Delirium, characterized by a change in cognition and a disturbance in awareness, is a universal problem that nurses encounter when caring for the elderly. About 50 % of hospitalized patients are older than age 65, and 56% of the patients will either have delirium on admission, or will acquire delirium throughout their clinic stay (Dahlke and Phinney, 2008). If remaining untreated, delirium can result in harmful results, changing the lives once got by older individuals. The next represents a good example of an older adult acquiring delirium during her hospitalization: "Ms. Cotes, get older 77, is in hospital after having a knee alternative surgery anticipated to osteoarthritis. She developed a UTI in hospital and required opioid pain medication for back throat pain. Her discharge to a rehabilitation center is on carry because of new issues. She has tried out to leave her room on her behalf own and seems to just forget about her procedure. She says that the staff is stealing her clothes and the food is poisoned; she won't drink or eat. Prior to hospitalization, Ms. Cotes lived at home, proved helpful as a volunteer, was a keen gardener, and performed credit cards often at the senior's middle. Her home was immaculate. " Studies also show that certain of the major explanations why delirium continues to be a common problem in the older adult population is having less efficient care distributed by the nurses (Dahlke and Phinney, 2008).
According to nursing theorist, Jean Watson, the imaginative domain of medical emerges as transpersonal caring-healing modalities which "correspond to providing comfort options, assisting the cared-for to alleviate pain, stress, and hurting, as well as to promote well-being and therapeutic. " (Cara, 2003). By concentrating on the case study of Ms. Cotes, the use of Watson's caring theory will allow nurses to give efficient care to patients with delirium by promoting effective therapeutic, and to help decrease the dangers of acquiring delirium in the future. First, one of Watson's assumptions expresses that caring promotes self-knowledge, and self-healing processes and choices (Cara, 2003). It is important to look after Ms. Cotes through engaging in health promotion and instructing her about her health to be able to achieve health and fitness and recovery. Also, regarding to Watson, the nurse's creativity contributes to making nursing a skill (Cara, 2003). Nurses will come up with a variety of nursing interventions to help Ms. Cotes with her troubles of delirium and help her heal. Last, it's important for nurses to acknowledge the elderly populace and avoid negative attitudes towards them; instead, nurses should apply Watson's theory by being "authentically present, and permitting and sustaining the profound belief system and subjective life world of self and the one-being-cared-for. " (Cara, 2003). As a result of applying Watson's caring theory into a practice, nurses can offer efficient care to clients like Ms. Cotes who suffer from the negative results of delirium.
One of Watson's assumptions state governments that nurturing promotes self-knowledge and self-healing operations and choices (Cara, 2003). To apply this assumption, nurses can give service to clients like Ms. Cotes through engaging in health campaign and teaching them about their health to be able to achieve health and fitness and healing. A significant part of order for a nurse to give care is to know about the client's conditions and preventing it from becoming worse. Dahlke and Phinney's (2008) study implies that nurses lacked the data to efficiently care for older individuals with delirium; because of this, "nurses often found themselves intervening with techniques that contradicted the needs of the more mature parents in their attention. " To prevent the introduction of delirium in older patients, nurses must be "equipped with the abilities and knowledge to identify and determine for delirium. The lowering on the incidence of delirium can be acquired through meticulous examination and early identification of symptoms. " (Feazah, 2008). The first step to prevent delirium is to identify the risk factors that lead to it. Regarding Ms. Cotes, several factors were provided which might have induced her to build up the disorder. For example, her knee substitution surgery played a major role in the acquisition of delirium since it led to her attaining a UTI, an infection known to cause delirium (Feazah, 2008). A knee replacement surgery could have maintained Ms. Cotes immobile for an extended period of time, leading to urine incontinence and the use of urinary catheterizations, both a leading reason behind UTI. To avoid the chance of attaining the illness, it is highly important for nurses to determine "following a set period of time, whether an indwelling urinary catheter is still indicated for the individual" (Bernard, 2012), to diminish the chance of attaining a bladder an infection. Moreover, care and attention can get by promoting health by informing Ms. Cotes about the risks of urinary catheters and the importance of urinary continence, so that she will have self-knowledge and will be self-informed of the possibilities of health and fitness and curing. Another risk factor of delirium regarding Ms. Cotes is the utilization of opioid medication on her behalf back neck pain. Nurses should minimize the medication dosage of pain medication in reducing the symptoms of delirium: "Opioid use has been associated with delirium in a number of large prospective studies in hospitalized patients. Some data claim that the chance of opioid-induced delirium is medication dosage related" (Alexander, 2009). By attaining understanding of associated risk factors, and making use of Watson's theory of caring by posting data with the client to allow them to be self-knowledgeable and self-informed on restoration possibilities, nurses will be able to provide effective good care to patients with delirium.
