School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
J Clin Nurs. 2020 Jul;29(13-14):2363-2377. doi: 10.1111/jocn.15248. Epub 2020 Apr 13.
To explore older inpatients' experiences and perceptions of delirium and nonpharmacological delirium prevention strategies (NDPS).
Delirium is a distressing and serious complication in hospitalised older adults. NDPS (supporting nutrition, mobility and cognitive participation) have strong supporting evidence. Few studies have explored older inpatients' perspectives of these strategies. This information may assist staff to better support patient participation in NDPS.
Qualitative study using an interpretive descriptive (ID) methodological approach to explore older patient's experience of delirium and NDPS.
Structured interviews of inpatients aged over 65 years across 6 medical and surgical wards explored patients' experiences and perceptions of delirium and prevention activities related to nutrition, mobility and cognition; and barriers and enablers to participation. Reporting used COREQ.
Twenty-three participants were included (12 male, 11 reported delirium experience). Participants reported a range of physiological, emotional and psychological responses to delirium, hearing about delirium was different to experiencing it. Most participants were aware of the benefits of maintaining nutrition and hydration, physical activity and cognitive engagement in hospital. Barriers included poor symptom control, inflexible routines and inconsistent communication, whilst enablers included access to equipment, family involvement, staff encouragement and individual goals. These were organised into themes: outlook, feeling well enough, hospital environment, feeling informed and listened to, and support networks.
A more patient-centred approach to delirium prevention requires consideration of older people's values, needs, preferences and fit within the hospital environment and routines. Feeling informed, listened to and receiving support from staff and family carers can improve older inpatients' engagement in NPDS to prevent delirium in hospital.
Nurses are ideally placed to improve patient participation in NDPS through holistic assessment and care, addressing symptoms, providing clear information about delirium and delirium prevention, and facilitating family carer support and patient interactions.
探讨老年住院患者对谵妄和非药物性谵妄预防策略（NDPS）的体验和看法。
谵妄是住院老年患者一种痛苦且严重的并发症。NDPS（支持营养、活动和认知参与）有强有力的支持证据。很少有研究探讨老年住院患者对这些策略的看法。这些信息可以帮助医务人员更好地支持患者参与 NDPS。
采用解释性描述（ID）方法的定性研究，探讨老年患者对谵妄和 NDPS 的体验。
在 6 个内科和外科病房中对 65 岁以上的住院患者进行了结构化访谈，探讨了患者对谵妄和与营养、活动和认知相关的预防活动的体验和看法；以及参与的障碍和促进因素。报告使用了 COREQ。
共纳入 23 名参与者（12 名男性，11 名报告有谵妄体验）。参与者报告了一系列与谵妄相关的生理、情感和心理反应，对谵妄的了解与体验不同。大多数参与者意识到在医院保持营养和水分摄入、进行身体活动和认知参与的好处。障碍包括症状控制不佳、常规活动缺乏灵活性以及沟通不一致，而促进因素包括设备的使用、家庭参与、医务人员的鼓励和个人目标。这些因素组织成以下主题：展望、感觉良好、医院环境、感觉被了解和倾听、支持网络。
预防谵妄需要采取更以患者为中心的方法，考虑老年人的价值观、需求、偏好以及与医院环境和常规的契合度。感到被了解、倾听并获得医务人员和家属的支持，可以提高老年住院患者参与 NDPS 以预防医院谵妄的意愿。
护士通过全面评估和护理、解决症状、提供关于谵妄和谵妄预防的明确信息、促进家属支持和患者互动，可以更好地提高患者参与 NDPS 的意愿。
