Identification of confusion among the elderly in an acute care setting.

An exploratory, descriptive study was conducted in a large acute care hospital to determine: (1) the indicator/descriptors used by staff nurses to arrive at the diagnosis of confusion, and (2) which indicators/descriptors are perceived as most significant in such a diagnosis. In addition, because the literature frequently cites the occurrence of nurses stereotyping patients as confused and thereby treating them as confused (Libow's self-fulfilling prophecy), the third question explored was the type and quantity of information that was given to nurses at intershift report. A self-constructed interview schedule was used on a sample of 25 staff nurses who were primary caregivers of a confused patient on a given day. Content analysis revealed emergent themes of confusion in two domains: cognitive and behavioral. The findings from this study revealed nurses used cognitive descriptors more frequently to diagnose confusion; however, a large majority of nurses used a combination of both cognitive and behavioral descriptors for diagnosis. Nurses also used independent assessment based on their own observations rather than those from the night nurse in arriving at a nursing diagnosis of confusion. This investigation responds to the need to "confirm defining characteristics of the phenomenon of confusion" posited by Foreman. In addition, results from this study will provide a basis for a taxonomy on the phenomenon of confusion. It is hoped that such a taxonomical classification will enable nurses to assess the confused patient more effectively.