course material

1. NURS11170 Professional Practice Placement 1
Answer:
Question 1
One of the roles of the registered nurse in an aged care environment is to reduce the risks of
harm to an older person. An older person is at a higher risk of developing delirium. Discuss
two (2) associated risk factors of delirium.
Describe strategies that could be implemented to minimise the associated risks.
Delirium is a disorder in mental abilities which results in perplexed thinking and lack of
awareness of the surroundings. It happens in a usually rapid state- within a few hours or
days. It is most common in elderly adults. If not taken care of properly, it can result in
factors that can harm the elder’s people ( Eske, 2019). Delirium is the situation where
elderly peoples are the ones who are most affected. This happens in them because their
brain become resilient which can had severe memory loss and even can lead to a situation
of hospitalization. Various factors can increase the risk of delirium. Some are intrinsic
factors like age, chronic illness, sensory impairment(Dylan, 2019). Some are extrinsic
factors like infectious, Metabolic, and many more. Some of the factors are discussed under:
Brain disorders like dementia, Parkinson’s disease: If a person is not taken care of properly
in the initial stage of Delirium, he/she become more prone to dementia (Mayoclinic, 2020).
Dementia is similar to Delirium, where a person tends to lose his/her memory (Cleveland
Clinic, 2020). It is a chronic disease and gradually worsens over time.
Sensory Impairment: Sensory Impairment happens when one of the senses is no longer
normal. There is a strong association of visual and hearing impairment with delirium. Vision
and hearing may be lost or a person can have difficulty when a person is suffering from
Delirium. Also, it can result in dehydration due to which urinary tract infections can be
there because of which patients are afraid to drink (Morandi, et al., 2021).
Polypharmacy can also be a risk factor as overprescribing medications can also pose a
threat to health. Proper dosage should be taken, as excess intake of medicines can
drastically affect people minds and behaviour (Hein, et al., 2014).
Preventive Measures To Minimize Associated Risks:

2. For minimizing the occurrence of delirium, prevention is the most effective strategy. Drugs
named benzodiazepines or anticholinergics should be avoided (Korc-Grodzicki et al., 2015).
Clear communication and addressing sensory impairment help to minimize delirium risk.
Use tool named “This is me” should be used as it helps to reduce older person agitation and
improves experience (Dylan, 2019). Using short sentences and asking single questions also
help in minimizing confusion thus helping in the improvement of delirium. Besides this,
they should be given priority in minimizing their confusion by avoiding any room change.
They should regularly be reminded about where they are, what time it is. Certain Strategies
like promoting good sleeping habits, sufficient light, good nutrition and maximum hydration
can help a lot in reducing the severity of delirium (Brusie, 2018). For minimizing
dehydration fluid balance chart, monitoring for UTI must be undertaken. Also, instead of
taking over excessive doses of medicines, it is better to take pharmacist advice.
Question 2
Using at least two of the NMBA Registered Nurse Standards for Practice, discuss how you
will provide safe quality nursing care for a person exhibiting signs of delirium.
Ans: Delirium is mostly found in elderly people who are under hospitalization or are in care
centres. Delirium is not an illness it is a group of signs or symptoms which are being seen
mostly in the older patients who have gone through any surgery and are in care centres.
Both the chosen standards 1 and 6 of NMBA can help to provide a safe and quality
treatment to the patients, appropriate and responsive quality nursing practices, thinking
critically and analyzing nursing practice (HealthinAging, 2022). As delirium can be handled
by implementing evidence-based practices of these standards.
Standard Number 1-:
Thinks critically and analyses nursing practice: in this standard practice registered nurses
have to use a diversity of thinking approaches and the best obtainable pieces of evidence for
decision making and providing safer, healthier and quality nursing practices inside a
person-centred and proof-based agenda as patients have many signs which require
different treatments (Nursing and Midwifery Board of Australia, 2021). RNs have to
critically evaluate the reports of the patient and analyze the best possible way of their
treatment. RNs usually accesses, examines and practice the best accessible evidence in
which research discoveries for safe quality performance are included(Nursing and
Midwifery Board of Australia, 2021).
Standard No. 6-:
Provides safe, appropriate and responsive quality nursing practices: this practice helps the
nursing sector in creating and maintaining a safer environment for the patients who are

