The earliest work, published by Andersson, Knutsson, Hallberg and Norberg (1993), sought to explore the behaviours of older people who were delirious, the nursing response to those behaviours, as well as both the person’s and the nurses’ interpretation of the experience. The main finding associated with this study was that there existed a breakdown in communication between both the older adult and the nurse. The person who experienced delirium reported being restricted, isolated, not respected and had a strong need to be comforted. The nursing response was to approach the situation from a biomedical perspective, with interactions focussed on meeting physical care needs divorced from the emotional support the patient was seeking.
The purpose of Laitinen’s (1996) study was to describe the experience of being delirious following cardiac surgery in an intensive care unit. As with Andersson et al.’s (1993) above study the need to be comforted emerged as a major theme. All people interviewed recognised how important it was for nurses to develop relationships that were therapeutic to the patients, recognised people as individuals and to give reassurance that throughout their delirium they were safe, understood and accepted. The author recommends that nurses need to distance themselves from task orientated hospital routines and attend to the holistic needs of people who are delirious.
The aim of Schofield’s (1997) research was to retrospectively explore the older adults’ experience of delirium to see if it left them with any unresolved feelings of anxiety. A broad spectrum of representations were reported, identifying that individuals experience delirium in distinctly different and heterogenous ways. Respondents reported feeling anxious about some of the unpleasant hallucinations they experienced, as well as fearing what would happen to them in the future. There also appeared to be little evidence of
therapeutic communication with nursing staff, particularly once the episode of delirium had resolved. Consequently, participants in this study identified the importance of nurses providing them with appropriate support and information so they could maintain some personal control of their future destinies.
The next article sought to illuminate the emergence of patterns in speech and behaviours in older adults who were delirious (Andersson, Norberg & Hallberg, 2002). Delirium was manifested in disturbances of actions, speech and mood, with the symptoms fluctuating not only during the day but also from one day to the next. Participants had difficulty in understanding the situation they found themselves in and demonstrated a desire to regain control over their lives. Fluctuations inherent in the delirious episode meant that there were times of being “in confusion” and times of “viewing oneself as being confused” (p.313). Andersson et al. (2002) identified that older adults who are delirious will draw on previous life experiences as a means to make meaning of the present. They stress the importance of nurses knowing about, and utilising aspects of the person’s social, cultural and historical backgrounds in order to connect and support people who are delirious. This assertion resonates with the intentions of critical gerontology, a major influence underpinning the present research.
In a subsequent paper, the same authors use a phenomenological lens of inquiry, and imply that understanding the lived experience of delirium enables the development of effective methods of providing nursing care to this population (Andersson, Hallberg, Norberg & Edberg, 2002). Once again the findings identified the heterogeneity of experiences that were linked to the patient’s life history. The ‘take home message’ for nurses working with this group of older people was to sensitively provide meaningful support and opportunities to verbalise their experiences both during and after an episode of delirium.
McCurren and Cronin’s (2003) research report begins with an exemplar describing an 80 year old woman’s experience of being delirious. The placing of the exemplar at the beginning of the article attempts to give primacy to the personal experience of delirium. Once again a phenomenological approach was used to increase the awareness of health practitioners to the individual needs of older people who are delirious. As with some of the other studies previously reported, a variety of responses were recorded resulting in
the presentation of a variety of behaviours. As already outlined above, the importance of developing a therapeutic relationship through opportunities to engage in meaningful dialogue is beneficial to the recovery of people who are delirious.
The final article by Andersson, Hallberg and Edberg (2003), although titled Nurses’ experience of the encounter with elderly patients in acute confusional state in orthopaedic care, attempts to privilege a personal discourse on delirium. Interpretation of the findings showed that nurses experienced difficulty in understanding the patients’ reality which ultimately and negatively impacted on the quality of nursing care provided. The authors stress the importance of being able to interpret and understand older adult’s experience of delirium on an individual basis. This can be achieved through “… listening to the confused patients, evaluating verbal and non-verbal responses to assess for anxiety or physiological discomfort, seems useful” (Andersson et al., 2003, p.446).