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Nurses’ Assessment of Delirium With Underlying Dementia in End-of-Life Care

Oligario, Grace Cullen DNP, APRN-BC, ACHPN; Buch, Carrie PhD, RN; Piscotty, Ronald PhD, RN-BC

Journal of Hospice & Palliative Nursing: February 2015 - Volume 17 - Issue 1 - p 16–21
doi: 10.1097/NJH.0000000000000099
Symptom Management Series

Because of physical and metabolic changes during end of life, patients with dementia are very susceptible to develop delirium. The recognition of delirium with underlying dementia can be difficult because of their overlapping behavioral manifestations. Previous studies conducted among nurses caring for patients with delirium have shown that nurses are often not able to detect the presence of delirium using their subjective assessments. This study evaluated the nurses’ ability to subjectively assess for delirium in patients with underlying dementia in end of life. Their findings were compared with the results of objective assessments performed by the researcher using Confusion Assessment Method. In 30 paired assessments, the objective and subjective assessments had the same findings. The remaining 20 paired assessments showed disagreement between the subjective and objective findings. A κ measure of agreement was performed with a result of 0.074 and a significance of P > .05. This finding indicates no statistically significant agreement between the subjective nursing assessment for delirium and the objective assessment using Confusion Assessment Method. Accurate nursing assessment yields appropriate nursing interventions. The findings of this study support the need for improved subjective nursing assessment for delirium in patients with dementia at the end of life.

Grace Cullen Oligario, DNP, APRN-BC, ACHPN, is oncology and palliative care nurse practitioner, John D. Dingell VA Medical Center, Detroit, Michigan.

Carrie Buch, PhD, RN, is associate professor, School of Nursing, Oakland University, Rochester, Michigan.

Ronald Piscotty, PhD, RN-BC, is assistant professor, College of Nursing, Wayne State University, Detroit, Michigan.

Address correspondence to Grace Cullen Oligario, DNP, APRN-BC, ACHPN, 4646 John R St, Detroit, MI 48202 (

The authors have no conflicts of interest to disclose.

© 2015 by The Hospice and Palliative Nurses Association.