Background Delirium is a serious neuropsychiatric syndrome. It is common amongst terminally ill people in the community, with studies reporting a prevalence of 4–12% on initial palliative care assessment, rising to 44% towards the end of life. District nurses have an important role in supporting terminally ill people to remain at home.
Aim To explore how delirium is assessed and managed by district nurses, and to identify the support they need to do this well.
Design/participants Semi-structured interviews were conducted via Microsoft Teams with 12 district nurses in Scotland, UK. Data was analyzed using a framework approach.
Results Overarching themes were challenges in delirium detection, uncertainty regarding delirium management, and education and support needs. Time constraints on home visits, limited knowledge about patients, reliance on family carers, and the fluctuating intensity of delirium symptoms contributed to complexity in delirium detection and management. District nurses were unsure about the value of delirium detection tools and used delirium terminology inconsistently. They were familiar with non-pharmacological strategies, but uncertainty remained regarding pharmacological management of distressing hyperactive delirium symptoms, developing towards the end of life. When terminally ill people deteriorated acutely with delirium, organizational difficulties were reported, with challenges accessing timely advisory and practical support from other health and social care professionals. District nurses identified educational needs concerning delirium detection and management.
Conclusion Caring for terminally ill people with delirium in the community is challenging. Educational interventions may be beneficial in developing district nurses’ confidence in supporting these patients and their families. Specialist palliative care services are required to provide more responsive advice and support.
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