Perceptions and Practices of Clinicians Undertaking Invasive Procedures With Patients Experiencing Delirium in Hospital: A Sequential Mixed Methods Study.

People with cognitive impairment account for ~30% of hospital admissions, commonly require invasive procedures, and are vulnerable to hospital-acquired complications. This sequential mixed methods research explored clinician approaches to procedures for patients experiencing cognitive impairment. Data were collected 2021-2022 in a 26-bed medical ward containing a secure eight-bed unit in Australia. Observational data and semi-structured interview data were analyzed using Framework Analysis and synthesized with Pillar Integration. There were 24 procedures conducted on 12 unique patients and nine clinicians were observed; 12 clinicians were interviewed. During seven (29%) procedures, patients were distressed; however, most (n = 22, 92%) were completed. Clinicians were observed to value the patient, foster familiarity and trust, engage at each step, and adopt last resort actions. Clinicians reported key strategies: knowing the individual and context, adopting known strategies, and getting it done. Three overarching themes were: (1) Creating a safe shared space for care, (2) Enabling the procedure, and (3) When things don't go to plan. Clinicians were cognizant of risks and used tacit knowledge and specific strategies to enable effective procedures. These strategies may be adopted in other settings.