Abstract
Delirium is associated with increased mortality, morbidity, and length of hospital stay. In the acute stroke setting, delirium identification is challenging due to the complexity of cognitive screening in this patient group. The aim of this study was to explore how members of interprofessional stroke-unit teams identified and responded to a potential delirium in a patient. Online focus groups and interviews utilizing case vignettes were conducted with 15 participants: nurses, occupational therapists, speech and language therapists, and physiotherapists working in acute stroke services. Participants’ understandings of delirium varied, most participants did not identify the symptoms of a possible hypoactive delirium, and nearly all participants discussed delirium symptoms in tentative terms. Aspects of interprofessional working were discussed through the expression of distinct roles around delirium identification. Although participants demonstrated an ethos of person-focused care, there are ongoing challenges involved in early identification and management of delirium in stroke survivors.
Highlights
Delirium is a complex neuropsychiatric condition characterized by acute onset and fluctuating disturbance of attention, cognition, perception, motor behavior and sleep-wake patterns (American Psychiatric Association, 2013)
We set out to explore the ways in which clinicians working in interprofessional stroke-unit teams understood and would respond to potential delirium in stroke survivors
Whilst the present study was not concerned with delirium education per se, elements of this emerged from our findings
Summary
Delirium is a complex neuropsychiatric condition characterized by acute onset and fluctuating disturbance of attention, cognition, perception, motor behavior and sleep-wake patterns (American Psychiatric Association, 2013). Delirium can present as either hyperactive, hypoactive or an unpredictable fluctuation between the two. Stroke survivors often possess a number of the risk factors associated with developing delirium (Oldenbeuvinget al., 2014), it is found to affect 26%-28% of patients in the acute stroke setting (Carin-Levy et al, 2012; Shiet al., 2012). Stroke survivors who develop delirium are affected by significantly poorer outcomes compared with patients who do not: increased 12-month mortality, poorer functional outcomes and an increased risk of developing dementia (Carin-Levy et al, 2012; Shi et al, 2012)
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