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Scholar's Report

Research: Delirium Superimposed on Dementia: Closing the “Know-Do Gap”

2016/57 - Claire Pryor

Abstract

I would like to thank the Florence Nightingale Foundation and NHS Professionals for their support and research award, which made this study possible. I would also like to extend my sincere thanks and gratitude to my research supervisors Professor Amanda Clarke and Dr Matthew Kiernan for their continued support and guidance.

Background

This paper details the second year of a PhD. As the research study is ongoing and unpublished this report reflects on the year from a personal stance, discussing pertinent points throughout the year and how these have influenced the study. In tandem to my personal reflections, key areas for consideration and subjects that have become exposed throughout the year are discussed in relation to how these have impacted on the study direction.

Research Aims

The research aims to explore the concept of care delivery and knowledge underpinning that registered mental health nurses (RNMH) use in practice when looking after patients with delirium superimposed on dementia (DSD). It is envisaged that data will be collected to illuminate what experiences of care the RNMH participants have had, what they base their care and clinical decisions upon, what helps or hinders them in practice and if there is an organisational way to move the DSD care agenda forward. The paper explores the variance between the conditions of delirium, dementia and DSD.

Methods

For this phase of the research, an extensive literature review was undertaken. The search strategy was two fold. For each phase a list of key terms was devised, applied and refined. Clinical databases were searched alongside hand searching reference lists and literature discussed with peers. Phase one identified literature relating to DSD and nursing care whilst phase two pertained to nursing knowledge, use of knowledge and factors that impact on evidence use in practice.

Analysis of Information

Delirium superimposed on dementia is a confusing clinical condition. Often the new presentation of delirium is associated with an underlying dementia. With delirium being recognised as a preventable and treatable condition, failure to assess for delirium may impact negatively on patient outcomes. One key identifying factor for delirium, and thus DSD in a person with dementia, is the presence of an acute and often fluctuating nature of presentation. This may be used to identify a potential DSD and commence appropriate assessments. Driving the need for robust understanding and assessment is the findings that those who have a diagnosis of DSD may have a significantly increased mortality rate within one year of diagnosis. It is in these findings that the urgency and pertinence of understanding how care is understood, delivered and its underpinning foundations can be seen.

Extensive literature searching exposes a significant gap pertaining to RNMHs perspectives using evidence or knowledge in practice. Professionally bound by the Nursing and Midwifery Council code to deliver care that is evidence based, questions still remain around nurses research literacy and ability to “use” research and evidence to base practice upon. Significant to the study is the lack of information or research conducted with RNMHs and delirium, dementia or indeed DSD.

Reflections

The research award has impacted on me both professionally and personally. I have gained greater insight into conducting formal research. Affording me the time and recognition of the importance of nurses conducting research for nurses, I have been able to advance my professional career and seek full time employment lecturing at a University. I have been challenged to undertake areas of study which are complex but of great benefit and explore writing academic papers for publication.