Annmarie Hosie1, Meera Agar2, Elizabeth Lobb3, Patricia M Davidson4, Jane Phillips2. 1. IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney (UTS), Faculty of Health Building 10, Level 3, 235-253 Jones St, Ultimo, NSW 2007, Australia. Electronic address: annmarie.hosie@uts.edu.au. 2. IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney (UTS), Faculty of Health Building 10, Level 3, 235-253 Jones St, Ultimo, NSW 2007, Australia. 3. Calvary Health Care Sydney, Palliative Care Department, 91-111 Rocky Point Rd, Kogarah, NSW 2217, Australia. 4. Johns Hopkins University, School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States.
Abstract
BACKGROUND: Delirium is a serious acute neurocognitive condition frequently occurring for hospitalized patients, including those receiving care in specialist palliative care units. There are many delirium evidence-practice gaps in palliative care, including that the condition is under-recognized and challenging to assess. OBJECTIVES: To report the meta-synthesis of a research project investigating delirium epidemiology, systems and nursing practice in palliative care units. METHODS: The Delirium in Palliative Care (DePAC) project was a two-phase sequential transformative mixed methods design with knowledge translation as the theoretical framework. The project answered five different research questions about delirium epidemiology, systems of care and nursing practice in palliative care units. Data integration and metasynthesis occurred at project conclusion. RESULTS: There was a moderate to high rate of delirium occurrence in palliative care unit populations; and palliative care nurses had unmet delirium knowledge needs and worked within systems and team processes that were inadequate for delirium recognition and assessment. The meta-inference of the DePAC project was that a widely-held but paradoxical view that palliative care and dying patients are different from the wider hospital population has separated them from the overall generation of delirium evidence, and contributed to the extent of practice deficiencies in palliative care units. CONCLUSION: Improving palliative care nurses' capabilities to recognize and assess delirium will require action at the patient and family, nurse, team and system levels. A broader, hospital-wide perspective would accelerate implementation of evidence-based delirium care for people receiving palliative care, both in specialist units, and the wider hospital setting.
BACKGROUND:Delirium is a serious acute neurocognitive condition frequently occurring for hospitalized patients, including those receiving care in specialist palliative care units. There are many delirium evidence-practice gaps in palliative care, including that the condition is under-recognized and challenging to assess. OBJECTIVES: To report the meta-synthesis of a research project investigating delirium epidemiology, systems and nursing practice in palliative care units. METHODS: The Delirium in Palliative Care (DePAC) project was a two-phase sequential transformative mixed methods design with knowledge translation as the theoretical framework. The project answered five different research questions about delirium epidemiology, systems of care and nursing practice in palliative care units. Data integration and metasynthesis occurred at project conclusion. RESULTS: There was a moderate to high rate of delirium occurrence in palliative care unit populations; and palliative care nurses had unmet delirium knowledge needs and worked within systems and team processes that were inadequate for delirium recognition and assessment. The meta-inference of the DePAC project was that a widely-held but paradoxical view that palliative care and dying patients are different from the wider hospital population has separated them from the overall generation of delirium evidence, and contributed to the extent of practice deficiencies in palliative care units. CONCLUSION: Improving palliative care nurses' capabilities to recognize and assess delirium will require action at the patient and family, nurse, team and system levels. A broader, hospital-wide perspective would accelerate implementation of evidence-based delirium care for people receiving palliative care, both in specialist units, and the wider hospital setting.
Authors: Annmarie Hosie; Jane Phillips; Lawrence Lam; Slavica Kochovska; Beverly Noble; Meg Brassil; Susan E Kurrle; Anne Cumming; Gideon A Caplan; Richard Chye; Brian Le; E Wesley Ely; Peter G Lawlor; Shirley H Bush; Jan Maree Davis; Melanie Lovell; Linda Brown; Belinda Fazekas; Seong Leang Cheah; Layla Edwards; Meera Agar Journal: BMJ Open Date: 2019-01-28 Impact factor: 3.006
Authors: Mary Godfrey; John Green; Jane Smith; Francine Cheater; Sharon K Inouye; Keith Hurst; John Young Journal: BMC Geriatr Date: 2019-12-31 Impact factor: 3.921