IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney (UTS), Faculty of Health Building 10, Level 3, 235-253 Jones St, Ultimo, NSW 2007, Australia.
IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney (UTS), Faculty of Health Building 10, Level 3, 235-253 Jones St, Ultimo, NSW 2007, Australia.
Int J Nurs Stud. 2017 Oct;75:123-129. doi: 10.1016/j.ijnurstu.2017.07.007. Epub 2017 Jul 12.
Delirium is a serious acute neurocognitive condition frequently occurring for hospitalized patients, including those receiving care in specialist palliative care units. There are many delirium evidence-practice gaps in palliative care, including that the condition is under-recognized and challenging to assess.
To report the meta-synthesis of a research project investigating delirium epidemiology, systems and nursing practice in palliative care units.
The Delirium in Palliative Care (DePAC) project was a two-phase sequential transformative mixed methods design with knowledge translation as the theoretical framework. The project answered five different research questions about delirium epidemiology, systems of care and nursing practice in palliative care units. Data integration and metasynthesis occurred at project conclusion.
There was a moderate to high rate of delirium occurrence in palliative care unit populations; and palliative care nurses had unmet delirium knowledge needs and worked within systems and team processes that were inadequate for delirium recognition and assessment. The meta-inference of the DePAC project was that a widely-held but paradoxical view that palliative care and dying patients are different from the wider hospital population has separated them from the overall generation of delirium evidence, and contributed to the extent of practice deficiencies in palliative care units.
Improving palliative care nurses' capabilities to recognize and assess delirium will require action at the patient and family, nurse, team and system levels. A broader, hospital-wide perspective would accelerate implementation of evidence-based delirium care for people receiving palliative care, both in specialist units, and the wider hospital setting.
谵妄是一种严重的急性神经认知障碍，经常发生在住院患者中，包括在专科姑息治疗病房接受治疗的患者。姑息治疗中存在许多谵妄证据与实践之间的差距，包括该病症未被充分识别和难以评估。
报告一项研究项目的元综合，该项目调查姑息治疗病房中谵妄的流行病学、系统和护理实践。
《姑息治疗中的谵妄（DePAC）》项目是一个两阶段顺序转化混合方法设计，以知识转化为理论框架。该项目回答了五个关于姑息治疗病房中谵妄流行病学、护理系统和护理实践的不同研究问题。数据整合和元综合在项目结束时进行。
姑息治疗病房人群中存在中度至高度的谵妄发生率；姑息治疗护士对谵妄知识存在未满足的需求，并且在识别和评估谵妄方面，他们的工作系统和团队流程不足。《DePAC》项目的元推断是，一种普遍存在但矛盾的观点认为，姑息治疗和临终患者与更广泛的医院人群不同，这种观点将他们与整体谵妄证据的产生隔离开来，并导致姑息治疗病房中实践缺陷的程度。
提高姑息治疗护士识别和评估谵妄的能力需要在患者和家属、护士、团队和系统层面采取行动。更广泛的医院范围的视角将加速为接受姑息治疗的人实施基于证据的谵妄护理，无论是在专科病房还是更广泛的医院环境中。
