presented by Kathleen Fletcher & Heather Teller
Delirium can be difficult to recognize and distinguish between other mental disorders such as dementia and depression. This second course, in a series of three on delirium, gives nurses in all settings a framework for identifying the various features of each of the 3 D’s (delirium, dementia, and depression,) and provides guidance on recognizing when the presentation may be a mixed form. Because the presentation may not be obvious, the routine use of evidence-based tools is recommended. Several of these tools will be discussed. Family members and all members of the health care team can be instrumental is observing and reporting changes in mental status to a health care professional.
Kathleen Fletcher is currently working as a PRN staff nurse at the Riverside Center for Excellence in Aging and Lifelong Health and as a Clinical Assistant Professor at the University of Virginia School of Nursing. She maintains a hands-on role, working as a clinician, educator, and researcher in gerontology for more than 35 years. She has demonstrated a sustained commitment to improving the knowledge, skills, and abilities of the geriatric workforce. She has published extensively and exclusively in geriatrics. Kathleen demonstrates a passion for geriatric education and is much in demand as a speaker nationally at the state and local level. She is renowned for her expertise in delirium, dementia, and depression. She is plenary faculty for a HRSA Geriatric Workforce Enhancement Program (GWEP) grant and has presented annually to interprofessional faculty scholars on delirium, comprehensive geriatric assessment, geriatric syndromes, and family caregivers. She is lead faculty in the GWEP Train the Trainer program. She received the David Butler Spirit of Caring award, the highest award by the Geriatric Advanced Practice Nurse Association, in 2017 and received the highest award given by the Virginia Nurses Association, the Nancy Vance Award for Clinical Excellence, in 2001. She was inducted as a Fellow in the American Academy of Nursing in 2002.
Heather Teller is a Virginia-based nurse educator and acute care facility staff development coordinator. For the past eight years, she has worked on the subject of delirium as part of an interdisciplinary team at Riverside Health System. During that time, she developed the nursing education program to help reduce hospital-acquired delirium and aid in the treatment of those who are at risk of or are experiencing delirium. Ms. Teller received her early training in education, psychology, and history from Virginia Commonwealth University, followed by a Bachelor of Science degree in Nursing from Old Dominion University. She taught various subjects in the Virginia public school setting before pursuing her interests in nursing and health care, where she has worked for more than 10 years. After becoming a licensed RN, becoming a certified medical surgical nurse, and earning her BSN from Old Dominion University, she blended the skills and knowledge obtained as a teacher with her love of nursing and desire to train nursing staff, becoming a nurse educator. She remains dedicated to the mission of increasing knowledge and sharing a love of learning and serving with nursing staff in multiple settings.
Nurses in all settings need to able to recognize that delirium, dementia, and depression are common mental disorders in the elderly. They need to be able to assess if delirium is the primary concern, or if it coexists with dementia and/or depression, in order to tailor and modify the plan of care accordingly. This chapter will help nurses distinguish between presenting features of the 3 Ds.
The routine use of a standardized delirium screening is the most effective way of screening due to the fluctuating nature of delirium. In addition, there are techniques and approaches that may be helpful in the assessment of delirium. In this chapter, several screening tools will be discussed.
In all settings, nurses work with families and members of the interprofessional team. This chapter focuses on the important role of caregivers in identifying and reporting on mental status changes.