Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives.
Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives.
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DOI：
10.1186/s12913-023-09681-4
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发表时间：
2023-06-29
影响因子：
2.8
通讯作者：
Vlisides, Phillip E.
中科院分区：
文献类型：
--
作者：
Ragheb, Jacqueline;Norcott, Alexandra;Benn, Lakeshia;Shah, Nirav;McKinney, Amy;Min, Lillian;Vlisides, Phillip E.
住院患者的谵妄是一个主要的公共卫生问题，但谵妄往往是不认识的，在住院期间错过。本研究的目的是确定障碍谵妄筛查，识别和管理从护理的角度对住院，急性监护病房。这是一项实施前的诊断评估研究，旨在确定当前的实践模式和潜在的障碍，以优化一家大型大学医院的谵妄护理。定性的方法，其中包括重点小组的住院护士工作的主要内科和外科急症室。焦点小组进行，直到出现主题饱和的迹象，并通过归纳主题分析，没有预定的理论或结构的数据进行了分析。一个共识的方法被用于转录本编码，最终的主题后，对转录本数据集的初始主题的多次审查产生。与两个主要住院病房的18名护士举行了焦点小组会议（n = 3）。护士报告了成功进行谵妄筛查和管理的几个障碍。具体的挑战包括难以使用谵妄筛查工具，不利于谵妄预防的组织文化，以及相互竞争的临床优先事项。还讨论了拟议的解决方案，包括决策支持系统与自动寻呼机警报和相关的谵妄顺序集，这可能有助于改善谵妄护理的协调和标准化。在一所主要的大学医院，护士肯定了谵妄筛查和识别的困难，特别是由于筛查工具的挑战，文化障碍和临床工作量。这些障碍可以作为未来实施试验的目标，以改善谵妄筛查和管理。在线版本包含补充材料，可通过10.1186/s12913-023-09681-4获得。
Delirium in hospitalized patients is a major public health issue, yet delirium is often unrecognized and missed during inpatient admission. The objective of this study was to identify barriers to delirium screening, identification, and management from a nursing perspective on inpatient, acute care units. This was a pre-implementation, diagnostic evaluation study to determine current practice patterns and potential barriers to optimizing delirium care at a major university hospital. A qualitative approach was used, which included focus groups of inpatient nurses working on major medical and surgical acute care units. Focus groups were conducted until signs of thematic saturation were present, and data were analyzed via inductive thematic analysis, without predetermined theories or structures. A consensus approach was utilized for transcript coding, and final themes were generated after multiple reviews of initial themes against transcript datasets. Focus group sessions (n = 3) were held with 18 nurses across two major inpatient units. Nurses reported several barriers to successful delirium screening and management. Specific challenges included difficulty with using delirium screening tools, an organizational culture not conducive to delirium prevention, and competing clinical priorities. Proposed solutions were also discussed, including decision-support systems with automated pager alerts and associated delirium order sets, which may help improve delirium care coordination and standardization. At a major university hospital, nurses affirm the difficulty experienced with delirium screening and identification, particularly due to screening tool challenges, cultural barriers, and clinical workload. These impediments may serve as targets for a future implementation trial to improve delirium screening and management. The online version contains supplementary material available at 10.1186/s12913-023-09681-4.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
影响因子：
9
作者：
Hshieh TT;Saczynski J;Gou RY;Marcantonio E;Jones RN;Schmitt E;Cooper Z;Ayres D;Wright J;Travison TG;Inouye SK;SAGES Study Group
通讯作者：
SAGES Study Group
影响因子：
5.7
作者：
Stetler, CB;Legro, MW;Smith, JL
通讯作者：
Smith, JL
影响因子：
16.9
作者：
Gleason LJ;Schmitt EM;Kosar CM;Tabloski P;Saczynski JS;Robinson T;Cooper Z;Rogers SO Jr;Jones RN;Marcantonio ER;Inouye SK
通讯作者：
Inouye SK