Patients' and nurses' experiences of delirium: a review of qualitative studies

Bélanger, Louise; Ducharme, Francine

doi:10.1111/j.1478-5153.2011.00454.x

Cited by 97 publications

(97 citation statements)

References 38 publications

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“…Although the overall number of patients with incident delirium across time points is too small to draw inferences about the relationship with care quality, the results highlight the scale of the problem of delirium among this 'at-risk' group, given the level of distress caused to patients [120][121][122] and the challenges in providing appropriate care as a consequence. To make meaningful inferences about the relationship between delirium and care delivery would require the collection of delirium data over a longer period of time pre and post intervention with a sufficient sample size to make the necessary adjustments to reflect varying levels of risk.…”

Section: Outcomes Of Person Interactions and Environmentmentioning

confidence: 85%

The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

Godfrey

Young

Shannon

et al. 2018

Health Serv Deliv Res

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Background Improving the care of people with dementia on acute hospital wards is a policy priority. Person-centred care is a marker of care quality; delivering such care is a goal of service improvement. Objectives The Person, Interactions and Environment (PIE) Programme comprises an observation tool and a systematic approach to implement and embed a person-centred approach in routine care for hospitalised patients with dementia. The study aims were to evaluate PIE as a method to improve the care of older people with dementia on acute hospital wards, and develop insight into what person-centred care might look like in practice in this setting. Methods We performed a longitudinal comparative case study design in 10 purposively selected wards in five trusts in three English regions, alongside an embedded process evaluation. Data were collected from multiple sources: staff, patients, relatives, organisational aggregate information and documents. Mixed methods were employed: ethnographic observation; interviews and questionnaires; patient case studies (patient observation and conversations ‘in the moment’, interviews with relatives and case records); and patient and ward aggregate data. Data were synthesised to create individual case studies of PIE implementation and outcomes in context of ward structure, organisation, patient profile and process of care delivery. A cross-case comparison facilitated a descriptive and explanatory account of PIE implementation in context, the pattern of variation, what shaped it and the consequences flowing from it. Quantitative data were analysed using simple descriptive statistics. A qualitative data analysis employed grounded theory methods. Results The study furthered the understanding of the dimensions of care quality for older people with dementia on acute hospital wards and the environmental, organisational and cultural factors that shaped delivery. Only two wards fully implemented PIE, sustaining and embedding change over 18 months. The remaining wards either did not install PIE (‘non-implementers’) or were ‘partial implementers’. The interaction between micro-level contextual factors [aspects of leadership (drivers, facilitators, team, networks), fit with strategic initiatives and salience with valued goals] and meso- and macro-level organisational factors were the main barriers to PIE adoption. Evidence suggests that the programme, where implemented, directly affected improvements in ward practice, with a positive impact on the experiences of patients and caregivers, although the heterogeneity of need and severity of impairment meant that some of the more visible changes did not affect everyone equally. Limitations Although PIE has the potential to improve the care of people with dementia when implemented, findings are indicative only: data on clinical outcomes were not systematically collected, and PIE was not adopted on most study wards. Research implications Further research is required to identify more precisely the skill mix and resources necessary to provide person-focused care to hospitalised people with dementia, across the spectrum of need, including those with moderate and severe impairment. Implementing innovations to change practices in complex organisations requires a more in-depth understanding of the contextual factors that have an impact on the capacity of organisations to absorb and embed new practices. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Outcomes Of Person Interactions and Environmentmentioning

confidence: 85%

The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

Godfrey

Young

Shannon

et al. 2018

Health Serv Deliv Res

View full text Add to dashboard Cite

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“…Som noget helt nyt og banebrydende er der i projektet foretaget grundige analyser af den landsdaekkende kliniske retningslinje i forbindelse med omsaetning til en konkret lokal hospitalspraksis (VIP) 3 . Der er foretaget før-og efteranalyser af outcome for patienter (journalaudit), implikationer for den enkelte kliniker og for organisationen (interessent-og organisationsanalyse) samt hvad klinikerne taler om i forhold til evidens, identifikation, forebyggelse og behandling af delirium (analyse af kommunikation).…”

