How do nurses in Aged Residential Care facilities assess and manage patients experiencing delirium?

Abstract

Older adults in Aged Residential Care (ARC) facilities with numerous pre-existing illnesses frequently experience delirium. This condition is associated with diminished quality of life and preventable morbidity and death. Nurses do not always recognise delirium across ARC settings. With awareness of risk factors and knowledge about delirium, ARC nurses can play a vital role in early identification, assessment, and treatment but most importantly preventing delirium in older adults in their care. Nurses often lack the necessary knowledge in relation to delirium and the complex inter play of other physical and mental health symptoms associated with it. Nevertheless, ARC nurses play a crucial role in keeping patients safe and ensuring optimal health outcomes. There is a high cost of care associated with delirium management both in ARCs and for the District Health Boards. As nurses are at the forefront of delivering good quality care, the issue of how well they do assessment and management of delirium poses a serious question. Nurses’ day-to-day care is not necessarily standardised among all the ARC facilities, as they have different levels of expertise. Nurses also have different levels of proficiency, skills, and knowledge. There is considerable evidence that if delirium cannot be treated promptly, patients end up in the Emergency Department (ED) for urgent treatment or they can easily die easily from it if not treated quickly. This study has examined the rate of admission to the ED of MH to form a database of all patients admitted from ARC with a suspected delirium. The data generated was then used to establish the ARCs with the highest and lowest incidence rate of admission. Subsequent to that, focus groups were carried out in those ARCs with both low and high rates of presentation to determine how the ARC nurses do actually assess and manage delirium. It is hoped that the results will shed light on the nurses’ strengths as well as barriers to how they do assessment and managing of delirium. The outcome will also help to identify how to better help ARC nurses to continue doing their task, to look at the possibility of reducing the rate of admission, to look at care and treatment of delirium in general, and to aim at reducing or preventing this morbidity and death for older people living in an ARC. It is hoped that ARC nurses’ opinions could contribute to advancing knowledge and research into delirium assessment and management as well as for themselves to be well-informed and insightful providers of care for older people in their respective ARCs.