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Griffiths S, Shepherd V, Volkmer A. Determining capacity of people with dementia to take part in research: an electronic survey study of researcher confidence, competence and training needs. BMC Med Ethics 2024; 25:65. [PMID: 38802779 PMCID: PMC11131177 DOI: 10.1186/s12910-024-01056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Researchers are required to determine whether a person has capacity to consent to a research study before they are able to participate. The Mental Capacity Act and accompanying Code of Practice for England and Wales provide some guidance on this process, but researchers have identified that it can be difficult to determine capacity to consent when a person has complex cognitive or communication needs. This study aimed to understand the experiences and opinions of researchers who recruit people with dementia to research projects, to inform the future development of training resources. METHODS A mixed method, cross-sectional, electronic survey was circulated via social media and research networks in England and Wales. The survey remained open for ten weeks and included open and closed questions exploring respondents' confidence in determining capacity in the context of recruiting people with dementia to consent, their views on training and support they have experienced and their suggestions for future training and support needs. RESULTS 60 respondents completed the survey from across England and Wales. Although 75% of respondents had experience of determining capacity to consent with people with dementia to research, only 13% rated themselves as feeling 'very confident' in this. Qualitative content analysis of open responses led to the generation of six themes, explaining researchers' confidence, competence and future training needs in this area: (1) Researcher uncertainties, (2) Lack of time, (3) Balancing information complexity with accessibility, (4) Gatekeepers, (5) Existing enablers and (6) Envisioning future training. CONCLUSIONS Researchers would benefit from specific training in undertaking conversations around consent with people with dementia. People with dementia may have fluctuating capacity, and despite support from caregivers, researchers have little practical guidance on methods of determining a person's ability to understand or appreciate the information they have provided during the consent process. Given the development of large complex trials within dementia research, there is an urgency to develop specific and practical guidance and training for researchers working with people with dementia and their families.
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Affiliation(s)
- Sarah Griffiths
- Centre for Ageing Population Studies, Primary Care and Population Health, University College London, London, UK.
| | | | - Anna Volkmer
- Psychology and Language Sciences, University College London, London, UK
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Bridgstock L, Pilnick A, Goldberg S, Harwood RH. 'Alright my lovely': The use of terms of endearment as a mitigation device in the care of people living with dementia in the acute hospital environment. Health (London) 2024:13634593241238856. [PMID: 38576080 DOI: 10.1177/13634593241238856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This paper examines how terms of endearment (ToE) are used as a mitigation device in interactions between staff and people living with dementia (PLWD) in the acute hospital environment. ToE are often discouraged in training for healthcare staff. However, this research demonstrates that they are still commonly used in practice. Using conversation analysis, video and audio data were examined to identify the interactional functions of ToE. Analysis showed that ToE play an important role in mitigating potentially face-threatening actions such as when patients are asked to repeat hard-to-interpret talk, or when patient agency is compromised through instruction sequences or having necessary healthcare tasks undertaken. The success of this mitigation is sensitive to the specific interactional circumstances, as well as the responsiveness of the HCP to the patient's voiced concerns. These findings have implications for healthcare practice, training and wider care of PLWD.
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Affiliation(s)
| | | | | | - Rowan H Harwood
- University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, UK
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Slocombe F, Peel E, Pilnick A, Albert S. Keeping the conversation going: How progressivity is prioritised in co-remembering talk between couples impacted by dementia. Health (London) 2024; 28:272-289. [PMID: 36226854 PMCID: PMC10900852 DOI: 10.1177/13634593221127822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article explores how partners keep the conversation going with people living with dementia (PLWD) when speaking about shared memories. Remembering is important for PLWD and their families. Indeed, memory loss is often equated with identity loss. In conversation, references to shared past events (co-rememberings) can occasion interactional trouble if memories cannot be mutually recalled. This article analyses partners' interactional practices that enable progressivity in conversations about shared memories with a PLWD. In previous research, both informal and formal carers have reported that they can find interacting with PLWD difficult. Identifying practices used by partners is one way to begin addressing those difficulties. Analytical findings are based on over 26 hours of video data from domestic settings where partners have recorded their interactions with their spouse/close friend who is living with dementia. The focus is on 14 sequences of conversation about shared memories. We show how particular practices (candidate answers, tag questions and single-party memory of a shared event) structure the interaction to facilitate conversational progression. When partners facilitate conversational progressivity, PLWD are less likely to experience stalls in conversation. Our findings suggest the actual recall of memory is less relevant than the sense of shared connection resulting from the conversational activity of co-remembering, aiding maintenance of individual and shared identities. These findings have relevance for wider care settings.
