Category: NSG 420 Posts

Throughout my time of seeing patients with the HELP program I feel that I got a routine down of how to talk to the patients and be observing for signs of delirium simultaneously. I did not see any clients experiencing delirium, but I was able to look at the paperwork to get a sense of what their baseline was and observe for any changes.

            The most meaningful aspect of my volunteer experience was with a patient I saw first in the HELP program and then at clinical the next week. I had a really good conversation with this patient, as we talked about all the books he liked to read and how he liked that he was able to read in the hospital. He was in a great mood and was very enthusiastic about his recovery. At clinical I was able to help him with the discharge process, so that was a cool moment for me to be able to care for a patient in two different settings.

            I did meet my learning goal of getting better at recognizing and remembering signs of delirium. None of the patients I saw were in active delirium, but I was able to observe for any changes from previous visits and look for factors that could potentially cause delirium. I also met my goal of becoming more comfortable seeing patients in a different setting, which is something I will take with me moving forward, as I may be caring for patients in many different settings as a nurse. 

Delirium usually begins over a few hours to a few days. Delirium is not the same as dementia which has a slow progressive onset. Delirium often happens in the hospital where patients are bed bound and in a new environment that may be upsetting or confusing to them. Medications, infection, sleep deprivation, malnutrition, pain, stroke, and heart attack are some causes of delirium that are commonly seen in the hospital. Delirium can present as reduced environmental awareness, such as being distracted or not responding to the environment. You also might see disorientation, poor memory, difficulty speaking, hallucinations, and restlessness. Delirium also includes disturbed sleep habits, fear, depression, and mood and personality changes. 

I experienced caring for a patient with delirium at clinical this year. The nurses described this patient’s delirium as “waxing and waning”. This patient went from being oriented to where they were and asking questions about their care to being very restless and distracted, not knowing where they were, and having trouble speaking. After this patient had an episode of delirium they returned to their baseline neurological status a few hours later, so it was interesting to see that shift.

            One learning goal I have for this experience is to get better at recognizing signs of delirium since that will help me to provide better care for the patients. The next learning goal I have for this experience is to become more comfortable working with patients who are experiencing delirium, as this is not something I have a lot of experience in. I am a little bit nervous for this experience since I have only seen a few patients experience delirium so far. However, I do feel ready to work with patients in a bit of a different setting than clinical, and still provide them with good care. A few community support networks for the aging population that I am aware of include senior centers, and meal delivery programs.