Nursing Care - Evidence Based Nursing Care for Delirium

Running head: NURSING CARE
Nursing care
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Introduction:
Evidence based practice (EBP) is a necessary expectancy in nursing as it promotes
clinical decision making process through the utilization of research based knowledge to inform
decisions about care delivery process (Schmidt and Brown 2017). Majid et al. (2011) explains
EBP as a basis to deliver quality health care and effectively handle clinical issues in daily
practice. It pays emphasis to data extraction from prior studies and critiquing those data to decide
its application in actual practice. The main purpose of this essay is to undertake a review of the
literature to explore the evidence based surrounding the care of people with dementia. The essay
will analyze the case study of Mr. De Jong who suffered from delirium and explore best
practices related to delirium care and discuss how delirium could have been managed in this
care. The critique of the evidence will be presented to find out whether is linked to best practice
or not.
Evidence based nursing care for delirium
The case study is about Mr. Lars, a 68 years old male who has been hospitalized
recently. He used to work in bakery. However, he left his work since he had to take care of his
wife Isa, who was suffering from multiple ailments like COPD, walking difficulty due to weight
gain and diabetes mellitus. His financial condition was not good too as his sons accumulated
debts and left the city. Hanna, Mr. Lar’s daughter observed Lars to very down since the past few
months. During hospitalization, Lars was found to be agitated and restless and many non-
pharmacological protocols for delirium were initiated to reorientate him to the environment.
Delirium is a mental disorder associated with impaired cognitive function and characterized by
impaired attention, consciousness and cognition. Symptoms of confusion, restlessness and

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agitation are a common symptom in patient and Mr. Lars possessed similar symptoms too
(ACSQHC et al. 2016). The cause of delirium is multi-factorial and the review of evidence on
risk factors suggests that aged greater than 70 years, visual impairment, use of 3 or more
medications, depression and use of physical restraints are common risk factors of delirium (). In
case of Lars, age is risk factor because he is 68 years old. In addition, being in depressed state
because of his wife condition, financial struggles and loss of contact with his sons might also
have contributed to delirium risk. Kalish, Gillham and Unwin (2014) revealed that risk factor of
delirium in hospitalized elderly patients include cognitive impairment, elevated level of blood
urea nitrogen/serum creatinine ratio, severe illness and vision impairment. Severe illness, being
in mechanical ventilation for more than 24 hours and high rate of creatinine levels of Mrs. Lars
made the nurse to predict the risk of delirium.
According to Perez-Ros et al. (2018), delirium is a condition that affects about 15-50%
of hospitalized elderly patients. In elderly individuals like Mr. Lars, preventing delirium is
important as it could lead to functional decline, loss of independence, longer period of hospital
stay and even death. Preventive strategies are needed to control the progression of disease and
promote safety of patient. The recommendation for delirium care mostly suggests the
effectiveness of multi-component intervention in controlling delirium episodes. Although both
pharmacological and non-pharmacological treatment options are available to treat delirium,
evidence shows that pharmacological intervention should be initiated for those patients who
engage in self-harm too (Kalish, Gillham and Unwin 2014). In the case study, no
pharmacological intervention was implemented and this decision is appropriate because Mr. Lars
symptom was not that severe to require pharmacological intervention. The study by
Barbateskovic et al. (2019) reported about pharmacological intervention such as use of anti-

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psychotic medications for management of delirium in intensive care patient. A systematic review
of randomized controlled trials which investigated on the effects of pharmacological prevention
of delirium and this study also revealed very low evidence for the use of pharmacological
intervention. This intervention is used in exceptional cases only where non-drug methods of
delirium treatment has failed. This study ranks under highest level in evidence hierarchy.
However, lack of methods to minimize random errors is one of the limitation of the study.
The nurse implemented several non-pharmacolgiical interventions to manage symptom
of Mr. Lars. This included reorientation to the environment, mobilization activities and ensuring
range of motion exercise. The nurse’s decision is in relevance with best practice guidelines as
these paper recommends use of non-pharmacological interventions like early mobilization,
reorientation, risk factor assessment and balancing sleep-wake cycle for the management of
delirium too (Barbateskovic et al. 2019). The Delirium Clinical Care guideline by ACSQHC
(2016) states that multi-component interventions can reduce the occurence of delirium and it’s
associated complication. The strength of this guideline is that it provides separate quality
statement for patients and clinicians. This resource informs health care professionals regarding
the steps to prevent delirium. This includes mobility activities, promoting sleep, visual aids, pain
assessment, oxygen therapy, correction of malnutrition and stimulating cognition. However, as
this guideline does not support the rationale behind the use of various multi-component
intervention, individually reviewing the effectiveness of each one of the treatment is critical to
ensure quality care and better understanding about delirium management.
As Mr. Lars was found to be having delirium symptoms post hospitalizations, those
papers were reviewed which had hospitalized older patients with delirium as the sample group.
The study by Inouye et al. (1999) randomized controlled to investigate about the topic. The study