Background delirium is common in older emergency department (ED) patients, but vastly under-recognised, in part due to lack of standardised screening processes. Understanding local context and barriers to delirium screening are integral for successful implementation of a delirium screening protocol. Objectives we sought to identify barriers and facilitators to delirium screening by nurses in older ED patients. Methods we conducted 15 semi-structured, face-to-face interviews based on the Theoretical Domains Framework with bedside nurses, nurse educators and managers at two academic EDs in 2017. Two research assistants independently coded transcripts. Relevant domains and themes were identified. Results a total of 717 utterances were coded into 14 domains. Three dominant themes emerged: (i) lack of clinical prioritisation because of competing demands, lack of time and heavy workload; (ii) discordance between perceived capabilities and knowledge and (iii) hospital culture. Conclusion this qualitative study explored nursing barriers and facilitators to delirium screening in older ED patients. We found that delirium was recognised as an important clinical problem; however, it was not clinically prioritised; there was a false self-perception of knowledge and ability to recognise delirium and hospital culture was a strong influencer of behaviour. Successful adoption of a delirium screening protocol will only be realised if these issues are addressed.

中文翻译：

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老年急诊患者护理谵妄筛查的障碍和促进因素：使用理论领域框架的定性研究

背景 谵妄在急诊科 (ED) 的老年患者中很常见，但人们对其认识不足，部分原因是缺乏标准化的筛查流程。了解当地情况和谵妄筛查的障碍是成功实施谵妄筛查方案不可或缺的。目的 我们试图确定护士对老年 ED 患者进行谵妄筛查的障碍和促进因素。方法 2017 年，我们根据理论领域框架对两个学术急诊室的床边护士、护士教育者和管理人员进行了 15 次半结构化、面对面的访谈。两名研究助理独立对记录进行了编码。确定了相关领域和主题。结果共有 717 条话语被编码到 14 个领域。出现了三个主要主题：(i) 由于相互竞争的需求、缺乏时间和繁重的工作量，缺乏临床优先次序；(ii) 认知能力和知识与 (iii) 医院文化之间的不一致。结论 这项定性研究探讨了老年 ED 患者谵妄筛查的护理障碍和促进因素。我们发现谵妄被认为是一个重要的临床问题；然而，它不是临床优先考虑的；存在错误的知识自我认知和识别谵妄的能力，医院文化是行为的强烈影响因素。只有解决了这些问题，才能成功采用谵妄筛查方案。结论 这项定性研究探讨了老年 ED 患者谵妄筛查的护理障碍和促进因素。我们发现谵妄被认为是一个重要的临床问题；然而，它不是临床优先考虑的；存在错误的知识自我认知和识别谵妄的能力，医院文化是行为的强烈影响因素。只有解决了这些问题，才能成功采用谵妄筛查方案。结论 这项定性研究探讨了老年 ED 患者谵妄筛查的护理障碍和促进因素。我们发现谵妄被认为是一个重要的临床问题；然而，它不是临床优先考虑的；存在错误的知识自我认知和识别谵妄的能力，医院文化是行为的强烈影响因素。只有解决了这些问题，才能成功采用谵妄筛查方案。