Page 144 - Encyclopedia of Nursing Research

DELPhi TEChniQUE n 111

while providing symptomatic and support- outcomes of care in delirium remain incon-
ive care. sistent, indicating that much work remains to
For adults, proactive geriatric consul- improve the care of individuals at risk for or D
tations and multicomponent interventions experiencing delirium. Guidelines for delir-
targeting several risk factors, rather than ium prevention, management, and treatment
targeting a single risk factor for delirium, in children do not exist.
and interventions with surgical versus med- on the basis of this summary of the state
ical patients have proved more successful in of knowledge of delirium, the need for fur-
reducing the incidence, severity, or duration ther study of delirium in all ages and care
of delirium. however, interventions have had settings is clearly documented. Such study
no effect on the recurrence of delirium or on should focus on all aspects of delirium,
outcomes 6 months after discharge from the including the epidemiology and natural his-
hospital. tory of delirium, to improve our understand-
To better understand why these interven- ing of the duration, severity, persistence, and
tions for adults have not been more success- recurrence of delirium and to better target
ful, some investigators have conducted post and time interventions. Greater insight into
hoc analyses to identify the characteristics of the underlying pathologic mechanism(s) of
patients for whom these interventions have delirium would enable more rigorous devel-
failed. These analyses have indicated that opment and testing of the efficacy and effec-
these interventions were less successful with tiveness of interventions to prevent and treat
patients who are at greatest risk for delir- delirium.
ium: those who are demented, functionally
impaired, and frailer. however, it is difficult Marquis D. Foreman
to determine how to improve these inter- Patricia E. H. Vermeersch
ventions because these studies have been
conceptually confused: Efficacy has been
confused with effectiveness, changing pro-
vider behavior has been confused with pre-
venting or treating underlying causal agents Delphi teChnique
for delirium, and primary prevention has
been confused with secondary prevention.
Moreover, interventions have targeted risk The Delphi technique is a research method
factors rather than the underlying pathologic used to identify key issues, to set priorities,
mechanisms (i.e., the metabolic and physio- and to improve decision making through
logic deviations that disrupt neurotransmit- aggregating the judgments of a group of
ter synthesis and functioning). Also, these individuals. The technique consists of using
studies have not been designed or powered a series of mailed questionnaires to develop
in such a way as to determine which of the consensus among the participants with-
multicomponents actually contributed to the out face-to-face participation. it provides
positive outcomes. the opportunity for broad participation
To improve the recognition, prevention, and prevents any one member of the group
and treatment of delirium in adults, sev- from unduly influencing other members’
eral professional organizations have devel- responses. Feedback is given to panel mem-
oped practice guidelines. These guidelines bers on the responses to each of the question-
tend to be comprehensive and are based on naires. Thus, panel members communicate
research and expert clinical opinion. Despite indirectly with each other in a limited, goal-
the existence of guidelines, the process and directed manner.