Hosie Annmarie, Agar Meera, Lobb Elizabeth, Davidson Patricia M, Phillips Jane
The University of Notre Dame Australia, School of Nursing, 160 Oxford St , Darlinghurst, NSW 2010, Australia.
Braeside Hospital, HammondCare, Department of Palliative Care, 340 Prairie Vale Rd., Prairiewood, NSW 2176, Australia; ImPaCCT: Improving Palliative Care through Clinical Trials (New South Wales Palliative Care Clinical Trials Group), South Western Sydney Clinical School, University of New South Wales, Faculty of Medicine, Sydney, NSW 2052, Australia; Flinders University, Palliative and Supportive Services, Adelaide, South Australia, Australia.
Int J Nurs Stud. 2014 Oct;51(10):1353-65. doi: 10.1016/j.ijnurstu.2014.02.005. Epub 2014 Feb 28.
Delirium is prevalent in palliative care inpatient settings and management is often challenging. Despite nurses' integral patient care role, little is known about palliative care nurses' capacity to recognise, assess and respond to patients' delirium symptoms.
To explore the experiences, views and practices of inpatient palliative care nurses in delirium recognition and assessment.
30 nurses from nine Australian specialist palliative care inpatient services.
Critical incident technique (CIT) guided a series of semi-structured interviews. Prior to interviews participants were given a vignette of a palliative care inpatient with an unrecognised hypoactive delirium, to prompt their recollection and recounting of a similar clinical incident. Clearly recalled and described incidents were analysed using thematic content analysis.
20 of 30 participants recalled and described 28 relevant delirium incidents. Two themes and six sub-themes provide a general description of participants' experiences, views and practice in delirium recognition and assessment. Participants experience distress related to caring for patients with delirium and express compassion and empathy for delirious patients. Enhancing their delirium knowledge, strengthening collaborative multidisciplinary team relationships and better communication are important supports. Some participants, usually those in advance practice roles, describe more comprehensive assessment capabilities that incorporate clinical expertise with whole person awareness, yet systematic and structured delirium screening and assessment processes and application of the delirium diagnosis criteria are largely missing. Use of ambiguous terminology to describe delirium symptoms contributes to ineffective practice.
The findings of this study expands our understanding of how palliative care nurses' capacity to recognise and assess patients' delirium symptoms in the inpatient setting could be strengthened.
谵妄在姑息治疗住院环境中很常见，管理往往具有挑战性。尽管护士在患者护理中发挥着不可或缺的作用，但对于姑息治疗护士识别、评估和应对患者谵妄症状的能力知之甚少。
探讨住院姑息治疗护士在谵妄识别和评估方面的经验、观点和做法。
来自澳大利亚九个专科姑息治疗住院服务机构的30名护士。
关键事件技术（CIT）指导了一系列半结构化访谈。在访谈前，向参与者提供了一个患有未被识别的安静型谵妄的姑息治疗住院患者的案例，以促使他们回忆和讲述类似的临床事件。使用主题内容分析法对清晰回忆和描述的事件进行分析。
30名参与者中有20名回忆并描述了28起相关的谵妄事件。两个主题和六个子主题对参与者在谵妄识别和评估方面的经验、观点和做法进行了总体描述。参与者在照顾谵妄患者时会感到困扰，并对谵妄患者表达同情和同理心。增强他们的谵妄知识、加强多学科团队协作关系和改善沟通是重要的支持。一些参与者，通常是那些担任高级实践角色的人，描述了更全面的评估能力，将临床专业知识与对患者整体的认知相结合，但谵妄的系统结构化筛查和评估过程以及谵妄诊断标准的应用在很大程度上缺失。使用模糊术语描述谵妄症状导致实践效果不佳。
本研究的结果扩展了我们对如何加强姑息治疗护士在住院环境中识别和评估患者谵妄症状能力的理解。
