Personal experiences of older hospitalised patients suffering from delirium, their family members, and hospital nurses

Delirium is a serious complication that affects between 14% and 40% of all
older hospital patients, and which could be avoided in up to 40% of these
cases, by employing early detection methods and taking preventive measures. The
American Psychiatric Association describes delirium as a disorder of
fluctuating consciousness with cognitive problems, such as memory loss,
disorientation, and language problems, which develops in a matter of hours or
days, as a result of an underlying physical condition. It is a predictor of
many negative long term consequences, such as prolonged duration of
hospitalisation, higher chances of dementia and institutionalisation, less
functional recovery, and death within 12 months after the delirium.

In the last two decades, a lot of research has been done in the fields of
diagnosis, risk factors, consequences, and treatments for delirium. This has
resulted in, amongst other things, the development of guidelines for the
treatment of delirium in adults (richtlijn *Delier voor volwassenen*).
However, little is known about how patients, their family members, and hospital
nurses experience the delirium. Previous research shows that in some cases
depression or post-traumatic stress disorder can occur, both in patients and in
family members, and that some patients refuse further hospital treatments out
of fear of developing another delirium. Nurses too experience elevated levels
of stress and pressure, sometimes leading to a burn-out, when working with
delirious patients, because this group of patients need more time and attention
than do regular patients, and information about the disorder is often not on
hand. To our knowledge, this is the first study to combine the points of view
of all three groups simultaneously: patients, family members, and hospital
nurses.

The research question fort his study is: *What are the personal experiences of
older hospital patients who have suffered a delirium, their family members, and
their handling nurses?*.
The aim of the current study is to gather the personal experiences of older
patients, their family members (naasten) and hospital nurses, and to gain
insights into how this experience could be improved, for example by providing
more information or support, before, during, and after the delirious episode.

The study is a qualitative study based on the principles of grounded theory,
and will be done using semi-structured interviews.

Before the start of the actual study, three pilot interviews (one with a
patient, one with a family member, and one with a nurse) will be done to
evaluate the clarity and usefulness of the questions and if the intended
information can be obtained. All interviews will be audio-recorded with consent
of the participants.

The interviews will last a maximum of one hour, and the potential risk for
participants is low. In case a participants experiences negative emotions due
to the interview, they may stop the interview at any time and refuse further
participation in the study.

Interviews with patients are planned during their routine follow-up at the
delirium poli in the MUMC+, six weeks after release from the hospital.
Interviews with patients are only conducted if they are no longer suffering
from the delirium. Interviews with family and nurses will take place at a place
and time previously agreed upon.