Delirium is a serious and acute condition commonly experienced by older people in hospital with broad ranging impacts on the individual, their social networks and on healthcare costs.
Delirium causes health and safety issues for the older person, such as falls, pressure areas, long-term functional and cognitive damage resulting in a deteriorating quality of life and an increased risk of death beyond the day of hospital discharge.
Prevention using non-pharmacological methods is currently evidenced as the most effective strategy for delirium care, however, it is concerning that despite the availability of screening tools delirium continues to be under-recognised at rates of 60% (Oh et al. 2017).
The Dementia Delirium Clinical Nurse Consultants (CNCs) working in NSW Health hospitals fulfil an important role in educating and raising awareness about dementia and delirium, contributing to improved outcomes for older people and their families. The purpose of this paper is to report on a study undertaken by a Dementia Delirium CNC working in regional NSW focused on delirium recognition.
The study provided a means to engage registered nurses (RNs) in a reflection on their clinical practice and give a voice to their understanding about the barriers and enablers they experience in recognising delirium in older people during a hospital admission (Coyle et al. 2017).
Set in a large teaching hospital this qualitative study collected data via semi structured group interviews with Registered Nurse participants.
Findings by thematic analysis revealed a dichotomy in the clinical practice of participants and opportunities to improve RN capacity in delirium recognition. This prompted a review of educational methods in delirium recognition among RNs. Development of Objective Structured Clinical Examinations (OSCEs) in delirium recognition became an effective focus to further clinical competence and empathy in RN practice in the local setting (Traynor et al. 2016).
Adhering to best practice in busy and complex hospital environments requires cultures of care which value older people and reject stereotyping to ensure assessments are competent and care compassionate (El Hussein & Hirst 2015). Collaboration and linkage with national and state-wide initiatives, along with educational interventions, will promote adherence to best practice and ensure older people are screened for delirium.
References
- Coyle M.A, Burns P., Traynor V. (2017). Is it My Job? The Role of RNs in the Assessment and Identification of Delirium in Hospitalized Older Adults: An Exploratory Qualitative Study. J Gerontol Nurs. 43(4) 29-37.
- El Hussein, M., & Hirst, S. (2015). Institutionalizing clinical reasoning: A grounded theory of the clinical reasoning processes RNs use to recognize delirium. Journal of Gerontological Nursing, 41(10), 38-44.
- Oh, E.S., Fong, T.G., Hshieh, T.T., Inouye, S.K., 2017. Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA 318(12), 1161–1174.
- Traynor, V., McAllan, P., Riley-Henderson, A., Coyle, M., & French, A. (2016, July). Evaluating an innovative delirium education programme: How do objective structured clinical examinations (OSCEs) improve practice? Poster session presented at the meeting of the DECLARED Bi-Annual Conference of the Australasian Delirum Association
Miriam Coyle, MPhil, Master of Science (Dementia Care), Registered Nurse, PhD Candidate, University of Wollongong
Victoria Traynor, PhD, BSc Nursing Studies Hons, Professor, University of Wollongong
Dr Pippa Burns, PhD, Master of Public Health, BSc Pharmacology Hons, Lecturer, University of Wollongong
