| 1. |
- Andersson, Edith, et al.
(författare)
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Acute confusional episodes in elderly orthopaedic patients: the patients' actions and speech.
- 2002
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Ingår i: International Journal of Nursing Studies. - 1873-491X. ; 39:3, s. 303-317
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to illuminate the pattern of confusional episodes with regard to the content of elderly patients' actions and speech. Fifty-one (11.2%) out of 457 people admitted to an orthopaedic clinic developed acute confusional state. Non-participant direct observations and daily clinical bedside follow-up observations were made during the confusional episodes, focusing on the patients' speech, actions and reactions with reference to situation, the surroundings, and the nurses' actions, including their verbal communication with the patient. The texts were analysed using manifest and latent content analysis and revealed disturbances in motor activity, speech and mood. 'Struggling to understand and to gain control when in a state of confusion and viewing oneself as being confused' was the main theme illuminated in the texts. In the struggle to achieve understanding and take control over themselves and what was currently taking place, the patients used a variety of strategies. They attempted to find clarity, to make a sensible story out of the present and to impute meaning to the present by using their life story. The findings indicated that the patients had a drive to achieve control when they were confused and that they were both aware and unaware of their state and tended to oscillate between being in a confused state and viewing their confusion from an outside perspective. The findings indicated that possibly the best approach is to support their inner drive to gain control. This means moving between confirmation of their emotional state and their perceptions and trying to introduce 'reality' when they realize their state of confusion. Thus the nurse--patient relationship perhaps needs to hold a balance between confirmation and introducing in reality.
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| 2. |
- Andersson, Edith, et al.
(författare)
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Acute confusional state in elderly orthopaedic patients: factors of importance for detection in nursing care
- 2001
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Ingår i: International Journal of Geriatric Psychiatry. - 1099-1166. ; 16:1, s. 7-17
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aims of this study were to identify factors of significance in the development of acute confusional state (ACS) and the differences between patients who developed ACS and those who did not. METHOD AND RESULTS: Assessment, observations and interviews with 505 patients admitted to an orthopaedic clinic revealed that 51 patients developed ACS during their in-hospital stay. Patients admitted for hip fracture had a higher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthros or gonarthros (3.6%). The highest hazard ratio for ACS was several other physical diseases 15.94 (CI: 4.60-55.31 and p-value <0.00001) and the lowest was age 1.10 (CI: 1.04-1.15 and p-value <0.0002). The ACS lasted from 1 to 9 days, and patients had one (N=42), two (N=8) or three episodes (N=1) of confusion during their stay on the ward. More patients who developed ACS before surgery had two or more confusional episodes and emergency patients developed ACS more rapidly. The ACS lasted longer in patients with a higher score on the OBS scale at admittance and with rapid development of ACS. CONCLUSIONS: Acuteness in the situation seems an important risk indication for ACS in the elderly. Awareness of factors associated with the development of ACS makes it possible to more systematically identify those at risk, for instance by systematic assessment in the first interview with the patient on admission to hospital.
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| 3. |
- Andersson, Edith M
(författare)
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Acute confusion in orthopaedic care. With the emphasis on the patients' view and the episode of confusion.
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to investigate factors of significance for the development of acute confusional state (ACS), the confusional episodes, the lived experiences of having been confused in elderly patients admitted for emergency or elective surgery in orthopaedic care. A further aim was to investigate the nurses’ view of the ACS and the encounter with patients who developed ACS. A case study with one patient preceded the main study including 457 patients, of whom 51 patients developed ACS. Results are based on assessments of the patients’ orientation with Organic Brain Syndrome (OBS) scale, observations during the period of confusion, and interviews with patients who had developed ACS after the confusion had ceased and with nurses (n=48) who took care of the patients in connection with the ACS. Patients admitted for hip fracture had a higher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthrosis or gonarthrosis (3.6%). Factors associated with development of ACS were four or more physical diseases, emergency admission, impaired vision, more preoperative treatment because of cardiovascular or pulmonary problems, longer anaesthesia time, higher score on the OBS scale on admission and age. The higher the score on the OBS scale on admission, and the more rapid the development of ACS after admission, the longer the period of ACS. Disturbances in motor activity, speech and mood, and symptoms that developed rapidly and fluctuated during the day and from day to day were signs of the confusion. “Struggling to understand and to gain control when in a state of confusion and viewing oneself as being confused” was the main theme illuminated in the texts from the observations during the ACS. In the struggle to achieve understanding and take control over themselves and what was currently taking place, the patients used various strategies: trying to achieve clarity, making a sensible story out of the present and imputing meaning to the present by using their life story. The meaning of the patients’ lived experiences of being and having been confused was interpreted as “being trapped in incomprehensible experiences and a turmoil of past and present and here and there”. It meant that impressions of all kinds invaded the mind of the person and were experienced as reality. They seemed to be victims of these impressions rather than having control over what came into their mind. The findings indicated that one possible approach to the patients is to confirm and support them in narrating their experiences both during the confusion and also after the ACS has ceased. The nurses’ experiences of the encounter with acutely confused patients obtained from the interviews revealed that they had difficulties in reaching the patients and their reality, and understanding their experiences. The nurses found it difficult to reach the patients’ reality because the patients were felt to be in a divided and/or different world. The interaction with the confused patients indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and following the patients’ reality and/or being a surrogate and taking over the patients’ responsibility. The results were more successful when the strategies were derived from the nurses’ interpretation of the patients’ situation and the nurses paid attention to the patients and confirmed them, i.e. being a companion. The results of this thesis are basic for understanding and meeting people in acute confusional state. General vulnerability in elderly people means an increased risk of developing ACS, earlier debut and longer duration of confusion. The patients both understand and do not understand their situation and they struggle to recapture control during the confusion. After the confusion the patients remembered and could narrate their experiences. From the nurses’ perspective it was clear that they had lost contact with the patient during the confusion, and a helpful approach may be to alternate between the validation and the reality orientation approach.
