ResultsThe uncharacteristic behaviours and cognitive changes that accompany delirium may estrange family who, despite the older person's corporeal presence, sense the profound absence or loss of their loved one. The findings from two qualitative research studies about family experiences during an older loved one's delirium are discussed in relation to the concepts of absence and nondeath loss. experiences of family during an older loved one's delirium, an acute condition accompanied by marked changes in demeanour, have received little consideration. Backgroundįamilies who care for older people with chronic illnesses experience many losses. Read moreĪims and objectivesTo examine qualitative research findings about family experiences of absence or loss during older person delirium, and provide a critical discussion of the similarities and differences in these experiences with conceptual understandings of absence and loss. A larger study is being planned across a variety of settings. Two significant actions towards practice improvement were undertaken by this PAR group: (i) development of a draft delirium alert prevention protocol and (ii) a separate section of the ward became a dedicated space for the care of patients with delirium. Clinicians perceived that management driven by length of a patient’s stay was incongruent with best practice delirium care which required more time for older patients to recover from delirium. A wide range of assessment skills was identified as prerequisites for working in this acute care ward, with older people and delirium. Underreporting of delirium and attributing confusion to dementia was viewed as an education deficit across disciplines. The following constraints to best practice were identified: delayed transfer of patients from the Emergency Department routine ward activities were not conducive to provision of rest and sleep assisting with the patient’s orientation was not possible as relatives were not able to accompany and/or stay with the older patient. Following PAR group debate about concerns and issues, there were actions toward improved practice taken by clinicians. Stories were analysed to identify constraints to best practice. Clinicians described care of patients with delirium. Thirteen PAR sessions were held over 5 months. The PAR group comprised research academics and eight clinicians from the ward. best approach for involving ward staff to make sustainable clinical practice decisions. Participatory action research (PAR) was selected as the. To explore ways health practitioners might redesign their practice to include prevention, early detection and management of delirium in older people based on the best current practice. Read moreĪn Australian research team conducted a six-month acute care pilot study in a medical ward of a large hospital in New South Wales.Īim. We are confident that working collaboratively with practitioners is the way to bring evidence to practice in delirium care for older people in acute care settings. The strategy of raising the awareness of delirium in older people was successful. Whilst there continued to be older people admitted with a diagnosis of delirium, there were fewer incidences of delirium developing on the ward and there was less disruption to other patients, especially at night. The nurse manager reported that early detection strategies had prevented episodes of acute hyperactive delirium.

Physical and chemical restraints had not been used for 3 months subsequent to the study's completion.

There was evidence that practice had changed. A delirium alert protocol was developed for implementation by the clinicians and later evaluation as a separate study. Raising awareness about delirium and its prevention were the selected action strategies. Clinicians set the agenda for redesign of practice. Eight volunteer clinicians and three researchers met weekly as a group for 13 sessions over 6 months. Delirium and the high percentage of older people who succumb to this condition was the main practice problem requiring a response. PAR is a process in which 'we', researchers and participants, systematically work together in cycles of 'looking, thinking and acting'. We selected Participatory Action Research (PAR) as the methodology to involve health practitioners in practice redesign. To collaboratively explore ways in which clinical practice could be improved. hospitalised older people signalled a major practice problem.

Lack of recognition, underreporting and inadequate care responses to delirium in. The problem drawn to the attention of researchers was that approximately 60% of older people were delirious on arrival or develop incident delirium during their hospital stay. In 2007 three researchers completed a 6-month study in one 32-bed acute care medical ward in a large hospital in New South Wales, Australia.

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