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District nursing staff’s experiences with implementing an evidence-informed triage instrument for delirium in home care; an action research-informed qualitative study
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DOI：10.1186/s12912-026-05028-6.png)
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Abstract
En 中文
Timely recognition of delirium in people living at home remains challenging, despite the availability of evidence-informed approaches. District nurses and nursing assistants play a key role in translating such evidence into daily practice. This study aimed to explore how district nurses and nursing assistants experienced using and implementing the Delirium Caregiver Questionnaire (DCQ), an evidence-informed delirium triage tool, in routine home care. An action research-informed qualitative study was conducted with fifteen participants (district nurses and nursing assistants) from six district nursing teams. Implementation comprised three phases: preparation, training, and application. After three months of use, team-based interviews were conducted to explore experiences with the DCQ. Data were analysed inductively using thematic analysis. Following 28 baseline assessments, the DCQ was used only four times during the three-month implementation period. Participants reported that the DCQ supported more structured delirium recognition by guiding observation, analysis, communication, and evaluation. Facilitators included the tool’s user-friendliness, collaborative engagement and commitment to client well-being. Barriers included stressful working conditions, not being ingrained in practice, a low sense of urgency, and limited opportunities to assess delirium. The DCQ was perceived as clinically valuable by supporting more structured delirium recognition and strengthening clinical reasoning. Despite strong perceived facilitators, integration into routine practice was limited by contextual and organisational constraints. Future research should evaluate targeted delirium screening in high-risk situations and explore how tools such as the DCQ can be embedded into routine workflows and electronic health records to support consistent use and timely consideration of delirium during clinical reasoning.
Keywords:
District nursing
Screening
Delirium
Research implementation
Aging
Action research
Clinical judgement
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