“This is not my mom.” A nurse practitioner’s journey to improve delirium recognition, prevention and recovery

Delirium isn’t something you hear every day, but for Kim Hill, a geriatric nurse practitioner at the Nova Scotia Health QEII Health Sciences Centre’s Camp Hill Veterans Memorial Building in Halifax, it is something we should all be talking about.

This year marks Hill’s 30th year as a registered nurse. She has worked across five provinces and taught nursing at the University of Ottawa and the University of New Brunswick. In 2019, Hill graduated from Dalhousie University’s Master of Nursing Nurse Practitioner Program.

Motivated by her desire to help patients and those that care for them as well as mentor new nurses, Hill uses her experience as an educator to present to teams across Nova Scotia Health, and to other partners such as the Victoria Order of Nurses (VON), to highlight the all-too-common health condition of delirium. “These education sessions have been very well received”, said Hill. “They began with a single request from the Nova Scotia Health Frailty and Elder Care Network and there was so much interest I have continued doing them for the past year.”

Through her presentations, Hill outlines how to identify and treat delirium and the difference between delirium and dementia. Hill primarily presents to nurses, occupational therapists, physiotherapists and other allied health professionals as they tend to spend more time with patients and may notice changes to their behaviour and thinking that could be a warning sign that they are experiencing delirium. These presentations are often in collaboration with workshops conducted by the Frailty and Elder Care Network.

Delirium is often confused with dementia as symptoms can be similar. Unlike dementia, a form of Alzheimer’s disease, delirium can happen quickly over hours or days, affecting an individual’s behaviour and thinking. “On any given day, 1 in 5 Nova Scotians experience delirium in hospital”, said Dr. Samuel Searle, geriatrician/hospitalist at Nova Scotia Health.

Delirium symptoms can be subtle or more obvious, including increased confusion, decreased ability to focus and pay attention, impaired thinking, restlessness, agitation, inappropriate behaviour, hallucinations, lethargy, lack of interest, reduced motor activity (staying in bed), incoherent speech or the person may be awake at night and sleep during the day.

There are several factors that can contribute to delirium including a person having another illness such as dementia, heart disease, Parkinson’s or they suffer from severe pain, lack of sleep, dehydration/poor nutrition or are not moving. Vision loss or lack of hearing can also be contributing factors.

Within the health system, Hill and others are advocating to improve assessment, reporting and documentation of delirium to be more in line with how other key health indicators are measured such as blood pressure, hemoglobin, etc. “Delirium is a medical emergency and can be a sign of a change in someone’s health. It can be prevented and treated, but early intervention is key,” said Hill.

A person with delirium increases their chances of developing other medical complications and can increase their risk of dying in hospital. It can also increase frailty in older adults and impact a person’s ability to recover from illnesses and can lead to a permanent decline in cognition or function. It is also a risk factor for the development of dementia.

Hill believes that we need to shift how we think about confusion in society. We often normalize a loved one being ‘pleasantly confused’. However, this could indicate they are suffering from delirium or other illness such as dementia.

If someone suspects that their loved one may be experiencing delirium, Hill encourages them to tell their family physician or nurse practitioner or a member of the hospital healthcare team as soon as possible.

“People know their loved ones best and may recognize a subtle change before someone else. It is important that this is communicated to the healthcare team as this may change the care plan for the patient,” says Hill. She is hoping to do more to educate families about the signs of delirium and what they can do to help someone experiencing delirium.

“The good news is that recovery from delirium is very possible”, said Hill. Treatment can include improving the person’s nutrition, increasing their fluids and encouraging them to participate in programs such as the Nova Scotia Health Early Mobility Program that is available at the nine regional hospitals across the province.

Recovery time from delirium varies from person to person. It can take up to several weeks or months for some people to return to their normal levels of memory and thinking. For others it could take months.

Hill comes from a family of nurses and is passionate about the important role that nurses have within the healthcare system. She is a married mother of two adult children. Along with her family, she loves spending time exploring the outdoors and swimming at her family cottage in Falls Lake Nova Scotia.

Photo of Kim Hill, NP