Delirium is often triggered as a result of anesthesia or surgery - and should be treated to avoid possible consequential damage. At Vivantes, nursing has developed a prevention concept – and cares for patients with delirium entirely without medication.
Doris W. had brought her husband Horst (69 y.o.) to the clinic in the afternoon, and the hip operation was scheduled for the next morning. At the first patient visit, she immediately noticed, "Something's wrong." Her husband looked around the hospital room uneasily, fiddled nervously with his wristwatch and reacted unusually irritably to her questions. "He was different," he said.
"A typical behavior in post-operative delirium," judges Tina Kling, area nursing manager for psychiatry at Vivantes Auguste-Viktoria Hospital and Vivantes Wenckebach Hospital.
Sporadically, hallucinations also occur. It used to be called 'transit syndrome,' but today it's called 'delirium.'" People affected by it are often older than 65, but it can also affect younger people.
Co-therapists: family and friends
Delirious patients are not always aware of their condition themselves, which makes information from family and friends all the more important. They often react in a disturbed manner and find it difficult to adjust, sometimes even withdrawing.
For Tina Kling, this is the wrong approach: "Familiar people provide security and consistency. Relatives have the role of co-therapists, they are very important for the recovery process." Together with Christin Schultz, ward nursing manager at the Clinic for Surgery - Visceral and Vascular Surgery at the Vivantes Auguste-Viktoria Hospital in Schöneberg, Tina Kling developed a comprehensive concept for prevention and nursing therapy for delirium.
Balanced day-night rhythm
Tina Kling explains: "Patients often get bored in the hospital, lie down a lot and wait for meals or rounds. This is often the first cause of a disturbed day-night rhythm: If I lie in bed all day, I usually nod off and can't sleep well at night. Yet there are so many possibilities for occupation – even in the sick bed."
Information and an activity box
To support the nursing team in their daily work, Tina Kling and Christin Schultz designed information flyers and put together an "activity box" to promote patients' cognition. It contains games, puzzles, painting utensils and small dexterity tasks.
Strength lies in calm
Trust is the best basis for "treating" patients. In the full extent of delirium, they can become very aggressive, even physically, and distrustful of the treatments and care measures to be carried out. For the therapeutic team, this means a great challenge.
Appeal to the inner attitude
"In addition to teaching tips and tricks for prevention, we therefore make a stronger appeal to the inner attitude in our intensive training courses. It is difficult, but absolutely necessary, to remain patient even under stress. A patient in the peak phase of delirium is not accessible even to convincingly presented arguments. However, since we act preventively, in the best case it should not even get that far," says Christin Schultz.
Therapy without medication
Not only the nursing staff, who spend most of their time with the patients, but also the doctors are aware of non-pharmacological therapy, i.e. therapy alternatives. "With every major and also minor success achieved together, with every delirium averted, enthusiasm and commitment to the subject grow," the two nursing directors report.
For the increasingly elderly patients, these measures are the best prerequisite for improving their health – both during a hospital stay and afterwards.