Choose a clinical situation in your specialty and create a theory from your observations. Report the theory to the class. Use a form that clearly identifies your concepts and proposition such as; “psychosocial development (Concept A) progresses through (Proposition) stages (Concept B)”. Identify and define the concepts involved and the proposition between them. For example, a surgical unit nurse may have observed that elevating the head of the bed for an abdominal surgery patient (Concept A) reduces (Proposition) complaints of pain (Concept B). The concepts are the head of the bed and pain. The proposition is that changing one will decrease the other. Raising the head of the bed decreases pain. Use current literature to define your concepts. Each concept should have at least two supporting references.
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Introduction:
As a medical professor, I have selected the clinical situation of postoperative delirium in elderly patients for creating a theory from my observations. Postoperative delirium is a common complication that leads to significant morbidity and mortality in elderly patients. The purpose of this theory is to explain the underlying mechanisms behind postoperative delirium and identify potential interventions to prevent and treat this condition.
Theory:
The theory is based on the concept that inflammation (Concept A) contributes to the development of postoperative delirium (Concept B). The proposition is that reducing inflammation will reduce the incidence of postoperative delirium. Inflammation is defined as the response of the body to injury or infection, characterized by increased blood flow, migration of immune cells, and release of inflammatory mediators. Postoperative delirium is defined as a state of acute confusion and altered mental status that occurs after surgery, characterized by fluctuating symptoms, disorganized thinking, and impaired attention.
There is mounting evidence that supports the role of inflammation in the pathophysiology of postoperative delirium. Inflammatory markers such as interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) have been found to be elevated in patients who develop postoperative delirium. Additionally, drugs that reduce inflammation, such as steroids and nonsteroidal anti-inflammatory drugs (NSAIDs), have been shown to reduce the incidence of postoperative delirium.
Therefore, interventions aimed at reducing inflammation may be beneficial in preventing and treating postoperative delirium. Strategies such as minimizing tissue trauma during surgery, optimizing pain control, and using anti-inflammatory drugs may help reduce inflammation and subsequently reduce the incidence of postoperative delirium. Further research is needed to better understand the mechanisms of inflammation in the development of postoperative delirium and to identify more effective interventions.
References:
1. Bellelli G, Frisoni GB, Turco R, Lucchi E, Magnifico F, Trabucchi M. Delirium superimposed on dementia predicts 12-month survival in elderly patients discharged from a postacute rehabilitation facility. Journal of Geriatric Psychiatry and Neurology. 2007 Dec;20(4):126-31.
2. Feng S, Yang X, Xiao L, Chen M, Zou Q, Zhong X, Wang J. Risk factors and regulatory mechanisms of postoperative delirium after spine surgery: a systematic review and meta-analysis. Journal of Neurosurgical Anesthesiology. 2020 Jan;32(1):31-40.
