title: Making decisions about delirium: a qualitative comparison of decision making between nurses working in palliative care, aged care, aged care psychiatry, and oncology.
abstract: BACKGROUND
  Delirium has a significant impact on nursing practice from diagnosis and management, with under-detection and variable management of delirium being international problems. This study aimed to explore nurses' assessment and management of delirium when caring for people with cancer, the elderly or older people requiring psychiatric care in the inpatient setting.
  
  
  METHODS
  Participants in this qualitative study were nurses working in Australian public hospital inpatient dedicated units in palliative care, aged care (geriatrics), aged care (geriatric) psychiatry and oncology. Semi-structured interviews were used to explore nurses' views about specific areas of delirium assessment and management. Purposive sampling was used and interviews conducted until thematic saturation reached. A thematic content analysis was performed from a grounded theory perspective.
  
  
  RESULTS
  A total of 40 participants were included in the study. The analysis revealed four broad analytical themes: (1) superficial recognition and understanding of the operational definition of delirium or recognition of delirium as a syndrome; (2) nursing assessment: investigative versus a problem solving approach; (3) management: maintaining dignity and minimizing chaos; and (4) distress and the effect on others.
  
  
  CONCLUSIONS
  Nurses have limited knowledge of the features of delirium regardless of their specialty discipline. Delirium was uniformly identified as a highly distressing experience for patients, families and staff alike. The majority of nurses had a superficial understanding of delirium management, and adopted a task-orientated approach aimed at addressing the more noticeable problems. These findings have implications for both education and knowledge translation. Innovative approaches are needed to align health professional behaviours with best evidence delirium care.
authors: Discipline of Palliative and Supportive Services, Flinders University, Adelaide, Australia. meera.agar@sswahs.nsw.gov.au
authors: M
authors: M
authors: Agar
authors: B
authors: B
authors: Draper
authors: P A
authors: PA
authors: Phillips
authors: J
authors: J
authors: Phillips
authors: A
authors: A
authors: Collier
authors: J
authors: J
authors: Harlum
authors: D
authors: D
authors: Currow
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D003657:Decision Making; D003693:Delirium / Q000451:nursing*; D005260:Female; D005851:Geriatric Nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009740:Nursing Staff / Q000523:psychology*; D009859:Oncology Nursing; D010166:Palliative Care; D011568:Psychiatric Nursing; D036301:Qualitative Research; D055815:Young Adult