Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Gerontologist. 2019 Mar 14;59(2):327-337. doi: 10.1093/geront/gnx153.
While there are qualitative studies examining the delirium-related experiences of patients, family caregivers, and nurses separately, little is known about common aspects of delirium burden among all three groups. We describe common delirium burdens from the perspectives of patients, family caregivers, and nurses.
We conducted semistructured qualitative interviews about delirium burden with 18 patients who had recently experienced a delirium episode, with 16 family caregivers, and with 15 nurses who routinely cared for patients with delirium. We recruited participants from a large, urban teaching hospital in Boston, Massachusetts. Interviews were recorded and transcribed. We used interpretive description as the approach to data analysis.
We identified three common burden themes of the delirium experience: Symptom Burden (Disorientation, Hallucinations/Delusions, Impaired Communication, Memory Problems, Personality Changes, Sleep Disturbances); Emotional Burden (Anger/Frustration, Emotional Distress, Fear, Guilt, Helplessness); and Situational Burden (Loss of Control, Lack of Attention, Lack of Knowledge, Lack of Resources, Safety Concerns, Unpredictability, Unpreparedness). These burdens arise from different sources among patients, family caregivers, and nurses, with markedly differing perspectives on the burden experience.
Our findings advance the understanding of common burdens of the delirium experience for all groups and offer structure for instrument development and distinct interventions to address the burden of delirium as an individual or group experience. Our work reinforces that no one group experiences delirium in isolation. Delirium is a shared experience that will respond best to systemwide approaches to reduce associated burden.
虽然有一些定性研究分别考察了患者、家属照顾者和护士的与谵妄相关的体验，但对于这三组人群共有的谵妄负担的常见方面知之甚少。本研究从患者、家属照顾者和护士的角度描述了共同的谵妄负担。
我们对 18 名最近经历过谵妄发作的患者、16 名家属照顾者和 15 名经常照顾谵妄患者的护士进行了关于谵妄负担的半结构式定性访谈。我们从马萨诸塞州波士顿的一家大型城市教学医院招募了参与者。访谈进行了录音和转录。我们采用解释性描述作为数据分析的方法。
我们确定了谵妄体验的三个共同负担主题：症状负担（定向障碍、幻觉/错觉、沟通障碍、记忆问题、人格改变、睡眠障碍）；情绪负担（愤怒/挫败感、情绪困扰、恐惧、内疚、无助感）；和情境负担（失去控制、缺乏关注、缺乏知识、缺乏资源、安全顾虑、不可预测性、准备不足）。这些负担来自于患者、家属照顾者和护士之间不同的来源，对于负担体验有明显不同的看法。
我们的发现增进了对所有人群共有的谵妄体验负担的理解，并为开发工具和实施针对作为个体或群体体验的谵妄负担的特定干预措施提供了结构。我们的工作强化了一个事实，即没有一个群体孤立地经历谵妄。谵妄是一种共同的体验，需要采取系统的方法来减轻相关负担，才能取得最佳效果。