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Pilnick A, O'Brien R, Beeke S, Goldberg S, Murray M, Harwood RH. Conversation Analysis Based Simulation (CABS): A method for improving communication skills training for healthcare practitioners. Health Expect 2023; 26:2461-2474. [PMID: 37589441 PMCID: PMC10632656 DOI: 10.1111/hex.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Actors portraying simulated patients are widely used in communication skills training in healthcare, but debates persist over the authenticity of these interactions. However, healthcare professionals value simulation-based training because of the opportunity to think and react in real time, which alternatives cannot provide. OBJECTIVE To describe a method for the use of simulation which maximises authenticity by grounding training in real, observed, patterns of patient communication. DESIGN Naturally occurring care interactions were video recorded and analysed using conversation analysis (CA) to identify communication patterns. We focused on sites of recurring interactional trouble as areas for training, and identified more and less effective ways of dealing with these. We used the CA findings to train actors portraying simulated patients, based on the observed interactional patterns. SETTINGS AND PARTICIPANTS Patients living with dementia and healthcare practitioners (HCPs) on two acute healthcare of the elderly wards in the English East Midlands. OUTCOME MEASURES One month later HCPs reported using the skills learned in clinical practice. Masked-ratings of before and after simulated patient encounters confirmed these self-reports in relation to one key area of training. RESULTS The Conversation Analysis Based Simulation (CABS) method used in this setting showed positive results across a range of quantitative and qualitative outcome measures. What is significant for the transferability of the method is that qualitative feedback from trainees highlighted the ability of the method to not only illuminate their existing effective practices, but to understand why these were effective and be able to articulate them to others. DISCUSSION/CONCLUSION While the CABS method was piloted in the dementia care setting described here, it has potential applicability across healthcare settings where simulated consultations are used in communication skills training. Grounding simulated interaction in the observed communication patterns of real patients is an important means of maximising authenticity. PATIENT AND PUBLIC CONTRIBUTION The VideOing to Improve dementia Communication Education (VOICE) intervention which piloted the CABS method was developed by a multidisciplinary team, including three carers of people with dementia. People living with dementia were involved in the rating of the before and after video simulation assessments.
