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Advanced Practice Nursing- Delirium In Adult Hospitalized Patients

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Advanced Practice Nursing- Delirium In Adult Hospitalized Patients

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Advanced Practice Nursing- Delirium In Adult Hospitalized Patients

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Discuss about the Advanced Practice Nursing- Delirium in Adult Hospitalized Patients.


Story about acute onset delirium in critically ill-hospitalized ICU patient
This story is involved with a patient named John Simons who is suffering from dementia and has been admitted to the ICU two weeks ago. He stays with his wife and a son who is married and lives in the other city (Lee et al., 2013).  The patient was known already to the societal services with a package of care already in position, so the doctors thought that the procedure of discharging the patient would be uncomplicated. The initial interdisciplinary meeting was arranged without informing his wife or son. When his son insisted the doctors and the other staff of the hospital to rearrange the meeting, they agreed for the same. After that the care of patient started in a proper way (Barr et al., 2013).
The patient cannot be left unsupervised because he was not able to do anything by his own and the family had a feeling that he needs a high quality of care. He had a risk of dehydration, malnutrition and was prone to persistent infections. The doctors were not able to arrive at a conclusion regarding whether John was permitted to continuing healthcare and what is the best form of treatment for him. Then began the next battle, in which the care package of the patient had to be arranged by means of the team of social services of the hospital that meant that the patient could no longer be provided with the care, which he had been using since two years. The patient had the same carer who used to take care of him since two years. She had become familiar with the patient (Ryan et al., 2013).
The community nursing team made a last attempt to obtain to get continuing funding for healthcare for the patient and he died before they turned him down. The family members of the patient said that the team of community nursing visited him one in a day to change the pump and the day sitter for the last two days was the health involvement to the care of the patient. The question in front of us is that why an individual at the last part of his/her life have to pay his/her own expenses for dying at residence (Fick et al., 2013).
Best Practice Guideline (BPG)
The development of this best practice guideline addresses the questions how to deal with the patients who are above 65 years and are critically ill as well as hospitalized in the ICU (Intensive Care Unit). This guideline focuses on the following:
Recommendations for practice: The nurses are directed to guide practice concerning the strategies for caregiving for the older adults with delirium
Educational recommendations: focused on the organizations and educational institutions in which the nurses work in order to support its execution
Policy and organization recommendations: focused at the settings of practice and the environment to smooth the progress of nursing practices
Indicators of monitoring and evaluation (Ward, 2015).
It is recognized that the individual capabilities of the nurses differs between the nurses and across the nursing professional’s categories and are based the critical analysis, knowledge, attitudes, skills and decision-making ability which are improved eventually by education and experience (Salluh et al., 2015). Since the strategies associated with the care for delirium are based on accurate assessments of screening of all these conditions, the panel of development for this guideline recommends the execution and accomplishment of this guideline in combination with the Registered Nurses Association of Ontario, best practice guideline entitled screening for delirium in the older adults. In spite of the high occurrence and unconstructive outcomes, delirium=m in the ICU is not detected and therefore remains untreated in the patient scores. For several years, delirium has been considered as a benign problem by the teams of medical and critical care nursing (Khan et al., 2012).
A delirium goes undetected by the doctors as well as the nurses in more than 68% of the patients in the ICU due to the absence of a validated tool. This guideline underlines the necessity for the organized utilization of the standardized tools for assessment, which is in collaboration with the recommendations from the national and the internal guidelines. These tools are essential for the detection of delirium that might otherwise are not detected and therefore untreated. Two tools with robust dependability and validity are the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment method (CAM) for the ICU. Both of these tools have a high accurateness and constructive compliance and needs minimal education (Inouye et al., 2014).
Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., … & Coursin, D. B. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.Critical care medicine, 41(1), 263-306.
Fick, D. M., Steis, M. R., Waller, J. L., & Inouye, S. K. (2013). Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. Journal of hospital medicine,8(9), 500-505.
Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.
Khan, B. A., Zawahiri, M., Campbell, N. L., Fox, G. C., Weinstein, E. J., Nazir, A., … & Boustani, M. A. (2012). Delirium in hospitalized patients: implications of current evidence on clinical practice and future avenues for research—a systematic evidence review. Journal of hospital medicine, 7(7), 580-589.
Lee, E. A., Gibbs, N. E., Fahey, L., & Whiffen, T. L. (2013). Making hospitals safer for older adults: updating quality metrics by understanding hospital-acquired delirium and its link to falls. The Permanente Journal, 17(4), 32.
Ryan, D. J., O’Regan, N. A., Caoimh, R. Ó., Clare, J., O’Connor, M., Leonard, M., … & Meagher, D. (2013). Delirium in an adult acute hospital population: predictors, prevalence and detection. BMJ open, 3(1), e001772.
Salluh, J. I., Wang, H., Schneider, E. B., Nagaraja, N., Yenokyan, G., Damluji, A., … & Stevens, R. D. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. bmj, 350, h2538.
Ward, C. W. (2015). A decision tree model for postoperative pain management. Urologic nursing, 35(5), 251-257.

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