Better care for acute confusion


If patients who are at increased risk of confusion are identified quickly, proper nursing care can reduce suffering, anxiety and complications. Large patient groups are at risk of confusion within both the Heart and Vascular Theme and the Aging Theme.

Margareta Skog, Aging Theme, and Carolin Nymark, Heart and Vascular Theme, both heads of nursing development, have collaborated to improve nursing care for patients suffering from delirium, also known as acute confusional state or confusion.

"Nursing interventions and not drugs are the primary strategy for patients suffering from delirium," says Carolin Nymark. "For our part, patients who have undergone major open-heart surgery and have been cared for in a heart-lung machine are particularly vulnerable. But other patient groups are also at high risk."

They have now introduced the Nu-DESC (Nursing delirium screening scale) assessment instrument for some of their patient groups. This instrument provides nurses and nursing assistants with a structured approach to assess patient condition.

"We've trained nurses and nursing assistants to use the instrument to assess the patients as part of their daily nursing duties. In health care, it's important to respond rapidly to patients who show signs of acute confusion in the same way that we respond to a drop in blood pressure," says Margareta Skog.

Healthcare staff have also been trained to initiate appropriate nursing measures for acute confusion.

The Heart and Vascular Theme has also introduced a new procedure to improve follow-up specifically for patients who have undergone open heart surgery and who have been temporarily confused. They call those patients who have had some form of confusion to discuss how the patients are feeling and their experiences. The patients also see the doctor at recheck visits, and if they suffered from delirium while they were hospitalized, the doctors address this problem as well.

But why do you want to identify patients who might suffer from confusion more quickly?

"There are several reasons. Mortality is higher in the group that suffers from acute confusion, it's a signal that the patient is likely to have some somatic problem. A quicker response improves the likelihood that we'll detect conditions such as infection, incorrect medication, distended bladder or pain. There's also an increased risk that the confused patient will get up without supervision and might fall, especially at night, and suffer from additional injuries," says Margareta Skog.

"We also know that patients who suffer from confusion may require an extended length of stay," says Carolin Nymark.

Nor it is uncommon for patients who suffer from acute confusion to be ashamed of something they said or did while they were under care and they may be too embarrassed to talk about it.

"Some studies show that patients may feel bad even one year after saying or doing something unpleasant to their relatives or staff while hospitalized. Now we do a better job of identifying these patients so that they get the right help faster – the condition can be helped with the right care. Drugs are used only if nursing interventions don't help, for example if patients have major problems sleeping at night, or suffer from severe hallucinations," says Carolin Nymark.

How does this affect memory?

"Patients who are usually cognitively clear and who suffer from acute confusion while under care may carry the memory of the event with them for the rest of their lives. There's a big difference between dementia and acute confusional state and these conditions shouldn't be mixed up. People with dementia can also suffer from acute confusion. The sense of discomfort may remain in people with dementia, though they rarely remember the details of the experience," says Margareta Skog.

Can patients experience acute confusion several times?

"Yes, and sometimes it can be worse if it happens again. That's why it's so important for us to address follow up and prevention in health care," says Margareta Skog. "Care providers should also talk to patients who have experienced an episode of confusion to explain why the brain failed and that it was a transient condition," says Margareta Skog.

"Our new procedures will make the patient encounter easier and it is also our duty to provide the right nursing care," according to both Margareta Skog and Carolin Nymark.

Acute confusion

Delirium is the medical diagnosis for acute confusional state, which is also often simply called acute confusion.

Typically, the condition develops over a few hours to a few days and varies over the course of the day. Patients may find it difficult to focus and they may be easily distracted, incoherent or drowsy.

Carolin Nymark and Margareta Skog were brought together by the latter's pamphlet "Advice for caring for patients with acute confusion," which they then went on to further develop together.