"It should not be that difficult to manage a condition that is so frequent": A qualitative study on hospital nurses' experience of delirium guidelines

Aims and objectives To explore hospital nurses' experiences of enablers and barriers to apply the recommendations of a hospital delirium guideline, focusing on identification and nonpharmacological prevention and treatment. Background Nurses' application of delirium guidelines is important as they have a pivotal role in identifying, preventing and managing delirium. Research is sparse concerning barriers and enablers to nurses ' application of guideline recommendations on nonpharmacological prevention and treatment of delirium. Design Qualitative design using focus group and individual interviews. Methods Twenty-three nurses, nurse supervisors and senior staff nurses from four departments in a Danish 530-bed university hospital participated in the study. The interview guide was based on the Theoretical Domains Framework. Data were analysed using inductive content analysis. The COREQ checklist was used preparing the manuscript. Results The analysis identified four main categories concerning barriers and enablers to applying the recommendations of a delirium guideline: factors relating to employing the guideline, the individual nurse, collaboration and the context. Lack of identification of delirium and lack of preventive actions were prominent, with inter-related barriers such as lack of knowledge, lack of meaningfulness, lack of priority, lack of resources and working conditions, causing frustration and discouragement in the nurses. Conclusions The study identified a wide range of barriers and enablers experienced by hospital nurses to the application of a delirium guideline, showing the complexity of delirium care and applying guidelines. Relevance to clinical practice Improving the identification, prevention and treatment for patients with delirium requires a determined and focused effort from all stakeholders, both clinicians, leaders and policymakers. Nurses, nurse leaders and educators must be aware of the barriers and enablers related to knowledge, attitudes and co-operation. Managers and policymakers must be aware of the organisational factors related to priority and working conditions.