Also, relating to Watson, the nurses' creativeness plays a part in making nursing a skill (Cara, 2003). Nurses will come up with a variety of nursing interventions to help Ms. Cotes with her difficulties with delirium and help triumph over the disorder to diminish her clinic stay. For instance, nurses can be creative through the use of Watson's 6th carative element in practise: "a caring environment preserves individuals dignity, wholeness, and integrity; they feature an authentic presencing and choice. " (Cara, 2003). A nurse can apply this carative factor by modifying the environment to suit the needs of Ms. Cotes, aiding in the healing up process. There are a variety of creative ways that a nurse is capable of doing therapeutic environmental changes in reducing the risk of delirium episodes. A nurse can: Modify Ms. Cotes' environment by keeping the physical environment constant and by preserving exercises; provide continuity of staffing for appropriate diagnosis of her health status and consistent good care; involve family in good care and providing recurrent orientation to market a sense of well-being; using a no-restraint or least-restraint insurance policy to lessen worsening of delirum; promote familiarity like the encouragement of using personal items; create well-lit area; maintain appropriate room temperatures; and reduce sound levels on the machine (Gillis & Macdonald, 2006). Corresponding to Gillis and Macdonald (2006), nursing environmental interventions focuses on balance - "between sensory deprivation and sensory overload, and between patient independence and supportive treatment. " The total amount of recovery, exercise, and constant nursing designates nursing as a technology and a skill. By maintaining balance in the surroundings of Ms. Cotes, the application of Watson's nurturing theory of an healing-environment is achieved. Watson talks about the way the "curing space or environment can expand the individuals 'understanding and consciousness' and promote mindbodyspirit wholeness and recovery. " (Cara, 2003). Therefore, through the use of Watson's ideas, nurses should be creative by changing the surroundings of the delirius elderly, and provide routine care and attention to promote wellness and treating success.
Lastly, it's important for nurses to acknowledge the elderly populace and steer clear of the negative attitudes towards them. Instead, nurses should apply Watson's theory of being "authentically present, and allowing and sustaining the deep notion system and subjective life world of self applied and the one-being-cared-for. " (Cara, 2003). To be able to give efficient care to patients like Ms. Cotes, nurses must understand that delirium is an acute disease, not the elderly's personality. It really is observed that "nurses who assumed confusion was normal in older people would be less inclined to discover symptoms of delirium as a medical crisis necessitating their attention and involvement. " (Dahlke and Phinney, 2008). Dahlke and Phinney's (2008) study also revealed that nurses understand delirious elderly as children who require babysitting, and therefore a burden in their work. Furthermore, nurses fail to provide efficient care when they focus on collecting physical data while ignoring the subjective experiences of your client. Watson shows that when collecting physical data about the individual, nurses should find out about his mind and soul as well (Cara, 2003). She strongly thinks that spirituality "upholds a main importance inside our profession. Actually, she ascertains that the health care of the heart remains the most powerful aspect of the art work of caring in nursing. " (Cara, 2003). Regarding Ms. Cotes, a nurse can enter in her phenomenal field by asking her a number of questions about herself such as life experience, bodily sensations, spiritual and cultural values, and goals and anticipations (Cara, 2003). This technique of transpersonal caring may encourage Ms. Cotes to talk about her life history, and help her to find harmony and so this means to her life problems. Therefore, it's important for nurses to disregard the negative behaviour towards clients with delirium and provide care when you are authentically present.
In conclusion, nurses can offer delirious clients with useful treatment utilizing Watson's theories: promoting attention by participating in health teaching to permit clients to be become self-informed and self-knowledgeable of healing possibilities; providing nursing health care artistically through creative interventions like therapeutic environmental changes; and by disregarding negative attitudes towards the elderly and providing transpersonal caring when you are authentically present. Certainly, by using Watson's caring theories, nurses can offer effective and effective care to the elderly with delirium, and invite them to reach harmony, wellbeing and curing.
