The Development of a Care Model for Elderly Patients with Delirium-like Symptoms in General Hospitals

本研究旨在建立一种老年谵妄样症状住院患者的急性护理模式。该研究是与一家私立综合医院的护士合作进行的。在1996学年，我们总结了一项关于一家私立综合医院谵妄患者实际情况的研究结果（从1995学年开始）。我们分析了谵妄症状出现和消失的主要因素。我们还对160名护士进行了问卷调查，了解他们对谵妄的看法和他们所提供的护理。本调查显示谵妄患者护理的重要因素包括确保安全、沟通、观察、刺激和日常生活节奏。研究结果于1996年1月在日本老年护理学会1^<st>科学会议上发表。在1997学年，我们研究了有关谵妄的评估和护理计划的文献。基于我们的研究，我们考虑了护理模式的内容和结构。我们制定了“谵妄护理模式的建议”，以澄清如何确定谵妄的存在，以及如何处理和区分谵妄的原因。该建议包括谵妄评定量表，原因信息，以及急性和预防性护理指南。该模型旨在作为护士在临床环境中做出决定和采取行动的指导方针。为了提高护理模型的内容效度，我们分析了实际使用该模型的案例，并获得了专家和临床护士对该模型的评价。根据上述结果，我们对模型进行了修正，并设计了“谵妄护理模型”。

This research aims at developing an acute care model for elderly patients hospitalized with delirium-like symptoms. The research was carried out in cooperation with nurses in a private general hospital.In the 1996 academic year, we summarized the results of a study (from the 1995 academic year) on the actual conditions of patients with delirium in a private general hospital. We analyzed the primary factors in the appearance and disappearance of symptoms of delirium. We also conducted a questionnaire survey of 160 nurses on their perception of delirium and the care they are delivering. This survey showed that important factors in the care of patients with delirium include securing safety, communication, observation, stimulation and the rhythm of daily life. The results were presented at the 1^<st> Scientific Meeting of the Japan Academy of Gerontological Nursing (January, 1996).In the 1997 academic year, we examined the literature on the assessment of and care plans for delirium. We considered the content and structure of a care model based on our studies. We developed "a Proposal for a Care Model of Delirium"to clarify how to determine the pressence of delirium, and how to deal with and distinguish the causes of delirium. This proposal includes a delirium rating scale, information on causes, and guidelines for acute and preventive care.The model is intended as a guideline for nurses in a clinical setting for making decisions and taking action. In order to increase the content validity of the care model, we analyzed case studies in which the model was actually used, and obtained evaluations of the model from specialists and clinical nurses. We revised the model based on the above results and devised the "Care Model for Delirium".