Section: Boks 1: Fakta Om Deliriumunclassified

“…Patienter i delirium vil ofte vaere kendetegnet ved nedsat koncentrationsevne, nedsat hukommelse, desorienteret i tid/sted, tale-og sprogforstyrrelser mv. (2,3,6,7,(26)(27)(28).…”

Section: Sufficient Smertevurdering Og -Behandlingunclassified

Implementering af evidensbaseret praksis - et innovationsprojekt mellem teori og praksis

Scheel

Hansen²

2017

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“…Four key themes emerged: 'physical sensation' , 'psychological preparation' , 'trust and confidence' and the 'essentialness of communication' [11]. Similarly, a literature review of qualitative studies on delirium revealed that a patient's lived experience could be grouped according to (1) incomprehension and feelings of discomfort; (2) the need to keep one's distance and to protect oneself and (3) interventions that diminish suffering [12]. Fundamentally, the challenge to the clinician at the bedside is to recognise firstly that the patient is experiencing symptoms such as pain, discomfort, anxiety, distress or agitation and then focus on what may be responsible for that experience.…”

mentioning

confidence: 99%

Mind over matter? Pain, withdrawal and sedation in paediatric critical care

2016

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Is your paediatric intensive care (PICU) patient free of pain, comfortable and calm? The answer to this seemingly innocuous question may not be straightforward. Recognition and management of pain in intensive care units (ICUs) is challenging because of the many exacerbating and confounding factors that exist in this setting. Adding to this complexity may be misconceptions which relate to patient perception and capacity, the healthcare system and the clinicians themselves [1]. Clinician-associated barriers to adequate pain relief in ICU patients include knowledge deficits, low prioritization, failure to assess, acknowledge or evaluate treatment effects, plus attitudes and biases related to pain relief and communication difficulties.Nearly 50 % of adult patients report experiencing moderate to severe pain during their ICU stay [1]. In adults, inadequate pain relief with persistent pain has profound short-and long-term consequences, including negative physiological and psychological impacts, which in turn affect socio-economic health. Alarmingly, children are even less likely to receive appropriate analgesia than adults [2]. This is further complicated by recent concerns regarding the adverse effects of sedation (particularly deep sedation [3]) and analgesia in both adult [4] and paediatric patients. Thus this is a very difficult area of medicine to get right-steering between the Scylla of deep sedation and opiate comas on the one hand, and the Charybdis of pain, agitation and the chronic sequelae of these on the other.In a recent article in Intensive Care Medicine, a multidisciplinary group of experts from the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) have reviewed the literature relating to the assessment and management of pain, anxiety, withdrawal and delirium in critically ill children and neonates [5]. The authors have provided a comprehensive summary of the relevant literature and recommended scoring tools based on 32 manuscripts (after screening 1151) pertaining to 15 recommended assessment tools. The recommended scoring systems come with the advantages of some standardization and formalization of review processes-these may be particularly helpful for less experienced staff.The need for standardization has been highlighted in studies in other areas, such as in accident and emergency departments where knowledge, biases (e.g. sex, racial [6], age, opiophobia, etc.) and emergency department culture itself were identified as variables that influenced provision of adequate analgesia [7].However, the use of assessment scores has not been entirely validated as a means of improving the quality of care of pain, anxiety and distress. Added to this we know that parental attitudes towards pain differ [8] and there is discordance between self reports and behavioural pain measures following surgery in 3-to 7-year-olds [9], raising questions about the applicability of behavioural scales as sole measures of pain intensity in younger children. A recent review on pain management in children in the em...

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Patients' and nurses' experiences of delirium: a review of qualitative studies

Abstract: The findings suggest that nurses must acknowledge the lived experience of the persons cared for and they must seek out the meaning that patients ascribe to this experience to understand the situation and thus conduct interventions that meet the needs expressed.

Cited by 97 publications

References 38 publications

The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

Implementering af evidensbaseret praksis - et innovationsprojekt mellem teori og praksis

Mind over matter? Pain, withdrawal and sedation in paediatric critical care

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