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Affiliation(s)
- Alison Pilnick
- School of Sociology and Social Policy, University of NottinghamNottinghamUK
| | - Rebecca O'Brien
- School of Health Sciences, University of NottinghamUK and Nottinghamshire Healthcare NHS Foundation TrustNottinghamshireUK
| | - Suzanne Beeke
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Sarah Goldberg
- School of Health SciencesUniversity of NottinghamNottinghamUK
| | | | - Rowan H. Harwood
- School of Health Sciences, University of NottinghamUK and Nottingham University Hospitals NHS TrustNottinghamUK
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Handley M, Theodosopoulou D, Taylor N, Hadley R, Goodman C, Harwood RH, Phillips R, Young A, Surr C. The use of constant observation with people with dementia in hospitals: a mixed-methods systematic review. Aging Ment Health 2023; 27:2305-2318. [PMID: 37293755 DOI: 10.1080/13607863.2023.2219632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Constant observation is used in hospitals with people with dementia to manage their safety. However, opportunities for proactive care are not consistently recognised or utilised. A systematic review of constant observation was conducted to understand measures of effectiveness and facilitators for person-centred approaches. METHOD Electronic databases were searched between 2010 and 2022. Four reviewers completed screening, quality assessments and data extraction with 20% checked for consistency. Findings were presented through narrative synthesis (PROSPERO registration CRD42020221078). FINDINGS Twenty-four studies were included. Non-registered staff without specific training were the main providers of constant observation. Assessments and processes clarifying the level of observation encouraged reviews that linked initiation and discontinuation to a patient's changing needs. Examples of person-centred care, derived from studies of volunteers or staff employed to provide activities, demonstrated meaningful engagement could reassure a person and improve their mood. Proactive approaches that anticipated distress were thought to reduce behaviours that carried a risk of harm but supporting evidence was lacking. CONCLUSION Non-registered staff are limited by organisational efforts to reduce risk, leading to a focus on containment. Trained staff who are supported during constant observation can connect with patients, provide comfort and potentially reduce behaviours that carry a risk of harm.
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Affiliation(s)
- Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Nicky Taylor
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Rebecca Hadley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Rowan H Harwood
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Rosemary Phillips
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Alex Young
- Cancer Awareness, Screening and Diagnostic Pathways (CASP) Research Group, Hull York Medical School, University of Hull, Hull, UK
| | - Claire Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
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Mundadan RG, Savundranayagam MY, Orange JB, Murray L. Language-Based Strategies that Support Person-Centered Communication in Formal Home Care Interactions with Persons Living with Dementia. J Appl Gerontol 2023; 42:639-650. [PMID: 36464843 PMCID: PMC9996793 DOI: 10.1177/07334648221142852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Language-based strategies are recommended to improve coherence, clarity, reciprocity, and continuity of interactions with persons living with dementia. Person-centered care is the gold standard for caring for persons with dementia. Person-centered communication (PCC) strategies include facilitation, recognition, validation, and negotiation. Little is known about which language-based strategies support PCC in home care. Accordingly, this study investigated the overlap between language-based strategies and PCC in home care interactions. Analysis of conversation of 30 audio-recorded interactions between personal support workers (PSWs) and persons living with dementia was conducted. The overlap between PCC and language-based strategies was analyzed. Of 11,347 communication units, 2578 overlapped with PCC. For facilitation, 21% were yes/no questions. For recognition, 25% were yes/no questions and 22% were affirmations. For validation, 81% were affirmations and positive feedback. Finally, 60% were yes/no questions for negotiation. The findings highlight the person-centeredness of language-based strategies. PSWs should use diverse language-based strategies that are person-centered.
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Affiliation(s)
- Reanne G Mundadan
- Health and Rehabilitation Sciences, 6221Western University, London, ON, Canada
| | | | - J B Orange
- School of Communications Sciences and Disorders, 6221Western University, London, ON, Canada
| | - Laura Murray
- School of Communications Sciences and Disorders, 6221Western University, London, ON, Canada
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Backhouse T, Killett A, Mioshi E, Khondoker M. What are the factors associated with people with advanced dementia refusing assistance with personal care? Int J Geriatr Psychiatry 2023; 38:e5857. [PMID: 36490270 PMCID: PMC10107826 DOI: 10.1002/gps.5857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with dementia sometimes refuse assistance with personal care activities such as washing or dressing. We aimed to investigate the factors associated with refusals of care in advanced dementia. METHODS A cross-sectional study using informant-based measures. Participants were people with advanced dementia and their caregivers (family carers or care-home staff) (n = 260, 130 dyads) in the UK. Mixed effects linear models were used to examine the effects of neuropsychiatric behaviours, ability with activities of daily living, professional input, co-morbidities, psychotropic medications, environment modifications, and caregiver factors including type and training status on refusals of care. The Refusal of Care Informant Scale was used, range 1-13; higher scores indicate more refusal behaviours. RESULTS Higher independence in activities of daily living was associated with less refusal behaviours (coefficient = -0.11, p < 0.001 [95% confidence interval -0.15, -0.07]). Higher agitation was associated with more refusal behaviours (0.11, p < 0.001 [0.06, 0.15]). No other statistically significant differences were found. There was no demonstrable evidence of differences in number of refusals of care between family and care-home caregivers or between dementia-trained or -untrained caregivers. CONCLUSIONS Results suggest refusals of care have similar prevalence regardless of caregiver type (family or care home) or dementia training status, indicating that current dementia training has no impact on refusals of care or may not be implemented as intended. Improving independence in activities of daily living and reducing agitations may help prevent refusals of care. To establish causality, future research should consider embedding these factors into interventions targeting refusal of care.
