Knowing is empowering: Registered nurse, Stephanie Russell-Totten says delirium education leads to more patient, family-centered care

Nova Scotia Health Registered Nurse, Stephanie Russell-Totten
Nova Scotia Health Registered Nurse, Stephanie Russell-Totten

For older adults being admitted to hospital, it’s common to have concerns about complications due to treatment or surgery.

According to Stephanie Russell-Totten, registered nurse, and health services manager on the three-west, medical surgical floor at the Dartmouth General Hospital, Delirium isn’t a complication that is top-of-fmind for patients and their loved ones. It is however one she believes needs to be discussed more often and openly.

“Delirium is a type of confusion that happens when the combined strain of illnesses, environmental circumstances or other risk factors disrupts a patient’s brain baseline function,” said Totten.

“Delirium can be tricky to diagnose immediately in a patient because the underlying causes are not always obvious. These causes vary but can include things like infection, low oxygen, blood pressure or glucose levels, severe pain or dehydration, critical illness, certain medications or withdrawal of drugs and alcohol.”

The risk of delirium increases with age, specifically in individuals 65 years and older. Additional factors include undergoing general anesthesia, multiple medications, individuals with Dementia, Parkinson’s disease or stroke, or pre-existing cognitive impairments. Those who are hearing or visually impaired are also at risk. The acute onset of confusion can last for a few hours or weeks.

Totten says it’s important for patients and their support people or caregivers to know about Delirium prior to coming to hospital because it can be a quick start and change in an individual’s baseline – which can be shocking.

“It can be upsetting for loved one’s to see,” said Totten. “Our biggest role is to support and encourage everyone involved. As your health care team, it’s something we can monitor, guide a patient through successfully and help families understand that it’s a possible, expected reaction to their loved one’s medical circumstances and is likely temporary.”

Recognizing the emotional difficulties Delirium can bring for patients andfamilies, Totten says there is something empowering in knowing what to look for.

“We really make an effort to focus on patient and family-centered care and that includes having conversations with the patient and their support people about health care goals,” said Totten.

“If a patient is in a delusional state, we often look to their loved one to speak for them. Having those open, honest conversations empowers both the patient and their family to make decisions they are most comfortable with. Having a family or friend involved during that time provides a familiar face for the patient, a voice that they recognize and can engage with – all of which have positive results.”

Recognizing that Delirium is one small piece of a very complex health care system in Nova Scotia, Totten believes education is a great first step to helping others understand what delirium is, how to detect it, treat it and manage it.

“Delirium is becoming a more globally recognized, acute health care need,” said Totten.

“I think one of the most powerful things we can do as health care providers for a patient and family going through it, is to just be with them and be present. Making sure patients and their families feel they are heard and seen. It helps them feel more safe during a time of genuine uncertainty. That positivity and compassion go a long way in their healing journey.”

March 15 is World Delirium Awareness Day. To learn more, visit the American Delirium Society website.