The impact of containment strategies on nurses caring for patients with delirium during the COVID-19 pandemic

Background: The COVID-19 pandemic changed the care of older patients in hospitals, whether it was for COVID-19 or another reason for admission. Patients with delirium posed additional challenges to clinicians, particularly because they were in isolation and the family was unable to be present due to the rapidly implemented and strictly enforced infection control measures. Objectives/Aims: To explore nurses’ experiences of caring for patients with delirium in an Australian acute care setting, with a focus on how infection prevention and control measures implemented in response to the COVID-19 pandemic impacted clinicians. Design: Descriptive qualitative study. Nurses from two acute aged care wards in a Sydney metropolitan tertiary hospital were invited to participate in semi-structured interviews to explore their overall experience of nursing patients with delirium. Eleven interviews were recorded and transcribed verbatim. Data were analysed qualitatively using human factors principles as an analytical lens. Experiences related to COVID-19 were extracted from the data. Findings: Participants experienced difficulties delivering patient-centred care, as the presence of family was restricted due to the public health orders and infection prevention and control policies imposed in hospitals. Enforcing isolation and excluding the family resulted in care failing to meet nurses’ expected standards, with additional challenges in care provision and communication. Conclusion: Nurses described an overwhelming sense of responsibility and moral injuries. The advice to place patients with delirium in isolation was inconsistent with the national delirium clinical care standard. A deeper understanding of the complexity and barriers to managing delirium during a pandemic, where rapid and, at times, conflicting information was available, is needed. These findings will contribute to informing the implementation of controls in the event of future responses, including workforce preparation and support.