Knowledge

• Distinguish between symptoms of delirium and dementia.
  • Define delirium and dementia.
  • Identify key characteristics of each condition.
  • Differentiate between common symptoms of delirium and dementia.

Skills

• Effectively communicate client information using the STOP & WATCH and CUS tools.

Attitudes

• Demonstrate awareness of the importance of early identification and intervention for delirium.
• Demonstrate a commitment to clear and effective communication with healthcare colleagues.

Key Challenges

• Under-recognition: Delirium is often confused with and mistaken for dementia. This is due to:

  • Difficulty distinguishing between similar symptoms: while delirium and dementia have similar signs and symptoms, they have important differences including

    onset, duration, course, and the person’s level of attention, alertness, and

    consciousness.

  • Course of the disease:
    • Delirium can fluctuate across the day with varying severity and frequency of symptoms.
    • Dementia is often seen as a gradual loss of abilities over time resulting in progressive changes in personality, behavior, emotion, and function.
• Understanding the causes:
  • Delirium is caused by underlying physical illnesses like infections, medication side effects, pain, and low oxygen levels.
  • Dementia is caused by permanent brain changes.

Why Understanding the Difference Matters

• Delirium is reversible if treated. If not, it can cause permanent loss of ability that robs the person of being able to do daily care routines and activities that add meaning to their life.
• Dementia is irreversible. However, there are effective ways to maintain quality of life of a person living with dementia.

How Direct Care Workers Can Help

• Are there signs of another illness? Talk with your healthcare team and report your concerns about any underlying illnesses.
  • Is there something you can do differently to address the person’s needs?

• If delirium is detected:

  • First and foremost, ensure safety. One of the most important roles of direct care workers is to assure safety for persons who have delirium.
  • Report behaviors to your healthcare team and supervisor.
  • Promote safe mobility.
  • Reorient the person to time and place using clocks and calendars.
  • Encourage and assist fluid intake.
  • Gently reassure the person if they are fearful or anxious.
  • Promote sensory input: increase lighting and encourage the use of the person’s

  eyeglasses and hearing aids.

• If the person is living with dementia:
  • Consider how dementia affects communication and behavior.
  • Focus on being person-centered.
  • Use Validation Therapy to acknowledge the feelings expressed by the resident without agreeing with them
  • “Listen” to behavior and adjust your approach to help the person meet their needs and be more comfortable.
  • If an issue arises, work with your team to share information and problem-solve together.

Key Takeaways

• Direct care workers’ oversight of daily routines and care helps the person stay safe,

comfortable, and as functional as possible.

• Direct care workers are vital in observing and distinguishing the signs and symptoms of delirium and dementia.
• Delirium is reversible if treated promptly. Dementia is not reversible, but there are ways to promote quality of life in people living with dementia.

Let's move on to the simulation, where you'll practice putting these principles into action!

The facilitator may choose to divide learners into partners or allow them to self-select. The facilitator will need to monitor the time closely and communicate time marks.

Prebrief

1. Review objectives with learners.
2. What to expect from the activity:
   1. This activity is a partnered activity that highlights two learning goals to meet the objectives:
      1. Identification of delirium vs dementia.
      2. Communication skills between the direct care worker and the registered nurse.
   2. Part 1: Each partner group will have a Delirium vs Dementia Symptom Sorting activity to complete. Use the resource guide for support while you sort your activity. Early identification of delirium is important because it allows for appropriate assessment, management, and preventive measures to be put in place.
   3. Part 2: Each partner group will complete a role-play activity.
      1. During the role-playing, you will use two tools to communicate as a direct care worker to a registered nurse. The tools you will be using are the STOP & Watch and the CUS communication tool. These tools are provided for you today.
3. Timeline: You will have 6 minutes to complete the Delerium vs Dementia Sorting activity and discuss the answers. After that time, you will have 10 minutes to participate in the role-play activity with your partner, with each partner taking turns to report to the nurse. Then the group will come together to complete a 10 minute debrief of the activities.
   1. Please note any questions the learners will have throughout the activity.
   2. Be available to answer questions as they arise.

After everyone completes both scenarios, the facilitator will lead a group debrief.

