Self Directed Learning Package - University of Queensland

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150 • The Palliative Approach ToolkitSayReport your assessmentSigns of delirium always need to be reported to a nurse.Be as clear and detailed as possible.Thinking PointWhich of the following do you think will get the bestresponse?Careworker to nurse:‘Alfred appears to be confused. He wants to go andcatch chickens. He seems to have become confusedfollowing a urine infection last week’.Is much better than:‘Alfred is confused. You need to see him to sort it out’.DoManage the problemIt may be appropriate to treat the cause of delirium (if it isknown). However, at the end of life simple measures aimed atmanaging the symptoms may be preferable.Thinking PointImagine you are Alfred. It is night-time and you arelying in your bed. It is dark, no one is around and youare confused, frightened and not sure where you are.You hear noises outside your door that sometimesdisturb you. Perhaps you want to get out of bed tofind somewhere better to be.Look at the following lists of strategies. Which ofthese measures might help you feel less confusedand anxious?Environmental strategies 11• appropriate lighting• minimise noise especially at night• provide a clock that the resident can see• avoid room or location changes and keep personal andfamiliar objects in view• modify the environment to minimise the risk of injurye.g. low bed in the lowest position with cot sides down, bedagainst the wall, potential hazards such as beside tablesremoved.Clinical strategies 11• address anxiety; residents with delirium are often veryfrightened• manage discomfort or pain• minimise sensory deficits by providing and assisting withhearing and visual aidse.g. clean spectacles and remove wax deposits in hearing aids,check batteries are fresh and hearing aid is turned on• encourage the presence of people known to the residente.g. family and friends and regular staff members• reassure and reorientate the resident• explain and reassure the resident and/or family regardingthe possible causes of the delirium and describe themanagement plan• avoid use of physical restraints• use interpreters and communication aids for residentswith culturally and linguistically diverse needs (CaLD)• promote relaxation and sufficient sleepe.g. assisted by massage and/or encouraging wakefulnessduring the day• minimise use of indwelling catheters• medication reviewe.g. cease or reduce all non-essential medications; changeto a different opioid medication; utilise medications to targetagitation or hallucinations.
151 • Self Directed Learning Package - CareworkerWriteKey PointMany of these environmental and clinicalinterventions for delirium are within the scope ofcareworkers. When in doubt discuss with a nurse.Document your actionsMany residential aged care facilities expect careworkersto document information on assessment charts and inthe clinical record. If this is part of your role, try andavoid general statements. Be as specific as possible.Avoid general statementsPOOR COMMUNICATIONEvaluation of interventions ‘with effect’ or‘effective’.GOOD COMMUNICATION‘Resident has not reported hallucinationsin the last two hours and physicalplucking at the bed sheets has stopped’.ReviewEvaluate and reassess as necessaryIt is important to evaluate the effectiveness of the care youdeliver to residents.Every time you provide care to a resident, ask yourself:• Does it seem to be effective?• Is it doing any harm?Key PointDelirium can develop quickly, regular assessment isimportant.If you have any concerns, report them to the nurse(and document them if this is part of your role as acareworker).
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Self Directed Learning Package - University of Queensland

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