GRNs and delirium

October 2nd, 2017

Oct. 2, 2017 — Preventing delirium among hospitalized patients is a priority because delirium, often confused with dementia, can affect future quality of life, a JPS Health Network physician said at the network’s first Geriatric Nursing Seminar.

Geriatric Resource Nurses

JPS nurses at the first Geriatric Nursing Seminar, including Geriatric Resource Nurses (GRNs) from across the hospital and Rhonda McLemore (back row, fifth from left), the first to also earn gerontological nursing certification.

Elderly patients are three times more likely to be discharged to a nursing home, rather than home, if they experience delirium while hospitalized, said Dr. Cheryl Hurd, citing recent medical literature. “Our population is aging. We’re going to be dealing with this more and more. We really need to be preventing it,” said Hurd, a specialist dual-trained in psychiatry and internal medicine.

Early recognition and prevention of delirium are among the skills emphasized in Geriatric Resource Nurse (GRN) training. GRN training started when JPS became the region’s first public hospital recognized by NICHE, Nurses Improving Care for Healthsystem Elders, in 2015. JPS now has 48 GRNs on units throughout the hospital.

Hurd said she is often called to provide consultation for patients with symptoms of delirium because she is a psychiatrist. “But delirium is not a psychiatric problem, it’s a medical problem with psychiatric symptoms.” The first order of business is to identify medical causes, she said.

Delirium in the hospital can be caused by a variety of medications including antihistamines, metabolic imbalances such as low calcium, dehydration, malnutrition, sleep deprivation, surgery that required anesthesia and many other medical conditions.


Dementia is a gradual, progressive decline in memory and other cognitive skills. Alzheimer’s disease is the most common cause. In contrast, delirium comes on more suddenly, and symptoms may fluctuate throughout the day, better sometimes than others. Delirium can often be reversed once the cause is identified and eliminated.

People with delirium may have hallucinations and be unable to stay focused on one topic, easily distracted. They may be hyperactive, thrashing about and striking out, but also may be withdrawn. Their sleep habits may be disturbed.

Nursing interventions include helping patients stay oriented, making sure they know the day of the week and time of day, discouraging sleep during daylight hours, monitoring labs and medications, urging substitutions for drugs associated with delirium and promptly calling for consults when symptoms first appear.

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