title: Nurse perceptions of the Nursing Delirium Screening Scale in two palliative care inpatient units: a focus group study.
abstract: OBJECTIVE
  To explore nurse perceptions of the feasibility of integrating the Nursing Delirium Screening Scale into practice within the inpatient palliative care setting.
  
  
  BACKGROUND
  Delirium occurs frequently in palliative care inpatient populations, yet is under-recognised. Exploring feasibility of delirium screening tools in this setting can provide insights into how recognition can be improved.
  
  
  METHODS
  This was a qualitative study using a focus group methodology.
  
  
  METHODS
  Four semi-structured focus groups were conducted with 21 nurses working in two Australian palliative care units. Focus groups were digitally recorded and transcribed verbatim. Thematic content analysis was used to analyse the data.
  
  
  RESULTS
  Three major themes were identified: (1) Delirium screening using the Nursing Delirium Screening Scale is feasible, but then what? (2) Nuances, ambiguity and clinical complexity; and (3) Implementing structured processes requires firmer foundations. Themes describe how nurses perceived the Nursing Delirium Screening Scale to be an easy and brief screening tool which raised their awareness of delirium. They were largely willing to adopt it into practice, yet had uncertainty and misunderstandings of the tool specifically and delirium screening generally, application in a palliative care context, interventions for delirium and impact of screening on medical practice.
  
  
  CONCLUSIONS
  The Nursing Delirium Screening Scale is feasible for use in a palliative care inpatient setting, but requires investigation of its psychometric properties before routine use in this patient population.
  
  
  CONCLUSIONS
  Nurses require understanding of delirium, tailored guidance and a united approach with doctors to support their effective use of a delirium screening tool in the palliative care unit. Delirium practice change in this setting will also require nurses to become more active leaders and collaborators within their interdisciplinary teams.
authors.affiliation: School of Nursing, The University of Notre Dame Australia, Darlinghurst, NSW, Australia.|Faculty of Health, University of Technology Sydney, Darlinghurst, NSW, Australia.
authors.forename: Annmarie
authors.identifier: http://orcid.org/0000-0003-1674-2124
authors.initials: A
authors.lastname: Hosie
authors.affiliation: Palliative Care Department, Calvary Health Care Sydney, Kogarah, NSW, Australia.|Cunningham Centre for Palliative Care, Sacred Heart Hospice, St Vincent's Health Network, Darlinghurst, NSW, Australia.|ImPaCCT: Improving Palliative Care through Clinical Trials (New South Wales Palliative Care Clinical Trials Group), Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, 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), Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia.|Department of Palliative Care, Braeside Hospital, HammondCare, Prairiewood, NSW, Australia.|Palliative and Supportive Services, Flinders University, Adelaide, SA, 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), Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia.|School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.affiliation: Cunningham Centre for Palliative Care, Sacred Heart Hospice, St Vincent's Health Network, Darlinghurst, NSW, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Chye
authors.affiliation: ImPaCCT: Improving Palliative Care through Clinical Trials (New South Wales Palliative Care Clinical Trials Group), Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia.|Centre for Cardiovascular and Chronic Care, University of Technology, Broadway, NSW, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003693:Delirium / Q000451:nursing*; D005260:Female; D017144:Focus Groups; D006299:Health Services for the Aged; D064946:Hospice and Palliative Care Nursing; D006801:Humans; D007297:Inpatients; D008297:Male; D009517:New South Wales; D009733:Nursing Diagnosis; D011594:Psychometrics; D012720:Severity of Illness Index
keywords: assessment; delirium; focus group; hospitalised patients; nursing; palliative care; screening tools