Developing and implementing an integrated delirium prevention system of care: a theory driven, participatory research study
نویسندگان
چکیده
BACKGROUND Delirium is a common complication for older people in hospital. Evidence suggests that delirium incidence in hospital may be reduced by about a third through a multi-component intervention targeted at known modifiable risk factors. We describe the research design and conceptual framework underpinning it that informed the development of a novel delirium prevention system of care for acute hospital wards. Particular focus of the study was on developing an implementation process aimed at embedding practice change within routine care delivery. METHODS We adopted a participatory action research approach involving staff, volunteers, and patient and carer representatives in three northern NHS Trusts in England. We employed Normalization Process Theory to explore knowledge and ward practices on delirium and delirium prevention. We established a Development Team in each Trust comprising senior and frontline staff from selected wards, and others with a potential role or interest in delirium prevention. Data collection included facilitated workshops, relevant documents/records, qualitative one-to-one interviews and focus groups with multiple stakeholders and observation of ward practices. We used grounded theory strategies in analysing and synthesising data. RESULTS Awareness of delirium was variable among staff with no attention on delirium prevention at any level; delirium prevention was typically neither understood nor perceived as meaningful. The busy, chaotic and challenging ward life rhythm focused primarily on diagnostics, clinical observations and treatment. Ward practices pertinent to delirium prevention were undertaken inconsistently. Staff welcomed the possibility of volunteers being engaged in delirium prevention work, but existing systems for volunteer support were viewed as a barrier. Our evolving conception of an integrated model of delirium prevention presented major implementation challenges flowing from minimal understanding of delirium prevention and securing engagement of volunteers alongside practice change. The resulting Prevention of Delirium (POD) Programme combines a multi-component delirium prevention and implementation process, incorporating systems and mechanisms to introduce and embed delirium prevention into routine ward practices. CONCLUSIONS Although our substantive interest was in delirium prevention, the conceptual and methodological strategies pursued have implications for implementing and sustaining practice and service improvements more broadly. STUDY REGISTRATION ISRCTN65924234.
منابع مشابه
Does Participation in Farmer Field School Extension Program Improve Crop Yields? Evidence from Smallholder Tea Production Systems in Kenya
Agricultural Extension services are among the most important rural services in developing countries. The services are considered to be a key driver of technological change and productivity growth in agriculture. In Kenya, like in the rest of the developing economies, agricultural extension has largely been delivered through supply–driven approaches. Due to perceived low impact of agricultural e...
متن کاملThe effect of antipsychotics in the prevention and treatment of delirium in the elderly admitted to intensive care units: a systematic review
Introduction: The present study reviews published studies on the effects of antipsychotic use in the treatment of delirium in the elderly in order to determine the effect of antipsychotic drugs on the prevention and treatment of delirium in the elderly admitted to the intensive care unit and the possible side effects of these drugs in this group of patients. Method: The present review arti...
متن کاملPotential Role of Exogenous Melatonin Supplement in Delirium Prevention in Critically Ill Patients: A Double-Blind Randomized Pilot Study
Critically ill patients often suffer from disturbance of sleep-wake cycle and consequently delirium development, in intensive care units (ICU). In this study, we aimed to evaluate the effect of exogenous melatonin on delirium development and its related adverse sequelae in the subgroup of medical and surgical ICU patients. We performed a double-blind placebo-controlled randomized pilot study i...
متن کاملPotential Role of Exogenous Melatonin Supplement in Delirium Prevention in Critically Ill Patients: A Double-Blind Randomized Pilot Study
Critically ill patients often suffer from disturbance of sleep-wake cycle and consequently delirium development, in intensive care units (ICU). In this study, we aimed to evaluate the effect of exogenous melatonin on delirium development and its related adverse sequelae in the subgroup of medical and surgical ICU patients. We performed a double-blind placebo-controlled randomized pilot study i...
متن کاملImproving the Quality of The Integrated Care for The Elderly in A Comprehensive Health Center
Objectives: In elderly care provided by health centers, healthy elderly are neglected in care and education. This qualitative study aimed to standardize healthy ageing care. Methods & Materials: This community-based participatory research with 4 steps (problem detection-design of change programs-implementation of interventions-evaluation) was conducted from 1395 to 1397 in Motahari Health Cent...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره 13 شماره
صفحات -
تاریخ انتشار 2013