Welcome to Unit 6: Looking after you!

Section 1

Well done you have worked your way to the last unit and you should feel much more confident in your knowledge of how to identify and respond to delirium.  This unit is an important part of the issue and that is, looking after you when care is challenging.

Not taking it personally

If an individual responds to you in a negative way when you are trying to help them it is normal to feel frustrated, defensive or angry.  As nurses we try to keep on doing what we feel will help the person.  If we don’t address this frustration this can lead to carer strain.  Under these circumstances if can be difficult to work effectively.  If a person has delirium and behaves aggressively it is usually because they are misperceiving your good intentions and not because they have anything against you personally.  Consciously, reminding yourself of this can help at times when you are finding caring for someone is particularly demanding.

In addition, despite the additional care and attention a delirious patient requires, delirium is associated with poor outcomes which possibly makes care of delirious patients particularly unrewarding. A delirious patient can take quite some time to recover during which time their behaviour typically fluctuates rather than following a steady course to recovery.  If your assessment of improvement in a patient is done after a shift it can seem like no improvement has been made at all.  However, if you consider improvement over a few days it can be easier to perceive that all the hard work and perseverance is paying off and there is an upward trajectory over all.

Section 2 – Teamwork

One response to dealing with people like Ted, particularly used in acute care, is to get a ‘special’  to deal with Ted while the ward team get on with caring for the acutely unwell people on the ward.  This might be a solution in the short term but it does not help achieve what needs to happen in the medium and long term.  In the medium and long term the regular ward staff need to get to know Ted, his preferences and behaviour triggers and most importantly Ted needs to get to know the ward staff, to build trust and security as what he is experiencing is probably psychologically traumatic.

However, caring for someone like Ted for an eight or 12 hour shift and maintaining a therapeutic mindset is almost impossible.  If you are in charge of allocating patients to a team of nurses and there is a patient such as Ted, care must be taken to share the responsibility between the team.  A ‘special’ can be useful as caring for a delirious patient is time consuming, however, the special should be used to take up other responsibilities not to care for Ted (possibly one of the most complex and demanding allocations).

In Ted’s case he was cared for by a special for a long time and whilst being costly it effectively marginalised him from the ward community.  The same special rarely wanted to return so he had a stream of different people care for him in a week, none of whom knew him as an individual.  Under these circumstances it is difficult for things to get better.  In fact, even important aspects of his physical care got missed for long periods, such as the fact that he was delirious and not just demented or that he had a UTI and needed antibiotics.

Section 3 – Stress and coping

Clinical supervision is one intervention aimed at supporting staff dealing with stressful work based issues in a constructive manner.  However, supervision is not always available to nurses.  If you are in charge of managing nurses who are caring for delirious patients in the absence of formal clinical supervision it is important that you acknowledge the strain the nurses may experience and ensure they are falling into the trap of taking it personally, looking at improvement over a short period of time or becoming burnt out from being over allocated to the patient.  This can often happen when a particular nurse is very skilled at looking after a delirious patient so they end up being allocated to that patient on a very regular basis.

Other activities that can help with stress include guided relaxation or gentle exercise classes such as yoga or Tai chi.  Coping mechanisms are quite individual but the message is that they should be something you do for yourself because you care for your self and not because you feel guilty if you don’t or because you feel obliged to.

 Section 4 – Conclusion

I hope you have enjoyed completing this module and that you have found it enlightening in terms of improving your knowledge and skills in caring for a delirious individual.  Please complete the following feedback questionnaire to help improve this learning intervention.

Please print out and complete this questionnaire and give this to Kate Irving.

1) I would / would not recommend this learning intervention to a colleague
True / False / don’t know

2) The intervention was set:
at the right level / too in depth / too simplistic for my needs.

3) The units I particularly found useful were 1 / 2 / 3 / 4 / 5 / 6

Why?

4) The units I thought could be left out were 1 / 2 / 3 / 4 / 5 / 6

Why?

In total it took …… amount of time to complete this learning intervention.

5) I don’t think I would be able to relate the knowledge I have gained into clinical practice
True / False / not sure

6) I feel confident that I could identify a patient who was at risk of delirium
True / False / not sure

7) I feel confident in my skills to respond to delirium
True / False / not sure

8) I feel confident that I could identify a patient who could be delirious.
True / False / not sure

9) I found the on-line format flexible and easy to navigate.
True / False / don’t know

10) I would complete other on-line learning interventions as a result of this experience.
True / False / not sure

11) I would much prefer to experience education in a class room with peers and an expert teaching the subject.
True / False / don’t know