Mansutti Irene, Saiani Luisa, Morandini Marzia, Palese Alvisa
Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.
Department of Diagnostics and Public Health, University of Verona, Italy.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105013. doi: 10.1016/j.jstrokecerebrovasdis.2020.105013. Epub 2020 Jun 17.
Higher rates of delirium have been reported among patients with acute stroke. However, poorly modifiable risk factors have been documented to date while sign and symptoms capable of early detecting its onset and outcomes in this specific population have been largely neglected. The aim of this study was to emerge nurses' clinical knowledge and experiences regarding post-stroke delirium (a) risk factors, (b) signs and symptoms of delirium onset, and (c) outcomes.
A qualitative study based upon focus groups have been performed on 2019 and here reported according to the COnsolidated criteria for REporting Qualitative research. A purposeful sample of 28 nurses was invited to participate in focus groups at two Italian hospitals, and 20 participated. A semi-structured question guide was developed; all focus groups were audio recorded and then transcribed verbatim. Two researchers independently analysed, coded and categorised the findings according to the main research question. A member checking with ten nurses was also performed to ensure rigour.
Four risk factors emerged (a) at the individual level; (b) associated with previous (e.g., dementia) and the current clinical condition (stroke), (c) associated with the nursing care delivered, and (d) associated with the hospital environment. In their daily practice, nurses suspect the onset of delirium when some motor, verbal or multidimensional signs and symptoms occur. The delirium episodes affect outcomes at the individual, family, and at the system levels.
In a field of research in need of study, we have involved expert nurses who shared their tacit knowledge to gain insights regarding risk factors, early signs and symptoms of delirium and its outcomes to address future directions of this research field.
急性中风患者的谵妄发生率较高。然而，迄今为止已记录的可改变风险因素较少，而在这一特定人群中能够早期检测其发作和预后的体征和症状在很大程度上被忽视了。本研究的目的是了解护士关于中风后谵妄的临床知识和经验，包括（a）风险因素，（b）谵妄发作的体征和症状，以及（c）预后。
2019年进行了一项基于焦点小组的定性研究，并根据报告定性研究的统一标准进行报告。邀请了28名护士作为有目的的样本，参与意大利两家医院的焦点小组，20人参与。制定了一份半结构化问题指南；所有焦点小组都进行了录音，然后逐字转录。两名研究人员根据主要研究问题独立分析、编码和分类研究结果。还对十名护士进行了成员核对，以确保严谨性。
出现了四个风险因素：（a）个体层面；（b）与既往（如痴呆）和当前临床状况（中风）相关；（c）与提供的护理相关；（d）与医院环境相关。在日常实践中，当出现一些运动、言语或多维度的体征和症状时，护士会怀疑谵妄的发作。谵妄发作会在个体、家庭和系统层面影响预后。
在一个需要研究的领域，我们让专家护士参与进来，他们分享了自己的隐性知识，以深入了解谵妄的风险因素、早期体征和症状及其预后，从而为该研究领域指明未来方向。