3. suffering from Delirium. As the RNs provide quality and principled goal-focused actions. For
example, if any patient is having any issue with the environment, then RNs can help them by
giving examples of other patients who are having a great experience with the place and by
this RNs can make them calm mentally as well as make them believe that they are safe at the
centres. This will provide a better and safer environment experience for the patent for a
better quality of practice (Nursing and Midwifery Board of Australia, 2021).
Question 3
An older person with cognitive impairment is at greater risk of malnutrition, dehydration,
falls, pressure injuries, developing incontinence, and medication issues. Discuss why family
involvement is an essential element of care for a person with cognitive impairment.
For a person suffering from cognitive impairment family involvement has an important role
in taking care of the patients. The person experiences a noticeable lowering in mental
abilities such as memory and thinking skills, cognitive impairment is a condition where the
person has problems with their memory, thinking, language or judgement. Cognitive
impairment can be from mild to severe, the person can have trouble in remembering basic
things such as -eating or drinking, trouble in concentrating or learning and it can affect their
lives here the family or the caretakers can provide basic things and help them in taking their
medications in time. In hospitals, half of the patients are over 65 years of age, for treating
cognitive impairment such as dementia or delirium medications are given according to the
patient’s seriousness the involvement of the family plays a major role in treating a patient
(Rieck, Pagali, & Miller, 2020). It is seen that in old age, people are not able to make
decisions for themselves. They become stubborn and sometimes forget or refuse to take
medicines. The family provides a calm and comfortable environment for them. In a
research, it was found that most of the old aged patients and family caregivers wanted a
family dominance or involvement of family in the treatment as one feel calm and safe when
they are with the family. (Shin, et al., 2018). Family involvement in patient’s care has
multiple benefits such as giving the details and additional information of the patient,
assistance in providing care at home and hospitals, providing extra safety and also being
involved in decision making (Volker, Taher, & Jazieh, 2020). The family soothes the agitated
patients and provides recognized objects at home, in some cases involvement of family or
family members in sitting with the patient or assisting helps the patient with great benefit
(Caplan, Cumming, & Kurrle, 2016).
References
Brusie, C. (2018, April 24). Everything You Should Know About Sleep Talking.
https://www.healthline.com/health/sleep-talking
Caplan, G. A., Kurrle, S. E., & Cumming, A. (2016). Appropriate care for older people with
cognitive impairment in hospital. The Medical Journal of Australia, 205(10), S12–S15.

4. https://doi.org/10.5694/mja15.00898
Cleveland Clinic. (2020, September 09). Delirium.
https://my.clevelandclinic.org/health/diseases/15252-d
Dylan, F. B. (2019). Delirium risk in non-surgical patients: a systematic review of predictive
tools. Archives of gerontology and geriatrics, 83, 292-302
Eske, J. (2019, October 15). What to know about delirium.
https://www.medicalnewstoday.com/articles/326684
Healthinaging. (2022, January 27). Delirium https://www.healthinaging.org/a-z-
topic/delirium
Hein, C., Forgues, A., Piau, A., Sommet, A., Vellas, B., & Nourhashémi, F. (2014). Impact of
polypharmacy on occurrence of delirium in elderly emergency patients. Journal of the
American Medical Directors Association, 15(11), 850.e11–850.e8.5E15.
https://doi.org/10.1016/j.jamda.2014.08.012
Korc-Grodzicki, B., Root, J., & Alici, Y. (2015). Prevention of post-operative delirium in older
patients with cancer undergoing surgery. Journal Of Geriatric Oncology, 6(1), 60-69.
https://doi.org/10.1016/j.jgo.2014.10.002
Mayoclinic. (2020, September). Delirium. https://www.mayoclinic.org/diseases-
conditions/delirium/symptoms-causes/syc-20371386
Morandi, A., Inzitari, M., Udina, C., Gual, N., Mota, M., Tassistro, E., Andreano, A., Cherubini,
A., Gentile, S., Mossello, E., Marengoni, A., Olivé, A., Riba, F., Ruiz, D., de Jaime, E., Bellelli, G., &
Italian Study Group of Delirium (2021). Visual and Hearing Impairment Are Associated With
Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study. Journal of the
American Medical Directors Association, 22(6), 1162–1167.e3.
https://doi.org/10.1016/j.jamda.2020.09.032
Nursing and Midwifery Board of Australia. (2021, March 30). Safety and quality guidelines
for nurse practitioners. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Codes-Guidelines/Safety-and-quality-guidelines-for-nurse-practitioners.aspx
Rieck, M. K., Pagali, S., & Miller, D. M. (2020). Delirium in hospitalized older adults. National
Library of Medicine, 3-16.
Shin, D. W., Cho, J., Roter, D. L., Kim, S. Y., Park, J. H., Yang, H. K., Lee, H. W., Kweon, S. S., Kang,
Y. S., & Park, K. (2018). Patient's Cognitive Function and Attitudes towards Family
Involvement in Cancer Treatment Decision Making: A Patient-Family Caregiver Dyadic

5. Analysis. Cancer research and treatment, 50(3), 681–690.
https://doi.org/10.4143/crt.2017.201
Volker, S., Taher, S., & Jazieh, A. R. (2020). Involving the Family in Patient Care: A Culturally
Tailored Communication Model. Global Journal on Quality and Safety in Healthcare, 33-37.