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Journal Critique on Confusion 1


Journal Critique on Confusion

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Journal Critique on Confusion 2

Journal Critique on Confusion

What a Nurse Can Do without Doctor’s Help for a Patient Experiencing Confusion

Nurses, over the years have been lauded for their role as care-takers, but their role in

treatment and administration of interventions is usually neglected. Few people care to

acknowledge the fact that usually nurses have better work ethics, skills, compassion,

commitment, diligence and dedication than most of other professionals. It is only a matter of

providing them with ample chances to prove their dexterity and mettle. The following article

presents another example of nurses’ importance in times when a doctor is not present.

Summary of the Article - Waszynski, C. M., Petrovic, K. Nurses’ Evaluation of the

Confusion Assessment Method. (2008) Journal of Gerontological Nursing; 2008, Volume 34,

Number 4, p 49-56.

Delirium is normally ignored in hospitalized persons of all ages. As nurses spend

considerable amount of time with patients, their assessment is critical to the identification of

delirium. This pilot study has investigated nurses’ evaluation of the Confusion Assessment

Method from the aspects of ease of use and helpfulness in recognizing delirium among

mature patients on two hospital units. The purpose of the study was to gather nurses’ point of

view about the usefulness of this method and also their willingness to adapt to newer ways of

doing things. The nurses participated in the study were first given a 30 minute educational in-

service session and were provided with a handout of the same for future references. This

method provides the caretaker (nurse) tools for assessment of four elements of delirium:

fluctuation in mental condition as compared with the normal state (also called baseline state),

inattentiveness, confused thinking and distorted levels of consciousness. A flow sheet is

prepared for recording the aforementioned four parameters. An Advanced Practice RN

(APRN) was supervising the whole study. A sample of 233 patients was used. At the end of

the study nurses were also asked to share their experiences in form of a questionnaire
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designed on Likert scale and dichotomous questions. Results showed that approximately

18.4% (n=41) patients experienced delirium. Most of them experienced delirium during the

first 48 hours of being hospitalized. 16 nurses participated in the study voluntarily, 62.5%

(n=10) found the method helpful for determining the cognitive status of the patient, whereas

93.8% (n=15) found it helpful in determining changes in cognitive status of the patient. The

method also helped nurses in assessing correctly cases of delirium superimposed with

dementia and differentiation between cases of delirium with dementia. 81% (n=13) of nurses

recommended, and also showed eagerness for the method to be included in bedside flow

sheet for continual assessment of cognitive delirium in patients. Another interesting finding

was the increased rates of delirium during the early part of the day time, contradicting the

more famous belief of sundowning, which says that a patient becomes more and more

confused and disoriented as the day progressed. Delirium rates are recorded for patients in all

shifts for a period of one month. Most of the nurses found Confusion Assessment Method to

be an efficient and easily comprehensible instrument for the evaluation of patients’ cognitive

standing over time.

Personal Views about the Article

It is an excellent study on the subject keeping in mind the constraints inherent to it. Using two

hospital units has decreased the chances of random error and selection bias in the study. One

of the limitations in the study is that nurses could have given positive remarks just to please

the APRN. Also there was no method incorporated to judge the correctness of data recorded.

More studies are needed on the topic and especially on the frequency of delirium among the

younger population and relationship between delirium and time of day when it occurs more

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Waszynski, C. M., Petrovic, K. Nurses’ Evaluation of the Confusion Assessment Method.

(2008) Journal of Gerontological Nursing; 2008, Volume 34, Number 4, p 49-56.