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Affiliation(s)
- Tamara Backhouse
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Anne Killett
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Eneida Mioshi
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
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Udushirinwa CC, McVicar A, Teatheredge J. Utilization of Job Demands-Resources (JD-R) Theory to Evaluate Workplace Stress Experienced by Health Care Assistants in a UK In-Patient Dementia Unit after 10 Years of National Financial Austerity (2008-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:65. [PMID: 36612387 PMCID: PMC9819305 DOI: 10.3390/ijerph20010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
AIMS Workplace stress for support workers in UK hospitals (Health Care Assistants; HCAs) is poorly understood. This study explores experiences of HCAs working in a National Health Service in-patient dementia unit after 10 years of national financial austerity (2008-2018). DESIGN Qualitative evaluation. METHODS 15 HCAs (42%) from a specialist dementia care Unit were interviewed. Interviews were guided by UK Health & Safety Executive published dimensions of work stress. Framework analysis was applied to interview transcriptions, corroborated by a follow-up focus group (6 HCAs). Post hoc interviews with 10 nurses were later introduced to obtain a balanced view of teamwork on the Unit. RESULTS Health care assistants were altruistic regarding demands of dementia care but otherwise negative of most aspects of their work environment. Staff shortages had increased job demands: workload, poor shift rotas, and excessive reliance on inexperienced agency staff. According to HCAs, job resources of the care team were in significant deficit: nurses in charge were perceived as poor team leaders, had poor interpersonal skills, lacked respect for experienced HCAs, and deemed to be frequently absent from the ward so failing to support carers. HCAs' lack of decision-latitude exacerbated the situation. In contrast, nurses interviewed did not recognise the teamwork issues raised by HCAs, who were considered obstructive, unsupportive, lacked awareness of nurses' responsibilities, and of insights how understaffing meant excessive administration and time required to support patients' relatives. Such dissonant inter-group views caused considerable friction and exacerbated the work pressure. CONCLUSION Study outcomes spotlighted impacts of socioeconomic issues for HCAs. Staff shortage, exacerbated by financial austerity measures (pre-COVID pandemic), increased job demands for HCAs but their psychosocial job resources were in serious deficit, so putting them at risk of burnout. Inter-group relations are key for a collaborative ethos, and are amenable to interventions. Such difficulties should not be allowed to fester.
