Chasing the Mirage: a grounded theory of the clinical reasoning processes that Registered Nurses use to recognize delirium.
OBJECTIVE
The aim of this study was to construct a grounded theory that explains the clinical reasoning processes that registered nurses use to recognize delirium in older adults in acute care hospitals.


BACKGROUND
Delirium is under-recognized in acute hospital settings, this may stem from underdeveloped clinical reasoning processes. Little is known about registered nurses' (RNs) clinical reasoning processes in complex situations such as delirium recognition.


METHODS
A grounded theory approach was used to analyse interview data about the clinical reasoning processes of RNs in acute hospital settings.


METHODS
Seventeen RNs were recruited. Concurrent data collection and comparative analysis and theoretical sampling were conducted in 2013-2014.


RESULTS
The core category to emerge from the data was 'chasing the mirage', which describes RNs' clinical reasoning processes to recognize delirium during their interaction with older adults.


CONCLUSIONS
Understanding the reasoning that contributes to delirium under-recognition provides a strategy by which, this problem can be brought to the forefront of RNs' awareness and intervention. Delirium recognition will contribute to quality care for older adults.
Faculty of Health & Community Studies, School of Nursing, Mount Royal University, Calgary, Alberta, Canada.
Mohamed
M
El Hussein
Faculty of Nursing, University of Calgary, Alberta, Canada.
Sandra
S
Hirst
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D002983:Clinical Competence; D064648:Critical Care Nursing / Q000379:methods*; D003693:Delirium / Q000175:diagnosis* / Q000451:nursing*; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D009732:Nursing Care / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D013850:Thinking
acute care; clinical reasoning; delirium; grounded theory; nursing; recognition