Poikajärvi Satu, Rauta Satu, Salanterä Sanna, Junttila Kristiina
Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland.
Department of Perioperative, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Int J Nurs Stud Adv. 2022 Sep 27;4:100103. doi: 10.1016/j.ijnsa.2022.100103. eCollection 2022 Dec.
The term delirium has been defined in medical diagnosis criteria as a multidimensional disorder, and the term acute confusion is included in nursing classifications. Delirium can be a serious complication assessed in a patient after a surgical procedure. Still, the patient's delirium frequently remains unrecognised. Care of patients with delirium after surgical procedure is complex, and it challenges nursing expertise. From the nurses' viewpoint, delirium is associated with ambiguity of concepts and lack of knowledge. Therefore, reseach on how nurses perceive patients with delirium in a surgical context is needed.
The aim of this study was to describe the concepts of delirium and acute confusion, as well as the associated dimensions, in adult patients in a surgical context from the nursing perspective.
The study used Schwartz and Barcott's hybrid concept analysis with theoretical, fieldwork, and final analytical phases.
Surgical wards, surgical intensive care units, and post-anaesthesia care units.
A systematic literature search was performed through Pubmed (Medline), Cinahl, PsycInfo, and Embase.
Registered nurses and licensed practical nurses ( = 105) participated in the fieldwork phase.
In the theoretical phase, the concepts' working definitions were formulated based on a systematic literature search with the year limitations from 2000 until February 2021. At the fieldwork phase, the nurses' descriptions of patients with delirium were analysed using the deductive content analysis method. At the final analytical phase, findings were combined and reported.
The concepts of delirium, subsyndromal delirium, and acute confusion are well defined in the literature. From the perspective of the nurses in the study, concepts were seen as a continuum not as individual diagnoses. Nurses described the continuum of delirium as a process with acute onset, duration, and recovery with the associated dimensions of symptoms, symptom severity, risk factors, and early signs. The acute phase of delirium was emphasised, and preoperative or prolonged disturbance did not seem to be relevant in the surgical care context. Patients' compliance with care may be decreased with the continuum of delirium, which might challenge both patients' recovery from surgery and the quality of nursing care.
In clinical practice the nurses used term confusion inaccurately. The term acute confusion might be used when illustrating an early stage of delirium. Nurses could benefit from further education where the theoretical knowledge is combined with the clinical practice. The discussion about the delirium, which covers the time both before surgery and after the acute phase should be increased.
在医学诊断标准中，谵妄被定义为一种多维度障碍，而急性意识模糊这一术语包含在护理分类中。谵妄可能是手术后患者需评估的一种严重并发症。然而，患者的谵妄常常未被识别。术后谵妄患者的护理很复杂，对护理专业知识构成挑战。从护士的角度来看，谵妄与概念模糊和知识缺乏相关。因此，需要研究护士在手术背景下如何看待谵妄患者。
本研究的目的是从护理角度描述手术背景下成年患者的谵妄和急性意识模糊概念及其相关维度。
本研究采用施瓦茨和巴科特的混合概念分析法，包括理论、实地调查和最终分析阶段。
外科病房、外科重症监护病房和麻醉后护理病房。
通过PubMed（Medline）、CINAHL、PsycInfo和Embase进行系统的文献检索。
注册护士和执业护士（n = 105）参与了实地调查阶段。
在理论阶段，基于2000年至2021年2月的系统文献检索制定概念的工作定义。在实地调查阶段，使用演绎性内容分析法分析护士对谵妄患者的描述。在最终分析阶段，汇总并报告研究结果。
谵妄、亚综合征性谵妄和急性意识模糊的概念在文献中有明确界定。从本研究中护士的角度来看，这些概念被视为一个连续体，而非单独的诊断。护士将谵妄连续体描述为一个具有急性起病、持续时间和恢复过程，伴有症状、症状严重程度、危险因素和早期体征等相关维度。强调了谵妄的急性期，术前或长期干扰在手术护理背景下似乎不相关。谵妄连续体可能会降低患者对护理的依从性，这可能会对患者术后恢复和护理质量构成挑战。
在临床实践中，护士对意识模糊一词的使用不准确。在描述谵妄早期阶段时可使用急性意识模糊这一术语。护士可以从理论知识与临床实践相结合的进一步教育中受益。应增加关于谵妄的讨论，其涵盖手术前和急性期后的时间。
