SENSORY PERCEPTUAL ALTERATION: Diagnosis, Prediction, and Intervention in the Hospitalized Adult

Abstract

This article proposed the nursing diagnosis SPA as the appropriate term for a phenomenon that has been frequently studied, described, and discussed by nurses and physicians using various diagnostic and descriptive labels. SPA affects patients, significant others, and nurses. SPA results in inflated health care costs because it prolongs hospitalization and increases the vigilance required by the nursing staff to maintain patient safety. It is also a source of emotional distress for the patient and his or her significant others. It has been proposed that alteration in NF is the primary cause of SPA. Physiologic, psychological, and environmental alterations represent barriers to adequate NF, thereby interfering with accurate perception of stimuli. A temporary adverse response characterized by impaired cognition and inappropriate behavior occurs. A review of nursing and medical literature during the last 30 years has identified a multitude of conditions that may precipitate SPA, thus supporting the theory that SPA has a multivariate. Yet, a consistent pattern or cluster of risk factors has not been identified. Recent data on the incidence of SPA in hospitalized patients are sparse, and previous research reveals inconsistency in data regarding incidence in all of the populations studied. This inconsistency reflects differences in the settings and demographic characteristics of the subjects studied. In addition, differences in reported incidence can also be attributed to methodological variations brought about by differences in terminology and criteria used to define and diagnose the phenomena associated with SPA. Future research should include reestablishing the incidence of the phenomenon in various populations of hospitalized patients. Populations previously overlooked in the investigation of SPA should also be studied. Examples include organ transplant patients and patients treated with cardiac-assist devices. The behavioral sequelae of SPA have been adequately established in the literature. Therefore, future research should focus on identifying those patients at risk rather than continuing to describe behaviors associated with SPA. The importance of risk identification has been discussed. Identifying patients most at risk for SPA by systematically screening them with a risk tool would facilitate allocation of resources and preventative interventions. Predictive tools need to be developed and tested. A risk-assessment tool could be included with the admission nursing history, and a daily risk assessment could be incorporated into the assessment documentation system. To develop risk prediction tools, it may be necessary to further investigate the barriers to accurate NF. Replication of prior descriptive studies on the causes of SPA should be attempted. Finally, several potentially effective interventions for the treatment and prevention of SPA were proposed. Further research is needed to assess their effectiveness and to identify other effective interventions. Suggested questions to guide further research on SPA follows: 1. What is the incidence of SPA in specific patient populations, that is, cardiac surgical patients, organ transplant patients, medical patients? 2. What are the risk factors associated with SPA? 3. To what extent does the number of risk factors present produce greater risk for developing SPA? 4. Why do some people develop SPA and others do not when the same cluster of risk factors are present? 5. Which interventions are effective in the prevention and treatment of SPA?