老年住院患者谵妄的表现和处理：回顾性患者病历分析。
Delirium in older hospitalized patients-signs and actions: a retrospective patient record review.
机构信息
Skaraborg Hospital, Skövde, Sweden.
Jönköping University, Jönköping, Sweden.
出版信息
BMC Geriatr. 2018 Feb 6;18(1):43. doi: 10.1186/s12877-018-0731-5.
BACKGROUND
Delirium is common in older hospitalized patients, and is associated with negative consequences for the patients, next of kin, healthcare professionals and healthcare costs. It is important to understand its clinical features, as almost 40% of all cases in hospitals may be preventable. Yet, delirium in hospitalized patients is often unrecognized and untreated. Few studies describe thoroughly how delirium manifests itself in older hospitalized patients and what actions healthcare professionals take in relation to these signs. Therefore, the aim of this study was to describe signs of delirium in older hospitalized patients and action taken by healthcare professionals, as reported in patient records.
METHODS
Patient records from patients aged ≥65 (n = 286) were retrospectively reviewed for signs of delirium, which was found in 78 patient records (27%). Additionally, these records were reviewed for action taken by healthcare professionals in relation to the patients' signs of delirium. The identified text was analyzed with qualitative content analysis in two steps.
RESULTS
Healthcare professionals responded only in part to older hospitalized patients' needs of care in relation to their signs of delirium. The patients displayed various signs of delirium that led to a reduced ability to participate in their own care and to keep themselves free from harm. Healthcare professionals met these signs with a variation of actions and the care was adapted, deficient and beyond the usual care. A systematic and holistic perspective in the care of older hospitalized patients with signs of delirium was missing.
CONCLUSION
Improved knowledge about delirium in hospitals is needed in order to reduce human suffering, healthcare utilization and costs. It is important to enable older hospitalized patients with signs of delirium to participate in their own care and to protect them from harm. Delirium has to be seen as a preventable adverse event in all hospitals units. To improve the prevention and management of older hospitalized patients with signs of delirium, person-centered care and patient safety may be important issues.
背景
谵妄在老年住院患者中很常见，会给患者、家属、医护人员和医疗费用带来负面影响。了解其临床特征很重要，因为医院中近 40%的病例可能是可以预防的。然而，住院患者的谵妄常常未被识别和治疗。很少有研究详细描述老年住院患者谵妄的表现以及医护人员针对这些症状采取的措施。因此，本研究旨在描述老年住院患者谵妄的表现以及医护人员在患者病历中记录的针对这些症状采取的措施。
方法
回顾性分析 286 名年龄≥65 岁患者的病历，寻找谵妄迹象，其中 78 份病历（27%）中发现了谵妄迹象。此外，还对这些病历中记录的医护人员针对患者谵妄迹象采取的措施进行了审查。对识别出的文本进行了两步的定性内容分析。
结果
医护人员仅部分回应了老年住院患者与谵妄迹象相关的护理需求。患者表现出各种谵妄迹象，导致他们参与自身护理的能力下降，无法免受伤害。医护人员针对这些迹象采取了各种措施，护理存在不足和缺陷，超出了常规护理。在照顾有谵妄迹象的老年住院患者时，缺乏系统和整体的视角。
结论
需要提高医院对谵妄的认识，以减少人力痛苦、医疗利用和成本。让有谵妄迹象的老年住院患者参与自身护理并保护他们免受伤害非常重要。谵妄应被视为所有医院科室都可预防的不良事件。为了改善有谵妄迹象的老年住院患者的预防和管理，以患者为中心的护理和患者安全可能是重要问题。
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