Emergency medical service, nursing, and physician providers' perspectives on delirium identification and management.
Emergency medical service, nursing, and physician providers' perspectives on delirium identification and management.
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DOI：
10.1177/1471301215591896
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发表时间：
2017-04
期刊：
影响因子：
--
通讯作者：
Miller DK
中科院分区：
文献类型：
--
作者：
LaMantia MA;Messina FC;Jhanji S;Nazir A;Maina M;McGuire S;Hobgood CD;Miller DK
本研究的目的是了解供应商的看法，关于识别和治疗老年人谵妄，一种常见的并发症，急性疾病的人与痴呆症，在院前和急诊室（艾德）的环境。作者对不同的急诊医疗服务（EMS）工作人员、急诊护士和急诊医生进行了结构化的焦点小组访谈。每次会议的录音都被转录，编码和分析的主题与代表性的支持报价确定。提供者分享说，忙碌的艾德环境是谵妄识别和治疗的最大挑战。在描述谵妄时，参与者经常详细描述谵妄的过度活跃特征，而不是活动减退特征。参与者分享说，他们没有采用明确的诊断策略来识别这种疾病，他们使用了不同的方法来治疗这种疾病。为了改善对老年谵妄患者的护理，急诊护士认为需要更多的培训来管理病情。EMS提供商认为，在送往医院的途中，需要更多支持来管理激动的患者，并需要急诊医生提供更多关于从患者家庭环境中收集哪些信息的指导。急诊医生认为，如果他们能够获得患者的基线精神状态数据，如果他们能够获得简单，准确的诊断工具，谵妄护理将得到改善。EMS提供者，急诊护士和急诊医生经常遇到谵妄患者，但没有采用明确的诊断策略来识别病情，并且在管理病情时有不同程度的舒适度。应采取明确的措施，以改善谵妄护理的艾德，包括机制的发展，沟通患者的基线精神状态，采用系统化的方法来识别谵妄，并制定一个标准化的方法来治疗的条件时，确定。
The study objective was to understand providers’ perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department (ED) environments. The authors conducted structured focus group interviews with separate groups of emergency medical services (EMS) staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Providers shared that the busy ED environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. EMS providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient’s home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. EMS providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the ED including the development of mechanisms to communicate patients’ baseline mental status, the adoption of a systematized approach to recognizing delirium, and the institution of a standardized method to treat the condition when identified.
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影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
DOI：
10.1056/nejmoa1301372
发表时间：
2013-10-03
期刊：
The New England journal of medicine
影响因子：
--
作者：
Pandharipande PP;Girard TD;Jackson JC;Morandi A;Thompson JL;Pun BT;Brummel NE;Hughes CG;Vasilevskis EE;Shintani AK;Moons KG;Geevarghese SK;Canonico A;Hopkins RO;Bernard GR;Dittus RS;Ely EW;BRAIN-ICU Study Investigators
通讯作者：
BRAIN-ICU Study Investigators
影响因子：
6.2
作者：
Chisholm, Carey D.;Weaver, Christopher S.;Brizendine, Edward J.
通讯作者：
Brizendine, Edward J.
DOI：
10.1093/gerona/62.2.174
发表时间：
2007-02-01
影响因子：
5.1
作者：
Kiely, Dan K.;Jones, Richard N.;Marcantonio, Edward R.
通讯作者：
Marcantonio, Edward R.
影响因子：
5.7
作者：
Callahan, CM;Dittus, RS;Tierney, WM
通讯作者：
Tierney, WM