Delirium or an acute confusional state, occurs as a result of disease or physiological imbalance secondary to impaired brain function. One of its main clinical features is widespread cognitive impairment, which causes patients to become disconnected from their immediate surroundings and misinterpret reality. It has a sudden onset and its duration is relatively brief. Some authors take the view that delirium might be interpreted as a precursor to dementia. The aim of the study was to retrospectively explore older peoples' experience of an episode of delirium. In particular, whether they knew what had caused and cured it; and whether it had left them with any unresolved feelings of anxiety. A cross sectional design using grounded theory methodology was chosen, as being the most appropriate method for exploring this issue. A sample of 19 patients was selected using predetermined criteria, and engaged in a semi-structured interview with the researcher, in the ward environment. The interviews were audiotaped, transcribed, and analysed using the constant comparison method. Those interviewees who had illusions and hallucinations, were often able to describe their experiences in detail. They ranged from being pleasant and entertaining, to horrible and frightening. They were also able to remember short verbal commands from nurses during the episode of altered perception. Others remembered, or chose not to remember, very little. Few interviewees appeared to know exactly what had caused and cured the delirium, although some were able to tentatively connect the experience to their present medical condition. There also appeared to be little evidence of therapeutic communication with nursing staff once the episode of delirium had resolved. Although no one connected the experience with dementia, there did seem to be some evidence of mildly disturbed feelings, on reflecting back over the episode. As interviewees were generally willing to discuss their experiences with the researcher, it suggests that it would be helpful for nurses to provide opportunities to do so. Nevertheless, interviewees appeared to regard the episode simply as a transitory event in the overall context of illness, admission to hospital and their future welfare. The latter was of prime concern; yet again it appeared that they did not always receive the information they required to maintain control over their personal destinies.

Current methods of care guidance construction rarely address the concerns of nurses and the evidence from which guidelines are developed is narrowly defined with regard to inclusion and acceptability. In contrast this model focuses on nursing issues, embraces a wider definition of evidence and ensures that the published Best Practice Statements are credible and achievable in gerontological practice, where they are tested and refined as an inherent aspect of the development process.

Football reminiscence for men with dementia: lessons from a realistic evaluation A major challenge of studies of non pharmacological dementia interventions is the likely modest intervention effect size and difficulties collecting data from individuals with behavioural, psychological and communicative symptoms. The reported Realist Evaluation is built around sets of contextually comparable case studies of Football Focussed Reminiscence for men with dementia. The study aim was to evaluate benefits of football related reminiscence for individuals and family carers. Four case studies were constructed; two community groups, one nursing home groups and individual sessions within their family home. Data was collected as field notes from non-participation observation of reminiscence sessions, notes of conversations with people with dementia, audio recorded interviews with family members, facilitators and dementia link workers. The analysis was framed around identification and extraction of data pertaining to Context-Mechanism-Outcome configurations within each data set, and patterns and threads were compared across the cases. An important finding was that anticipation of pleasure in tandem with a sense of continuity appeared to be important mechanisms triggering optimal benefit. The paper explores design considerations, project delivery experiences and the contribution that innovative theory driven research adds to the study of complex interventions including those with behavioural and communicative symptoms of dementia.

The evaluation indicates the potential merits of e-practice development, particularly for nurses who feel geographically and professionally isolated or disenchanted with available continuing professional development opportunities. Participation in the virtual college appeared to enrich practice and foster a culture of change.

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