Claire Pryor, Nurse Practitioner in older people’s services at Northumberland Tyne and Wear NHS Foundation Trust, has been awarded a Florence Nightingale Foundation research scholarship to undertake her Professional Doctorate. The title of her study is: ‘The Nursing Concept of Delirium superimposed on Dementia: Recognition of Delirium in an Organic Mental Health Assessment Unit.’ We spoke to Claire to find out a bit more about her project.
How did you hear about the Florence Nightingale Foundation and how did you find the application process?
Having recently completed an MSc in Advancing Healthcare Practice, I was interested in exploring opportunities to further both my research and academic career while remaining in clinical practice. I was intrigued when a colleague recommended the sponsorship programme. I found the application process very helpful as the depth of information required helped focus and clarify my research premise from an early stage. Knowing that I was expected to articulate the finer points of the research premise an interview gave direction to my proposal. My work colleagues were also extremely supportive of my application and gave me time off to attend the London based interview.
Why did you choose to conduct your research on this topic?
Understanding the complex interplay between delirium (a change in consciousness and cognition; not caused by dementia) and dementia is of the utmost importance. Being a RGN advanced nurse practitioner working for a mental health Trust, my working day revolves around providing equity of care between the physical and mental health of patients in older people’s services. Deterioration or fluctuation of cognition is sometimes wrongly attributed to dementia progression; it is paramount that potential delirium and underlying physical causes are investigated thoroughly and treated appropriately.
The knowledge and skill sets of registered mental health nurses (and nursing assistants) and their understanding of delirium superimposed on dementia has a profound effect on early recognition of delirium, treatment initiation and patient outcomes.
What are the aims of your research?
The research aims to gather an in-depth understanding of nursing conceptualisation and knowledge base of delirium, it will explore the nurses’ self-articulated areas of need related to knowledge and how a work-based programme of education may improve the nurse’s concept of delirium in patients with dementia.
The work will be centred on how nurses understand delirium and what aspects of patient behaviour and care they associate with delirium. This will help build an understanding of the mental health nurses framework of knowledge regarding delirium and identify educational needs to address any deficits.
Through education and ward-based learning the research aims to provide and improve collective knowledge of delirium superimposed on dementia by upskilling the nursing team in clinical assessments of delirium and remove uncertainties of diagnosis. It is envisaged that it may promote a synthesis of knowledge relating to mental and physical health in delirium and dementia.
What do you hope to achieve?
Personally, I hope the completion of the Professional Doctorate research will raise awareness of the extremely complex area of delirium and dementia within mental health services.
Promoting, educating and supporting mental health nurses to enhance their skills in relation to certain elements of physical health will have positive effects on the patients, the staff and the organisation.
What are your plans after you have completed the research?
I plan to roll the process of education and support trust wide to ensure that the total nursing group delivering care to dementia patients have the knowledge and skills to recognise and facilitate early intervention of delirium.
What methodologies will you use to achieve your objectives?
The study will be undertaken using action research to allow the participants (nurses) to become co-researchers and have maximum influence in articulating their needs and requirements in this area. Observations of practice and interviews of staff both individually and in focus groups will allow for a cycle of critical reflection on practice.
Learning through practice will allow nursing staff to recognise and lead on their own practice needs relating to education, recognition and appropriate treatment strategies of delirium when superimposed on dementia. With the evolution of a highly skilled and motivated nursing staff group, it is perceived that the nurse-led recognition and analysis of contributing factors (hydration, infection, nutrition etc) will promote timely recognition/diagnosis of delirium and subsequently improve and impact on patient outcomes.
We will be following Claire’s research progress over the next year and look forward to seeing the results.