Nurse aims to improve quality of life for palliative care patients

(Nursing Allied Health) A Sydney palliative care nurse hopes her research into delirium will improve nursing care for palliative care patients.

Annmarie Hosie, a nurse at Calvary Health Care Sydney and PhD student at The University of Notre Dame Australia, is researching palliative care inpatients’ prevalence of delirium and how palliative care nurses can better recognise and respond to symptoms of delirium.

Ms Hosie, a nurse for more than 20 years who has worked in palliative care and in aged care settings for the past 12 years, said research shows nurses often fail to recognise delirium but delirium can have a major impact on quality of life for patients and their families.

“There are quite a number of studies, particularly around nursing recognition, that show that across the board, nurses don’t recognise delirium. It’s a real issue in nursing,” she said.

“If you don’t recognise it, you don’t put in the following steps that are necessary but if you recognise it, you can then think more critically about what’s going on for the person.”

Ms Hosie said hypoactive delirium, where patients are often withdrawn, quiet and vague, was the least recognised subtype.

Delirium is an acute neuropsychiatric syndrome related to a physical cause, with fluctuating changes to levels of consciousness or alertness, cognition and often perception.

Patients can experience a wide range of symptoms such as inattention, altered alertness, impaired memory, language, behaviour changes, hallucinations, illusions or delusions, mood changes and altered sleep cycles.

Ms Hosie said patients who experience delirium report it as being frightening, humiliating and distressing.

“Older, hospitalised patients who experience delirium are more likely to fall, stay in hospital longer and be discharged to a nursing home,” she said.

“These patients also have increased mortality compared to those patients who did not experience delirium.”

Ms Hosie said research indicates between a third and a half of palliative care patients’ delirium was reversible.

And she said the introduction of a comprehensive screening process for delirium would improve its recognition.

“In palliative care inpatient settings, patients are screened every day for their level of pain, nausea, appetite, their bowels, breathing and their levels of energy,” she said.

“Part of the reason for screening is to be able to address what are the most significant problems for the patient and show that you have made a difference.

“We don’t actually do that with delirium. I think there’s a number of reasons why we don’t. I think it’s a gap and I think we need to have a conversation around it.

“If there’s an opportunity to reverse someone’s delirium we should be taking that opportunity.

“A day without delirium is a better day than a day with delirium. You can make a real difference there.”

Ms Hosie said early recognition of a patient’s delirium would help clinicians treat the underlying physical cause and potentially reverse the delirium.

“Even if the delirium cannot be reversed, patients and families will need information and support about what is happening, and there are interventions that may reduce the severity of the symptoms.”

Ms Hosie’s review, titled ‘Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review’, was conducted under the supervision of Notre Dame’s Professor of Palliative Nursing Jane Phillips and written in collaboration with her co-authors. It was recently published in Palliative Medicine.

Ms Hosie plans to develop and test a pilot intervention in 2014, aimed at improving nursing practice in delirium prevention, recognition and assessment.

As part of her work to develop the pilot, Ms Hosie is now recruiting about 30 palliative care nurses for a study on aspects of practice.

To be eligible to participate in the study, participants must be registered nurses with at least 12 months clinical experience, employed for at least three months by a specialist palliative care inpatient service in Australia, and working in a role which includes clinical responsibilities.