Therapeutic Nursing Interventions: Delirium

NURS 403: Transition to BSN Practice

 

Purpose of Assignment

The purpose of this assignment is to define a clinical problem, review literature for appropriate research supported nursing interventions, critique current practice, and provide a plan for changing or adapting clinical practice.

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Student Approach to Assignment

My approach to this assignment was to discuss a clinical problem that I recognized on my unit, which is the inadequate screening and management of delirium. I discussed what the current practice is for delirium management, and where the gaps exist in relation to what the evidence says. The most personal aspect of the paper is that I provided examples from my own experience of what formal and informal mechanisms for delirium management are in place on my unit, such as how the CAM assessment is used and avoidance or use of benzodiazepines. By learning what research-based evidence indicates, I also developed creative ideas on how to implement interventions related to delirium prevention and management on my unit, such as environmental corrections, cognitive stimulation activities, and effective screening and protocols.

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Reason for Inclusion of this Assignment in the Portfolio 

This assignment is important to include in my portfolio, as it shows my dedication to solve clinical practice problems within my work environment. As a professional nurse, constant improvement should be a career goal, which is done by evaluating current evidence and implementing into my own practice.  The assignment reflects growth in my knowledge of delirium and in my ability to plan improvement in my practice.

 

Domain 2: Person-Centered Care &
Domain 3: Population Health 

(8) Applies appropriate knowledge of major health problems to guide nursing practice.

I met this criteria by explaining in depth what the health problem of delirium is, including its complications and risk factors. Based on multiple research articles’ evidence, I outlined what current nursing interventions can be performed to prevent and manage delirium, such as reducing overstimulation within the hospital environment (e.g. lights out policies, quiet time policies, etc.), providing cognitive stimulation activities (e.g. crossword puzzles, memory recall activities, etc.), and performing effective screening for delirium, with adherence to a protocol developed specifically for delirium management.

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Domain 2: Person-Centered Care &

Domain 3: Population Health 

(10) Demonstrates an awareness of cultural preferences and complementary modalities and their usefulness in promoting health.

This outcome is met by my discussion of the Spanish 4AT screening tool. The article determines that the 4AT, which has until then only been used in English, is also compatible for Spanish-speaking individuals. The relevance of this article to my paper is that our unit frequently cares for only Spanish-speaking individuals. My inclusion of this research is a demonstration of awareness for what is helpful for cultures other than my own, as I ensure that my interventions are compatible for not only English-speaking, but also Spanish-speaking patients.  

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Domain 2: Person-Centered Care & 
Domain 3: Population Health & 
Domain 5: Quality and Safety

(11) Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques.

This assignment directly meets this outcome, as its purpose is to research the best therapeutic interventions for a clinical problem in my work environment. The problem of delirium within my workplace was extensively discussed, and three types of therapeutic interventions with examples were provided (environmental correction, cognitive stimulation, and screening/following a protocol), with plans of implementation to put into my practice. These plans are based off of evidence-based literature in order to ensure the interventions incorporate both quality and safety, and include mandated lights out/quiet times, improved communication to promote cluster care, providing cognitive simulation activities on the unit and collaborating with other healthcare team members to utilize them, emphasizing family involvement, improving our whiteboard and verbal updates for reorientation, and development of a delirium-specific protocol for our unit.

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Download a Word document of my Intro Page here.

Download my Therapeutic Nursing Interventions paper here.