The caregiving experience: How much do health professionals understand?

Legal, social and economic factors have changed the delivery of care to people who have a mental disorder. Many of these people are now treated in the community and they live with or in close proximity to their family. The aim of this paper is to provide health professionals with an insight into the experience of being a caregiver to a person with a mental disorder. For these families caregiving becomes an integral part of everyday life.Positive outcomes for both the caregiver and the ill family member are more likely to occur when effective levels of collaboration exist between health professionals and caregivers. Collaboration is enhanced when caregivers and health professionals value each other's contribution to the ill family member's care. Often the burden, stress, and socio-economic effects on the family caring for a person with mental illness is not sufficiently appreciated and further increases this burden. A review of the literature from the caregiver's perception is presented. An increased understanding of the caregiving experience will enable health professionals to develop and implement strategies that facilitate positive outcomes for the caregiver and the ill family member

Nurses descriptions of changes in cognitive function in the acute care setting

To describe nurses' documentation of cognition and behavioural changes in patients in acute care settings. Hospitalised patients often present with multiple co-morbidities including declining levels of cognitive functioning and this is particularly so for older people. Many older people will experience a delirium during hospitalisation. While prevention or prompt management of delirium is paramount to providing quality care, research suggest that health professionals regularly fail to differentiate between delirium and other cognitive changes in hospitalised patients. A total of 1209 patients were surveyed over the four audit days with 183 patients (15%) being identified as confused. 'Confusion" was the most common descriptor used by nurses to describe cognitive and behavioural changes; in many cases it was the only term used. Many of these changes were indicative of delirium. Little use by any health professional of cognitive screening tools were found.Cognitive and behavioural changes are a common problem in hospitalised patients who are elderly. The use of the term confusion to describe a range of cognitive and behavioural changes is a barrier to accurate identification of delirum, which is often the first indicator of serious underlying illness

Prevalence rate of delirium at two hospitals in Western Australia

Objective: To estimate the prevalence of delirium in patients on 15 medical and surgical wards at two hospitals in Western Australia. Design: Following a review of the literature on delirium a standardised data collection tool was developed and four prevalence audits were conducted over a four week period at the target hospitals. The nurse cordinator on each ward was asked to identify any patient who was experiencing a delirium or who was confused. These patient's records were then examined for documentation that confirmed the presence of delirium or confusion. Main outcome measures: The audit measured those patients with a confirmed documented delirium and identified patients who had a possible delirium superimposed on a confirmed or suspected dementia or unconfirmed organic brain disorder. Patients with a known dementia or organic brain disorder who displayed symptoms of confusion but had no evidence of delirium were also identified. Results: Of 1209 patients surveyed in four prevalence audits, 132 patients (10.9%) displayed behaviours suggestive of the presence of delirium; however only 48 of the 132 patients had a confirmed diagnosis of delirium. The remaining 84 patients displayed features of delirium that were superimposed on symptoms of dementia (diagnosed/undiagnosed) or an organic brain disorder. An additional 51 (4.2%) of the 1209 patients were identified with confusion resulting from other causes. Conclusions: Accurate assessment of delirium is particularly important in elderly people where behaviours associated with delirium are often assumed to be caused by dementia. This may result in delirium going undiagnosed and untreated

A questionnaire to determine nurses' knowledge of delirium and its risk factors

Delirium is a frequent complication of hospital admission, especially among the elderly. It can have serious consequences in terms of morbidity, mortality and decreased quality of life. Nevertheless, an extensive literature review found that it is poorly recognised and poorly managed by medical and nursing staff.Although some researchers have found that education programs for nurses can improve outcomes for patients with delirium, no research assessing nurses' knowledge was found. The objective of this research was to determine nurses' level of knowledge regarding delirium and its risk factors. A questionnaire survey sent to nurses at a teaching hospital found that nurses? knowledge of delirium was generally inadequate, although one ward which had had inservice education attained better results. It is recommended that cognitive assessment in general and delirium in particular be incorporated into nursingeducation. Improved education could potentially lead to improved health outcomes and considerable cost savings

Perceptions of infection control practices among health professionals

Infection control practice is a cornerstone of modern health care. However, there is minimal research into health professionals' perception of infection control practices and how those perceptions influence staff compliance with recommended protocols. The objective of this study was to explore health care professionals' perceptions of infection control practices in relation to the management of infectious diseases. A grounded theory approach was used as the research framework. Semi-structured interviews were completed with a sample of 16 nurses and doctors working at hospitals in Western Australia. Four major categories emerged from the data. These were: knowledge, culture, conflict, and risk assessment. The findings indicate the importance of both individual and organisational factors in determining clinicians' levels of compliance with recommended infection control practices. Identification of the factors that influence health professionals' level of compliance can be used to develop strategies to support long-term compliance with infection control practices