When Delirium Is Mistaken for Dementia

We hope you had a chance to read “No Country for Old Women,” yesterday’s moving post by AJN associate editor Amy Collins, in which she described the failure of multiple providers to assess and treat the underlying cause of her grandmother’s rapid acceleration of already existent dementia symptoms (or what were assumed to be dementia symptoms).

It so happens that several years ago we ran an article on a frequently undiagnosed condition in older adults; the article was called “Delirium Superimposed on Dementia.” Maybe this is why two of our nurse editors were able to point Amy in the right diagnostic direction as to possible hidden causes of her grandmother’s crisis. Here’s an excerpt from that article:

A systematic review . . . found that prevalence rates of delirium in people with dementia ranged from 22% among older adults who lived in the community to 89% in hospitalized patients . . .  It’s more difficult to recognize delirium in people with dementia than in those without because of overlapping symptoms, difficulty in ascertaining baseline mental status and the acuteness of symptoms, and the tendency to attribute symptoms of delirium to a worsening of dementia symptoms.4 Yet early recognition is essential in order to determine and treat underlying causes; institute interventions to maintain safety; [and] restore prior cognitive function and improve short- and long-term outcomes.

The article gives a useful algorithm for recognizing as well as managing this condition. There’s also a video which discusses the condition and shows a […]

2016-11-21T13:15:36-05:00September 23rd, 2010|nursing research|0 Comments
Read More

With Inadequate Staffing, ‘Nonessential’ Care Goes First–Then Patient Safety

A coworker of mine made a medication error a few weeks ago. It was a multifactorial error—the medication had been ordered wrong, labeled wrong, and administered wrong—and was investigated accordingly. That particular nurse was also “tripled,” with two ICU trauma patients and one critically ill medical resident patient. The nurse’s workload wasn’t factored into the documentation or investigation of the error, though, since the nurse manager didn’t consider it relevant. I heard her say, “An extra patient shouldn’t make any difference in the standard procedure for passing medications.”

2016-11-21T13:15:51-05:00September 8th, 2010|Ethics, nursing perspective, nursing research, safe staffing|7 Comments
Read More

Scutari: A Blog Post Will Never Do Justice To This Visit

This is the second to last in a series of posts by Susan Hassmiller, Robert Wood Johnson Foundation Senior Adviser for Nursing, that chronicle her summer vacation spent retracing Florence Nightingale’s influential career.

Scutari was a “tragedy of epic proportions of which bureaucratic muddle and sheer human incompetence played the larger part, thrown in with a measure of bad luck.”

–Mark Bostridge, from his book, Florence Nightingale: The Making of an Icon

The Hospital: What Florence Experienced
It is almost incongruent that a woman who wrote more than 14,000 letters and 200 books said upon arriving at Scutari Hospital, a converted army barracks, that she was without words to describe what she saw. Of course, as time caught up with her, the words flowed quite freely. Death and mutilation surrounded her in this well-known deathtrap.  Her nurses slept (“in catnaps”) in cramped quarters. Men were cramped into rooms and spilled out into the long corridors as they lay on straw beds on cold stone floors. Attendants had to walk over the men who were, by Nightingale’s command, a requisite 18 inches apart. More men died than lived.

Nightingale hardly slept, took her meals by the spoonful, and spent most of her time caring for the men, overseeing the […]

2016-11-21T13:16:28-05:00July 22nd, 2010|nursing research|4 Comments
Read More

Tech, EBP Buzzwords Among Nurse Researchers

By Shawn Kennedy, AJN interim editor-in-chief

As a lover of history, especially nursing history, I’ve been following Sue Hassmiller’s posts retracing the steps of Florence Nightingale with great interest and a bit of envy.

Well I went on a trip, too—to Sigma Theta Tau International’s 21st International Nursing Research Congress in Orlando. I was astounded by the truly international aspect of the meeting—many meetings say they are international if there’s a few hardy travelers from abroad, but there were many presenters, poster presenters and attendees from outside the United States.

What AHRQ does. Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), was the good choice for keynote. She shared some interesting data—like the fact that AHRQ is the leading funder of patient safety research in hospital and ambulatory care, or that the U.S leads the world in rates of hysterectomy. (While our rates are comparable with other countries for hysterectomy for endometrial cancer, they are “all over the map” for hysterectomy for noncancer diagnoses.) She also spoke about the agency’s research priorities—patient safety and quality of care, comparative effectiveness research, and reducing disparities in access to care for minorities and women (she acknowledged that “lack of health insurance is the biggest barrier”).

If there was a catchphrase from this conference, it was “evidence-based practice”—how to do it, teach it, evaluate it, and use it to transform practice, education, leadership style, and workplaces.

Using technology—virtual technology, simulation, social media, and Web technology—was another major theme, and presenters focused on […]

2016-11-21T13:16:35-05:00July 19th, 2010|Nursing, nursing perspective, nursing research|0 Comments
Read More

Interventions to Promote Physical Activity in Chronically Ill Adults: What Does the Evidence Tell Us?

By Sylvia Foley, AJN senior editor

It sounds like a no-brainer: physical activity can have great health benefits for people who are chronically ill. But which interventions promote physical activity in this population most effectively? Many studies evaluating such interventions have been conducted; but “without the benefit of a statistical analysis across studies it can be difficult to detect patterns and interpret results,” say the authors of this month’s CE feature, Todd M. Rupper and Vicki S. Conn.

In 2008 Conn and colleagues did just that, performing a meta-analysis that summarized the findings of 163 reports on 213 independent tests of interventions used to promote physical activity among more than 22,000 adults with various chronic illnesses. Now, in this article, Rupper and Conn discuss the implications of  the findings from that meta-analysis, describe the strategies and practices most commonly used, and identify which ones have proven most effective. Among the take-aways: […]

2016-11-21T13:16:44-05:00July 14th, 2010|nursing perspective, nursing research|0 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
Go to Top