Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Clinicians' Experiences of Participating in an Action Research Study

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Clinicians' Experiences of Participating in an Action Research Study

Article excerpt

INTRODUCTION

I used to think nursing research was something abstract that I would never be able to do as a clinical nurse, or that was too academic for me. However, my thoughts have changed after being involved in this study.

PAR group participant

The objective of this paper is to share our experiences of participating in an action research project designed to improve the care of older people at risk of delirium. The setting for the study and the subject of this paper was a busy medical ward in a 550 bed regional tertiary referral hospital located in New South Wales, Australia. The participants for the project included eight clinical nursing and allied health staff based on a 32 bed general medical ward at the time of the study and three academic staff from the local university. The patients cared for on the ward include a significant number of frail older people with chronic and complex illnesses who are also at risk of developing delirium. This was one of the challenges for staff on the ward related to caring for people with delirium.

Delirium in the older person is characterized by a disturbance of consciousness and a change in cognition over a short period of time, usually hours to days, and tends to fluctuate during the course of the day. Ability to focus, sustain or shift attention is impaired. On admission to hospital 10-15% of older patients might have delirium, with up to 40% developing delirium during their hospital stay (Clinical Epidemiology and Health Service Evaluation Unit Melbourne Health & Group, D C G E W, 2006). Delirium is a direct physiological consequence of a general medical condition, substances withdrawal or intoxication, use of medication or combination of these factors (American Psychiatric Association, 2000). It may last for a few days, weeks or even months.

Hypoactive delirium is the most common form of delirium in older people and has a poorer prognosis than the other sub types. In hypoactive delirium the patient is quiet, cooperative, may need strong verbal or physical stimuli to arouse them and arousal is often transient (Milisen, Steeman, & Foreman, 2004). Hyperactive delirium on the other hand is more obvious as it is characterized by increased agitation, hallucinations and inappropriate behaviour (British Geriatric Society and Royal College of Physicians, 2006). Mixed delirium in the older person is characterized by alternation between agitated and quiet forms of delirium (Casarett & Inouye, 2001). Though delirium in the older person can be prevented during hospitalization with assessment of the risk factors (Inouye, 2006; Inouye et al., 1999), it is often overlooked and so the underlying illness can be undertreated (Schuurmans, Duursma, & Shortridge-Baggett, 2001).

In the discussion that follows, the authors outline the details of the study, participatory action research (PAR), what we were asked to do to participate, our reasons for agreeing to participate, our expectations of the project, the group process, what we did during the PAR cycles: look, think and act, and the benefits and challenges of participating in the project. In conclusion we highlight the gains of participating in PAR and we make recommendations for the future.

RECRUITMENT: AROUSING OUR INTEREST

In January 2007 we were approached by academic nursing staff from the local University who sought our interest in participating in a research project about the management of delirium in older people. A copy of the research proposal was provided along with an information letter which described the study as follows:

This study will use a partnership approach, through the use of participatory action research (PAR) processes to work with clinicians to redesign the implementation and evaluation of best practice guidelines for early detection and management of delirium in older people in an acute care setting. If you are a clinician working in the ward and interested in improving practice and quality of care for older people with delirium, we invite you to work with the research team from January to July, 2007. …

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