Page 143 - Encyclopedia of Nursing Research

110 n DELiRiUM

chances for death. Despite these profound Severity Scale, and Breitbart’s Memorial Deli-
negative consequences for patients, families, rium Assessment Scale (Maldanado, 2008).
D health care providers, and society, delirium Each has its advantages and disadvantages; the
remains understudied, especially in children selection of which instrument to use depends
and adolescents. in part on the purpose and patient popula-
Delirium is frequently underrecognized tion. The most frequently used instrument
and misdiagnosed, although more health in research and clinical practice with adults
care providers than that in the past report is inouye’s Confusion Assessment Method
screening for delirium (heatherill & Flisher, and in children and adolescents, Trzepacz’s
2010; Kuehn, 2010; Patel, 2009). Recognition Delirium Rating Scale. The Diagnostic and
of delirium continues to be problematic in Statistical Manual of Mental Disorders, Fourth
elderly patients with an underlying dementia Edition, Text Revision diagnostic criteria for
or those with the hypoactive-hypoalert vari- delirium remains as the gold standard in com-
ant of delirium. Explanations for the under- paring all instruments. Research supports the
recognition and misdiagnosis of delirium use of brief, standardized bedside screening
include the fluctuating nature of delirium; measures as timely, effective, and inexpen-
the variable presentation of delirium; the sive methods for assessing cognitive status
similarity among and frequent co-occurrence and diagnosing delirium. Current standards
of delirium, dementia, and depression; and for surveillance of delirium are to screen for
the failure of providers to use standardized the presence of delirium on admission to the
methods of detection. hospital and at a minimum daily. others rec-
improving the recognition of delirium ommend brief screening every shift as an
requires a complex and dynamic solution. element of the standard nursing assessment.
Knowledge of delirium and skill in its detec- Additionally, when there is evidence of new
tion are necessary starting points for improv- inattention, unusual or inappropriate behav-
ing the recognition of delirium. however, ior or speech, or noticeable changes in the way
knowledge and skill alone are insufficient, the patient thinks, it is recommended that the
given the profound impediment to the assessment be repeated.
recognition of delirium posed by negative The only other testing reported is the
ageist stereotypes. These conclusions are use of the electroencephalogram to confirm
supported by the work of McCarthy (2003) the presence of delirium in any age group.
and neville (2008), which also highlight however, the electroencephalogram has
the powerful influence of the practice envi- been only modestly diagnostic and is not
ronment on how providers think about and practical in all situations. Pharmacological
respond to delirium. and nonpharmacological strategies to pre-
Several instruments have been developed vent and/or treat delirium in patients of
to screen for or diagnose delirium. Such instru- various ages and in settings have resulted in
ments include inouye’s Confusion Assessment only modest benefits, in particular with chil-
Method, Vermeersch’s Clinical Assessment dren and adolescents (heatherill & Flisher,
of Confusion—Form A, Albert’s Delirium 2010). The prevailing principles guiding pre-
Symptom interview, Trzepacz’s Delirium vention and treatment consist of multifacto-
Rating Scale, neelon and Champagne’s nEE- rial interventions that (a) identify patients
ChAM Confusion Scale, o’Keefe’s Deli rium at risk, (b) target strategies to minimize or
Assessment Scale, hart’s Cognitive Test for eliminate the occurrence of precipitating
Delirium, Robertson’s Confusional State Eva- factors as primary prevention accomplished
luation, otter’s Delirium Detection Score, through risk reduction, and (c) identify, cor-
McCusker’s Delirium index, Bettin’s Delirium rect, or eliminate the underlying cause(s)