The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this?

Partridge, Judith; Martin, Finbarr C.; Harari, Danielle; Dhesi, Jugdeep

doi:10.1002/gps.3900

Cited by 165 publications

(150 citation statements)

References 62 publications

(175 reference statements)

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“…In addition, our results replicated other studies that suggest that frequent exposure to workplace violence and the threat of violence within psychiatric wards increases psychiatric nurses' levels of stress (Chen et al, 2008). The exposure to patients' violence is frequently accompanied by feelings of uncertainty and inability to predict the patients' behavior (Partridge, Martin, Harari, & Dhesi, 2013). These stress-residues might contribute to job dissatisfaction and burn-out among nurses (Rossi et al, 2012).…”

Section: Discussionsupporting

confidence: 85%

The Relations between Violence Exposure, Posttraumatic Stress Symptoms, Secondary Traumatization, Vicarious Post Traumatic Growth and Illness Attribution among Psychiatric Nurses

Zerach¹,

Shalev²

2015

Archives of Psychiatric Nursing

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Section: Discussionsupporting

confidence: 85%

The Relations between Violence Exposure, Posttraumatic Stress Symptoms, Secondary Traumatization, Vicarious Post Traumatic Growth and Illness Attribution among Psychiatric Nurses

Zerach¹,

Shalev²

2015

Archives of Psychiatric Nursing

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“…It is associated multiple adverse outcomes, including increased risk of complications, longer length of stay, mortality, and high levels of personal and family distress [2]–[4]. Delirium is also associated with enormous healthcare costs, with UK analyses estimating an extra £13,200 per hospital admission [5].…”

Section: Introductionmentioning

confidence: 99%

Validation of a Consensus Method for Identifying Delirium from Hospital Records

Kuhn

McGrath

et al. 2014

PLoS ONE

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BackgroundDelirium is increasingly considered to be an important determinant of trajectories of cognitive decline. Therefore, analyses of existing cohort studies measuring cognitive outcomes could benefit from methods to ascertain a retrospective delirium diagnosis. This study aimed to develop and validate such a method for delirium detection using routine medical records in UK and Ireland.MethodsA point prevalence study of delirium provided the reference-standard ratings for delirium diagnosis. Blinded to study results, clinical vignettes were compiled from participants' medical records in a standardised manner, describing any relevant delirium symptoms recorded in the whole case record for the period leading up to case-ascertainment. An expert panel rated each vignette as unlikely, possible, or probable delirium and disagreements were resolved by consensus.ResultsFrom 95 case records, 424 vignettes were abstracted by 5 trained clinicians. There were 29 delirium cases according to the reference standard. Median age of subjects was 76.6 years (interquartile range 54.6 to 82.5). Against the original study DSM-IV diagnosis, the chart abstraction method gave a positive likelihood ratio (LR) of 7.8 (95% CI 5.7–12.0) and the negative LR of 0.45 (95% CI 0.40–0.47) for probable delirium (sensitivity 0.58 (95% CI 0.53–0.62); specificity 0.93 (95% CI 0.90–0.95); AUC 0.86 (95% CI 0.82–0.89)). The method diagnosed possible delirium with positive LR 3.5 (95% CI 2.9–4.3) and negative LR 0.15 (95% CI 0.11–0.21) (sensitivity 0.89 (95% CI 0.85–0.91); specificity 0.75 (95% CI 0.71–0.79); AUC 0.86 (95% CI 0.80–0.89)).ConclusionsThis chart abstraction method can retrospectively diagnose delirium in hospitalised patients with good accuracy. This has potential for retrospectively identifying delirium in cohort studies where routine medical records are available. This example of record linkage between hospitalisations and epidemiological data may lead to further insights into the inter-relationship between acute illness, as an exposure, for a range of chronic health outcomes.

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“…13,14 Refractory delirium, in which the optimal therapeutic interventions have failed to control its clinical features, is the most common indication for the use of continuous sedation at the end of life. 15 …”

Section: Introductionmentioning

confidence: 99%

Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

Bush

Kanji

Pereira

et al. 2014

Journal of Pain and Symptom Management

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Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed.

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The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this?

Abstract: A better understanding of the experience and psychological consequences of delirium will inform the development of appropriate methods of providing support and information to those at risk of delirium and their families or carers.

Cited by 165 publications

References 62 publications

The Relations between Violence Exposure, Posttraumatic Stress Symptoms, Secondary Traumatization, Vicarious Post Traumatic Growth and Illness Attribution among Psychiatric Nurses

The Relations between Violence Exposure, Posttraumatic Stress Symptoms, Secondary Traumatization, Vicarious Post Traumatic Growth and Illness Attribution among Psychiatric Nurses

Validation of a Consensus Method for Identifying Delirium from Hospital Records

Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

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