presented by Kathleen Fletcher & Heather Teller
The broad spectrum of pathologies for delirium dictates that not all patients in rehabilitation or residents in long-term care have to be hospitalized when they demonstrate signs and symptoms of delirium. Hospitalization, in fact, can make the condition worse due to change in the environment and care providers. However, delirium can be a life-threatening event, and at times emergent care is required. This final course in the three-part series of courses on delirium will emphasize good clinical decision-making skills and the need for all nurses in all settings to have these skills. In many settings, including rehabilitation, long-term care, and outpatient care, management of delirium may be successful, provided an accurate assessment and diagnosis can be made and the interventions necessary to address the care needs in that setting can be accomplished. This course will emphasize both non-pharmacological and pharmacological interventions in the care of persons with delirium.
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.
Delirium can be a life-threatening condition for patients in all settings if it is not recognized and treated expeditiously. It is critical that all nurses in all settings recognize and respond urgently to this condition. Collaborating and discussing the situation with the primary care provider is essential. If transfer to another setting is necessary, good communications between staff in both settings can assure a safer handoff of care.
Non-pharmacological therapy is the cornerstone of management of delirium. These supportive care strategies need to be part of the plan of care. All interventions need to be tailored to the specific etiology of delirium and the needs of the person experiencing it. This chapter discusses interventions that are appropriate for all settings, including: assuring safety of the person and those around the person, proper nutrition and hydration, adequate pain control, mobilizing the individual, providing good sleep measures, attending to the communication needs of the individual, evaluating the number and type of medications given, and encouraging family involvement.
Medications for delirium are never a first-line approach. There are currently no drugs that are FDA approved for delirium, and many medications can cause serious adverse effects. Nurses can influence the decision to use medications, and they are responsible for proper administration and monitoring relative to medication effectiveness or any side effects or adverse reactions. This chapter will focus on pharmacological treatment options for delirium.
Quality improvement programs are essential to monitor the prevalence, assessment, and effective management of persons with delirium. Nurses in all settings need to be consistent in their identification and appropriate management of delirium.
Delirium: Observing and Reporting Mental Status Changes by the Nursing Assistant
presented by Kathleen Fletcher & Heather Teller