Confusion: an ambiguous term in A&E practice

The term 'confusion' can create conflicting images in terms of a patient's level of consciousness, awareness and ability to communicate effectively. In relation to Accident and Emergency (A&E) practice it is crucial that the nurse assessing the patient is not only taking into account the presenting clinical picture, but is also cognisant of the potential cumulative effects of physiological, psychological, pharmacological, sociological and environmental factors. Clearly, the assessment process should take these factors and the possible effects of the patient's journey to the A&E department into account when forming an opinion in respect of levels of consciousness. This paper will explore a number of potential co-factors, factors that could influence the patient's presentation and create an ambiguous misleading and conflicting picture unless all co-factors are considered.