Acute confusion in the elderly hospitalized patient: An exploration of experienced nursing care

Karen L Dick, University of Rhode Island


Acute confusion in hospitalized elderly patients is a significant and serious health problem. The incidence estimates for this condition in hospitalized medical patients range from 10-50% to as high as 70% in some postoperative patients. Additionally, researchers have found evidence that acute confusion in the elderly contributes to increased morbidity and mortality, longer hospital stays, functional impairment, and progression to more permanent forms of cognitive impairment if not recognized and treated in a timely fashion. Nurses are in key positions to recognize, identify, and manage patients with acute confusion in the hospital setting. But there has been a lack of exploration into the actual practice of acute care nurses in regards to the assessment, recognition, and management of acute confusion. Little is known as to one, how the nurse first assesses and identifies acute confusion, two, how these actions influence patient outcomes, and three, what factors influence this process. The main research question in this descriptive study was "To what extent is there a process in the way experienced nurses assess, recognize and care for acutely confused patients in the hospital setting and what factors influence this process?" Seven acute care medical nurses with baccalaureate degrees or higher in nursing with experience ranging from 7-19 years were purposively selected as key informants. Written patient exemplars and indepth interviews were the primary methods used for data collection. A participant observation period with the chief informant was conducted over a one month period as well as well during a second followup period at the end of the study. Difficulties in finding situations of patients who were acutely confused as well as organizational changes in the study setting prohibited the use of individual periods of participant observation with each of the remaining six informants.^ A generalized process consisting of three phases (observing and gathering information, meeting the patient, and providing nursing care) was identified by which key informants assessed and cared for confused patients. Overarching goals for this process included maintaining the patient's safety, comfort, dignity, and restoring normalcy.^ Specifically, factors in the patient, eg, behavior, history of confusion, and acuity, factors in the environment, eg nurse-patient ratio, time of day, availability of other staff, and factors in the nurse, eg., knowledge of the patient, personal repertoire of interventions, and availability of time, influenced the nature of the process in each phase.^ The process that emerged in this study can now be used to theoretically link specific patient outcomes with variations of this process. This description is also useful as a framework for exploring theoretical linkages between domains for the advancement of nursing knowledge. ^

Subject Area

Gerontology|Health Sciences, Nursing

Recommended Citation

Karen L Dick, "Acute confusion in the elderly hospitalized patient: An exploration of experienced nursing care" (1998). Dissertations and Master's Theses (Campus Access). Paper AAI9902556.