Date Available

4-24-2024

Year of Publication

2024

Degree Name

Doctor of Nursing Practice

Advisor

Dr. Jean Edward

Committee Member

Dr. Andrew Makowski

Co-Director of Graduate Studies

Dr. Patricia K. Howard

Abstract

Background: Emergency Department (ED) overcrowding is a global healthcare crisis documented in the literature for more than a decade, impacting patient outcomes and resource availability. While awaiting delayed transfer to an inpatient room, older adults in the ED remain vulnerable to developing acute delirium. Boarding potentiates the risk for worsening health outcomes, which are further compounded by delirium. Scarcity of resources and time constraints delay delirium detection and increase risk for down-stream hospital-acquired complications, higher cost, and prolonged length of stay. Current ED models do not prioritize caregiver partnership or involvement in delirium-conscious care, which is a holistic approach to prevention, recognition, and nonpharmacologic treatments.

Purpose: The purpose of this study was to assess the effect of an educational session designed to engage caregivers in the prevention of clinical delirium for older adults boarding in the ED setting. This intervention pertained only to caregivers with attention to their knowledge, confidence, and behavior.

Methods: Caregivers for older adults (65y+) in the ED of a Level 1 Trauma Center received a 10 minute presentation on an electronic tablet with a pre- and post-intervention survey. This was a single-center quasi-experimental study with a pretest-posttest design (N=15). Descriptive statistics were used to analyze changes in three outcome variables: knowledge, confidence, and behavior change.

Results: A statistically significant (p<.05) change in knowledge, confidence, and implementation of reality orientation and environment familiarity was revealed post-intervention. Implementation of sleep-wake cycles was not statistically significant.

Discussion: Delirium education tailored to the caregiver through video format could be effective in improving a caregiver’s knowledge and experience of delirium, as well as strengthening partnership with healthcare providers in formation of a holistic care plan. Caregiver interest and participation was a significant barrier that will require further investigation.

Conclusion: This project provides insight into the value of introducing delirium education and prevention in the ED setting through caregiver partnership. Further studies are needed to understand the impact of caregiver education on patient outcomes throughout hospitalization.

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