Modified Hospital Elder Life Program in the emergency department of a public university hospital: a multicomponent intervention program for preventing delirium
Abstract:Objective To evaluate the feasibility of implementing an adaptation of the Hospital Elder Life Program (HELP) with the participation of family caregivers in a public university hospital. Method Descriptive exploratory pilot study developed with 30 hospitalized patients and their caregivers. Registration Forms were applied to identify risk factors for delirium, to select intervention protocols, and track implementation. Participants' level of satisfaction and barriers to implementing the program were assessed … Show more
“…Family carers in one study in the ICU setting also suggested a communication resource box could be shared by family carers and staff (Bannon et al., 2018). Lack of access to glasses and hearing aids was identified as a barrier to communication and family carer ability to support delirium management (Assis et al., 2022).…”
AimTo identify, describe and synthesise what is known about family carers' experiences and perspectives of engagement in delirium prevention and care for adults in hospital.DesignSystematic review and synthesis of qualitative evidence.Data SourcesComprehensive literature search within PubMed, CINAHL, EMBASE, Scopus, Cochrane Central and PsycInfo databases to August 2022. Peer reviewed original qualitative research published in English.MethodsData were extracted using Covidence systematic review software. Methodological quality was reviewed against the Critical Appraisal Skills Program (CASP) Qualitative Checklist. Thematic synthesis was used to develop analytical themes. Confidence in the Evidence from Reviews of Qualitative Research (GRADE‐CERQual) framework was applied to findings.ResultsOf 3429 records identified, 29 met criteria for final inclusion. Studies included a range of settings (intensive care, medical and surgical wards) and family carer types (spouse, daughter, parent and friend). Three primary themes Shared Caregiving, Partnership and Support, Communication for Shared Understanding and three cross‐cutting contextual themes Care Transitions, Family Carer Context and Hospital Context were identified. Family carers have mixed experiences of involvement in delirium care and prevention. Family carer engagement in care impacted perceptions of care quality and their own self‐efficacy. Where person‐centred care expectations were not met, some family carers adopted compensatory or care contingency strategies. Information sharing and timely support from hospital staff who understood the carer context supported carer involvement. Supportive physical environments and addressing power imbalances allowed greater engagement.ConclusionFamily carers often wish to be involved in delirium prevention and care, but need to be recognised as individuals, listened to, informed and supported to optimise their contribution.ImpactThe review findings can guide health professional and decision makers to optimise family carer involvement in delirium care programs.Protocol RegistrationPROSPERO [CRD42020221854].ReportingENTREQ.No Patient or Public Contribution.
“…Family carers in one study in the ICU setting also suggested a communication resource box could be shared by family carers and staff (Bannon et al., 2018). Lack of access to glasses and hearing aids was identified as a barrier to communication and family carer ability to support delirium management (Assis et al., 2022).…”
AimTo identify, describe and synthesise what is known about family carers' experiences and perspectives of engagement in delirium prevention and care for adults in hospital.DesignSystematic review and synthesis of qualitative evidence.Data SourcesComprehensive literature search within PubMed, CINAHL, EMBASE, Scopus, Cochrane Central and PsycInfo databases to August 2022. Peer reviewed original qualitative research published in English.MethodsData were extracted using Covidence systematic review software. Methodological quality was reviewed against the Critical Appraisal Skills Program (CASP) Qualitative Checklist. Thematic synthesis was used to develop analytical themes. Confidence in the Evidence from Reviews of Qualitative Research (GRADE‐CERQual) framework was applied to findings.ResultsOf 3429 records identified, 29 met criteria for final inclusion. Studies included a range of settings (intensive care, medical and surgical wards) and family carer types (spouse, daughter, parent and friend). Three primary themes Shared Caregiving, Partnership and Support, Communication for Shared Understanding and three cross‐cutting contextual themes Care Transitions, Family Carer Context and Hospital Context were identified. Family carers have mixed experiences of involvement in delirium care and prevention. Family carer engagement in care impacted perceptions of care quality and their own self‐efficacy. Where person‐centred care expectations were not met, some family carers adopted compensatory or care contingency strategies. Information sharing and timely support from hospital staff who understood the carer context supported carer involvement. Supportive physical environments and addressing power imbalances allowed greater engagement.ConclusionFamily carers often wish to be involved in delirium prevention and care, but need to be recognised as individuals, listened to, informed and supported to optimise their contribution.ImpactThe review findings can guide health professional and decision makers to optimise family carer involvement in delirium care programs.Protocol RegistrationPROSPERO [CRD42020221854].ReportingENTREQ.No Patient or Public Contribution.
