Nurse Recognition of Delirium Superimposed on Dementia in Hospitalized Older Adults
Open Access
- Author:
- Steis, Melinda R
- Graduate Program:
- Nursing
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 09, 2009
- Committee Members:
- Donna Marie Fick, Dissertation Advisor/Co-Advisor
Donna Marie Fick, Committee Chair/Co-Chair
Janice Lee Penrod, Committee Member
Susan Jayne Loeb, Committee Member
Robert William Schrauf, Committee Member - Keywords:
- delirium superimposed on dementia
nurse recognition
older adults - Abstract:
- ABSTRACT Background: Delirium is an acute, fluctuating confusional state that is potentially preventable and treatable, especially when recognized early. Unrecognized delirium in older adults results in increased risk for poor health outcomes. Persons who experience delirium in addition to dementia have a two-fold increase of death within one year. Purpose: To explore acute care nurses’ recognition of delirium in hospitalized older adults with dementia and to describe how nurses manage their patients using the Recognition in the Context of Nurse-Patient Interactions framework to guide this study. Methods: This study was a secondary analysis of data from a previous study that followed 140 hospitalized older adults with dementia, followed by a retrospective chart review of the nurses’ documentation. Results: In the original study by Fick, research assistants assessed the patients daily using the Confusion Assessment Method to determine if they experienced delirium or not. This study sample consisted of two groups of hospitalized older adults (>/=65 years) (Dementia-Only and Delirium Superimposed on Dementia). Analysis of nurses’ documentation included qualitative content analysis, descriptive statistics, logistic analysis with repeated measures and logistic analysis and multinomial logistic regression. The most significant finding was that there were no patient days (n=116) on which acute care nurses recognized delirium in this population. Conclusion: The absence of recognition may lead to improper or ineffective nursing management of the patient experiencing delirium, potentially increasing the risk of poor health outcomes. Implications of these results include the need for comprehensive education of acute care nurses.