Do you know how to detect delirium?

As the RCN seeks to increase awareness of this confusional state, lecturer Gary has developed training for students at his university

Delirium is a common yet under-recognised medical condition that can have serious or even life-threatening consequences. Health care professionals play a key role in its early identification and management, but research suggests a lack of confidence, knowledge and skills means it can often go undetected.

In response to this, the RCN launched Don’t Discount Delirium, an online hub providing information and resources to help nursing staff increase their knowledge of the condition and support them to become delirium champions in their workplace.

Student training

But it isn’t only registered nurses who can benefit from increased education surrounding the recognition and treatment of delirium, students can too.

Last year, Dr Gary Mitchell, a lecturer from the School of Nursing and Midwifery at Queen’s University Belfast, collaborated with the RCN to design a two-hour, face-to-face learning package for first-year nursing students.

Gary says: “Despite delirium becoming a growing global health care concern, it is frequently under-diagnosed. This is particularly concerning as delirium is a symptom of acute illness that is often avoidable and reversible if detected early enough.”

 

Delirium is often avoidable and reversible if detected early enough

Becoming a delirium champion

The resulting workshop was delivered earlier this year to groups of 15-20 students at a time. The four core elements of delirium education covered were: defining delirium, recognising delirium, managing delirium, and reflection on practice.

“The aim was to give students an introduction to the knowledge and tools they need to detect and manage delirium and to empower them to become delirium champions when they’re on placements,” says Gary.

Students gave positive feedback after attending the workshop and said they felt significantly more confident in providing care to someone with delirium and discussing delirium with a patient’s family.

To date, 800 nursing students at Queen’s University Belfast have become “delirium champions”. Due to its success, this training has now been embedded within the university’s nursing curriculum.

Second-year Queen’s University student Kerry Canavan reflects on what she learnt about delirium in the workshops and how it’s affected her practice since

Student nurse Kerry giving a presentation on delirium

My knowledge of delirium before this workshop was severely lacking. I had heard it mentioned in practice but with limited explanation. This training helped it all to click.

I haven’t yet had to consider delirium for a patient on placement since then, but I have had a more personal experience with it. I was working on a bank shift as domestic staff in the hospital where my grandad was receiving post-operative care. When I went to see him, he appeared confused and didn’t seem to know who I was or why I was there.

Initially, I thought that might have been because I was in uniform but remembering what I’d learnt about delirium, I stopped to think twice. My instinct told me this wasn’t normal, especially as I’d only seen him recently. So I spoke to the nurses in charge about whether it could possibly be delirium.

I know now how important it is to be aware of delirium and not to discount symptoms


Fortunately, my grandad’s disorientation was due to lack of sleep in this case and he has recovered well. But this experience made me realise how important it is to be aware of delirium and not to discount symptoms.

Also, it’s made me realise the importance of asking a patient’s friends and family to let us know if they are acting unusually. They know them better than anyone and it can help speed up the care these patients receive, which I now know is vital in the management of delirium.

From now on if I come across a patient who seems to be behaving out of character and displaying possible symptoms, I will always think delirium.

How to spot the signs of delirium

An acute confusional state that has a sudden onset, delirium is often mistaken for symptoms of dementia or simply old age and can sometimes go untreated for long periods of time.

Know how to spot the signs by looking out for:

  • Arousal (awakeness). More sleepy than usual — more alert or active than usual — hard to wake up.
  • Thinking. Poor concentration — slow responses — more confused.
  • Perception. Seeing things — hearing things — paranoid.
  • Function. Less mobility — less movement — restless/agitated — not eating — sleep problems.
  • Behaviour. Refusing to co-operate — withdrawn — change in attitude — change in communication.

Find out more

 Visit the RCN Don't Discount Delirium pages to find out more about this confusional state and how you can become a delirium champion at your university and placement.

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