The '24-hour reality orientation' type of approach to the confused elderly: a minimum standard for care

The use of the two principle types of reality orientation with the confused elderly has been the subject of research by nurses, psychiatrists and psychologists. Reviews of this research suggest that the effects of these therapies on patient outcomes are extremely limited. However, a number of writers advocate their use on the grounds that their implementation results in more individualized care by nurses. This argument is rejected in favour of the demonstrated effect of introducing individualized care from a basis in nursing theory. Nursing theory also provides the remit for nurses to control the physical and interpersonal environment of the confused elderly patient. By examining moral principles as they are applied to nursing, it is argued that the nature of that environmental control should be towards a 24-hour reality orientation type approach. This should be implemented in an individualized way and should form the basis of a minimum standard of care for this client group.