A Qualitative Study to Explore Delirium Management and Capability Building in Nurses Caring for Older Patients With Complex Care Needs in the Acute Hospital Setting

BACKGROUND: Nurse-led strategies are important for preventing delirium and minimising its consequences when it occurs. Expertise in managing behavioural disturbances not only ensures safe care but also provides opportunities to mentor novice nurses. It is, however, important to know more about nurses' experiences caring for people with delirium to improve support for nurses caring for patients with complex care needs. AIMS: To explore the experience of nursing patients with delirium in the acute hospital setting. DESIGN: Descriptive qualitative study. METHODS: Nurses from two acute aged health wards in a Sydney metropolitan tertiary hospital participated in a semi-structured interview. Eleven interviews were recorded and transcribed verbatim. Data were qualitatively analysed by directed content analytical method using human factors principles as an interpretative lens. FINDINGS: The interaction of multiple human factors was identified under the 'people', 'management' and 'workplace' framework. Participants identified barriers to delirium management, such as inadequate workforce capability and limited opportunities for novice nurses to develop expertise in delirium management, deficiencies in the environment and information technology and inflexible roles within the multidisciplinary team, leading to a high burden of care for nurses. Most had experienced difficulties delivering patient and family-centred care stemming from excessive workloads and a lack of structured mentorship. CONCLUSION: Our study identified substantial challenges faced by nurses caring for patients with delirium in the acute care setting. It also highlighted the complexity of delirium care and the importance of clinical expertise, skills development and the capacity for nurses to mentor other nurses. IMPLICATIONS: Healthcare organizations need to ensure that nurses with expertise in the care of older patients with complex care needs are available to provide comprehensive, patient- and family-centred care and provide mentorship and support to less experienced nurses. Interdisciplinary workforce capability building should be a priority. IMPACT: This study contributes to addressing the multidisciplinary management of patients with delirium in acute settings. The study found that delirium management is complex and requires a multidisciplinary workforce with knowledge, skills and adequate numbers. This research will have an impact on clinicians and health services managers in tailoring the care of patients and supporting the workforce. REPORTING METHOD: Adherence to the COREQ Checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.