Over the last decade Waikato DHB’s Christine (Chris) Marra has transformed the way healthcare professionals identify and treat dementia and delirium as our aging population grows.
At 69, with a book on the way, Chris can say she is ready to retire without any regrets.
“I’m leaving before they cognitively test me” she cheekily says.
“But seriously, it’s time for me to do the things that have long interested me outside of healthcare.”
When asked why she focused the end of her career on delirium she said: “Because I saw the pain of what so many patients, family members and staff went through and delirium is one of the most common, preventable disorders encountered in older people.
“Working as a nurse I was able to do something for people, who were very, very frightened. In actual fact, some of the nurses caring for them were equally frightened of delirium and I wanted to know why.”
Chris’ work on delirium is significant and first started 10 years ago introducing the Confusion Assessment Method (CAM) tool to better diagnose delirium at a time when a majority of nurses didn’t know what delirium was.
And it was her genuine care for those people and learning through their experiences that brought about her new book due out in new year called ‘Lessons from our patients’ which brings together a variety of delirium experiences.
“I couldn’t walk out the door without recording some of these stories I’ve been told to help them and others recognise it was delirium.”
Although the book is specifically for health professionals everyone can read it.
“One of the things you’ll find in this book is that patients were often never told they had delirium and thought they were going crazy, which happens time over. When patients are informed they are given the words to describe their bewildering experiences to help them gain understanding.
“Ask anyone’s delirium story and they’re straight back in that moment. It is in their mind more real than the real word.”
Chris’ longest serving role at the DHB was as a nurse educator in the Older Person’s Rehabilitation (OPR) team.
“All the OPR nurses are really good at managing delirium thanks to the work Chris has invested over the years” said fellow nurse educator and registered nurse Karen Griffin.
“Her knowledge is outstanding and she’s always willing to share it with anyone – she will be truly missed.”
In her current role as a dementia pathway educator, travelling across the Midland community, Chris would talk with GPs and practice nurses about the dementia map of medicine, a software programme that helps medical staff to better diagnose dementia, and delirium through evidence based care.
She established the delirium study days in 2011 now held throughout the year where hundreds have attended.
One of her key focuses on these study days has been the recognition of hypoactive delirium, a condition where the patient becomes very sleepy and difficult to rouse. This type of delirium is often overlooked as requiring urgent medical attention and puts the patient at even greater risk of serious complications
The book The prevention, detection, assessment and management of Delirium that began in 2006, has been revised over the years and is now an education online module for health professionals.
A recent educational programme has been the elearning package for health staff put together by Chris, Paula von Holzen and Mark Reynolds also based on the delirium book and with additional component of assessing delirium in the Critical Care Department.
Christine has had to fight to get delirium on the radar says Waikato DHB older persons and rehabilitation nurse manager Bel Macfie.
“She has ignited an extraordinary, visible change in delirium education. Christine is unique and authentic in her approach and her conviction that caring for patients with delirium is essential.
“She’s real champion of the vulnerable. She often gets told ‘You have reminded me about why I became a nurse’ from people at her education days.
Before Waikato DHB
Some related career highlights for Chris was working in the far north as a public health nurse, providing rehabilitation for young people with disabilities in London, and upon settling in the Waikato, establishing a rehabilitation service for people with traumatic brain injury
Chris says “a lot of things have driven me in my work, and now I know there are equally driven and knowledgeable people to grow the dementia and delirium work into the future.
“I’ve loved my work and none of this happens in a vacuum. I’ve worked with some wonderful people and the collegial relationships and strong foundation has allowed me the freedom to specialise.”
What is delirium?
Delirium is characterised by a disorder in consciousness and change in cognition that develops over a short period space of time and may fluctuate in intensity.
You can find out more about delirium at Waikatodhb-ebooks.co.nz/delirium/index.html