Stenwall Ewa, Jönhagen Maria Eriksdotter, Sandberg Jonas, Fagerberg Ingegerd
Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
Int J Nurs Stud. 2008 Nov;45(11):1577-85. doi: 10.1016/j.ijnurstu.2008.02.001. Epub 2008 Mar 17.
Acute confusional state (ACS) is a common and difficult condition among older patients with a variety of opinions about how to act when encountering patients with ACS. Few studies to our knowledge have been found exploring the encounter from the perspective of older patients and their experiences.
The aim of this study was to understand the experiences of older patients with ACS when encountering professional carers and close relatives.
In order to understand older patients' experiences of encounters during their ACS a latent qualitative content analysis was used.
The data collection took place at two geriatric wards in an emergency hospital in a metropolitan area.
The inclusion criteria included being aged 65 years or older and having suffered from ACS, according to the DSM-IV criteria, and having regained lucidity. Participants were being cared for at one of two geriatric wards. Patients diagnosed with dementia were excluded. About 150 patients were screened, 67 patients fulfilled the inclusion criteria and seven patients were included in the study, four females and three males, aged between 78 and 98 years.
Data were collected by interviews.
Three themes were found, namely; 'Feeling lonely within the perceived reality of ACS', with three sub-themes: the unequal encounter, keeping a distance and being an outsider; 'striving towards understanding' with two sub-themes: searching for answers and it takes time to understand; and 'feelings of participation in the encounter' with two sub-themes: a mutual understanding and feeling safe and supported.
Within the encounter the older patients with ACS are searching for answers to what is happening and why. The patients feel dependent on the persons they encounter and their willingness to understand and communicate. The patients also feel lonely, unnecessarily questioned and untrustworthy; but they can also feel safe, trusted and understood.
急性意识模糊状态（ACS）在老年患者中很常见且处理起来较为棘手，对于遇到ACS患者时应如何应对存在多种观点。据我们所知，很少有研究从老年患者及其经历的角度探讨这种情况。
本研究的目的是了解患有急性意识模糊状态的老年患者在遇到专业护理人员和近亲时的经历。
为了了解老年患者在急性意识模糊状态期间的遭遇经历，采用了潜在定性内容分析法。
数据收集在一个大都市地区的一家急诊医院的两个老年病房进行。
纳入标准包括年龄在65岁及以上，根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准患有急性意识模糊状态，并且已经恢复清醒。参与者在两个老年病房之一接受护理。被诊断患有痴呆症的患者被排除在外。大约筛查了150名患者，67名患者符合纳入标准，7名患者被纳入研究，4名女性和3名男性，年龄在78岁至98岁之间。
通过访谈收集数据。
发现了三个主题，即：“在急性意识模糊状态的感知现实中感到孤独”，有三个子主题：不平等的遭遇、保持距离和成为局外人；“努力理解”，有两个子主题：寻找答案和理解需要时间；以及“在遭遇中的参与感”，有两个子主题：相互理解以及感到安全和得到支持。
在遭遇过程中，患有急性意识模糊状态的老年患者在寻找正在发生的事情以及原因的答案。患者感到依赖于他们遇到的人以及他们理解和沟通的意愿。患者也会感到孤独、被无端质疑和不值得信任；但他们也可以感到安全、被信任和被理解。
