Pilot testing an educational intervention to improve communication with patients with dementia.

Approximately one quarter of all hospitalized patients over age 75 years have a secondary diagnosis of dementia. A unique hospital-wide program to encourage appropriate communication techniques with patients who have dementia was provided to all departments of a hospital. Evaluation indicated improvement in some communication techniques. Additional education is needed to disperse the information to as many staff as possible and to sustain the change.

The special needs of the hospitalized patient with dementia.

As the population ages, the number of patients with dementia will increase rapidly. Nurses caring for patients with dementia will need knowledge of interventions for communicating; managing agitation, nutrition, hygiene, and pain; providing spiritual care; and determining decision-making capacity.

Undermedication for pain and precipitation of delirium.

INTRODUCTION: Review of the literature revealed an association of pain and delirium in patients with hip fracture. Literature was sparse on pain and delirium in other types of patients. PURPOSE: The purpose of this study was to determine if there was a difference in the amount of analgesia received by patients in pain who developed delirium compared with those who did not develop delirium. METHOD: A sample of 43 medical-surgical patients who were hospitalized with pain and who developed delirium was compared with a matched group of 43 medical-surgical patients with pain who did not develop delirium. The percentage of allowed analgesia received by each group was examined. FINDINGS: The dependent variable of "percentage of allowed analgesia received" was significantly different between the two groups. The mean percentage of analgesia received by those who developed delirium was 26.14% while the mean percentage of analgesia of those who did not develop delirium was 48.21%. CONCLUSION: The results revealed an association between low dose of analgesia and development of delirium for patients who are in pain. Nurses can increase their focus on adequate pain management for older patients.

Incidence, prevalence, and under-recognition of delirium in urology patients.

Unrecognized delirium may lead to negative outcomes, such as increased morbidity, longer hospital stays, and increased health care costs. A prospective cohort design study was used to determine the incidence and prevalence of delirium and percentage of patients with unrecognized delirium in a hospital inpatient unit. The sample consisted of 141 patients admitted to a urology/nephrology unit over a six-week period. Data were collected using the Confusion Assessment Method (CAM) and the Charlson Comorbidity Index (CCI). Results showed the incidence of delirium was 6%, and the prevalence was 12% in this sample. Out of 17 patients with delirium, 6 patient records (35%) had no documentation of delirium by physicians. In the nursing assessment, 1 of 17 (6%) had no documentation of any signs/symptoms of delirium. This study provided baseline data for the development, implementation, and evaluation of a delirium recognition program using the CAM. The CAM may represent an easy-to-use, valid, and reliable instrument to detect delirium as part of a routine nursing assessment.

Optimizing Outcomes in Urological Surgery: Postoperative Care.

INTRODUCTION: Understanding best practices in perioperative care is critical for quality of care for our urology patients. We compiled a single, concise resource that provides recommendations for optimizing postoperative outcomes in patients undergoing urological surgery. METHODS: Optimal postoperative care includes minimizing complications, optimizing recovery and improving patient outcomes. The assembled White Paper multidisciplinary writing team included experts in a number of different areas (urologists, nurses, anesthesiologists) to address a comprehensive set of topics that urological providers face when caring for postoperative patients. This article provides a summary of key elements to optimize postoperative care in adult urological surgery, including in-hospital considerations, transition/discharge, and followup and surveillance. RESULTS: In-hospital postoperative considerations include checklists, handoffs for safe transitions from the anesthesia to surgical team, level of care planning and enhanced recovery after surgery (ERAS®). Embedded in ERAS are postoperative nutrition, mobilization, wound care, judicious use of catheters and drains, and postoperative medications and transfusions. As the patient transitions to the outpatient setting, the urologist must provide clear and readable postoperative education, which includes medication management and coordinated followup with primary care providers and home health as needed. Finally, followup visits should be carefully considered using innovative methods such as telehealth and patient reported outcomes to elevate postoperative and long-term care. CONCLUSIONS: This article summarizes postoperative factors that may impact surgical outcomes in urology. By understanding and applying best practices for postoperative care, urologists can optimize the quality of care for their patients.

Aging and delirium: too much or too little pain medication?

Review of the literature revealed an association of pain and delirium in hip fracture patients. The literature was sparse addressing other types of patients. The purpose of the present study was therefore to examine the association of pain and delirium in medical and surgical patients. A retrospective record review was conducted using records of 100 patients who developed delirium while hospitalized. Data included: age, comorbidities, hospital day when delirium developed, presence of major risk factors for delirium on admission, and amount of medication received in the 24 h before onset of delirium. Descriptive statistics, correlations, and univariate analysis of variance were used to determine association between the variables. The mean age was 76.71 years. The mean number of comorbidities was 2.22. The mean number of risk factors for delirium on admission was 2.26 (range 0 to 5). The mean percentage of total amount of medication ordered that was received was 27.67%. Those individuals admitted with a risk factor of hearing loss received significantly less amount of pain medication than those with other risk factors (p = .023). Nurses should carefully assess pain management in their older patients. If using a PCA pump, the older patient's ability to manage the pump should be reassessed often. If a patient is admitted with risk factors for development of delirium, unmanaged pain might be the additional factor that precipitates delirium.

Development of an evidence-based protocol for reduction of indwelling urinary catheter usage.

Studies indicate 40% of indwelling urinary catheters are unnecessary in hospitalized patients (Gardam, Amihod, Orenstein, Consolacion, & Miller, 1998; Gokula, Hickner, & Smith, 2004). The results of a protocol developed to limit catheter use are described.

A program to reduce fatigue in convalescing elderly adults.

This study is an examination of the influence of a fatigue reduction program on the level of fatigue experienced by elderly individuals convalescing in subacute units after lower extremity injury, surgery, or weakness. Fifty participants with a mean age of 81 were divided into two groups of 25 participants. The experimental group received a fatigue reduction program consisting of planned rest periods after bathing and therapy; high-protein, high-carbohydrate liquid supplement; and a 3-minute back rub at bedtime. Each participant's level of fatigue was tested soon after admission and 1 week later, and data were analyzed using the paired t test. The difference between the change in pre-test and post-test scores of the two groups was significant in all three measures of fatigue. The experimental group exhibited a significantly greater reduction in fatigue. The outcomes reinforced the value of nursing interventions that have been an integral component of nursing care from its beginning: promoting nutrition, alternating periods of activity and rest, and including a back rub in evening care.

Delirium prevention for cognitive, sensory, and mobility impairments.

The purpose of this study was to determine the effectiveness of a protocol designed to prevent delirium in hospitalized elders with the risk factors of dementia and/or vision, hearing, and/or mobility impairments. A group of 80 patients with risk factors hospitalized before the protocol was implemented was matched with a group of 80 patients admitted after the implementation of the protocol. Records of patients in both groups were reviewed to identify patients with delirium. A significant reduction in delirium, from 37.5% to 13.8%, occurred in the elders receiving the protocol.