One of my nursing colleagues was discussing with me how she'd seen a lady in a care home who was distraught. The lady would often shout out, incoherently. When family were with her, she was settled and fine.
The nurse worked with the home to understand why the behaviour was arising and if there was unmet need.
She worked with the care home to look at if she was hungry or thirsty or needing assistance in mobilising or toileting, addressing practical elements of care.
The nurse sorted out analgesia for her, four times a day, over one week, to see if pain was causing her distress. It wasn't, so she suggest stopping the analgesia and things were neither better nor worse.
She arranged with District Nurses to have blood tests undertaken to exclude common causes of delirium.
She visited when the lady was distraught and told me, "Her blood pressure and respiratory rate and pulse were all normal."
In order to ensure the patient was communicating and not anxious, she'd thought to look for signs of autonomic overactivity consistent with an anxiety state, checking pulse etc.
I'd never have thought of doing that.
Some people are so clever. Very impressed.