Project for improving nurses' assessment skills to detect and alleviate delirium symptoms

In the future, nurses may more accurately detect and alleviate symptoms of delirium in persons with dementia, thanks to a five-year, $2.7-million grant from the National Institute of Nursing Research.

The project, led by Donna Fick, professor of nursing, Penn State, seeks to improve nurses' assessment skills and reduce the use of drugs to treat delirium and dementia.

Delirium and dementia have similar symptoms -- decline in cognitive abilities such as memory, attention, and problem solving -- but they have radically different causes and treatments. Dementia is a chronic, progressive condition that increases with age. Delirium, in contrast, is an acute condition that has a rapid onset and results from insults to the body, such as dehydration, infection, or a drug side effect.

"Delirium is reversible, preventable and treatable," said Fick.

About 40 percent of patients with dementia also develop bouts of delirium, a condition known as "Delirium Superimposed on Dementia" or DSD. The condition substantially worsens outcomes in a population who are already burdened by functional decline, said Fick.

Sorting through the various types of cognitive decline is not easy, according to Fick. Unfortunately, some doctors and nurses automatically opt for a drug treatment, which can lead to further problems including falls or worsened delirium.

Fick's solution is a multifaceted training approach that she will implement and test in three hospitals: one in urban Tennessee and two in rural Pennsylvania. She and her colleagues will integrate electronic medical records as one component of the training. They are testing an approach that provides decision-making support and integrates reminders to check for specific symptoms. This approach is already used to assess the risk of falling and the integrity of the skin.

The project will establish a nursing opinion leader on the staff who will encourage evidence-based practices to treat delirium and dementia. These leaders will also be reliable information sources for nurses.

The training incorporates a weekly feedback session for nurses and the use of video, in person presentations, articles, case studies, on-line presentations -- narrated power point -- for continuing education.

In addition to assessing whether the training helps nurses distinguish between delirium and dementia and choose non-drug treatment options, the study will assess how effectively the approach improves patients' health.

In past research, Fick found that nurses are common initiators of drug treatments, so educating nurses is the most efficient way to address the medication issues. A survey she conducted on nurses who deal with dementia and delirium patients showed that 32 percent of nurses would call a physician to ask for medication in a patient with DSD before trying other non-drug approaches to the problem.

"Not recognizing and treating these conditions efficiently can result in people being put in nursing homes quicker, higher health care costs, and in the worst-case scenario early death," said Fick.