Background Delirium is a syndrome of decreased cognitive function, consciousness and attention. It has an acute onset and fluctuating course. The prevalence of delirium amongst palliative care in-patients is about 30%. There is no similar data for out-patients. A focus group was conducted at a Scottish hospice to explore the experiences of clinical nurse specialists (CNSs) in managing delirium in the community. This formed part of a wider quality improvement project on hospice patients with delirium.

Method Two facilitators explored the experiences of CNSs in the management of delirium. Discussions were recorded and transcribed to allow analysis of themes.

Results The focus group involved eight CNSs and generated 21 pages of text. Data was reviewed by two members of the project team. Themes emerged including importance of skilled assessment, impact on families, challenges in the management of delirium at home and the impact of delirium on choices available at the end of life.

The CNSs reflected on the impact of delirium on patients' families, who experienced guilt, fear and a sense of early bereavement. They also recognised particular challenges associated with managing patients with delirium in the community. They felt pressure to avoid admission to hospital but also felt there was a lack of the support services required to offer a non-pharmacological approach to management at home. Drugs were resorted to earlier than would be necessary in a different care setting to manage symptoms and risk. The CNSs also spoke of ‘walking away’ but being left with feelings of responsibility for the situation. Delirium was also felt to negatively impact on choices at the end of life e.g. place of death.

Conclusion Management of delirium in the community represents unique challenges compared with an in-patient setting. There is a need for educational resources targeting professionals working in the community.