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Gabay G, Ben-Asher S. An Inverted Container in Containing and Not Containing Hospitalized Patients—A Multidisciplinary Narrative Inquiry. Front Public Health 2022; 10:919516. [PMID: 35875012 PMCID: PMC9304809 DOI: 10.3389/fpubh.2022.919516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePatient-centered care calls to contain patients in their time of crisis. This study extends the knowledge of provider patient interactions in the hectic environment of acute care applying Bion's container-contained framework from psychoanalysis.MethodsFollowing ethical approval, we performed a narrative inquiry of the experiences of ten patients upon discharge from lengthy hospitalizations in acute care. Interviews were conducted upon discharge and about one-month post-discharge.FindingsData analysis suggests four modes of containing of patients by providers. In nurturing interactions, typical of an active container-contained mode, patients experienced humanized care, symptom control, hope, and internal locus of control. This mode yielded patient gratitude toward providers, wellbeing, and post-discharge self-management of diseases. In rigid and wall-free modes of containing, patients experienced a sense of powerlessness and discomfort. A new mode of container-contained was identified, the “Inverted Container”, which extends Bion's theory and contradicts patient-centered care. In inverted containers, patients contained the providers yet reported feeling gratitude toward providers. The gratitude constitutes a defense mechanism and reflects a traumatic experience during hospitalization, which led to post-discharge distrust in providers and hospitals and poor self-management of illness.ConclusionsTo effectively provide patient-centered care, provider-patient interaction in lengthy hospitalizations must move along a clinical axis and a relationship axis. This shifting may facilitate containing patients in their time of crisis so essential processes of reflection, projection, and transference are facilitated in-hospital care.
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Affiliation(s)
- Gillie Gabay
- Multi-Disciplinary Studies, Achva Academic College, Shikmim, Israel
- *Correspondence: Gillie Gabay
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Dooley J, Barnes DR. Negotiating 'the problem' in GP home visits to people with dementia. Soc Sci Med 2022; 298:114862. [PMID: 35248896 DOI: 10.1016/j.socscimed.2022.114862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/16/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Abstract
People with dementia are often marginalised in health care due to the effects of the condition on short term memory and communication. The problem presentation is a key area of primary care consultations where patients 'have the floor', and hence are able to direct the trajectory of the consultation to achieve certain ends. An exploration of how patients with advanced dementia participate in this stage of the consultation can thus demonstrate their participation and subsequent engagement. We used conversation analysis to describe how healthcare professionals (HCPs), people with dementia, and their carers establish the presenting problem in 17 out-of-hours primary care home visit consultations. In all cases, the carer had called the out of hours service on behalf of the patient. Rather than traditional "what can I help you with?" problem solicits, HCPs instead stated their reason-for-visit using information provided by the carer. All the patients showed some misalignment with this presented reason-for-visit, by denying the existence of current symptoms and/or their involvement in the decision to call the doctor. Carers appeared to show respect for the patient's ownership of their experience, only providing input on invitation from doctors or patients. Patient acknowledgement and willingness to engage in examination were needed for progressivity, but agreement with the reason-for-visit was not. In two consultations, the reason-for-visit was not explained to patients, and in both cases this resulted in the person with dementia showing frustration and resistance to examination. People with dementia may resist doctor home visits for many reasons, such as embarrassment for not remembering symptoms, or stoicism in the face of medical ailments. These findings show how the balance of progressivity and intersubjectivity tips towards progressivity in consultations with people with dementia, but this is reversed when the patient is not engaged in the reason-for-visit.
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Affiliation(s)
- Jemima Dooley
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS82PL, UK.
| | - Dr Rebecca Barnes
- Nuffield Department of Primary Care, Medical Science Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Armstrong M, Aker N, Nair P, Walters K, Barrado‐Martin Y, Kupeli N, Sampson EL, Manthorpe J, West E, Davies N. Trust and inclusion during the Covid-19 pandemic: Perspectives from Black and South Asian people living with dementia and their carers in the UK. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5689. [PMID: 35137453 PMCID: PMC9015357 DOI: 10.1002/gps.5689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/26/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION People from ethnic minority backgrounds living with dementia are more likely to be diagnosed later and have less access to health and social care support than their White counterparts in the United Kingdom (UK). Covid-19 has exacerbated health inequalities and diminished trust from underserved communities in the government and health services. The wider aim of the study was to explore the impact of covid-19 on Black and South-Asian people living with dementia and their carers as well as exploring the experiences of dementia care. The present paper specifically explores their views on trust and mistrust using an ecological model. METHOD Semi-structured interviews were conducted with 11 family carers and four people living with dementia from South Asian or Black communities living in the community. Thematic analysis was used to analyse data. DESIGN An exploratory qualiative design was used. RESULTS Four main themes were developed exploring trust at the structural, organisational, community and individual level. At the structural level, participants discussed the inequity of Covid-19, some lack of trust in the UK Government and confusion in its messaging, and the anxiety sometimes leading to curtailment of media usage. At the organisational level, there was some evidence of a perceived lack of person-centred and culturally sensitive care from healthcare professionals, as well as concerns around care homes as places of safety. At the neighbourhood community level, participants discussed both a distrust as well as a strengthening of relationships and, at the individual level, factors such as knowledge of services, identity, and faith influenced their experience of the pandemic. CONCLUSIONS People living with dementia need support at all levels and this study highlights how the pandemic impacted each level. Ways to improve trust in the Government and health professionals alongside culturally adapted health messaging should be explored. Alongside this, an examination of how cultural values and norms may influence help-seeking responses to dementia and increase trust in services may be helpful post-pandemic.
