Running head: NURS 2020: LEARN REFLECTION 1

NURS 2020: LEARN Reflection

Melissa Friskney

Trent University
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LEARN Reflection

Looking Back

I will be reflecting on seeing an older adult patient (pt) in the emergency

department (ED). I implemented Montessori interventions to help reduce the pts signs

and symptoms of delirium. I am reflecting on this event because this was my first time

putting these interventions in place and it was wonderful to see such a positive result.

From this one simple interaction, I learned a lot including simple questions to ask older

adults who visit the ED, the impacts of music therapy and other interventions.

Elaborate

This event took place on my first day of my NURS 2020 clinical rotation. My

partner, preceptor and I spent the morning in the ED where we were assigned to an older

adult patient who had come into the hospital via ambulance because she had fallen at

home. This was her fourth trip to the ED for a fall in the last two months. When we first

saw the pt she was confused and disoriented. She thought she was in her twenties and the

year was 1962. Our preceptor noted these behaviors and asked her other questions such

as, I see you use a walker, is there enough room in your house to move around?, Who

cooks your meals? and Do you get dressed by yourself in the morning?. By asking

these questions we could get a better understanding of where our pt was coming from and

what her life was like. After this we got the pt out of bed and gave her some breakfast to

eat. It wasnt till later that we saw a positive change in her cognitive abilities. As the

morning went on our pt was slightly declining cognitively until we found out she liked

classical music. We got her an iPod and let her listen to classical music. It was incredible

because in about 20 minutes we already began to see a change in her cognitive abilities.
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Our pt could correctly identify where she was, what her name was and why she was in

the hospital. When I first saw this pt I felt sad because she was confused and disoriented

but seeing the change in her mental abilities from one simple intervention was amazing. I

also felt frustrated because I could not help but think, why arent more people performing

these interventions for older adults with cognitive decline? This experience opened my

eyes to the lack of knowledge there is around older adults and cognitive decline. This

experience also made me want to become more educated on cognitive decline in older

adults and the interventions that can be put into place to reduce the effects.

Analyze

When analyzing the event, I felt it was a very positive first experience at my

placement because I could see first-hand how interventions like music therapy impact

older adults. However, this event also frustrated me because this was the first time I

witnessed the impacts delirium can have on an older adult in the emergency department.

According to Delaney, Pepin and Somes (2015), patients who experience delirium onset

within the first 72 hours are at a greater risk of rehospitalisation and death. As well as

greater post discharge mortality, poor clinical outcomes have been reported in individuals

who develop delirium during their stay in the ED (Delaney, Pepin & Somes, 2015).

Delaney, Pepin and Somes conclude that interventions put in place to shorten length of

stay and to decrease the cases of delirium should be evaluated in the hopes of a better

overall prognosis and lower mortality and rehospitalisation rates in older adults (2015).

Based on this evidence I feel it is important to expand my knowledge on older adult stays

in the ED. I will also try to implement more interventions such as walking, getting the pt
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to a chair and table to eat, and turning the light on in the ED to help the elderly pt

decrease their chances of a delirious episode.

Revise

The most important thing I have learned from this experience was how simple

interventions such a music therapy can make an impact on a pt and their signs and

symptoms associated with cognitive decline. I have also learned that further exploration

is required on cognitive decline, older adults in the ED and activities that help reduce

their anxiety, delirium and other conditions during their ED visit. I feel by expanding my

knowledge I will be able to better complete/execute my project for NURS 2020 in a way

that could greatly impact older adults with cognitive decline in the ED at NHH.

New Perspective

Moving forward, I plan to expand my knowledge on cognitive decline within

older adults and the different interventions that can be put in place in the ED. I will do

this by talking to professionals such as the recreational therapist at the hospital, my

preceptor and the ED staff. Conducting research by observing how different interventions

impact each older adult differently and reading scholarly articles about cognitive decline

and interventions will also benefit my understanding. I feel by doing these things I will be

able to build on my knowledge on cognitive decline in the ED. In the future, I hope that

with my expanded knowledge I will be able to assist other older adults in the ED and try

to find interventions that work for everyone to ensure they have the best possible stay.
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References

Delaney, M., Pepin, J., & Somes, J. (2015). Emergency Department Delirium Screening

Improves Care and Reduces Revisits for the Older Adult Patient. JEN: Journal Of

Emergency Nursing, 41(6), 521-524. doi:10.1016/j.jen.2015.08.013