Discipline of Palliative and Supportive Services, Flinders University, Adelaide, Australia.
Palliat Med. 2012 Oct;26(7):887-96. doi: 10.1177/0269216311419884. Epub 2011 Sep 9.
Delirium has a significant impact on nursing practice from diagnosis and management, with under-detection and variable management of delirium being international problems. This study aimed to explore nurses' assessment and management of delirium when caring for people with cancer, the elderly or older people requiring psychiatric care in the inpatient setting.
Participants in this qualitative study were nurses working in Australian public hospital inpatient dedicated units in palliative care, aged care (geriatrics), aged care (geriatric) psychiatry and oncology. Semi-structured interviews were used to explore nurses' views about specific areas of delirium assessment and management. Purposive sampling was used and interviews conducted until thematic saturation reached. A thematic content analysis was performed from a grounded theory perspective.
A total of 40 participants were included in the study. The analysis revealed four broad analytical themes: (1) superficial recognition and understanding of the operational definition of delirium or recognition of delirium as a syndrome; (2) nursing assessment: investigative versus a problem solving approach; (3) management: maintaining dignity and minimizing chaos; and (4) distress and the effect on others.
Nurses have limited knowledge of the features of delirium regardless of their specialty discipline. Delirium was uniformly identified as a highly distressing experience for patients, families and staff alike. The majority of nurses had a superficial understanding of delirium management, and adopted a task-orientated approach aimed at addressing the more noticeable problems. These findings have implications for both education and knowledge translation. Innovative approaches are needed to align health professional behaviours with best evidence delirium care.
谵妄对护理实践具有重大影响，从诊断和管理方面来看，国际上普遍存在谵妄漏诊和管理方法各异的问题。本研究旨在探讨护士在住院环境中护理癌症、老年或需要精神科护理的老年人时对谵妄的评估和管理。
本定性研究的参与者为在澳大利亚公立医院住院专科病房工作的护士，包括姑息治疗、老年护理（老年科）、老年护理（老年精神科）和肿瘤学病房。采用半结构式访谈法探讨护士对谵妄评估和管理特定领域的看法。采用目的抽样法，直至达到主题饱和。从扎根理论的角度对主题内容进行分析。
共有 40 名参与者纳入本研究。分析结果揭示了四个广泛的分析主题：（1）对谵妄操作定义的肤浅认识和理解或对谵妄作为综合征的认识；（2）护理评估：调查与解决问题的方法；（3）管理：维护尊严和最大限度减少混乱；以及（4）痛苦及其对他人的影响。
无论专业学科如何，护士对谵妄的特征知之甚少。谵妄被一致认为是患者、家属和医护人员都深感痛苦的经历。大多数护士对谵妄管理的理解肤浅，采用以任务为导向的方法来解决更明显的问题。这些发现对教育和知识转化都有影响。需要创新方法使卫生专业人员的行为与最佳证据的谵妄护理保持一致。
