ABSTRACT
The authors use a case study to illustrate the risks of delirium in older adult patients and discuss ways to prevent, identify and manage its occurrence. An estimated 60 to 80 per cent of hospitalized frail older adults experience at least one preventable episode of delirium, often leading to prolonged hospitalization, functional decline, increased morbidity and eventual nursing home placement or death. Delirium is a medical emergency, characterized by acute onset and a fluctuating course that is demonstrated by abrupt changes in mental status and function. It has three categories: hyperactive, hypoactive and mixed. Although delirium is amenable to expert nursing care, it is unrecognized or misdiagnosed in up to 70 per cent of older patients. Delirium results from the interplay of multiple forces associated with illness in the older adult, including drugs, substance abuse, metabolic disturbances, nutritional deficiencies, fluid disturbances, acute trauma or illness, infection and impaired physical or functional ability A proactive strategy for delirium prevention and treatment targets defined risk factors and the management of physiologic factors that precipitate delirium. It includes assessment, therapeutic environmental modification, standardized protocols for physiological interventions and staff education.
Subject(s)
Delirium/diagnosis , Delirium/nursing , Geriatric Assessment/methods , Geriatric Nursing/methods , Nursing Assessment/methods , Postoperative Complications/diagnosis , Postoperative Complications/nursing , Activities of Daily Living , Acute Disease , Aged, 80 and over , Clinical Protocols , Delirium/etiology , Dementia/diagnosis , Depression/diagnosis , Diagnosis, Differential , Diagnostic Errors/statistics & numerical data , Emergencies/nursing , Environment Design , Female , Health Facility Environment , Hip Fractures/surgery , Humans , Nurse's Role , Patient Care Planning , Postoperative Complications/etiology , Risk FactorsSubject(s)
Clinical Competence/standards , Nurses/standards , Quality of Health Care , Social Responsibility , Canada , Humans , LeadershipABSTRACT
There is debate within the nursing profession in regard to determining the best approach to Leadership development for the new millennium. Should nursing adopt career pathways Like other disciplines that enable individuals to develop leadership potential in a timely fashion? St. Francis Xavier University (StFXU), the number one ranked undergraduate school in the country (DeMont 2002), has established an innovative strategy that promotes Leadership development at the undergraduate level. It has launched a special stream of its BScN program that culminates in an honours degree. The program, the first of its type in Canada, is designed to produce nursing leaders and scholars who will possess the core competencies required for leadership in diverse environments. This paper discusses the role of honours education in nursing, describes the curriculum and related Learning activities in the StFXU honours program and explores the benefits and challenges that an honours program has to offer. The findings will benefit nurse leaders in educational and practice settings, professional organizations and policy arenas who are interested in influencing the development of leadership in nursing.
