Data analysis

This descriptive survey collected two types of data: quantitative, for closed questions and qualitative for open questions inviting free text comments (Brace 2008).

Thus, a combination of analytic methods was required: quantitative and content analysis.

5.3.1 Quantitative analysis

Descriptive statistics were used to analyse the frequencies and percentages arising from the data (Buckingham and Saunders 2004). The BoS tool offers a simple method of analysing the data, due to the simplicity of the questions and responses this was deemed to be sufficient for the analysis.

171 5.3.2 Content analysis

Content analysis methodology was used for the analysis of responses to open ended questions (Cole 1998): the researcher read and re-read the words used in the responses and then classified these into small sets of categories of shared meaning.

The codes were counted to determine how frequently they appear within the text responses and patterns relating to the key themes emerged (Elo and Kyngas 2008, Morgan 1993, Krippendorf 2004).

5.3.3 Hospital size and number of stroke beds

Question 2 of the survey requested respondents to select the name of the hospital they work in. This question was used in conjunction with data on size of the stroke unit and number of stroke beds per hospital. These data were obtained from Information Service Division Scotland (ISD Scotland 2010), which at the time of conducting this research, was the most up-to-date version of this document available to the public.

5.4 Results

This section presents the findings of the survey. The data are presented in accordance with the order of appearance of the questions on the survey itself. Due to the decision to conduct a descriptive survey, descriptive statistics are used to summarise the findings.

5.4.1 Questions 1 and 2: Participant characteristics

A total of 65 (30% overall response rate) responses were logged during the period of data collection. A total of 36/90 (40%) of doctors replied, 29/127 (23%) of nurses replied. The profession and grade of respondents are summarised in Table 15. As

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for area of practice, most participants stated they worked in a specialised stroke unit, most participants also indicated that they worked in relatively large units (receiving between 250-500 stroke patients each year). Table 16 outlines the details of these data.

Table 15: Profession and grade of participants

Participants n=65 (%)

Senior nurse (band 7 and above) Main grade nurse (band 6 and below)

24 (36.9) 12 (18.4) 14 (21.5) 15 (23.0)

Table 16: Participants’ main area of practice

Area of Practice n=65 (%) N of stroke patients admitted to respondents’

workplace each year (ISD Scotland 2010):

5.4.2 Questions 3 to 5: Screening for delirium

In response to the question: “does your ward have a policy on screening new patients for delirium?” 21/65 (32%) respondents selected ‘yes’, 35 respondents (53.5%) replied ‘no’ and 9 respondents (14%) responded ‘unsure’. In response to the question “do you routinely screen for delirium on admitting new patients to the ward”

31 (48%) selected “yes” and 34 (52%) selected “no”. The following question: “Do you

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screen patients for delirium on a regular basis during admission?” yielded the same result, 31 (48%) selected “yes” and 34 (52%) selected “no”. Of the 31 respondents who selected “yes”, 25 (81%) reported screening “as the need arises” and two (6.5%) selected “once weekly”. Table 17 highlights these results as well as the differences between doctors’ and nurses’ responses, thus percentages refer to the number for each staff group rather than the overall number of respondents (n=65).

Table 17: Doctors' and nurses' practice of screening for delirium

Question

Doctors (n=36)

Nurses (n=29) 3. Does your ward have a policy on screening

new patients for delirium? 4. Do you routinely screen for delirium on

admitting new patients to the ward?

Yes 5. Do you screen patients for delirium on a

regular basis during admission? 5.a. Please state the most common frequency

of screening patients on the ward

Four (13%) respondents selected the option “other” in reply to question 5a, the text explanations were examined and cross-checked against profession and grade: one consultant physician responded that screening occurred daily, a further consultant physician reported screening “routinely on ward rounds but also if there is

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concern by nursing or therapy staff”. Another doctor, a senior trainee, stated that screening occurred “briefly at each ward round”. Only one nurse (consultant specialist) stated that screening occurred on admission (which answers the original question 4 “do you routinely screen for delirium on admitting new patients to the ward?”).

5.4.3 Question 6: Diagnostic methods

In response to the question: “How do you normally diagnose delirium in stroke patients?” 28 respondents (43%) reported applying their clinical judgement, two respondents (3%) reported using a standardised tool and the remaining respondents reported combining clinical judgement with the application of a standardised tool (n=21, 32.3%). Two respondents selected “other”, one reported using: “amt (Abbreviated Mental Test) and urine testing, observations” and the other reported using the CAM (Inouye et al. 1990) to diagnose delirium. 12 respondents (18.5%), all of whom were nurses of all grades, stated that they do not diagnose delirium in their practice and for question 6b, all of which selected the option “I have not been trained to use a standardised tool”. Table 18 (p.175) summarises these results, percentages refer to the n= for each staff group rather than the overall n=65.

No responses were logged for questions 6a on delirium diagnosis (see appendix 5.1). Once all the responses were logged and the analysis commenced, this matter was investigated. It appeared that the way the questions were routed online meant that none of the respondents were able to see this question as the researcher had set up the routing of questions 6a incorrectly. This matter will be discussed further in section 5.5.4 of the discussion.

175 5.4.4 Question 7: Choice of bedside tool

Table 18 outlines the structure of the questions relating to the choice of diagnostic tool. Free text comments made in response to the question on clinicians’

choice of diagnostic tool revealed that six (9%) respondents used the 4AT (Bellelli et al. 2014a), this tool was not listed as one of the main options as the survey predates the formal publication of this tool (Healthcare Improvement Scotland 2014). Four respondents reported using either the Abbreviated Mental Test (AMT)(Hodkinson 1972) or the MMSE (Folstein et al. 1975).

Table 18: Questions regarding diagnostic practices and tools used

Question Doctors

n=36

Nurses n=29 6. How do you normally diagnose delirium in

stroke patients?

Standardised tool Clinical judgement Both the above

I do not diagnose delirium in my practice

5.4.5 Question 8: Suitability of the bedside tool in stroke patients

Respondents were asked “Do you think the tool you use is suitable for a stroke population?”. A total of 52 (80%) of the 65 respondents answered this question.