Authors
- Annmarie Hosie1,
- Patricia M Davidson2,
- Meera Agar3,
- Elizabeth Lobb4,
- Jane Phillips5
- University of Notre Dame1,
- Johns Hopkins University2,
- Braeside Hospital3,
- Calvary Health Care Sydney4,
- University of Technology Sydney (UTS)5
2015
Excerpt
Objective
To improve delirium recognition and assessment in Australian inpatient palliative care.
Methods
A three-phase mixed methods knowledge translation study was conducted to better understand delirium epidemiology, systems and nursing practice in inpatient palliative care. The study included: 1) systematic review; 2) point-prevalence; 3) environmental scan; 4) semi-structured interviews; 5) focus groups; 6) Plan-Do-Study-Act (PDSA) methods. Participants included nurse, physician and allied health professionals and patients of Australian palliative care units. Data were integrated in the final phase.
Results
The systematic review reported prevalence of 26-62% during admission, and up to 88% in the last hours of patients who died. The pointprevalence study revealed 1/5 Australian palliative care inpatients were delirious in a 24-hour period. Guidelines recommend routine use of delirium tools and strategies, yet these are absent from organisational policy, admission assessment and symptom screening systems. Ambiguous terminology and nurses' poor understanding of delirium contributes to underrecognition and incomplete assessment. Focus groups and PDSA processes revealed insights of family, practice guidance, team communication, and education are required to enhance the impact of a screening tool.
Conclusion
Integration of data informed a multifaceted intervention to improve delirium recognition and assessment in palliative care units, which will be presented and discussed.
To improve delirium recognition and assessment in Australian inpatient palliative care.
Methods
A three-phase mixed methods knowledge translation study was conducted to better understand delirium epidemiology, systems and nursing practice in inpatient palliative care. The study included: 1) systematic review; 2) point-prevalence; 3) environmental scan; 4) semi-structured interviews; 5) focus groups; 6) Plan-Do-Study-Act (PDSA) methods. Participants included nurse, physician and allied health professionals and patients of Australian palliative care units. Data were integrated in the final phase.
Results
The systematic review reported prevalence of 26-62% during admission, and up to 88% in the last hours of patients who died. The pointprevalence study revealed 1/5 Australian palliative care inpatients were delirious in a 24-hour period. Guidelines recommend routine use of delirium tools and strategies, yet these are absent from organisational policy, admission assessment and symptom screening systems. Ambiguous terminology and nurses' poor understanding of delirium contributes to underrecognition and incomplete assessment. Focus groups and PDSA processes revealed insights of family, practice guidance, team communication, and education are required to enhance the impact of a screening tool.
Conclusion
Integration of data informed a multifaceted intervention to improve delirium recognition and assessment in palliative care units, which will be presented and discussed.