Data from: How do doctors and nurses manage delirium in intensive care units? A qualitative study using focus groups.

Objectives: The aim of this study was to explore the experiences of
doctors and nurses caring for patients with delirium in the intensive care
unit (ICU) and to describe the process of delirium management. Setting:
This study was performed in 5 ICUs located within 4 hospitals in Madrid
(Spain). Participants: Purposeful sampling was performed which included
(1) doctors and nurses working in ICUs, (2) with >1 year experience
in the ICU and (3) clinical experience with delirium. 38 professionals
participated (19 doctors, 19 nurses), including 22 women and 16 men. The
total mean age was 39 years. Design: A qualitative study using focus
groups. Methods: 7 focus groups were held to collect data: 3 nurse focus
groups, 3 doctor focus groups and 1 mixed focus group. Each group
comprised 6–10 participants. A semistructured questions guide was used.
Thematic analysis methods were used to analyse the data. Results: 3 themes
were identified: (1) the professional perspective on delirium; (2)
implementing pharmacological and non-pharmacological treatment for
delirium and (3) work organisation in the ICU. The professionals regarded
patients with delirium with uncertainty, and felt they were often
underdiagnosed and poorly managed. Doctors displayed discrepancies
regarding pharmacological prescriptions and decision-making. The choice of
medication was determined by experience. Nurses felt that, for many
doctors, delirium was not considered a matter of urgency in the ICU.
Nurses encountered difficulties when applying verbal restraint, managing
sleep disorders and providing early mobilisation. The lack of a delirium
protocol generates conflicts regarding what type of care management to
apply, especially during the night shift. A degree of group pressure
exists which, in turn, influences the decision-making process and patient
care. Conclusions: Patients with delirium represent complex cases,
requiring the implementation of specific protocols. These results serve to
improve the process of care in patients with delirium.