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| 4. |
- Andersson, Edith, et al.
(författare)
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Nurses' experiences of the encounter with elderly patients in acute confusional state in orthopaedic care.
- 2003
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Ingår i: International Journal of Nursing Studies. - 1873-491X. ; 40:4, s. 437-448
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to illuminate nurses’ experiences of the encounter with elderly patients who developed acute confusional state (ACS) in orthopaedic care. Forty-eight nurses with professional background as registered (n=26) or licensed practical nurses (n=22) who took part in the nursing care of acute confused patients were involved. Open-ended unstructured interviews were conducted with regard to the course of events, experiences and interpretation of what had happened during the ACS as well as the nurses’ actions and encounter with the confused patient. The texts were analysed using manifest and latent content analysis, revealing that the nurses had difficulties in reaching the patients and their reality, and thus in understanding their experiences. Interpretation of the nurses’ experiences showed that the nurses found it difficult to reach the patients’ reality because the patients were in a divided and/or different world. They interpreted the patients as seeking solitude or company, keeping a distance or being suspicious of the nurses. The findings indicated that the interaction in the encounter between the acutely confused patients and the nurses indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and/or being a surrogate. They acted in the encounter based on their view of the patient and their ability to enter into and understand the patients’ situation. The strategies were more or less successful, sometimes resulting in contact and calming the patients and in other cases increasing the patients’ irritation and anger. The results were more successful when the strategies were derived from the nurses’ interpretation of the patients’ situation and the nurses paid attention to the patients and confirmed them.
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| 5. |
- Andersson, Edith, et al.
(författare)
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The meaning of acute confusional state from the perspective of elderly patients.
- 2002
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 17:7, s. 652-663
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to illuminate lived experience of having been in an acute confusional state (ACS) as narrated by elderly patients in orthopaedic care. METHOD: Qualitative study with phenomenological hermeneutic method for analysing the data based on narrative interviews. Fifty patients (67-96 years of age) who developed ACS during hospitalisation and in all cases the ACS ceased during their stay on the ward were interviewed once lucid again regarding the course of the event, their experiences, memories and interpretation of what had happened during the ACS. RESULTS: The meaning of the patients' lived experiences of being and having been confused was interpreted as 'Being trapped in incomprehensible experiences and a turmoil of past and present and here and there', comprising the themes trying to get a grip on the experience of the confusion, encountering past, present and the realm of the imagination as reality during the period of confusion and confronting the idea of having been confused. Contradictory to earlier research the patients remembered and could tell in great detail about their ACS. While confused, the confusional state means that impressions of all kinds invade the mind of the person and are experienced as reality, making him/her a victim of these impressions rather than the one who controls what comes into his/her mind. While in the middle of these experiences the person simultaneously senses that the impressions are unreal, thus indicating that he/she is in some sort of borderland between understanding and not understanding. The things that come into the mind of the person can either be frightening or neutral or enjoyable scenarios that seem to be mainly familiar but can also be unknown. These scenarios seem to be a mixture of past and present, of events and people while they seem to float from location to location. CONCLUSIONS: The findings indicates that what takes place during the ACS is not nonsense but probably a mix of the patient's life history, their present situation and above all a form of communication concerning their emotional state and inner experiences in this new situation. The findings also indicated that one possible approach to the patients is to confirm and support the patients in narrating their experiences both during the confusion and also after the ACS had ceased.
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