Background and Objective: The prevalence of sleep disorders increases with increasing age, where secondary sleep disorders are most common. Various factors such as polypharmacy and comorbidity can cause altered sleep patterns among the elderly which in turn results in secondary sleep disorders. Since the elders (≥65 years) have a high hypnotic prescription, an increased risk of adverse drug effects and appears to be reluctant to discontinuation, there is a high relevance to investigate their experience of hypnotics. The objective of this qualitative study was to explore experience of hypnotics in geriatric patients. Design: The conducted study design was a qualitative interview study with a content analysis based on an inductive approach according to Elo & Kyngäs (2008). With the help of health care staff, nine suitable study participants were enrolled. The participants received an information letter about the aim of the study. Semi-structured interviews were conducted, recorded and transcribed. Setting: Two geriatric departments in the County Hospital in Kalmar. Main outcome measures: Experience of hypnotics in elderly. Results: Hypnotics were perceived as a form of reassurance that improved the sleeping patterns, where factors such as environment and life situation could affect the needs. A feeling of abandonment appeared in cases where the drug did not give any effect. Discontinuation of hypnotics appeared to be challenging, resulting with participants often returning back to the medication. A minority of the patients had received information about the potential risks with long term use of hypnotics. Conclusions: Hypnotics appeared to be a sense of security that facilitated the ability to sleep in elders, where various factors could affect the use of the medication. Long term use can result in failed discontinuation. To reduce unnecessary use of sleeping medicine there is a requirement of a plan for taper-discontinuation, that health care staff should inform the patients about potential risks and that a collaboration between the patients and the health care team is needed.

Titel: Sjuksköterskans erfarenhet av akut konfusion hos äldre i akutsjukvård – En kvalitativ intervjustudie. Bakgrund: Äldre som vårdas i akutsjukvård har en incidens mellan 11–51% att utveckla akut konfusion under vårdtiden. Tillståndet är förenat med en ökad sjuklighet och dödlighet hos äldre. Multifaktoriella orsaker ligger bakom att äldre drabbas. Akut konfusion är en klinisk diagnos, idag finns inga biomarkörer eller undersökningar som kan identifiera tillståndet. Akut konfusion kräver en tidig upptäckt, snabb utredning och ett medicinskt omhändertagande, god omvårdnad och en anpassad vårdmiljö för att patienten skall återhämta sig. Syfte: Att beskriva sjuksköterskans erfarenhet av att upptäcka, förebygga och vårda patienter med akut konfusion i akutsjukvård. Design: En kvalitativ intervjustudie med fem sjuksköterskor verksamma i geriatrisk akutsjukvård på två sjukhus i södra Sverige. Resultat: I resultatet framkom tre kategorier; strategier för att identifiera och bedöma tecken på akut konfusion, strategier och hinder för förebyggande insatser och god omvårdnad vid akut konfusion, förslag på förbättringar i vården av äldre med akut konfusion. Sjuksköterskan använde sig av observation, kommunikation och inhämtning av information från journal och anhöriga för att identifiera akut konfusion. En helhetssyn i omvårdnaden, kontinuitet i vårdkontakten, anpassning av vårdmiljön och anhörigas delaktighet var viktiga faktorer för att förebygga akut konfusion och ge god omvårdnad. Hindrande faktorer orsakades av brister i vårdmiljön, för lite resurser och tid samt bristande kunskap hos övrig vårdpersonal kring lämplig bemötande och förhållningssätt. Slutsats: Ett evidensbaserat screeninginstrument som identifierar olika konfusionstillstånd skulle underlätta bedömning och dokumentation för sjuksköterskor. En personcentrerad vård som bygger på att omvårdnaden planeras utifrån en helhetssyn och en kontinuitet i vårdkontakten samt att anhöriga görs mera delaktiga i vården förespråkas av sjuksköterskorna. Vårdmiljön skall anpassas, vara lugn och stödjande till sin utformning. Personal som arbetar med konfusoriska patienter behöver ha mer kunskap om lämpligt bemötandet och förhållningssätt för att underlätta patientens återhämtning. / Title: Nurses experience of acute confusion in elderly patients in acute emergency care- A qualitative interview study. Background: The elderly cared for in emergency care have an incidence between 11–51% to develop acute confusion during the care period. The condition is related to increased morbidity and mortality among the elderly. Multifactorial causes lie behind the elderly being affected. Acute confusion is a clinical diagnosis, at present there are not biomarkers or examinations that can identify the condition. Acute confusion requires early awareness, swift investigation, medical care and well adapted health care environment in order for the patient to recover. Purpose: To describe nurses experiences in detecting, preventing and caring for patients suffering from acute confusion in emergency care. Design: A qualitative interview with five nurses working within geriatric emergency care at two hospitals in the south of Sweden. Result: Three categories emerged in the result; strategies to identify and assess signs of acute confusion, strategies and hinders for preventative measures and good nursing upon acute confusion, and improvement proposals for the care of elderly suffering from acute confusion. Nurses used observation, communication, and gathering of information from medical records and relatives in order to identify acute confusion. A comprehensive view in care, continuity in contacts, adaption of health care environment and relatives engagement were important factors to prevent acute confusion and provide good nursing. Hindering factors were a result of shortcomings in the health care environment, insufficient resources and time, and lack of knowledge among other requisite staff regarding appropriate reception and approach. Conclusion: An evidence-based screening instrument which identifies various states of confusion would render assessment and documentation easier for nurses. Personal centered care built upon that such is planned based on a comprehensive view and continuity in contacts, and that relatives are more engaged in care, is advocated by the nurses. Health care environment shall be adapted, be calm and supportive in form. Staff that work with confused patients need more sufficient knowledge regarding appropriate reception and approach to render patient recovery easier.