Understanding the social significance of meals for residents in nursing homes would provide deeper insight into resident expectations. This will in turn help to improve service and quality of life for residents.
ObjectivesThe 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.SettingThis study was performed in 5 ICUs located within 4 hospitals in Madrid (Spain).ParticipantsPurposeful 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.DesignA qualitative study using focus groups.Methods7 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.Results3 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.ConclusionsPatients with delirium represent complex cases, requiring the implementation of specific protocols. These results serve to improve the process of care in patients with delirium.
palacios‐ceña d., cachón‐pérez j.m., gómez‐pérez d., gómez‐calero c., brea‐rivero m. & fernández‐de‐las‐peñas c. (2012) Journal of Nursing Management Is the influence of nurse care practices and nursing home organization understood? A qualitative study
Aim To describe residents’ experience of nursing home organization and nursing care practices in a region of Spain.
Background Nursing home organization, nursing practices and rules within the institution may all influence residents’ daily living and their perception on the quality of care provided.
Design A qualitative approach was conducted, using purposeful and theoretical sampling. Data were collected from nursing home residents, following unstructured and semi‐structured interviews, researcher field notes and residents’ personal diaries and letters. Giorgi analysis was conducted.
Results Two main themes emerged. (1) ‘Following nursing home rules’. Norms may be seen as boundaries, especially for those residents who were independent before admission. (2) ‘Prioritizing nursing care in residents’. Prioritizing the nursing care may limit the autonomy of residents because it does not meet their preferences and needs.
Conclusion Understanding the meaning of nursing home organization and nursing care practices with nursing home residents might provide deeper insight into their expectations.
Implications for nursing management Nursing staff should have greater involvement in the nursing home organization, as well as in prioritizing the care provision based on resident’s needs and preferences.
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