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Affiliation(s)
- Megan Armstrong
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College London (UCL)LondonUK
| | - Narin Aker
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College London (UCL)LondonUK
| | - Pushpa Nair
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College London (UCL)LondonUK
| | - Kate Walters
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College London (UCL)LondonUK
| | - Yolanda Barrado‐Martin
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College London (UCL)LondonUK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of PsychiatryUniversity College LondonLondonUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research Department, Division of PsychiatryUniversity College LondonLondonUK
| | | | - Emily West
- Marie Curie Palliative Care Research Department, Division of PsychiatryUniversity College LondonLondonUK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College London (UCL)LondonUK,Marie Curie Palliative Care Research Department, Division of PsychiatryUniversity College LondonLondonUK
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12
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Pilnick A, O'Brien R, Beeke S, Goldberg S, Harwood R. Avoiding repair, maintaining face: Responding to hard-to-interpret talk from people living with dementia in the acute hospital. Soc Sci Med 2021; 282:114156. [PMID: 34182355 DOI: 10.1016/j.socscimed.2021.114156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/29/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
People living with dementia (PLWD) are almost always admitted to the acute hospital for reasons unrelated to their dementia, finding themselves in the unfamiliar environment of a Health Care of Older Persons acute ward. The effect of this environment creates a challenge not just for a PLWD themselves, but also for the staff who care for them. Concerns have been raised by both policy makers and staff about the quality of communication between hospital staff and PLWD. Using conversation analysis, we examined 41 video recordings of healthcare professional (HCP)/PLWD interactions collected across three acute inpatient wards in a large teaching hospital in the UK. In this paper, we focus our analysis on hard-to-interpret talk (talk where there are problems in hearing, speaking and/or understanding), and the ways in which healthcare professionals respond to this. Repair of hard- to- interpret talk is common in ordinary interaction, but we find that HCPs in this setting use a range of approaches to avoid direct repair. These approaches are: the use of non-committal responses and continuers such as 'yeah' or nods; the use of repetitions or partial repetitions; responding to the emotional tone displayed in the PLWD's utterance; closing the current topic and shifting to the next; and treating the PLWD's talk as related to the task at hand. We suggest that the use of these approaches may be one way in which HCPs manage respecting the personhood of the PLWD, by preserving face and enabling a continuation of an interaction in which the PLWD can take an active part. Our paper provides an empirical demonstration of the high level of interactional skill involved in dementia care work. It also illustrates how these skills can be described and specified, and hence incorporated into the recommendations and tips that are produced for communication with PLWD.
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Affiliation(s)
- Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, United Kingdom.
| | - Rebecca O'Brien
- School of Health Sciences, University of Nottingham, United Kingdom
| | - Suzanne Beeke
- Language and Cognition Research Department, University College London, United Kingdom
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, United Kingdom
| | - Rowan Harwood
- School of Health Sciences, University of Nottingham, United Kingdom
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