Delirium in the intensive care unit.

Delirium in the intensive care unit (ICU) is a complex, common, and problematic condition that interferes with healing and recovery. It leads to higher morbidity and mortality and extended hospital stays. The aging population older than 65, and more likely to develop delirium, is the fastest growing population in the United States and is increasingly seen in the ICU. Delirium is often unrecognized and misdiagnosed, which leads to mistreatment or lack of appropriate treatment. This article discusses the definition of delirium, pathogenesis, clinical practice guidelines, newer assessment tools for ICU, and nursing interventions directed toward prevention and early identification of delirium.

Exploring loss to follow-up: abnormal Pap screening in Hispanic patients.

PURPOSE: The loss of patients to follow-up for abnormal findings from Pap screenings is an important public health concern, particularly among poor and minority women. This study explores factors affecting incomplete follow-up among a group of Hispanic women with low incomes. DESCRIPTION OF STUDY: A qualitative descriptive study was conducted of 11 Hispanic patients with incomplete Pap smear follow-up at a public clinic in a major city in south Texas. Patients were interviewed using a semistructured, open-ended schedule of questions, and their medical records were abstracted. The clinic's five staff members also were interviewed. Comparative chronologies were constructed for each case, contrasting patient and staff accounts of the same set of events. All data were coded by at least two investigators. RESULTS: All study patients had mildly abnormal Pap smear results and had not met the follow-up criteria, but all understood and were committed to Pap screening. Although viewed by staff as noncompliant, none of the patients viewed her behavior this way. This staff-patient discrepancy was attributable to poor communication, mixed messages, clinic errors, and, perhaps most importantly, to a conflict between program policies and the specific circumstances of individual cases. Two case examples are presented to illustrate key points. CLINICAL IMPLICATIONS: Strategies that may help to reduce loss to follow-up among similar patients include the following: allowing clinic staff more flexibility in follow-up procedures for women who have consistently normal follow-up tests, including Spanish translations of written messages; enlisting patients' agreement in setting appointments; and updating patient records to reflect follow-up care that had been received in other clinics.