of nursing patients with delirium with a view to expanding your knowledge of this important quality of care issue for older patients. For example, do you take steps to prevent delirium in the patients you care for? Do you currently use any formal method of cognitive screening for patients in your work? If not, would you consider using a screening tool?
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Templates:
- The Abbreviated Mental Test
- The Confusion Assessment Method (CAM)
- Delirium Observation Screening (DOS) Scale
- NEECHAM Confusion Scale
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