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Challenges of the Implementation of a Delirium Rate Scale in a Pediatric Intensive Care Unit: A Qualitative Approach
Paula Balsalobre-Martínez1, Raquel Montosa-García2, Ana Marín-Yago2
1Hospital Universitario Virgen de la Arrixaca, Public Murcian Health System, 30120 Murcia, Spain.
Insights
Pediatric nurses reported challenges in recognizing and managing childhood delirium, citing tool deficiencies and interprofessional communication issues. Addressing these gaps is crucial for improving care and program success.
Area of Science:
- Pediatric Intensive Care
- Delirium Management
- Nursing Experience
Background:
- Childhood delirium in pediatric intensive care units (PICUs) presents significant challenges, including complications and increased costs.
- This study investigates nursing staff experiences with a delirium prevention program in a PICU after 15 months of implementation.
Purpose of the Study:
- To explore the perceptions and experiences of nursing staff in a PICU regarding a program to combat childhood delirium.
- To identify barriers and facilitators to delirium management from the nursing perspective.
Main Methods:
- A qualitative study employing semi-structured interviews with PICU nurses.
- Analysis of interview transcripts using Interpretative Description and Qualitative Content Analysis.
- Adherence to SRQR and COREQ guidelines for reporting quality.
Main Results:
- Nurses demonstrated a lack of recognition of delirium as a significant issue within their unit.
- Deficiencies were noted in delirium identification, with the Child Abuse Potential Diagnosis (CAPD) tool deemed unreliable.
- Discrepancies existed in therapeutic objectives between nursing and medical staff regarding delirium management.
Conclusions:
- Nursing staff exhibited negative attitudes towards delirium, stemming from training gaps, clinical management issues, and tool dissatisfaction.
- Resistance to change and interprofessional communication conflicts hinder delirium program success.
- Urgent changes in training, attitudes, and interprofessional relationships are necessary for effective delirium management and child well-being.
Introduction:
Delirium in the pediatric population admitted to intensive care is a worrying reality due to its potential complications and the increase in associated costs. This study aims to explore the experiences of nursing staff of a Pediatric Intensive Care Unit after 15 months of starting a program to fight against childhood delirium in their unit.
Methodology:
A qualitative study was conducted through semi-structured interviews with Pediatric Intensive Care Unit (PICU) Key Informants. The Standards for Reporting Qualitative Research (SRQR) and the consolidated criteria for Reporting Qualitative Research (COREQ) were followed as quality measures for the study. Seven nurses (33% of the eligible population) from the PICU of a referral hospital were interviewed. Text transcripts were analyzed using the Interpretative Description and Qualitative Content Analysis method.
Results:
The interviewees indicated not identifying delirium as an important reality; with great deficiencies observed in what is related to the identification of delirium; identifying CAPD as an unreliable tool in their unit; and not sharing therapeutic objectives in this respect with the medical staff.
Conclusions:
The nursing staff presented a series of negative attitudes towards the phenomena of delirium in their unit, with gaps in training and in clinical management, and the diagnostic tool used, and did not see it as a priority objective of the unit, partly due to a resistance to change and a latent interprofessional communication conflict. A change at the formative, attitudinal, and relational levels is urgently needed for the success of the program and the well-being of the children in the unit.
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