What are the experiences and support needs of district nurses caring for terminally ill people with delirium at home? A qualitative study

BACKGROUND: Delirium is a serious neuropsychiatric syndrome, which is common amongst terminally ill people in the community. District nurses have a key role in supporting terminally ill people to remain at home. OBJECTIVES: To explore the experience and support needs of district nurses caring for people with delirium in home settings. METHODS: Semi-structured individual and small group interviews were conducted via Microsoft Teams with 12 district nurses in Scotland, UK. Data was analyzed using framework analysis. Data was coded both deductively and inductively. RESULTS: Overarching themes were (i) challenges of delirium detection in the community, (ii) challenges managing delirium in the community, (iii) family carers as providers and recipients of care and (iv) education, training and support needs. Participants valued clinical judgement alone in detecting delirium, over use of formal assessment tools. Patients were referred to district nursing services at an advanced stage of their illness, with nurses needing to make rapid decisions about their care, sometimes with limited information. Participants were familiar with non-pharmacological strategies and the importance of family carer support, but uncertainty remained regarding pharmacological management of distressing symptoms. The term 'delirium' was rarely used. Challenges accessing timely advice and practical support from other health and social care professionals were reported. Participants identified delirium detection and the pharmacological management of persistent delirium as priorities for training. 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 terminally ill patients and their families. Responsive advice and support are required from specialist palliative care services.