Nurses' Recognition of Delirium in the Hospitalized Older Adult

Rice, Karen L.; Bennett, Marsha; Gomez, Maureen; Theall, Katherine P.; Knight, Mike; Foreman, Marquis D.

doi:10.1097/nur.0b013e318234897b

Cited by 109 publications

(106 citation statements)

References 38 publications

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“…9 The researchers examined the rate of agreement and disagreement between 4 researchers and a sample of 167 nurses in rating for delirium using the CAM. 9 The nurses were only able to detect delirium 25% of the time.…”

Section: Literature Reviewmentioning

confidence: 99%

“…7 Similar cognitive deficits and behavioral symptoms associated with both delirium and dementia make it difficult to distinguish between the 2. 8 A study conducted by Rice et al 9 showed that delirium in the presence of underlying dementia is underdiagnosed a majority of the time. 9 Patients with delirium typically exhibit acute-onset confusion that fluctuates to periods of lucidity and resolves with the treatment of the underlying cause.…”

Section: Introductionmentioning

confidence: 98%

“…8 A study conducted by Rice et al 9 showed that delirium in the presence of underlying dementia is underdiagnosed a majority of the time. 9 Patients with delirium typically exhibit acute-onset confusion that fluctuates to periods of lucidity and resolves with the treatment of the underlying cause. 10 In addition, the patient's level of consciousness becomes impaired.…”

Section: Introductionmentioning

confidence: 98%

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Nurses’ Assessment of Delirium With Underlying Dementia in End-of-Life Care

Oligario

Buch

Piscotty

2015

Journal of Hospice & Palliative Nursing

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Because of physical and metabolic changes during end of life, patients with dementia are very susceptible to develop delirium. The recognition of delirium with underlying dementia can be difficult because of their overlapping behavioral manifestations. Previous studies conducted among nurses caring for patients with delirium have shown that nurses are often not able to detect the presence of delirium using their subjective assessments. This study evaluated the nurses' ability to subjectively assess for delirium in patients with underlying dementia in end of life. Their findings were compared with the results of objective assessments performed by the researcher using Confusion Assessment Method. In 30 paired assessments, the objective and subjective assessments had the same findings. The remaining 20 paired assessments showed disagreement between the subjective and objective findings. A 0 measure of agreement was performed with a result of 0.074 and a significance of P 9 .05. This finding indicates no statistically significant agreement between the subjective nursing assessment for delirium and the objective assessment using Confusion Assessment Method. Accurate nursing assessment yields appropriate nursing interventions. The findings of this study support the need for improved subjective nursing assessment for delirium in patients with dementia at the end of life. KEY WORDSconfusion assessment method, delirium, dementia, end of life, hospice, nurses, nursing D elirium is a cognitive disorder of an acute onset and a fluctuating course. It is manifested by impaired consciousness, attention, and perception. 1 During end of life, patients' ability to maintain their physical, emotional, and psychosocial integrity is threatened by changes caused by their terminal illnesses. Patients with underlying dementia who develop superimposed delirium are particularly vulnerable to this threat because of cognitive and physical changes associated with these conditions. The cognitive and physical changes associated with dementia are very similar to the changes patients experience with delirium, making it difficult to identify the underlying cause and appropriate treatment. Accurate nursing assessment for delirium may result in providing appropriate nursing interventions. Nursing interventions may help maintain patients' comfort, promote improved quality of life, and make the dying experience easier for patients and their families. Therefore, the purpose of this study was to identify nurses' subjective ability to assess for delirium in patients with underlying dementia during end of life by comparing nurses' findings for agreement or disagreement with the results of an objective assessment instrument, the Confusion Assessment Method (CAM). 2 BACKGROUND

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Section: Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

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Nurses’ Assessment of Delirium With Underlying Dementia in End-of-Life Care

Oligario

Buch

Piscotty

2015

Journal of Hospice & Palliative Nursing

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“…Delirium, which is associated with longer hospital stays and poorer outcomes, is often underrecognized by nurses (Rice et al, 2011). Functional decline among hospitalized patients is estimated to be 50% (Gill, Allore, Gahbauer, & Murphy, 2010).…”

Section: Educating Nurses In Gerontologymentioning

confidence: 99%

Educating Nurses in Gerontology: We Still Have a Way to Go

Koroknay

2015

J Gerontol Nurs

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“…10 This is thought to be a particularly pressing need given the widespread concern that currently, many patients with delirium are missed, particularly by palliative care nurses, and thus receive inadequate care. [26][27][28][29] In order to comprehend and to address this issue, we require a stronger understanding of how nurses and other caregivers construct their daily practice. To date, studies appear to reflect that nurses too often fail to identify the core features of delirium in their patients, and that they fail to make use of the notion of delirium in their clinical language and reasoning, thus rendering their mental status assessments superficial and unhelpful.…”

Section: David Kenneth Wright Et Almentioning

confidence: 99%

Delirium as letting go: An ethnographic analysis of hospice care and family moral experience

et al. 2015

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Background: Delirium is extremely common in dying patients, and appears to be a major threat to the family's moral experience of a good death in end-of-life care. Aim:To illustrate one of the ways in which hospice caregivers conceptualize end-of-life delirium, and the significance of this conceptualization for the relationships that they form with patients' families in the hospice setting. Design: Ethnography.Setting/participants: Ethnographic fieldwork was conducted at a nine-bed, freestanding residential hospice, located in a suburban community of eastern Canada. Data collection methods included 15 months of participant observation, 28 semi-structured audio-recorded interviews with hospice caregivers, and document analysis. Results:Hospice caregivers draw on a culturally established framework of normal dying to help families come to terms with clinical end-of-life phenomena, including delirium. By offering explanations about delirium as a natural feature of the dying process, hospice caregivers strive to protect for families the integrity of the good death ideal. Conclusions:Within hospice culture, there is usefulness to deemphasizing delirium as a pathological neuropsychiatric complication, in favour of acknowledging delirious changes as signs of normal dying. This has implications for how we understand the role of nurses and other caregivers with respect to delirium assessment and care, which to date has focused largely on practices of screening and management.

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Nurses' Recognition of Delirium in the Hospitalized Older Adult

Cited by 109 publications

References 38 publications

Nurses’ Assessment of Delirium With Underlying Dementia in End-of-Life Care

Nurses’ Assessment of Delirium With Underlying Dementia in End-of-Life Care

Educating Nurses in Gerontology: We Still Have a Way to Go

Delirium as letting go: An ethnographic analysis of hospice care and family moral experience

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