Managing delirium in the acute care setting: a pilot focus group study

Abstract

Background Delirium frequently occurs in hospitalised older adults leading to poor outcomes and frequent adverse events. Proper recognition and management of delirium by acute care nurses can minimise the effects of negative sequelae associated with delirium. Aim This pilot study used focus group methodology to: (i) describe acute care nurse’s experience and knowledge regarding assessment and management of delirium in hospitalised older adults; (ii) illustrate potential facilitators and barriers to non-drug management of delirium; and (iii) to explicate the use of non-drug interventions by acute care nurses to manage delirium in hospitalised older adults. Design Qualitative, pilot study. Methods A total of 16 nurse participants, working on medical, surgical and orthopaedic units from one acute care hospital participated in two focus groups. Results Main themes included the following: confusion is normal; our duty is to protect; and finding a balance. Nurses were able to identify non-pharmacological interventions for delirium and facilitators and barriers to using these in clinical practice. Conclusions Findings from this pilot study illustrate the need for regular assessment of cognitive status in hospitalised older adults and nursing staff education regarding the use of non-pharmacological management of delirium. Based on their experience, nurses have a wealth of ideas for managing delirium. Areas for future research and policy are also highlighted. Implications for practice More research is needed on how to improve delirium management by acute care nurses to increase the efficacy and use of non-pharmacological interventions in the management of delirium in hospitalised older adults. To translate these findings into practice, nursing care needs to be guided by evidence-based guidelines to implement non-pharmacological strategies in the acute care setting.

Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care

“…62 The evidence used to make individual recommendations within a guideline are often based on the potential benefit or harm of a particular intervention, whereas the evaluation of an implemented guideline appraises the potential additive, synergistic, or antagonistic effects of a multifaceted approach to a disease or syndrome, such as delirium.…”

Caring for a patient with delirium in an acute hospital: The lived experience of cardiology, elderly care, renal, and respiratory nurses

“…Nurses within this study expressed a lack of training and education in delirium. Inadequate knowledge of delirium by nurses has been identified previously with the recommendation for increased nurse education in delirium (Hare, Wynaden, McGowan, Landsborough, & Speed, 2008;de Yevchak et al, 2012). Educational interventions for nurses on delirium have been implemented and found to improve nurses' knowledge (Gesin et al, 2012;McCrow, Sullivan, & Beattie, 2014;Wand et al, 2014), with more experienced nurses gaining the most benefit (Meako, Thompson, & Cochrane, 2011).…”

Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital

“…The hospital ward rhythm is busy, chaotic, influenced by bureaucratic conditions and focused on diagnostics, clinical observation and treatment, with delirium prevention allocated a low priority (Godfrey et al, 2013). Staff may perceive delirium as a normal part of ageing (Yevchak et al, 2012); simple resources to promote cognitive stimulation may be considered to be 'housekeeping' or 'diversional' strategies rather than clinical interventions (Mudge, McRae, & Cruickshank, 2015); and fear of the older person falling may discourage staff from mobilizing patients (Mudge et al, 2015).…”