Faculty of Health, School of Nursing Science, Witten Herdecke University, Witten, Germany.
School VI -School of Medicine and Health Sciences, Carl von Ossietzky Universität, Oldenburg, Germany.
BMC Geriatr. 2024 Jul 25;24(1):633. doi: 10.1186/s12877-024-05213-9.
Delirium is a neuropathological syndrome that is characterised by fluctuating impairments in attention, cognitive performance, and consciousness. Since delirium represents a medical emergency, it can be associated with adverse clinical and economic outcomes. Although nursing home residents face a high risk of developing delirium, health care professionals in this field appear to have limited knowledge of delirium despite the critical role they play in the prevention, diagnosis, and treatment of delirium in nursing homes.
The purpose of this realist review is to develop an initial programme theory with the goal of understanding how, why, and under what circumstances educational interventions can improve the delirium-specific knowledge of health care professionals in nursing homes.
This realist review was conducted in accordance with the RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines and includes the following steps: (1) search strategy and literature review; (2) study selection and assessment; (3) data extraction; (4) data synthesis; and (5) development of an initial programme theory. It also included stakeholder discussions with health care professionals recruited from nursing home care, which focused on their experiences with delirium.
From a set of 1703 initially identified publications, ten publications were included in this realist review. Based on these publications, context-mechanism-outcome configurations were developed; these configurations pertained to (1) management support, (2) cognitive impairments among residents, (3) familiarity with residents, (4) participatory intervention development, (5) practical application, (6) case scenarios, (7) support from experts and (8) relevance of communication.
Educational interventions aimed at improving the delirium-specific knowledge of health care professionals should feature methodological diversity if they are to enhance health care professionals' interest in delirium and highlight the fundamental contributions they make to the prevention, diagnosis, and treatment of delirium. Educational interventions should also take into account the multidimensional contextual factors that can have massive impacts on the relevant mode of action as well as the responses of health care professionals in nursing homes. The identification of delirium in residents is a fundamental responsibility for nursing home staff.
This review has been registered at Open Science Framework https://doi.org/10.17605/OSF.IO/6ZKM3.
谵妄是一种神经病理学综合征，其特征是注意力、认知表现和意识波动受损。由于谵妄是一种医疗急症，它可能与不良的临床和经济结局有关。尽管护理院居民发生谵妄的风险很高，但该领域的医疗保健专业人员对谵妄的了解似乎有限，尽管他们在护理院预防、诊断和治疗谵妄方面发挥着关键作用。
本真实主义综述的目的是制定一个初步的方案理论，旨在了解教育干预如何、为何以及在何种情况下能够提高护理院医疗保健专业人员的谵妄特异性知识。
本真实主义综述是按照 RAMESES（真实主义和元叙述证据综合：和不断发展的标准）指南进行的，包括以下步骤：（1）搜索策略和文献综述；（2）研究选择和评估；（3）数据提取；（4）数据综合；以及（5）初步方案理论的制定。它还包括与从护理院护理中招募的医疗保健专业人员进行的利益相关者讨论，重点是他们对谵妄的经验。
从最初确定的 1703 篇出版物中，有 10 篇出版物被纳入本真实主义综述。基于这些出版物，制定了情境-机制-结果配置；这些配置涉及（1）管理支持，（2）居民认知障碍，（3）对居民的熟悉程度，（4）参与式干预措施的制定，（5）实际应用，（6）案例情景，（7）专家支持和（8）沟通的相关性。
旨在提高医疗保健专业人员谵妄特异性知识的教育干预措施如果要增强医疗保健专业人员对谵妄的兴趣，并强调他们对预防、诊断和治疗谵妄的基本贡献，就应该具有方法多样性。教育干预措施还应考虑到对相关作用方式以及护理院医疗保健专业人员的反应产生重大影响的多维情境因素。识别居民中的谵妄是护理院工作人员的基本责任。
本综述已在 Open Science Framework 上注册，网址为 https://doi.org/10.17605/OSF.IO/6ZKM3。
