护士在医院病房中管理老年人谵妄的经验：定性系统评价和荟萃聚合

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Abstract

Background

Delirium is a multifactorial syndrome closely associated with negative hospitalisation outcomes. Given the global growth of the ageing population, delirium becomes increasingly prevalent among older persons. Nurses play a pivotal role in delirium management and receive direct impacts of delirious presentations. Yet, there is a dearth of literature reviewing nurses’ experiences.

Objective

To synthesise the best available evidence exploring nurses’ experiences in managing delirium of older persons in acute care wards.

Design

Systematic review of qualitative studies and meta-aggregation.

Data sources

Published and unpublished literature between January 2010 and December 2020 were identified from PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO and ProQuest.

Review Methods

A systematic search strategy was applied in October 2020, with an update in January 2021. Two reviewers independently screened the titles and abstracts and selected the eligible studies after reading the full texts. This review included studies focusing on licensed nurses providing care to patients aged 65 and above, having any type of delirium during their hospitalisation stays in acute care settings. Studies included are qualitative papers with research designs such as phenomenology, ethnography, qualitative descriptive and grounded theory. The eligible studies were appraised independently using The JBI Critical Appraisal Checklist for Qualitative Research. Data of included studies were extracted by two independent reviewers using a standardised form. Findings were synthesised by the meta-aggregative approach.

Results

Thirty-one papers that considered nurses’ (n = 464) experiences in managing older persons’ delirium were included. A total of 375 findings were extracted, aggregated into 23 categories, and developed 5 synthesised findings: i) Delirium detection could be hindered when nurses possess a narrowed view of delirium. ii) nurses navigate through complexity when providing multi-faceted care iii) nurses carry personal emotions, assumptions, and identities iv) various stakeholders have double-edged influences, and v) nurses display preferences in their learning needs.

Conclusion

This review informed about nurses’ perceptions of delirium, delirious older persons, and their nursing management which were specific to older persons and acute care settings. Nurses should practise self-awareness regarding their own knowledge and attitudes while performing delirium management in older adults. Meanwhile, healthcare professionals and policymakers should make a concerted effort in cultivating a better working environment. Future research of delirium care that specifically investigate with a geriatric perspective would better contribute to the improvement of evidence-based nursing practices for older persons.

摘要翻译（仅供参考）

背景

谵妄是一种与负面住院结果密切相关的多因素综合征。鉴于全球老龄化人口的增长，谵妄在老年人中变得越来越普遍。护士在谵妄管理中发挥着关键作用，并受到谵妄表现的直接影响。然而，缺乏回顾护士经历的文献。

客观的

综合现有的最佳证据，探索护士在急性护理病房管理老年人谵妄的经验。

设计

定性研究和元聚合的系统审查。

数据源

2010 年 1 月至 2020 年 12 月期间已发表和未发表的文献来自 PubMed、Embase、Web of Science、护理和相关健康文献累积索引 (CINAHL)、Scopus、PsycINFO 和 ProQuest。

复习方法

2020年10月采用系统检索策略，2021年1月更新。两名审稿人独立筛选标题和摘要，阅读全文后选择符合条件的研究。本综述纳入的研究侧重于为 65 岁及以上的患者提供护理的有执照的护士，这些患者在急性护理环境中住院期间患有任何类型的谵妄。研究包括具有研究设计的定性论文，如现象学、民族志、定性描述和扎根理论。使用 JBI 定性研究关键评估清单对符合条件的研究进行独立评估。纳入研究的数据由两名独立审查员使用标准化表格提取。结果由元聚合方法综合。

结果

纳入了 31 篇关于护士（n = 464）管理老年人谵妄经验的论文。总共提取了 375 个发现，汇总到 23 个类别中，并得出了 5 个综合发现：i) 当护士对谵妄的看法狭隘时，谵妄检测可能会受到阻碍。ii) 护士在提供多方面护理时应对复杂性 iii) 护士携带个人情感、假设和身份 iv) 各种利益相关者具有双重影响，以及 v) 护士在学习需求中表现出偏好。

结论

本综述介绍了护士对谵妄、谵妄老年人的看法，以及他们针对老年人和急症护理环境的护理管理。在对老年人进行谵妄管理时，护士应该对自己的知识和态度进行自我意识。同时，医疗保健专业人士和政策制定者应齐心协力营造更好的工作环境。未来的谵妄护理研究，专门从老年人的角度进行调查，将更好地有助于改善老年人的循证护理实践。

原文链接：

https://doi.org/10.1016/j.ijnurstu.2021.104157

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