The purpose of this study was to identify role and functions of CCNS's (Certified Nurse Specialist in Critical Care Nursing) regarding the management of delirium care of patients. Self-administered questionnaires were distributed to seventy-four CCNS's asking about their roles in the care of delirium of their patients. Through a qualitative-inductive approach, the data were collected and analyzed according to the CNS's (Certified Nurse Specialists) roles and functions (except research function). The results revealed the following number of responses in each category of CNS functions: 29 responses related to practice, 8 related to consultation, 8 related to education, 5 related to coordination, and 2 related to ethical coordination.
The delirium care of patients by CCNS consists of 3 elements; 1) finding the cause of delirium and managing the delirium (the fundamental element); 2) assisting patients to regain cognition and rhythm of daily living (the core element); and 3) Patient-Family empowerment (the complementary element) in 3 phases of care, i.e., prevention, treatment, and rehabilitation. All of these elements actively interact each other in organic and spiral fashions and facilitated liberating from risk factors of delirium and restructuring home-living environment. In addition, this study revealed that the CCNS's had laid the foundation for families being care providers and members of the delirium care teams. In conclusion, this study suggests that the delirium care provided by the CCNS's consists of searching for patients' needs and providing a holistic nursing care to meet those needs. As such, the goal of CCNS's in delirium care would be to assist patients to meet self-actualization needs, that can be expressed in a concrete example, as "restructure of daily living."

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This study aimed to reveal how nurses recognize and interpret conscious or subconscious cues from critically ill patients who cannot easily express their own wishes and needs for care, and how information extracted from cues is integrated in nursing support. Subjects were 16 nurses who provided care for such patients in intensive care units or emergency wards. Data collected through participant observation and semi-structured interviews were analyzed using the modified grounded theory approach.
Four aspects were generated: "detecting cues", "interpreting cues" and "providing care", which represent recognition/understanding of cues from patients and nursing care assessment, and "increasing sensitivity towards cues", which serves as the foundation for the first three aspects. It was shown that critical care nurses put patients at the center of care, detected cues from patients based on their sensitivity, interpreted cues, and then provided care in response to patients' needs. Through repeated cycles of understanding of patient cues and nursing assessment, the nurses' awareness of patients as individuals with their own will and intention who should be respected was increased. Furthermore, nurses made full use of their skills and knowledge when interpreting patient cues, thereby increasing their sensitivity towards them.

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[in Japanese]

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[in Japanese]

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