Development of a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers: A multi-method study.

Acute care Caregivers Complex intervention Delirium Family Hospitals Patient care management Patient discharge Patient transfer

Journal

International journal of nursing studies
ISSN: 1873-491X
Titre abrégé: Int J Nurs Stud
Pays: England
ID NLM: 0400675

Informations de publication

Date de publication:
14 Nov 2023
Historique:
received: 05 04 2023
revised: 09 10 2023
accepted: 09 11 2023
medline: 14 12 2023
pubmed: 14 12 2023
entrez: 13 12 2023
Statut: aheadofprint

Résumé

Delirium is a common yet challenging condition in older hospitalized patients, associated with various adverse outcomes. Environmental factors, such as room changes, may contribute to the development or severity of delirium. Most previous research has focused on preventing and reducing this condition by addressing risk factors and facilitating reorientation during hospital stay. We aimed to systematically develop a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers during and after these procedures. The intervention combines stakeholder and expert opinions, evidence, and theory. This article provides guidance and inspiration to research groups in developing complex interventions according to the recommendations in the Medical Research Council framework for complex interventions. A stepwise multi-method study was conducted. The preparation phase included analysis of the context and current practice via focus groups. Based on these results, an expert workshop was organized, followed by a Delphi survey. Finally, the intervention was modeled and a program theory was developed, including a logic model. A complex intervention was developed in an iterative process, involving healthcare professionals, delirium experts, researchers, as well as caregiver and patient representatives. The key intervention component is an 8-point-program, which provides caregivers with recommendations for preventing delirium during the transition phase and in the post-discharge period. Information materials (flyers, handbook, videos, posters, defined "Dos and Don'ts", discharge checklist), training for healthcare professionals, and status analyses are used as implementation strategies. In addition, roles were established for gatekeepers to act as leaders, and champions to serve as knowledge multipliers and trainers for the multi-professional team in the hospitals. This study serves as an example of how to develop a complex intervention. In an additional step, the intervention and implementation strategies will be investigated for feasibility and acceptability in a pilot study with an accompanying process evaluation. Delirium prevention can benefit from optimizing discharge and transfer processes and involving caregivers of older patients in these procedures. DRKS00017828, German Register of Clinical Studies, date of registration 17.09.2019.

Sections du résumé

BACKGROUND BACKGROUND
Delirium is a common yet challenging condition in older hospitalized patients, associated with various adverse outcomes. Environmental factors, such as room changes, may contribute to the development or severity of delirium. Most previous research has focused on preventing and reducing this condition by addressing risk factors and facilitating reorientation during hospital stay.
OBJECTIVE OBJECTIVE
We aimed to systematically develop a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers during and after these procedures. The intervention combines stakeholder and expert opinions, evidence, and theory. This article provides guidance and inspiration to research groups in developing complex interventions according to the recommendations in the Medical Research Council framework for complex interventions.
DESIGN AND METHODS METHODS
A stepwise multi-method study was conducted. The preparation phase included analysis of the context and current practice via focus groups. Based on these results, an expert workshop was organized, followed by a Delphi survey. Finally, the intervention was modeled and a program theory was developed, including a logic model.
RESULTS RESULTS
A complex intervention was developed in an iterative process, involving healthcare professionals, delirium experts, researchers, as well as caregiver and patient representatives. The key intervention component is an 8-point-program, which provides caregivers with recommendations for preventing delirium during the transition phase and in the post-discharge period. Information materials (flyers, handbook, videos, posters, defined "Dos and Don'ts", discharge checklist), training for healthcare professionals, and status analyses are used as implementation strategies. In addition, roles were established for gatekeepers to act as leaders, and champions to serve as knowledge multipliers and trainers for the multi-professional team in the hospitals.
CONCLUSIONS CONCLUSIONS
This study serves as an example of how to develop a complex intervention. In an additional step, the intervention and implementation strategies will be investigated for feasibility and acceptability in a pilot study with an accompanying process evaluation.
TWEETABLE ABSTRACT CONCLUSIONS
Delirium prevention can benefit from optimizing discharge and transfer processes and involving caregivers of older patients in these procedures.
STUDY REGISTRATION BACKGROUND
DRKS00017828, German Register of Clinical Studies, date of registration 17.09.2019.

Identifiants

DOI: 10.1016/j.ijnurstu.2023.104645 PMID: 38091654
pubmed: 38091654
pii: S0020-7489(23)00210-9
doi: 10.1016/j.ijnurstu.2023.104645
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

104645

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Auteurs

Natascha-Elisabeth Denninger (NE)

Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany. Electronic address: Natascha.denninger@med.uni-heidelberg.de.

Simone Brefka (S)

Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany.

Stefanie Skudlik (S)

Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany.

Christoph Leinert (C)

Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany.

Thomas Mross (T)

Agaplesion Bethanien Hospital Heidelberg, Centre for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany.

Gabriele Meyer (G)

Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany.

Daniela Sulmann (D)

Centre for Quality in Care, Berlin, Germany.

Dhayana Dallmeier (D)

Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Boston University School of Public Health, Department of Epidemiology, Boston, USA.

Michael Denkinger (M)

Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany.

Martin Müller (M)

Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany.

Classifications MeSH