Background cognitively impaired hospital patients often experience agitation and aggression due to pain. Agitation complicates care, increasing the risk of adverse outcomes and patient-to-nurse violence. Managing agitation is challenging for nurses. Literature suggests they may rely on antipsychotics while missing other more appropriately targeted treatments. However, nurses’ management of agitation remains unclear and under-researched. Objective the aim of this study was to investigate hospital nurses’ management of agitation in older cognitively impaired patients with pain. Design this was a descriptive correlational study using virtual simulation. Setting and participants a total of 274 registered medical and surgical nurses from 10 public hospitals in Queensland, Australia participated in the study. Methods nurses undertook a virtual simulation requiring them to manage agitation in a patient with dementia and an injury. Nurses also completed a post-simulation questionnaire. Their simulation performances were correlated with demographics such as seniority, workplace, training, experience and gerontology-specific knowledge. Constructed from an original, validated vignette, the simulation included branching pathways, video scenarios and an avatar that could converse with participants. Results thirteen nurses (4.7%) recognised and treated the virtual patient’s agitation as pain-related. Most nurses (89%) gave antipsychotics of which 207 (78%) gave these first-line and 102 (38%) used them twice. Independent of other variables, nurses most likely to diagnose pain were dementia-unit nurses (OR = 8.7), surgical-unit nurses (OR = 7.3) and senior nurses (OR = 5). Conclusions hospital nurses predominately managed agitation with antipsychotics, a decision that most made after undertaking inadequate patient assessments. This confirmed a common gap in practice that may lead to the missing of pain in the clinical care of agitated patients with dementia and/or delirium.

中文翻译：

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医院护士对老年认知障碍患者躁动的管理：他们是否认识到与疼痛相关的躁动？

背景认知受损的住院患者经常因疼痛而感到激动和攻击性。情绪激动使护理复杂化，增加了不良后果和患者对护士暴力的风险。管理躁动对护士来说是一项挑战。文献表明，他们可能依赖抗精神病药，而缺少其他更合适的靶向治疗。然而，护士对躁动的管理仍不清楚且研究不足。目的 本研究的目的是调查医院护士对老年认知障碍疼痛患者的激越管理。设计这是一项使用虚拟仿真的描述性相关研究。来自澳大利亚昆士兰州 10 家公立医院的 274 名注册内科和外科护士参与了研究。方法护士进行了虚拟模拟，要求他们管理患有痴呆症和受伤的患者的躁动。护士还完成了模拟后问卷。他们的模拟性能与诸如资历、工作场所、培训、经验和老年学特定知识等人口统计数据相关。该模拟由一个经过验证的原始小插曲构成，包括分支路径、视频场景和一个可以与参与者交谈的化身。结果 13 名护士 (4.7%) 将虚拟患者的躁动视为与疼痛相关，并将其视为疼痛。大多数护士 (89%) 给予抗精神病药物，其中 207 名 (78%) 给予这些一线药物，102 名 (38%) 使用两次。独立于其他变量，最有可能诊断疼痛的护士是痴呆症科护士 (OR = 8.7)、外科科护士 (OR = 7. 3) 和高级护士 (OR = 5)。结论 医院护士主要使用抗精神病药物控制躁动，这是大多数在对患者评估不充分后做出的决定。这证实了实践中的一个普遍差距，可能导致痴呆和/或谵妄患者的临床护理中缺少疼痛。