Evidence, Expertise, and a Daughter's Request: Integrating Patient and Family Preferences Into Delirium Prevention for an 84-Year-Old Woman
[Student Name]
University of Phoenix
NSG/509: Research and Applied Statistics for Quality Improvement
Week 5 Poster
[Instructor Name]
[Date]
The patient, family and unit are a composite written for a model poster. No real patient is described.
Panel 1: The Decision
An 84-year-old woman with mild cognitive impairment was admitted with a hip fracture. On the first night she became confused and pulled at her intravenous line. Her daughter asked to stay overnight. Unit policy limited overnight visitors to patients receiving end-of-life care. The nurse had to decide whether to request an exception.
Panel 2: What the Research Says
Programs that combine several nondrug measures prevent new delirium in older inpatients. The original Hospital Elder Life Program lowered new delirium in older medical patients through reorientation, sleep support, mobility, hearing and vision aids and hydration (Inouye et al., 1999). A meta-analysis of such programs found reduced delirium incidence and fewer falls (Hshieh et al., 2015).
Families can deliver key parts. In a randomized trial in an acute hospital, a family-delivered intervention of reorientation, familiar objects and extended visits cut delirium incidence by more than half compared with usual care (Martinez et al., 2012).
Panel 3: Patient and Family Preferences and Values
The patient, when calm, said she was frightened at night and wanted her daughter. The daughter, a retired teacher, knew her mother's routines: a radio at bedtime, glasses on the nightstand and a habit of waking at 4 a.m. She was willing to stay and to help with reorientation. Both valued the mother's dignity and wanted to avoid sedating medications and restraints.
Panel 4: Clinical Expertise
The night nurse had cared for many confused older patients after hip surgery. She judged the patient's confusion to be early delirium rather than baseline impairment, based on its sudden onset and fluctuation. She knew the unit's two options for night agitation, a sitter or a sedating medication, and that sitters were often unavailable. She also judged that the daughter was calm, reliable and able to follow guidance, and that a recliner could fit in the room without blocking access.
Panel 5: Integration and Decision
Evidence: family-delivered reorientation reduces delirium.
Preference: the patient and daughter wanted the daughter present.
Expertise: early delirium, limited alternatives and a capable family member.
Decision: the nurse requested and received a policy exception from the nursing supervisor. The daughter stayed overnight with a written guide: reorient gently, keep glasses and hearing aids on during waking hours, dim lights and limit noise at night and call the nurse for pain or new confusion.
Panel 6: Outcome and Implications
Outcome: the patient's confusion resolved by day three, with no restraints and no sedating medication.
Implication for practice: the unit practice council proposed revising the visiting policy to allow a family member overnight for older adults at high risk of delirium, with a brief family guide.
Presenter Notes
When presenting this poster, the author would explain the reasoning in about two minutes. Evidence-based practice was defined by Sackett et al. (1996) as the integration of the best research evidence with clinical expertise and patient values, and this decision needed all three. The research alone would support family involvement in general, but it could not tell the nurse whether this daughter could safely stay or whether the patient wanted her there. The patient's and daughter's preferences alone might have been refused by policy. Clinical expertise alone, based on the nurse's experience, might have led to a sitter or medication. Together they pointed to a clear, defensible decision that none of the three could have reached alone.
The notes would also address likely questions. Viewers might ask whether the research applies, since the Chilean trial studied medical patients rather than surgical ones. The answer is that the evidence from the broader meta-analysis supports multicomponent programs across settings, and the family component was consistent with the patient's own wishes, so the risk of trying it was low. Viewers might also ask about staff concerns, such as a visitor's safety at night or disruption to other patients. In this case the patient was in a single room, and the daughter's guide set clear expectations.
The notes would be honest about limits. One patient's good outcome does not prove the exception caused it; her delirium might have resolved anyway as pain and anesthesia effects faded. The value of the decision lies in its fit with the evidence and with her wishes, not in the single result. If the unit adopts a revised policy, it should measure what matters across many patients: the incidence of delirium among older adults admitted with hip fracture, the use of restraints and sedating medications at night, falls and staff and family satisfaction with overnight family presence. It should also track how often families are unable or unwilling to stay, since a policy that depends on family availability could widen differences between patients with and without nearby relatives, and the unit would need volunteers or sitters for those patients.
Finally, the notes would connect the case to the policy change. A single exception helped one patient, but the pattern, frightened older patients at risk of delirium and willing family members turned away by policy, affects many. Using the case as the starting point for a policy review turns one evidence-based decision into a practice improvement.
References
Hshieh, T. T., Yue, J., Oh, E., Puelle, M., Dowal, S., Travison, T., & Inouye, S. K. (2015). Effectiveness of multicomponent nonpharmacological delirium interventions: A meta-analysis. JAMA Internal Medicine, 175(4), 512-520. https://doi.org/10.1001/jamainternmed.2014.7779
Inouye, S. K., Bogardus, S. T., Jr., Charpentier, P. A., Leo-Summers, L., Acampora, D., Holford, T. R., & Cooney, L. M., Jr. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9), 669-676. https://doi.org/10.1056/NEJM199903043400901
Martinez, F. T., Tobar, C., Beddings, C. I., Vallejo, G., & Fuentes, P. (2012). Preventing delirium in an acute hospital using a non-pharmacological intervention. Age and Ageing, 41(5), 629-634. https://doi.org/10.1093/ageing/afs060
Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't. BMJ, 312(7023), 71-72. https://doi.org/10.1136/bmj.312.7023.71
How this NSG 509 Week 5 example is structured
Course materials list a Week 5 Patient Preference, Values and Clinical Expertise Poster in NSG/509. The poster follows the three parts of evidence-based practice as separate panels so a viewer can see each input before seeing how they were combined. Panel text is kept short, as on a real poster, and the presenter notes carry the reasoning a viewer would hear when the author stands beside the poster. Students search this week as NSG 509 Week 5, NSG509 Wk 5 or NSG/509 Wk 5; all three are the same assignment.
NSG/509 Week 5 questions, answered
What does NSG/509 Week 5 usually ask for?
Course materials list a Week 5 poster on patient preference, values and clinical expertise. Many sections ask students to show, on a poster, how research evidence, clinical expertise and patient preferences are integrated in a real or realistic practice decision. Check your instructions for the required sections and size.
How much text belongs on a poster?
Much less than in a paper. Use short headings, brief phrases or sentences and numbers where possible, and put the explanation in presenter notes or a handout. A viewer should grasp the main point in under a minute.
What counts as clinical expertise in an evidence-based decision?
The clinician's knowledge of the patient, experience with similar situations and judgment about how evidence applies in this setting, including risks the research may not capture. It is one of the three parts of evidence-based practice, alongside research evidence and patient preferences.
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