Delirium is the most common neuropsychiatric disorder in patients with palliative and end of life care needs; therefore, providing effective care for patients, and their families, is a clinical priority for nurses. Delirium is characterised by a fluctuating state that affects an individual’s attention, orientation, thinking, perception, memory, psychomotor behaviour, emotions and sleep-wake cycle. Early recognition, assessment and management of delirium is essential, because this has the potential to relieve distress and improve the quality of life and death for patients. This article discusses the causes, effects, and signs and symptoms of delirium. It also outlines the non-pharmacological and pharmacological strategies that can be used to assess and manage patients with delirium at the end of life, alongside the support that should be provided to their families.