Featherstone Imogen, Johnson Miriam J, Sheldon Trevor, Kelley Rachael, Hawkins Rebecca, Bravington Alison, Callin Sarah, Dixon Rachael, Obita George, Siddiqi Najma
Department of Health Sciences, University of York, York, UK.
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
Palliat Med. 2025 Mar;39(3):391-400. doi: 10.1177/02692163241310762. Epub 2025 Jan 21.
Delirium is common and distressing for hospice in-patients. Hospital-based research shows delirium may be prevented by targeting its risk factors. Many preventative strategies address patients' fundamental care needs. However, there is little research regarding how interventions need to be tailored to the in-patient hospice setting.
To explore the behaviours of hospice in-patient staff in relation to delirium prevention, and the influences that shape these behaviours.
Focused ethnography supported by behaviour change theory. Observation, semi-structured interviews and document review were conducted.
SETTING/PARTICIPANTS: A total of 89 participants (multidisciplinary staff, volunteers, patients and relatives) at two UK in-patient hospice units.
Hospice clinicians engaged in many behaviours associated with prevention of delirium as part of person-centred fundamental care, without delirium prevention as an explicit aim. Carrying out essential care tasks was highly valued and supported by adequate staffing levels, multidisciplinary team engagement and role clarity. Patients' reduced physical capability limited some delirium prevention behaviours, as did clinicians' behavioural norms related to prioritising patient comfort. Delirium prevention was not embedded into routine assessment and care decision-making, despite its potential to reduce patient distress.
The value placed on fundamental care in hospices supports delirium prevention behaviours but these require adaptation as patients become closer to death. There is a need to increase clinicians' understanding of the potential for delirium prevention to reduce patient distress during illness progression; to support inclusion of delirium prevention in making decisions about care; and to embed routine review of delirium risk factors in practice.
谵妄在临终关怀住院患者中很常见且令人痛苦。基于医院的研究表明，针对谵妄的危险因素可预防谵妄。许多预防策略都涉及患者的基本护理需求。然而，关于如何根据住院临终关怀环境调整干预措施的研究很少。
探讨临终关怀住院工作人员在预防谵妄方面的行为，以及影响这些行为的因素。
以行为改变理论为支撑的聚焦人种学研究。进行了观察、半结构化访谈和文件审查。
地点/参与者：英国两家住院临终关怀机构的89名参与者（多学科工作人员、志愿者、患者及亲属）。
临终关怀临床医生在以患者为中心的基本护理中采取了许多与预防谵妄相关的行为，但预防谵妄并非明确目标。执行基本护理任务受到高度重视，充足的人员配备、多学科团队参与和角色明确对此起到了支持作用。患者身体能力下降限制了一些预防谵妄的行为，临床医生将患者舒适度置于优先地位的行为规范也有同样的限制作用。尽管预防谵妄有可能减轻患者痛苦，但它并未纳入常规评估和护理决策中。
临终关怀机构对基本护理的重视支持了预防谵妄的行为，但随着患者临近死亡，这些行为需要做出调整。有必要提高临床医生对预防谵妄在疾病进展过程中减轻患者痛苦的潜力的认识；支持在护理决策中纳入预防谵妄的内容；并在实践中对谵妄危险因素进行常规审查。
