Authors
  • Annmarie Hosie1,
  • Meera Agar1,
  • Elizabeth Lobb2,
  • Patricia M Davidson3,
  • Jane Phillips1,
  • Annmarie Hosie1,
  • Meera Agar1,
  • Elizabeth Lobb2,
  • Patricia M Davidson3,
  • Jane L Phillips1
Organisations
  • University of Technology Sydney (UTS)1,
  • Calvary Health Care Sydney2,
  • Johns Hopkins University3
Year

2016

Excerpt

Aim: To identify what is required to improve inpatient palliative care nurses’ recognition and assessment of patients with delirium.

Methods: The DePAC project used a two-phase mixed methods approach to examine delirium epidemiology, health care systems and nursing practice in palliative care inpatient settings. Phase one examined delirium epidemiology via a systematic review and cross sectional study, and organisational systems through an environmental scan. Phase two explored nurses’ delirium experiences, perceptions and capabilities using Critical Incident Technique and focus groups. Data were integrated at project conclusion.

Results: Delirium prevalence ranged internationally from 26% to 62% during admission to a palliative care unit, increasing to 88% in the last hours of life. Of 47 Australian palliative care inpatients with a mean age (SD) of 74 years (+10), one third screened positive and one in five were diagnosed with delirium in a 24- hour period. Most delirium guidelines exclude evidence and recommendations related to end‐of-life care, and delirium systems are absent within palliative care units. Nurses’ poor conceptual and diagnostic understanding of delirium and use of ambiguous terminology contributes to under-recognition and inadequate assessment. Nurses report the Nursing Delirium Screening Scale is feasible for use in specialist palliative care. Optimal recognition and assessment of delirium requires a range of actions at the patient (routine screening/assessment with low burden delirium tools), clinician (build patient rapport, engage families and strengthen interdisciplinary collaboration) and system levels (develop point-of-care guidance and implement tailored educational strategies).

Conclusion: The final integration of the DePAC project data enabled a broad understanding of the multi‐ level factors impacting on palliative care nurses’ delirium practice. Ten recommendations were made for practice, policy and research action to improve the future care of palliative care inpatients.

What is required to improve the recognition and assessment of delirium by nurses in palliative care inpatient units? (512kb pdf)