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The utility of nursing instruments for daily screening for delirium: Delirium causes substantial functional impairment

Published online by Cambridge University Press:  27 November 2019

Leonie Bode Open the ORCID record for Leonie Bode [Opens in a new window] ,
Florian Isler ,
Simon Fuchs Open the ORCID record for Simon Fuchs [Opens in a new window] ,
Justus Marquetand ,
Heidi Petry ,
Jutta Ernst ,
Maria Schubert ,
David Garcia Nuñez ,
Roland von Känel  and
Soenke Boettger Open the ORCID record for Soenke Boettger [Opens in a new window]
Leonie Bode
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Florian Isler
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Simon Fuchs
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Justus Marquetand
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Heidi Petry
Affiliation:
ZKPW, University Hospital Zurich, Zurich, Switzerland
Jutta Ernst
Affiliation:
Institute of Nursing Science, University Hospital Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
School of Health Professions, Zurich University of Applied Science School of Health Professions, Winterthur, Switzerland
David Garcia Nuñez
Affiliation:
Department of Psychiatry, University of Basel, University Hospital Basel, Basel, Switzerland
Roland von Känel
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
Soenke Boettger*
Affiliation:
Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
*
Author for correspondence: Soenke Boettger, Department of Colsultation-Liaison Psychiatry an Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland. E-mail: [email protected]
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Abstract

Objective

Nursing assessments have been recommended for the daily screening for delirium; however, the utility of individual items have not yet been tested. In a first step in establishing the potential of the electronic Patient Assessment-Acute Care (ePA-AC) as such, the impact of delirium on the functional domains was assessed.

Method

In this prospective observational cohort study, 277 patients were assessed and 118 patients were delirious. The impact of delirium on functional domains of the ePA-AC related to self-initiated activity, nutrition, and elimination was determined with simple logistic regressions.

Results

Patients with delirium were older, sicker, were more commonly sedated during the assessment, stayed longer in the intensive care unit (ICU) and floors, and less commonly discharged home. A general pattern was the loss of abilities and full functioning equivalent to global impairment. For self-initiated mobility, in and out of the bed sizable limitations were noted and substantial inability to transfer caused friction and shearing. Similarly, any exhaustion and fatigue were associated with delirium. For self-initiated grooming and dressing, the impairment was greater in the upper body. Within the nutritional domain, delirium affected self-initiated eating and drinking, the amount of food and fluids, energy and nutrient, as well as parenteral nutrition requirement. In delirious patients, the fluid demand was rather increased than decreased, tube feeding more often required and dysphagia occurred. For the elimination domain, urination was not affected — of note, most patients were catheterized, whereas abilities to initiate or control defecation were affected.

Significance of results

Delirium was associated with sizable impairment in the level of functioning. These impairments could guide supportive interventions for delirious patients and perspectively implement nursing instruments for delirium screening.

Keywords

AssessmentDeliriumElectronic Patient Assessment-Acute Care (ePA-AC)Functional impairmentNursing
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 3 , June 2020 , pp. 293 - 300
Copyright
Copyright © Cambridge University Press 2019

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