In this 6-minute activity, we will sharpen our skills in identifying the symptoms of dementia and delirium. Once you identify these symptoms for each condition, they will be the key to the next step of this activity.

Step One: Getting Sorting! (4 minutes):

• You and your partner will receive a list of symptoms.
• Take a moment to review the list together.
• Once you feel comfortable, sort the symptoms into two categories:
  • Delirium: Symptoms that might indicate delirium, a sudden change in mental state.
  • Dementia: Symptoms that might indicate dementia, a gradual chronic decline in cognitive function.

Step Two: Review and Discussion (2 minutes):

• Come together as a group to review the sorted symptoms.
• Discuss the rationale behind each category placement.
• Feel free to ask questions if anything is unclear.

We have this activity available in two versions. The first, is an online interactive version the learners can access using a button in their Learner Workbook, like the one displayed below. The second version, is a printable PDF version. This version may be printed for students to do in class or can be downloaded to their devices to use. The PDF has a fillable form for the students to interactive with. The Key to the activity is available below using the yellow button. This is not available in the Learner Workbook.

CUS Communication Tool

STOP & WATCH Tool

An early warning communication tool that can be used to alert a nurse if a change in condition is identified while caring for or observing a resident. This tool was designed to prevent unnecessary hospital transfers by promoting communication with other team members and patient safety.

https://www.in.gov/health/files/INTERACT_Stop_and_Watch_Early_Warning_Tool.pdf

Reporting Delirium Signs using the STOP & WATCH and CUS Communication Tools

This role-playing activity involves two rounds. Remain in pairs. Identify who will be Learner 1 (Direct Care Worker), and who will be Learner 2 (Nurse). You will have 10 minutes to complete this activity.

1. Briefly review the STOP & WATCH and CUS communication tools, highlighting their purpose and key elements.
2. Instruct participants to each select three delirium symptom cards from their pile that they will report to the nurse.
3. Taking turns, role-play the following scenario:
   • Learner 1 (Direct Care Worker): You are concerned about a resident exhibiting signs of delirium. Use the STOP & WATCH tool to mentally assess the resident's changes, and then approach Learner 2 (Nurse) to report your observations.
   • Learner 2 (Nurse): Listen attentively to the report on the resident. Encourage the direct care worker to utilize the CUS communication tool (Situation, Background, Assessment, Recommendation) for clear and concise reporting. Ask clarifying questions as needed.
4. After the role-play, switch roles. Learner 2 becomes the Direct Care Worker, and Learner 1 becomes the Nurse. Repeat the role-play, with new delirium symptoms.

Recognizing and Reporting Delirium (10 minutes)

CUS Communication Tool Debrief (3 minutes)

• How well did the Direct Care Worker use CUS to communicate their observations about the residents to the Nurse?
  • Ask learners to identify strengths and areas for improvement in the CUS reports delivered during the role-playing.
  • Discuss the importance of clear, concise, and specific information in the CUS (Concerned, Uncomfortable, Safety Issue).

Wrap-up and Key Takeaways (2 minutes)

• Summarize the key points of the debrief.
  • Reiterate the importance of early delirium detection and intervention to improve outcomes.
  • Encourage learners to continue developing their communication and assessment skills using tools like STOP & WATCH and CUS.
  • Have learners report out their Key Takeaways to practice.

Room

• Table and chairs

For Each Partner Group

• Distribute a link or QR code to the Learner Handbook. Participants will have access to the following activities and handouts:
  • Role-Playing Activity
  • STOP & WATCH and CUS Communication tools and information
    • Briefly explain the purpose and elements of each tool to aid learner understanding.
  • Delirium vs Dementia Sorter Activity
    • This can be used as a pre-activity to introduce the topic and have learners sort the symptoms.
• Optional: provide hard copy handouts to each learner. PDFs and links are provided below:
  • Role-Playing Activity
    • 1 copy should be provided for the learner acting as the Direct Care Worker and another for the learner acting as the Nurse.
  • STOP & WATCH Tool (external link)
  • CUS Communication Tool
  • Delirium vs. Dementia Sorter Activity