“…Based on a consensus approach, the studies included in this review were found to be of moderate (score of 3) to high quality (score of 5; Table 1). 23 Four studies were conducted in the United States of America [27][28][29][30] ; and one each in Brazil, 31 Chile 32 and South Korea. 33 Study designs included one randomised controlled trial, 32 two quasi-experimental pre-post-test designs, 29,30 two descriptive exploratory studies, 28,31 one qualitative study 33 and one mixed-method design.…”
Section: Resultsmentioning
confidence: 99%
“…23 Four studies were conducted in the United States of America [27][28][29][30] ; and one each in Brazil, 31 Chile 32 and South Korea. 33 Study designs included one randomised controlled trial, 32 two quasi-experimental pre-post-test designs, 29,30 two descriptive exploratory studies, 28,31 one qualitative study 33 and one mixed-method design. 27 One study did not report carer characteristics.…”
Section: Resultsmentioning
confidence: 99%
“…In addition to increasing knowledge for both carers 27,[29][30][31]33 and nurses, 29,30,33 therapeutic nurse-carer relationships were also identified as important for effective partnerships in the management of delirium. [28][29][30]33 Therapeutic nurse-carer relationships were achieved through concurrent carer-nurse education 29 and reciprocal, clear and honest communication, in which carers and nurses shared concerns and challenges about the management of delirium.…”
Section: Effective Partnershipsmentioning
confidence: 99%
“…33 Kang et al 33 reported that it was important that nurses documented work with carers and communicate carers' needs with other health-care professionals to provide clarity and responsibility of roles. Barriers to effective partnerships in the management of delirium included miscommunication and forgetfulness of carers to share information with other family members, 31,33 a lack of nurses' time and nurse shortages. 28,33…”
ObjectivesDelirium is a common, preventable condition. However, delirium is poorly recognised and often missed because symptoms are misinterpreted, and risk factors overlooked by health‐care professionals. Carers usually have intimate knowledge about the person they care for. Therefore, they are well placed within care teams to implement delirium prevention strategies, identify symptoms and support the early diagnosis of delirium. The aim of this integrative review was to synthesise findings from the published research reporting on partnering with carers in the management of delirium in general acute care settings.MethodsFive databases (Medline‐EBSCO, PubMed, PsycINFO, ProQuest, CINAHL and SCOPUS) were searched to identify primary research regarding partnering with carers in the management of delirium in acute care settings, and results were synthesised. PRISMA guidelines were adhered to, and quality appraisal was conducted using the Mixed Methods Appraisal Tool.ResultsAll seven studies reported that partnering with carers was a viable strategy in the management of delirium to maximise outcomes for people at risk of or experiencing delirium and that increasing carers' knowledge of delirium was key. The synthesis of findings also identified two themes: Increasing knowledge and Effective partnerships.ConclusionsA collaborative approach to increasing carers' and nurses' knowledge about the management of delirium, coupled with education on how to develop therapeutic nurse–carer relationships, is important for ongoing effective partnerships in the management of delirium. Good communication supported effective partnerships, which enabled both nurses and carers the opportunity to express their needs and concerns and negotiate collaborative involvement in the management of delirium.
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