title: Identifying the barriers and enablers to palliative care nurses' recognition and assessment of delirium symptoms: a qualitative study.
abstract: BACKGROUND
  Delirium is underrecognized by nurses, including those working in palliative care settings where the syndrome occurs frequently. Identifying contextual factors that support and/or hinder palliative care nurses' delirium recognition and assessment capabilities is crucial, to inform development of clinical practice and systems aimed at improving patients' delirium outcomes.
  
  
  OBJECTIVE
  The aim of the study was to identify nurses' perceptions of the barriers and enablers to recognizing and assessing delirium symptoms in palliative care inpatient settings.
  
  
  METHODS
  A series of semistructured interviews, guided by critical incident technique, were conducted with nurses working in Australian palliative care inpatient settings. A hypoactive delirium vignette prompted participants' recall of delirium and identification of the perceived factors (barriers and enablers) that impacted on their delirium recognition and assessment capabilities. Thematic content analysis was used to analyze the qualitative data.
  
  
  RESULTS
  Thirty participants from nine palliative care services provided insights into the barriers and enablers of delirium recognition and assessment in the inpatient setting that were categorized as patient and family, health professional, and system level factors. Analysis revealed five themes, each reflecting both identified barriers and current and/or potential enablers: 1) value in listening to patients and engaging families, 2) assessment is integrated with care delivery, 3) respecting and integrating nurses' observations, 4) addressing nurses' delirium knowledge needs, and 5) integrating delirium recognition and assessment processes.
  
  
  CONCLUSIONS
  Supporting the development of palliative care nursing delirium recognition and assessment practice requires attending to a range of barriers and enablers at the patient and family, health professional, and system levels.
authors.affiliation: School of Nursing, The University of Notre Dame, Sydney, Darlinghurst, New South Wales, Australia. Electronic address: annmarie.hosie1@my.nd.edu.au.
authors.forename: Annmarie
authors.initials: A
authors.lastname: Hosie
authors.affiliation: School of Nursing, The University of Notre Dame, Sydney, Darlinghurst, New South Wales, Australia; Palliative Care Department, Calvary Health Care Sydney, Kogarah, New South Wales, Australia; Cunningham Centre for Palliative Care, Sacred Heart Hospice, St. Vincent's Health Network, Darlinghurst, New South Wales, Australia; ImPaCCT: Improving Palliative Care through Clinical Trials (New South Wales Palliative Care Clinical Trials Group), South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lobb
authors.affiliation: ImPaCCT: Improving Palliative Care through Clinical Trials (New South Wales Palliative Care Clinical Trials Group), South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Department of Palliative Care, Braeside Hospital, HammondCare, Prairiewood, New South Wales, Australia; Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Meera
authors.initials: M
authors.lastname: Agar
authors.affiliation: ImPaCCT: Improving Palliative Care through Clinical Trials (New South Wales Palliative Care Clinical Trials Group), South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Faculty of Health, University of Technology, Broadway, New South Wales.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.affiliation: School of Nursing, The University of Notre Dame, Sydney, Darlinghurst, New South Wales, Australia; Cunningham Centre for Palliative Care, Sacred Heart Hospice, St. Vincent's Health Network, Darlinghurst, New South Wales, Australia; ImPaCCT: Improving Palliative Care through Clinical Trials (New South Wales Palliative Care Clinical Trials Group), South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D064946:Hospice and Palliative Care Nursing / Q000379:methods*; D006801:Humans; D007297:Inpatients; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D021641:Recognition, Psychology; D055815:Young Adult
keywords: Assessment; delirium; inpatient; nursing; palliative care; screening; systems