{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:55:59Z","timestamp":1792799759597,"version":"4.5.0"},"reference-count":47,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T00:00:00Z","timestamp":1682985600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["DRF-2017-10-063"],"award-info":[{"award-number":["DRF-2017-10-063"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Bradford District Care NHS Foundation Trust","id":[{"id":"https:\/\/ror.org\/03yzcrs31","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat Med"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Delirium is a distressing condition often experienced by hospice in-patients. Increased understanding of current multidisciplinary care of delirium is needed to develop interventions in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim(s):<\/jats:title>\n                    <jats:p>To explore hospice staff and volunteers\u2019 practice, its influences and what may need to change to improve hospice delirium care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Qualitative interview study using behaviour change theory from a critical realist stance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/participants:<\/jats:title>\n                    <jats:p>Thirty-seven staff, including different professional groups and roles, and volunteers were purposively sampled from two in-patient hospices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We found that participants\u2019 practice focus was on managing hyperactive symptoms of delirium, through medication use and non-pharmacological strategies. Delirium prevention, early recognition and hypoactive delirium received less attention. Our theoretically-informed analysis identified this focus was influenced by staff and volunteers\u2019 emotional responses to the distress associated with hyperactive symptoms of delirium as well as understanding of delirium prevention, recognition and care, which varied between staff groups. Non-pharmacological delirium management was supported by adequate staffing levels, supportive team working and a culture of person-centred and family-centred care, although behaviours that disrupted the calm hospice environment challenged this.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our findings can inform hospice-tailored behaviour change interventions that develop a shared team understanding and engage staff\u2019s emotional responses to improve delirium care. Reflective learning opportunities are needed that increase understanding of the potential to reduce patient distress through prevention and early recognition of delirium, as well as person-centred management. Organisational support for adequate, flexible staffing levels and supportive team working is required to support person-centred delirium care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692163231170655","type":"journal-article","created":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T08:11:41Z","timestamp":1683015101000},"page":"993-1005","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["\u2018It\u2019s tough. It is hard\u2019: A qualitative interview study of staff and volunteers caring for hospice in-patients with delirium"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9042-7600","authenticated-orcid":false,"given":"Imogen","family":"Featherstone","sequence":"first","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najma","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"},{"name":"Hull York Medical School, University of Hull, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"Jones","sequence":"additional","affiliation":[{"name":"Hull York Medical School, University of Hull, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Coppo","sequence":"additional","affiliation":[{"name":"Cardinal Massaia Hospital of Asti, Asti, Piemonte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Sheldon","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1674-2124","authenticated-orcid":false,"given":"Annmarie","family":"Hosie","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of Notre Dame Australia, Sydney, NSW, Australia"},{"name":"The Cunningham Centre for Palliative Care, St Vincent\u2019s Health Network, Sydney, NSW, Australia"},{"name":"IMPAACT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Wolkowski","sequence":"additional","affiliation":[{"name":"Dove House Hospice, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley H","family":"Bush","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada"},{"name":"Bruyere Research Institute, Ottawa, ON, Canada"},{"name":"Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5898-0900","authenticated-orcid":false,"given":"Johanna","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Teodorczuk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia"},{"name":"The Prince Charles Hospital, Metro North Mental Health, Brisbane, QLD, Australia"},{"name":"School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6204-9158","authenticated-orcid":false,"given":"Miriam J","family":"Johnson","sequence":"additional","affiliation":[{"name":"Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,5,2]]},"reference":[{"key":"bibr1-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/0269216319854944"},{"key":"bibr2-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211006313"},{"key":"bibr3-02692163231170655","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2014","edition":"5"},{"key":"bibr4-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24215"},{"key":"bibr5-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1002\/gps.1343"},{"key":"bibr6-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1176\/jnp.2008.20.2.185"},{"key":"bibr7-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.43.3.183"},{"key":"bibr8-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0632"},{"key":"bibr9-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1881"},{"key":"bibr10-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.7491"},{"key":"bibr11-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.11468"},{"key":"bibr12-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.12.002"},{"key":"bibr13-02692163231170655","unstructured":"Hospice Foundation of America. What is hospice? https:\/\/hospicefoundation.org\/Hospice-Care\/Hospice-Services (accessed 7 March 2023)."},{"key":"bibr14-02692163231170655","unstructured":"Australian Government Department of Health and Aged Care. What does palliative care cost? https:\/\/www.health.gov.au\/topics\/palliative-care\/about-palliative-care\/what-does-palliative-care-cost (accessed 7 March 2023)."},{"key":"bibr15-02692163231170655","volume":"3","author":"Siddiqi N","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr16-02692163231170655","volume-title":"Delirium: prevention, diagnosis and management. CG103","author":"National Institute for Health and Care Excellence","year":"2010"},{"key":"bibr17-02692163231170655","volume-title":"Risk reduction and management of delirium","author":"Scottish Intercollegiate Guidelines Network (SIGN)","year":"2019"},{"key":"bibr18-02692163231170655","doi-asserted-by":"publisher","DOI":"10.7326\/M19-1860"},{"key":"bibr19-02692163231170655","volume":"1","author":"Finucane AM","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr20-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311419884"},{"key":"bibr21-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2014.02.005"},{"key":"bibr22-02692163231170655","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2018.24.11.524"},{"key":"bibr23-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12234"},{"key":"bibr24-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951516000419"},{"key":"bibr25-02692163231170655","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2005.11.4.18038"},{"key":"bibr26-02692163231170655","first-page":"3","volume":"9","author":"Greaves J","year":"2008","journal-title":"Aust J Cancer Nurs"},{"key":"bibr27-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2013.08.015"},{"key":"bibr28-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/082585970902500303"},{"key":"bibr29-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/0269216307081129"},{"key":"bibr30-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951518000780"},{"key":"bibr31-02692163231170655","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2016.22.8.396"},{"key":"bibr32-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"bibr33-02692163231170655","unstructured":"Featherstone I. Developing a multi-component intervention for the prevention and management of delirium in hospice in-patient units: a targeted behaviour change approach, https:\/\/fundingawards.nihr.ac.uk\/award\/DRF-2017-10-063 (2017, accessed 13 June 2022)."},{"key":"bibr34-02692163231170655","volume-title":"Designing and conducting mixed methods research","author":"Creswell JW","year":"2018","edition":"3"},{"key":"bibr35-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42"},{"key":"bibr36-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"bibr37-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-69909-7_3470-2"},{"key":"bibr38-02692163231170655","volume-title":"The behaviour change wheel: a guide to designing interventions","author":"Michie S","year":"2014"},{"key":"bibr39-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"bibr40-02692163231170655","unstructured":"QSR International Pty Ltd. Nvivo (Version 12), https:\/\/www.qsrinternational.com\/nvivo-qualitative-data-analysis-software\/home (2018, accessed 13 June 2022)."},{"key":"bibr41-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/160940690600500107"},{"key":"bibr42-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1016\/0147-1767(85)90062-8"},{"key":"bibr43-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211022183"},{"key":"bibr44-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1177\/02692163221113163"},{"key":"bibr45-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-019-1264-2"},{"key":"bibr46-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610212002074"},{"key":"bibr47-02692163231170655","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.11466"}],"container-title":["Palliative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02692163231170655","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02692163231170655","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02692163231170655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:35:02Z","timestamp":1777660502000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02692163231170655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,2]]},"references-count":47,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1177\/02692163231170655"],"URL":"https:\/\/doi.org\/10.1177\/02692163231170655","relation":{},"ISSN":["0269-2163","1477-030X"],"issn-type":[{"value":"0269-2163","type":"print"},{"value":"1477-030X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,2]]}}}