目的:调查医疗专业人员识别和管理住院老年人谵妄的障碍。
方法:混合方法系统综述。
■CRD42020187932。
方法:MEDLINE,EMBASE,搜索了PsycINFO和CINAHL(2007年至2023年2月)。
方法:纳入的研究集中于医护人员对医院病房或急诊科65岁及以上患者谵妄的识别和管理。加强严谨,结果筛选由两名研究者独立进行.定性和定量数据分别列表并分组。比较数据以确定相似性和差异性。所有研究均进行了质量评价。
结果:包括43项研究;24项定量研究,16种定性方法和三种混合方法。数据综合强调了定性和定量结果之间的协同作用。障碍反映在六个主题中:(1)医疗保健专业人员的知识和理解;(2)沟通;(3)劳动力发展;(4)跨专业工作;(5)混杂因素;(6)组织约束。
结论:意义重大,对于在医院经历谵妄的老年人,是否以及如何识别和管理它存在差异。为防止不良后果,筛查最佳实践指导,承认,诊断和管理老年人谵妄需要达成共识并广泛传播。支持医疗保健专业人员使用综合方法来照顾这些患者人群至关重要,如何让患者及其家人和朋友参与和沟通,如何识别和管理有额外需求的患者的谵妄,例如,患有痴呆症和/或学习障碍的人。医院需要制定政策和指导,以识别和管理向病房或急诊科就诊的老年人的谵妄。需要一种IT基础架构,将评估和护理管理计划集成到患者电子记录中,并使其能够在医院的团队内部和团队之间访问。初级和社区护理设置。
■本次系统评价没有患者或公众的贡献。
■可以更好地支持医疗保健专业人员,以便能够在老年人急性住院期间识别和管理谵妄。这包括最大限度地为痴呆症患者提供最佳护理,让家人和朋友参与,以帮助了解患者的基线状态和变化,并在此过程中支持家人和朋友。意义重大,对医院IT基础设施的关注是必要的,整合筛选,患者电子记录中的评估和护理管理计划,并使护理机构中照顾该患者人群的医疗保健专业人员可以访问这些计划。
结论:这项研究解决了什么问题?谵妄是老年住院患者的常见病,但它始终被低估,这对患者和组织的结局有影响。为了帮助解决这个问题,了解医疗专业人员识别和管理这一患者人群谵妄的障碍至关重要.主要发现是什么?医疗保健专业人员识别和管理该患者人群谵妄的障碍被综合为六个主题:(1)医疗保健专业人员的知识和理解,(2)沟通;(3)劳动力发展;(4)跨专业工作;(5)混杂因素;(6)组织约束。这项研究将在何处以及对谁产生影响?这项原始系统评价的结果可以为医院政策和方案做出贡献,以识别和管理老年患者的谵妄。这些发现可以为在急性住院期间照顾老年人的从业者以及在出院后对患者进行随访的初级和社区环境中的从业者的劳动力专业发展做出有意义的贡献。对于研究人员来说,研究结果表明了一些研究建议,包括调查护士和其他医疗保健专业人员的教育计划对疾病的识别和管理以及理解的影响,以及调查如何最好地支持患者及其家人和从业者经历的与谵妄相关的痛苦。
■此系统评价是根据系统评价和荟萃分析的首选报告项目进行报告的(Page等。,2021)。
OBJECTIVE: To investigate barriers to healthcare professionals recognizing and managing delirium in hospitalized older people.
METHODS: A mixed-methods systematic
review.
UNASSIGNED: CRD42020187932.
METHODS: MEDLINE, EMBASE, PsycINFO and CINAHL were searched (2007 to February 2023).
METHODS: Included studies focused on healthcare professionals\'
recognition and management of delirium for patients aged 65 years and over in a hospital ward or emergency department. Enhancing rigour, screening of results was conducted independently by two researchers. Qualitative and quantitative data were tabulated separately and grouped. Data were compared to identify similarities and differences. All studies were quality appraised.
RESULTS: 43 studies were included; 24 quantitative, 16 qualitative and three mixed-methods. Data synthesis highlighted synergy between qualitative and quantitative findings. Barriers were reflected in six themes: (1) healthcare professionals\' knowledge and understanding; (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints.
CONCLUSIONS: Of significance, for older adults in hospital experiencing delirium, there is variability in whether and how well it is recognized and managed. To prevent adverse outcomes best practice guidance for screening, recognizing, diagnosing and managing delirium in older people needs to be agreed and disseminated widely. Supporting healthcare professionals to care for this patient population using an integrated approach is essential, how to involve and communicate with patients and their family and friends, how to recognize and manage delirium for patients with additional needs, e.g., those living with dementia and/or a learning disability. Hospitals need to have policy and guidance in place for the
recognition and management of delirium in older adults presenting to a ward or to an emergency department. An IT infrastructure is needed that integrates assessments and care management plans in patient electronic records and makes them accessible within and across teams in hospital, primary and community care settings.
UNASSIGNED: There was no patient or public contribution to this systematic
review.
UNASSIGNED: Healthcare professionals can be better supported to be able to recognize and manage delirium during an acute hospital stay for older adults. This includes maximizing best care for those patients living with dementia, involving families and friends to help understand patients\' baseline status and changes and supporting families and friends during this process. Of significance, attention to hospital IT infrastructures is warranted, integrating screening, assessment and care management plans in patients\' electronic records and making these accessible to healthcare professionals caring for this patient population across care settings.
CONCLUSIONS: What problem did the study address? Delirium is a common condition experienced by older hospitalized patients, but it is consistently under-recognized which has implications for patient and organization outcomes. To help address this, understanding barriers to healthcare professionals recognizing and managing delirium for this patient population is paramount. What were the main findings? Barriers to healthcare professionals recognizing and managing delirium for this patient population were synthesized in six themes: (1) healthcare professionals\' knowledge and understanding, (2) communication; (3) workforce development; (4) interprofessional working; (5) confounders; and (6) organizational constraints. Where and on whom will the research have an impact? The findings of this original systematic review can contribute to hospital policy and protocol for the
recognition and management of delirium in older patients. The findings can meaningfully contribute to workforce professional development for practitioners caring for older people during an acute hospital stay and for practitioners in primary and community settings involved in the follow-up of patients post hospital discharge. For researchers, the findings indicate several research recommendations including investigating the impact of an education programme for nurses and other healthcare professionals on the recognition and management of the condition and understanding and investigating how best to support delirium-related distress experienced by patients and their families and practitioners.
UNASSIGNED: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021).