¶ … Recognition of Delirium: Literature Review
The objective of this study is to conduct a review of the literature on the assessment and recognition of delirium. The study, which follows reviews literature, related to the recognition of delirium in older patients by nurses and examines the variations of recognition of delirium by nurses as it relates to their own personal views of age and aging related symptoms.
Devline et al. (2013)
There are few data in existence relating to the current assessment practices used by nurses for delirium. (Devline, et al., 2013, p.555) Delirium is reported to be characterized by "an acutely changing or fluctuating mental status, inattention, disorganized thinking and altered level of consciousness." (Devline, et al., 2013, p.556) Devline et al. (2013) additionally reports that while it is believed by many that patients with delirium are hyperactive they are in fact more likely to be hypoactive or have a mixed pattern. (Devline, et al., 2013, p.556) Delirium in the ICU is reported to be associated "with higher mortality, prolonged stay, and greater health care costs." (Devline, et al., 2013, p.556) Preexisting cognitive impairment is reported as the primary risk factor for delirium as well as are factors of "higher age, the presence of acute systematic illnesses or medical comorbid diseases, and the use of certain medications." (Devline, et al., 2013, p.556)
Ramaswamy et al. (1993)
The work of Ramaswamy, et al. (1993) reports a study that involved a "comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium. The study design and methods reported include "a 2-day CSI program that consisted of progressive 4-part didactic series, including evidence-based reviews of delirium recognition, prevention and management, interspersed with interactive and small group sessions and practical case conferences " which were reported to have been "conceptualized in a consultation with a leading expert on delirium." (Ramaswamy, et al., 1993, p.122) It is reported that the design of pre- and post-tests were focused on testing the participants in their knowledge and confidence around delirium identification. Study results state that there were an average attendance of 71 individuals at each didactic session. Specifically reported is "…Among all responses, 50 pretests and posttests were matched based on numeric coding (6 MD/DOs, 34 RNs, and 10 others). Mean pretest and posttest scores were 7.9 and 10.8 points, respectively (maximum: 17), showing a positive change in knowledge scores after the intervention (2.9 points, p < .001). Improvement in knowledge scores was higher in the cohort attending 2 or more lectures (3.8 points, p < .001)." (Ramaswamy, et al., 1993, p.122)
Tabet et al. (2005)
The work of Tabet, et al. (2005) reports a study that examined an educational intervention for preventing delirium on acute medical wards and states that delirium is a common disorder is older people who are hospitalized and that intervention may not improve such cases. The study reports the objective of testing the hypothesis "that an educational package for medical and nursing staff would both reduce the number of incident cases of delirium and increase recognition of cases of delirium within an acute medical admissions ward." (p.152) The study reported was a single-blind case control study in two acute admissions wards in a busy inner-city teaching hospital involving 250 participants over the age of 70 years of age. The state methodology was use of an educational package for staff on one ward of the hospital comprised by a one-hour presentation that was formal in nature accompanied by a group discussion, written management guidelines, and follow-up sessions. It is reported that the follow-up sessions "were based on one-to-one and group" and had the objective of making the provision of "continuous support of staff through emphasizing learning and testing knowledge. Diagnosis and management of some discharged delirium patients were also discussed to allow staff to learn from previous experience. The main outcome measures are point prevalence of delirium established by researchers, and recognition and case-note documentation of delirium by clinical staff." (Tabet, et al., 2005, p.152) Study results state that the point prevalence of delirium "…was significantly reduced on the intervention compared to the control ward (9.8% versus 19.5%, P < 0.05) and clinical staff recognized significantly more delirium cases that had been detected by research staff on the ward where the educational package had been delivered." (Tabet, et al., 2005, p.152)
Inoyue et al. (2001)
The work of Inouye et al. (2001) reports that nurses "play a key role in recognition of delirium, yet delirium is often unrecognized by nurses." (p.2467) Inouye (2004) reports a prospective study involving 797 patients ages 70 and older who underwent 2721 paired delirium rating...
In Mrs. K's case (as in terms of all patients to whom the test is administered) her educational attainment and age need to be considered. Mrs. K's rating was low - 14 points - and although this does correlate closely with dementia, caution has to be exercised since other mental disorders can also lead to low readings on the MMSE testing. It was also taken into account that physical problems,
ICU Delirium -- Type Of Study Clinical Question The PICOT question that will be evaluated in this study is, "Does the use of a validated delirium assessment instrument (intervention) improve delirium detection (outcome) among adults in the ICU (population) as compared multicomponent interventions (comparison) within a 6-month period (timeline)?" The clinical question demonstrates that the study will involve conducting a comparison of the impact of a validated delirium assessment instrument vis-a-vis multicomponent interventions
She also learns, too late, that the jewels and the life she coveted so long ago was a sham. Hence, the symbolic nature of the necklace itself -- although it appears to have great value, it is in fact only real in appearance, not in reality and the heroine is incapable of assessing the false necklace's true worth. The tale of "The Necklace" conveys the moral that what is real,
Caring for People With Dementia Older patients suffering from dementia admitted at care facilities are not accorded the best of care because of their complex needs. This category of patients struggle with progressive cognitive decline, functional decline and challenging behaviors that impacts their quality of life. Dementia not only impacts the patients' but also their families, healthcare systems and the larger society. The patients are not accorded the best care mainly
Falls THE ISSUE OF ACCIDENTAL FALLS At some point, anyone who had learned how to walk has had the experience of falling down -- it is a universal experience for infants as they gain ambulatory ability. In hospitals, however, the accidental fall is the most reported type of patient safety incident, with elderly patient populations displaying a particular vulnerability (Oliver 2007, p.173). Approximately one-third of adults over the age of sixty-five will
Building Linkages Between Nursing Care and Improved Patient Outcomes: The Role of Health Information Technology Health IT (HIT) is capable of transforming care quality and establishing connections between patient outcomes and nursing care. This article will examine the application of health IT and nursing-sensitive measures/indicators (NSIs) for improving care quality and establishing connections between better patient outcomes and nursing care. NSIs refer to measures reflecting nursing care process, structure, and outcomes.
Our semester plans gives you unlimited, unrestricted access to our entire library of resources —writing tools, guides, example essays, tutorials, class notes, and more.
Get Started Now