Improving delirium recognition and assessment for people receiving inpatient palliative care: a mixed methods meta-synthesis

Hosie, Annmarie; Agar, Meera; Lobb, Elizabeth; Davidson, Patricia M.; Phillips, Jane

doi:10.1016/j.ijnurstu.2017.07.007

Cited by 17 publications

(21 citation statements)

References 56 publications

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“…'don't get up', 'don't do that'), which was reported also among some staff in acute and palliative hospital wards. 79,82,83 This was in contrast to individual staff members, described as having a 'magic touch', who engaged empathically with such patients using touch and voice to provide a physical and metaphorical 'handhold' to assuage distress. It was also in stark contrast to staff's typical interactions with patients generally, which were suffused with warmth and sociability.…”

Section: Enacting Rehabilitationmentioning

confidence: 99%

Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study

Young

Hulme

Smith

et al. 2020

Health Serv Deliv Res

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Background Community hospitals are small hospitals providing local inpatient and outpatient services. National surveys report that inpatient rehabilitation for older people is a core function but there are large differences in key performance measures. We have investigated these variations in community hospital ward performance. Objectives (1) To measure the relative performance of community hospital wards (studies 1 and 2); (2) to identify characteristics of community hospital wards that optimise performance (studies 1 and 3); (3) to develop a web-based interactive toolkit that supports operational changes to optimise ward performance (study 4); (4) to investigate the impact of community hospital wards on secondary care use (study 5); and (5) to investigate associations between short-term community (intermediate care) services and secondary care utilisation (study 5). Methods Study 1 – we used national data to conduct econometric estimations using stochastic frontier analysis in which a cost function was modelled using significant predictors of community hospital ward costs. Study 2 – a national postal survey was developed to collect data from a larger sample of community hospitals. Study 3 – three ethnographic case studies were performed to provide insight into less tangible aspects of community hospital ward care. Study 4 – a web-based interactive toolkit was developed by integrating the econometrics (study 1) and case study (study 3) findings. Study 5 – regression analyses were conducted using data from the Atlas of Variation Map 61 (rate of emergency admissions to hospital for people aged ≥ 75 years with a length of stay of < 24 hours) and the National Audit of Intermediate Care. Results Community hospital ward efficiency is comparable with the NHS acute hospital sector (mean cost efficiency 0.83, range 0.72–0.92). The rank order of community hospital ward efficiencies was distinguished to facilitate learning across the sector. On average, if all community hospital wards were operating in line with the highest cost efficiency, savings of 17% (or £47M per year) could be achieved (price year 2013/14) for our sample of 101 wards. Significant economies of scale were found: a 1% rise in output was associated with an average 0.85% increase in costs. We were unable to obtain a larger community hospital sample because of the low response rate to our national survey. The case studies identified how rehabilitation was delivered through collaborative, interdisciplinary working; interprofessional communication; and meaningful patient and family engagement. We also developed insight into patients’ recovery trajectories and care transitions. The web-based interactive toolkit was established [http://mocha.nhsbenchmarking.nhs.uk/ (accessed 9 September 2019)]. The crisis response team type of intermediate care, but not community hospitals, had a statistically significant negative association with emergency admissions. Limitations The econometric analyses were based on cross-sectional data and were also limited by missing data. The low response rate to our national survey means that we cannot extrapolate reliably from our community hospital sample. Conclusions The results suggest that significant community hospital ward savings may be realised by improving modifiable performance factors that might be augmented further by economies of scale. Future work How less efficient hospitals might reduce costs and sustain quality requires further research. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.

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Section: Enacting Rehabilitationmentioning

confidence: 99%

Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study

Young

Hulme

Smith

et al. 2020

Health Serv Deliv Res

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“…Nursing, therapy and care staff on all wards reported minimal knowledge of delirium and its adverse consequences for patients and caregivers, similar to studies in acute settings elsewhere [29–31]. It was the disruptive behavioural manifestations of hyperactive delirium that were most salient in the problems posed for ward management.…”

