Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Practice Recommendations for Delirium, Dementia, and Depression
4.1 In consultation/collaboration with the interdisciplinary team:
  • Nurses should determine if a client is capable of personal care, treatment and financial decisions.
  • If client is incapable, nurses should approach substitute decision makers regarding care issues.
  • Nurses should determine whom the client has appointed as Power of Attorney (POA) for personal care and finances, and whenever possible include the Power of Attorney along with the client in decision-making, consent, and care planning.
  • If there is no Power of Attorney, nurses should encourage and facilitate the process for older adults to appoint Power of Attorney and to have discussions about end of life treatment and wishes while mentally capable.
4.2 In care settings where Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) instruments are mandated assessment tools, nurses should utilize the MDS data to assist with assessment for delirium, dementia and depression.
4.3 Nurses should avoid physical and chemical restraints as first line care strategies for older adults with delirium, dementia and depression.

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