Qualitative analysis of staff views on caring for inpatients with delirium and Parkinson's disease: Challenges, tensions and team working
Rachel Cullinan, Alison J Yarnall, Glenn Stebbins, John-Paul Taylor, David J Burn, Louise M Allan, Sarah J Richardson, Andrew Teodorczuk, Rachael A LawsonObjectives
People with Parkinson's disease (PD) are at increased risk of delirium. Documentation of delirium is poor, with challenges in making a diagnosis due to overlapping symptoms. This study interviewed healthcare workers about their experiences of caring for inpatients with PD and delirium to explore their perspectives.
Design
A qualitative study with semi-structured interviews and thematic analysis.
Participants
Twelve healthcare staff, comprising five doctors and seven nurses.
Results
Four themes emerged: environmental pressures, relationship tensions, challenges and team working. We divided findings into those relevant to all inpatients with delirium and those specific to patients with PD and delirium. Environment pressures negatively impacted on all patients with delirium, and empathy was expressed for all carers/relatives. Staff anxiety was higher caring for patients with PD and relationship tensions occurred with juxtaposition of staff delirium expertise and patient/carer lived experience of PD. PD specific challenges were PD medications and a reciprocal relationship between diagnostic overshadowing and identifying the cause of delirium. Roles of ward nursing team to identify acute changes and doctors to identify and diagnose delirium in all patients was clearly defined.
Conclusions
This study identified knowledge gaps and lack of confidence specific to patients with delirium and PD. We recommend clearer definition of delirium superimposed on PD, with education and training on its complexity, alongside inclusion of expert-by-experience teaching. Future study of patient and carer views will help better understand the relationship tensions and how we can improve patient care and experiences.