Dr. Sandra Hirst is an Associate Professor in the Faculty of Nursing, at the University of Calgary. She has held a number of leadership position in the fields of gerontology and nursing, and is currently the Vice President – North America for the IFA. Her research focus is on the health care of vulnerable older adults.
Delirium Recognition: Its Contribution to Health Promotion
The purpose of evidence-based health care is to take effective interventions built on research findings and apply them to improve the health and well-being of older adults. Health care providers need this kind of information—what has been shown to work, how to disseminate research findings to staff, and how to implement what works within their practice context. When this purpose is applied to the experience of older adults within acute care facilities, challenges emerge. One of which is delirium recognition by nursing staff. Delirium is an acute disorder of attention and cognition in older adults. It can contribute to or create cognitive impairments for older adults in acute care facilities, negatively influencing their health status. It affects half of the older adult population in acute care settings and is a major cause of increasing mortality and healthcare costs.
A literature review was conducted for the period January 2012 to December 2016. The objectives of the review were: to 1) articulate the evidence regarding how nursing staff recognize delirium in the acute care setting; 2) source published delirium assessment tools; 3) appraise their clinical utility, and 4) outline educational strategies to facilitate potential and actual delirium identification. A total of 46 possible articles were located, of which 19 contributed to the final review. Identified themes included: clinical reasoning, recognition ageism, tool confusion, not my role, don’t have the time, and organizational walls. This has serious implications for quality of care to older adults in the health care system. Suggestions are presented to enhance the recognition of delirium by acute care staff.