Frail elderly patients with delirium

How do family members and nursing staff ValueBasedHealthcare_logo_kleur_RGB_HR_nomineeprize2016 experience rooming-in, in frail elderly patients with delirium in hospital?

To improve outcome of care from the older patients’ perspective, which we state as return to pre-admittance autonomy, we believe a decrease of the incidence and severity of delirium is mandatory. We use rooming-in as the most important non-pharmacological intervention to reach that goal. Rooming-in is the co-admittance of relatives or other close informal caregivers, in order to improve orientation and understanding of what is happening during admittance in our hospital.


We expect the incidence and severity of frailty to increase in our hospitalized elderly patients. Because the number of elderly peoples still rises and the maximal lifespan still increases. Depending on frailty and triggering factors, the risk of delirium increases during admittance. A delirium is characterized by attentional deficits and generalized severe disorganization of behavior. It starts acutely (in hours to day) and symptoms fluctuate during the day. Treatment consists of multiple interventions, and pharmacological intervention is common. In Isala, located in Zwolle, we believe the intervention ‘rooming-in’ is effective and can be used instead of pharmacological treatment in the majority of cases.


We approached rooming-in in two ways:
1. Performing a study, to develop evidence, answering the question: How do family members and nursing staff experience rooming in, in frail elderly patients with delirium in hospital?
2. Developing and implementing rooming-in policy on the internal medicine ward.

1. Study

Sparse literature and lack of evidence about rooming-in, has led us to firstly perform a study answering the question: How do family members and nursing staff experience rooming in, in frail elderly patients with delirium in hospital? This qualitative research was performed by the specialized geriatric nurse.
Fourteen subthemes have been formulated from the analysis of the interviews with family members, these have been decreased to seven fundamental themes: physical and emotional burdening, moral duty, reassurance, personal satisfaction, appreciation of the nursing staff, added value for the patient and awareness of changes in personal relationship.
The nurses’ experiences from the focus group meeting can be differentiated in eleven subthemes and the four fundamental themes: importance of communication between nurses and family members, changes in work behavior of nurses, family members’ burdening and the patient’s value.
Both family members and nursing staff generally pointed out an improvement in behavior related to delirium. Communication has to be improved by the nurse and the nurse practitioner in applying rooming-in during the care for patients with a delirium.
The nurse practitioner can play an important role in developing a protocol or guideline. It is recommended to investigate the experiences of the patient during rooming-in and a quantitative study to explore effects of rooming-in on the patient.
We aim to extend our study to the effects on outcome by decrease in incidence and severity of delirium when rooming-in is applied.

2. Rooming-in policy: developing and implementing

Policy about rooming-in is developed and the staff of the internal medicine ward has been trained. Awareness amongst nurses has improved: the informal caregiver is important, for both patient and health care professionals in optimising outcome from a patient’s perspective.