Nurses' experiences of caring for older patients afflicted by delirium in a neurological department.

Abstract

To investigate nurses' experiences of caring for older (65+ years) patients afflicted by delirium in a neurological department. Delirium is a frequent, acute and potentially fatal condition. Patients experience delirium as painful and stressful. The literature shows that nursing care is crucial in the prevention and treatment of delirium. The nurses' approach to the patient with delirium is essential for the quality of care provided to the patient. A qualitative, exploratory design was used to study the nurses' experiences of caring for patients afflicted by delirium. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). A total of fourteen nurses participated in three focus groups. The nurses' narratives were used to elucidate their experiences, perceptions, attitudes and views towards the patient with delirium. The texts were analysed using thematic analysis. The analysis revealed three themes: The relationship with the patient is challenged, expertise is requested, and barriers to cooperation exist. Nurses experienced a relationship with patients with delirium that was influenced by a lack of knowledge about communication with such patients. This resulted in a lack of person-centred care and knowledge about the patient's habitual condition and life story; hence, nurses did not discover the patient's initial delirium. Inadequate and unstructured documentation did the nursing effort initiated late so the patient's delirium was developing. Uncertainty caused lack of dialogue between nurses, which afflicted the partnership and relation between the patient and the nurse. A fast pace workload affected relationships, knowledge, documentation and collaboration. Thus, the person-centred approach to the patient was challenged, which made the provision of professional nursing care difficult. A continuous focus on patients with delirium, as well as specialised care, based on factual knowledge about delirium is necessary. Hence, communication skills are required to accommodate this group of patients and their need for care.