Factors Determining Nurses' Clinical Judgments About Hospitalized Elderly Patients with Acute Confusion

School of Nursing, Chang-Gung Institute of Technology, 261 Wen-Hwa 1 Rd, RM 1110, Kwei-Shan, Tao-Yau 333, Taiwan.
Issues in Mental Health Nursing 07/2009; 30(6):399-405. DOI: 10.1080/01612840903037569
Source: PubMed


Acute confusion(AC)/delirium is a common clinical phenomenon in hospitalized elders that is often overlooked or misdiagnosed by nurses of various cultural backgrounds. The aim of this study was to better understand factors affecting nurses' clinical judgments regarding the detection of AC in elderly Taiwanese patients. Nurses from two hospitals in Taiwan (n = 654, response rate = 71.3%) participated in the study. A two-level hierarchical linear model analysis was used to examine the data. The characteristics of patients explained the most variance of the model (86.2%), with characteristics of nurse participants and their health organizations accounting for 13.8% of the variance. Patient characteristics of age, infection, hydration, and hypoactive subtypes of AC, as well as a nurse's strong belief in traditional Chinese values, such as respect for elders, hard work, modesty, noncompetitiveness, and respect for tradition, were positively associated with difficulty detecting acute confusion. Findings of this study indicated that the accuracy of nurses' clinical judgments in detecting AC were most related to characteristics of patients.

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Available from: Jeng Wang, Aug 15, 2014
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    • "The hypoactive form of delirium (representing the majority of cases, as reviewed above) and delirium in individuals with advanced age, sensorial deficits, prior cognitive impairment, or dementia and medical problems like infection or dehydration are the main reasons for the acute confusional sate not being recognised and diagnosed [69, 84, 85]. Hypoactive delirium and dementia comorbidity, appear to be the best predictors for overlooking delirium in the elderly with cognitive impairment [69]. "
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    ABSTRACT: Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of delirium is crucial to improve the prognosis of patients requiring the identification of subtle and fluctuating signs. Increased awareness of clinical staff, particularly nurses, and routine screening of cognitive function with standardized instruments, can be decisive to increase detection rates of delirium. General measures to prevent delirium include the implementation of protocols to systematically identify and minimize all risk factors present in a particular clinical setting. As soon as delirium is recognized, prompt removal of precipitating factors is warranted together with environmental changes and early mobilization of patients. Low doses of haloperidol or olanzapine can be used for brief periods, for the behavioural control of delirium. All of these measures are a part of the multicomponent strategy for prevention and treatment of delirium, in which the nursing care plays a vital role.
    06/2011; 2011(2090-1429):875196. DOI:10.1155/2011/875196
  • International Journal of Older People Nursing 06/2011; 6(2):83-4. DOI:10.1111/j.1748-3743.2011.00272.x
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    ABSTRACT: BACKGROUND; Delirium is a critical, costly, frequently reversible problem in older adults. Findings of previous studies indicate that delirium occurs in up to 65% of hospitalised older adults and up to 80% of terminally ill patients. Few studies address the frequency of delirium in community dwelling older adults and the extent to which delirium symptoms create distress for their family caregivers. To determine the frequency of delirium in older people attending two adult day centers (ADC) in the United States and identify the extent to which delirium symptoms were associated with family caregivers' mental health symptoms, and ways of coping with the older adults' care. A descriptive, cross-sectional design was used. Thirty older adults and their family caregivers were randomly selected from the rosters of the ADC. Only 6.7% of the older adults had a positive screen for delirium. The majority of family caregivers (96.6%) stated that they had no knowledge of delirium prior to participating in this study. Both older adults and their family caregivers need education about delirium symptoms and risks.
    International Journal of Older People Nursing 06/2011; 6(2):85-92. DOI:10.1111/j.1748-3743.2010.00260.x
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