title: Reconceptualizing models of delirium education: findings of a Grounded Theory study.
abstract: BACKGROUND
  Effectiveness of educational interventions targeted at improving delirium care is limited by implementation barriers. Studying factors which shape learning needs can overcome these knowledge transfer barriers. This in-depth qualitative study explores learning needs of hospital staff relating to care needs of the confused older patients.
  
  
  METHODS
  Fifteen research participants from across the healthcare spectrum working within an acute care setting were interviewed. Five focus groups were undertaken with patients, carers, and mental health specialists. A Grounded Theory methodology was adopted and data were analyzed thematically in parallel to collection until theoretical saturation was reached.
  
  
  RESULTS
  Eight categories of practice gap emerged: ownership of the confused patient, negative attitudes, lack of understanding of how frightened the patient is in hospital, carer partnerships, person-centered care, communication, recognition of cognitive impairment and specific clinical needs (e.g. capacity assessments). Conceptually, the learning needs were found to be hierarchically related. Moreover, a vicious circle relating to the core learning needs of ownership, attitudes and patient's fear emerged. A patient with delirium may be frightened in an alien environment and then negatively labeled by staff who subsequently wish for their removal, thereby worsening the patient's fear.
  
  
  CONCLUSIONS
  These findings reconceptualize delirium education approaches suggesting a need to focus interventions on core level practice gaps. This fresh perspective on education, away from disease-based delirium knowledge toward work-based patient, team and practice knowledge, could lead to more effective educational strategies to improve delirium care.
authors.affiliation: Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom. Andrew.Teodorczuk@ncl.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Teodorczuk
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Mukaetova-Ladinska
authors.forename: Sally
authors.initials: S
authors.lastname: Corbett
authors.forename: Mark
authors.initials: M
authors.lastname: Welfare
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000193:education* / Q000523:psychology; D003693:Delirium / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010348:Patient Care Team; D036301:Qualitative Research