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How do doctors and nurses manage delirium in intensive care units? A qualitative study using focus groups
  1. Domingo Palacios-Ceña1,2,
  2. José Miguel Cachón-Pérez3,
  3. Rosa Martínez-Piedrola1,
  4. Javier Gueita-Rodriguez1,
  5. Marta Perez-de-Heredia1,
  6. Cesar Fernández-de-las-Peñas1
  1. 1Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon/Madrid, Spain
  2. 2Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Universidad Rey Juan Carlos, Alcorcon/Madrid, Spain).
  3. 3Department of Nursing, Universidad Europea de Madrid, Villaviciosa de Oon, Spain
  1. Correspondence to Dr Domingo Palacios-Ceña; domingo.palacios{at}urjc.es

Abstract

Objectives The aim of this study was to explore the experiences of doctors and nurses caring for patients with delirium in the intensive care unit (ICU) and to describe the process of delirium management.

Setting This study was performed in 5 ICUs located within 4 hospitals in Madrid (Spain).

Participants Purposeful sampling was performed which included (1) doctors and nurses working in ICUs, (2) with >1 year experience in the ICU and (3) clinical experience with delirium. 38 professionals participated (19 doctors, 19 nurses), including 22 women and 16 men. The total mean age was 39 years.

Design A qualitative study using focus groups.

Methods 7 focus groups were held to collect data: 3 nurse focus groups, 3 doctor focus groups and 1 mixed focus group. Each group comprised 6–10 participants. A semistructured questions guide was used. Thematic analysis methods were used to analyse the data.

Results 3 themes were identified: (1) the professional perspective on delirium; (2) implementing pharmacological and non-pharmacological treatment for delirium and (3) work organisation in the ICU. The professionals regarded patients with delirium with uncertainty, and felt they were often underdiagnosed and poorly managed. Doctors displayed discrepancies regarding pharmacological prescriptions and decision-making. The choice of medication was determined by experience. Nurses felt that, for many doctors, delirium was not considered a matter of urgency in the ICU. Nurses encountered difficulties when applying verbal restraint, managing sleep disorders and providing early mobilisation. The lack of a delirium protocol generates conflicts regarding what type of care management to apply, especially during the night shift. A degree of group pressure exists which, in turn, influences the decision-making process and patient care.

Conclusions Patients with delirium represent complex cases, requiring the implementation of specific protocols. These results serve to improve the process of care in patients with delirium.

  • INTENSIVE & CRITICAL CARE
  • QUALITATIVE RESEARCH
  • HEALTH SERVICES ADMINISTRATION & MANAGEMENT

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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