Section: Resultsmentioning

confidence: 57%

Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study

et al. 2019

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BackgroundDelirium is a frequent complication of hospital admission among older people. Multicomponent interventions which can reduce incident delirium by ≈one-third are recommended by the National Institute of Health and Care Excellence. Currently, a standardised delirium prevention system of care suitable for adoption in the UK National Health Service does not exist. The Prevention of Delirium (POD) system of care is a theory informed, multicomponent intervention and systematic implementation process which includes a role for hospital volunteers. We report POD implementation and delivery processes in NHS hospital wards, as part of a feasibility study.MethodsA comparative case study design and participatory, multi-method evaluation was performed with sequential six month preparatory and six month delivery stages. Six wards in five hospitals in Northern England were recruited. Methods included: facilitated workshops; observation of POD preparatory activities; qualitative interviews with staff; collection of ward organisational and patient profiles; and structured observation of staff workload.ResultsPOD implementation and delivery was fully accomplished in four wards. On these wards, implementation strategies informed by Normalization Process Theory operated synergistically and cumulatively. An interactive staff training programme on delirium and practices that might prevent it among those at risk, facilitated purposeful POD engagement. Observation of practice juxtaposed to action on delirium preventive interventions created tension for change, legitimating new ways of organising work around it. Establishing systems, processes and documentation to make POD workable in the ward setting, enhanced staff ownership. ‘Negotiated experimentation’ to involve staff in creating, appraising and modifying systems and practices, helped integrate the POD care system in ward routines. Activating these change mechanisms required a particular form of leadership: pro-active ‘steer’, and senior ward ‘facilitator’ to extend ‘reach’ to the staff group. Organisational discontinuity (i.e. ward re-location and re-modelling) disrupted and extended POD implementation; staff shortages adversely affected staff capacity to invest in POD. Findings resulted in the development of ‘site readiness’ criteria without which implementation of this complex intervention was unlikely to occur.ConclusionsPOD implementation and delivery is feasible in NHS wards, but a necessary context for success is ‘site readiness.’

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“…(2018) used pragmatism (Feilzer, 2010) to argue that objective and subjective inquiry, using complementary methods, gives a better representation of reality. The good papers also referred and adhered to well‐established models for MMR studies, for example, Hall, Brosnan, Cant, Collins, and Leach (2018) and Näsström, Luttik, Idvall, and Stromberg (2017) cited Creswell and Plano Clark (2007), Hosie, Agar, Lobb, Davidson, and Phillips (2017) cited Creswell (2009), and Halpin et al. (2017) cited Wisdom and Creswell (2013).…”

Section: Discussionmentioning

confidence: 96%

The state of mixed methods research in nursing: A focused mapping review and synthesis

Irvine

Clark

Efstathiou

et al. 2020

Journal of Advanced Nursing

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Aims To consider the scope and quality of mixed methods research in nursing. Design Focused mapping review and synthesis (FMRS). Data sources Five purposively selected journals: International Journal of Nursing Studies, Journal of Nursing Scholarship, Journal of Advanced Nursing, Worldviews on Evidence‐Based Nursing, and Journal of Mixed Methods Research. Review methods In the target journals, titles and abstracts from papers published between 2015–2018 were searched for the words or derivative words ‘mixed methods’. Additional keyword searches were undertaken using each journal's search tool. We included studies that investigated nursing and reported to use a mixed methods approach. Articles that met the inclusion criteria were read in full and information was extracted onto a predetermined pro forma. Findings across journals were then synthesized to illustrate the current state of mixed methods research in nursing. Results We located 34 articles that reported on mixed methods research, conducted across 18 countries. Articles differed significantly both within and across journals in terms of conformity to a mixed methods approach. We assessed the studies for the quality of their reporting as regard the use of mixed methods. Nineteen studies were rated as satisfactory or good, with 15 rated as poorly described. Primarily, a poor rating was due to the absence of stating an underpinning methodological approach to the study and/or limited detail of a crucial integration phase. Conclusions Our FMRS revealed a paucity of published mixed methods research in the journals selected. When they are published, there are limitations in the detail given to the underpinning methodological approach and theoretical explanation.

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Improving delirium recognition and assessment for people receiving inpatient palliative care: a mixed methods meta-synthesis

Cited by 17 publications

References 56 publications

Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study

Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study

Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study

The state of mixed methods research in nursing: A focused mapping review and synthesis

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