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Confused patients present a management problem for nursing staff. The stress level of the nursing staff is raised when increased time and supervision is required to maintain the safety and improve the well-being of confused patients. Also, confusion during hospitalization is associated with increased morbidity, an increased length of stay, and an increased need for nursing home placement after discharge (Inouye, Van Dyck, Alessi, Balkin, Siegal, & Horwitz, 1990), making this a major dilemma for both the health care consumer and health care provider. However, despite the fact that nurses are concerned about the phenomenon of confusion, there have been few nursing studies done to describe the magnitude or prevalence of the problem from the nurse's perspective.
REVIEW OF RELATED NURSING RESEARCH
Nursing research on confused patients has been focused on the assessment and treatment of confusion. The categories of studies include determining nurses' descriptors of confused patients' behaviors; the prevalence of confusion; and descriptions of treatments.
In four studies, nurses' descriptors of confused or agitated patients were identified (Evans, 1987; Ryden, Bossenmaier, & McLachlan, 1991; Struble & Sivertsen, 1987; Yeaw & Abbate, 1993). Investigators found that nurses used combinations of cognitive, behavioral, and verbal terms to describe and identify the patients.
Two research teams measured the prevalence of some component of confusion or agitation. Ryden et al. (1991) determined that 86.3% of the cognitively impaired nursing home patients she studied showed some form of aggressive behavior within a 1-week period. Evans (1987) found that 12.4% of the patients she studied in a nursing home "sundowned." She described sundowning as agitation, restlessness, and confusion that occurs in the evenings. Although 82% of the sundowners were diagnosed with dementia, 85% of the sample diagnosed with dementia did not sundown in her study.
In most of the treatment studies, researchers observed or described the nursing interventions that were used with confused or agitated patients. These interventions included medications and restraints (Morse & McHutchion, 1991; Struble & Sivertsen, 1987), physical characteristics of the facility, staffing patterns, education of the staff, behavioral modification techniques (Herbei, Scherrnerhorn, & Howard, 1990), seizure precautions, one-to-one nursing care, decreasing environmental stimulation, and providing the patients with orientation to their surroundings with both verbal reminders and an orientation chart (Flanigan, 1986).
Although acute care...