Nurses' experiences in the management of delirium among older persons in acute care ward settings: A qualitative systematic review and meta-aggregation.

Background: Delirium is a multifactorial syndrome closely associated with negative hospitalisation outcomes. Given the global growth of the ageing population, delirium becomes increasingly prevalent among older persons. Nurses play a pivotal role in delirium management and receive direct impacts of delirious presentations. Yet, there is a dearth of literature reviewing nurses' experiences.

Objective: To synthesise the best available evidence exploring nurses' experiences in managing delirium of older persons in acute care wards.

Design: Systematic review of qualitative studies and meta-aggregation.

Data Sources: Published and unpublished literature between January 2010 and December 2020 were identified from PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO and ProQuest.

Review Methods: A systematic search strategy was applied in October 2020, with an update in January 2021. Two reviewers independently screened the titles and abstracts and selected the eligible studies after reading the full texts. This review included studies focusing on licensed nurses providing care to patients aged 65 and above, having any type of delirium during their hospitalisation stays in acute care settings. Studies included are qualitative papers with research designs such as phenomenology, ethnography, qualitative descriptive and grounded theory. The eligible studies were appraised independently using The JBI Critical Appraisal Checklist for Qualitative Research. Data of included studies were extracted by two independent reviewers using a standardised form. Findings were synthesised by the meta-aggregative approach.

Results: Thirty-one papers that considered nurses' (n = 464) experiences in managing older persons' delirium were included. A total of 375 findings were extracted, aggregated into 23 categories, and developed 5 synthesised findings: (i) delirium detection could be hindered when nurses possess a narrowed view of delirium, (ii) nurses navigate through complexity when providing multi-faceted care, (iii) nurses carry personal emotions, assumptions, and identities, (iv) various stakeholders have double-edged influences, and (v) nurses display preferences in their learning needs.

Conclusion: This review informed about nurses' perceptions of delirium, delirious older persons, and their nursing management which were specific to older persons and acute care settings. Nurses should practise self-awareness regarding their own knowledge and attitudes while performing delirium management in older adults. Meanwhile, healthcare professionals and policymakers should make a concerted effort in cultivating a better working environment. Future research of delirium care that specifically investigates with a geriatric perspective would better contribute to the improvement of evidence-based nursing practices for older persons.