2.50
Hdl Handle:
http://hdl.handle.net/10755/150955
Type:
Presentation
Title:
Early detection and treatment of delirium in the hospitalized elderly
Abstract:
Early detection and treatment of delirium in the hospitalized elderly
Conference Sponsor:Sigma Theta Tau International
Conference Year:1992
Conference Date:August 6 - 8, 1992
Author:Foreman, Marquis, PhD
P.I. Institution Name:University of Illinois at Chicago
Title:Assistant Professor
The aim of this project was to test consultation and education

provided by a doctorally-prepared Geriatric Clinical Nurse

Specialist (GCNS) relative to improving the timeliness and accuracy

of assessment, prevention, and management of delirium by staff

nurses. Nurses (n=68) on two 24-bed general medical units and two

24-bed general surgery units received the education program which

included both written and verbal instructional materials about:

(a) simple bedside tests for assessing cognitive function, (b) the

clinical features that distinguish delirium, dementia, and

depression, (c) common causes of delirium, and (d) independent,

interdependent, and dependent strategies for preventing and

managing delirium.



To determine the accuracy and timeliness of the detection of the

delirium as well as to the responses of nurses and physicians to

the delirium, the hospital records of all patients were reviewed by

a blinded geriatrician Accuracy of detection was compared to the

diagnosis of delirium by the research team on the basis of the

DSM-IIIR criteria; timeliness was determined by comparing the time

of detection of the nurses to the time delirium was detected by the

research team.



Responses by nurses to instances of delirium included verbatim

descriptions of the patients as documented in their hospital

records; whether or not the patient was referred to the housestaff

for additional diagnostics or therapeutics; use of physical or

pharmacologic restraints; and other actions considered

therapeutic, e.g., manipulation of various aspects of the

environment such as a change in the level of lighting.



The effects of the consultation and education program on patient

outcomes and the attitudes and satisfaction of nurses of the

consultation and educational program provided by the GCNS are

inconsistent. The incidence of delirium dropped from 16.6 percent

to 13.3 percent, a reduction that in some part may be attributable

to the changes in nursing practice relative to the care of elderly

patients. The high baseline rates of accuracy and timeliness of

the detection of delirium by nurses left little room for

improvement. Seventy-one percent (71 percent) of delirious

patients in Phase I versus 69 percent in Phase II were detected by

nurses as compared to the research team. Additionally, the nurses

detected 85 percent to 90 percent of these cases of delirium prior

to or at the same time they were detected by the research team.

Use of physical restraints dropped dramatically from 40 percent to

20 percent of patients. Referral to housestaff also declined from

55 percent to 30 percent -- a decline that is not surprising as the

major response of the housestaff was to do nothing. Although

speculative, the nurses had a greater armamentarium of strategies

for dealing with delirious patients and, therefore, may not have

felt a need for assistance in dealing with these patients. Last,

there was no change in attitudes and satisfaction of nurses as a

result of this program.



This study was funded by the John A. Hartford Foundation.



Repository Posting Date:
26-Oct-2011
Date of Publication:
6-Aug-1992
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEarly detection and treatment of delirium in the hospitalized elderlyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150955-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Early detection and treatment of delirium in the hospitalized elderly</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1992</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">August 6 - 8, 1992</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Foreman, Marquis, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Illinois at Chicago</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mdforemn@uic.edu</td></tr><tr><td colspan="2" class="item-abstract">The aim of this project was to test consultation and education<br/><br/>provided by a doctorally-prepared Geriatric Clinical Nurse<br/><br/>Specialist (GCNS) relative to improving the timeliness and accuracy<br/><br/>of assessment, prevention, and management of delirium by staff<br/><br/>nurses. Nurses (n=68) on two 24-bed general medical units and two<br/><br/>24-bed general surgery units received the education program which<br/><br/>included both written and verbal instructional materials about:<br/><br/>(a) simple bedside tests for assessing cognitive function, (b) the<br/><br/>clinical features that distinguish delirium, dementia, and<br/><br/>depression, (c) common causes of delirium, and (d) independent,<br/><br/>interdependent, and dependent strategies for preventing and<br/><br/>managing delirium.<br/><br/><br/><br/>To determine the accuracy and timeliness of the detection of the<br/><br/>delirium as well as to the responses of nurses and physicians to<br/><br/>the delirium, the hospital records of all patients were reviewed by<br/><br/>a blinded geriatrician Accuracy of detection was compared to the<br/><br/>diagnosis of delirium by the research team on the basis of the<br/><br/>DSM-IIIR criteria; timeliness was determined by comparing the time<br/><br/>of detection of the nurses to the time delirium was detected by the<br/><br/>research team.<br/><br/><br/><br/>Responses by nurses to instances of delirium included verbatim<br/><br/>descriptions of the patients as documented in their hospital<br/><br/>records; whether or not the patient was referred to the housestaff<br/><br/>for additional diagnostics or therapeutics; use of physical or<br/><br/>pharmacologic restraints; and other actions considered<br/><br/>therapeutic, e.g., manipulation of various aspects of the<br/><br/>environment such as a change in the level of lighting.<br/><br/><br/><br/>The effects of the consultation and education program on patient<br/><br/>outcomes and the attitudes and satisfaction of nurses of the<br/><br/>consultation and educational program provided by the GCNS are<br/><br/>inconsistent. The incidence of delirium dropped from 16.6 percent<br/><br/>to 13.3 percent, a reduction that in some part may be attributable<br/><br/>to the changes in nursing practice relative to the care of elderly<br/><br/>patients. The high baseline rates of accuracy and timeliness of<br/><br/>the detection of delirium by nurses left little room for<br/><br/>improvement. Seventy-one percent (71 percent) of delirious<br/><br/>patients in Phase I versus 69 percent in Phase II were detected by<br/><br/>nurses as compared to the research team. Additionally, the nurses<br/><br/>detected 85 percent to 90 percent of these cases of delirium prior<br/><br/>to or at the same time they were detected by the research team.<br/><br/>Use of physical restraints dropped dramatically from 40 percent to<br/><br/>20 percent of patients. Referral to housestaff also declined from<br/><br/>55 percent to 30 percent -- a decline that is not surprising as the<br/><br/>major response of the housestaff was to do nothing. Although<br/><br/>speculative, the nurses had a greater armamentarium of strategies<br/><br/>for dealing with delirious patients and, therefore, may not have<br/><br/>felt a need for assistance in dealing with these patients. Last,<br/><br/>there was no change in attitudes and satisfaction of nurses as a<br/><br/>result of this program.<br/><br/><br/><br/>This study was funded by the John A. Hartford Foundation.<br/><br/><br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T10:47:40Z-
dc.date.issued1992-08-06en_GB
dc.date.accessioned2011-10-26T10:47:40Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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