Person-Centred Dementia Care in an Acute Hospital: Experiences from Nurses Working in a Specialized Dementia Unit

Models of Integrated Acute Care for Older Adult Inpatients That Incorporate Integrative Health: An Integrative Review

Background

The use of integrated acute care for older adult inpatients is a growing field, especially the use of integrative health-care practices for managing complex, chronic, age-related health conditions. Scientific evidence suggests that these practices should be incorporated into older adult inpatients' daily care.

Aim

Conduct an integrative review of studies on integrated acute-care models for older adult inpatients that incorporate integrative health services.

Methods

We searched Medline Ovid ALL, Embase.com, CINAHL, APA PsycINFO Ovid, Web of Science Core Collection, ProQuest Dissertations & Theses A&I, Cochrane Library, and CAMBase bibliographic databases for studies, published between 1990 and 2023, on integrated acute-care models for older adult inpatients that incorporated integrative health services. The search associated the domains of acute care, geriatrics, internal medicine, rehabilitation, hospitalization, geriatric psychiatry, integrated/integrative care, care models, practices and coordination, interprofessionalism and multidisciplinarity, collaborative practices, and complementary therapies. The review was completed in June 2024.

Results

We retained 32 studies conducted in North America, Europe, Australia, and Asia, including 46,899 older adult inpatients, 39 physicians, 148 nurses, 695 allied health-care professionals, and 358 informal caregivers. Three integrated acute care models were identified: the Acute Care for Elders model, the Integrated General Hospital model, and the Transitional Care model. Three integrated acute psychogeriatric-care models were identified: the Admiral Nursing model, the Lewy body dementia Admiral nursing service model, and the Care for Acute Mentally Infirm Elders model. A single, hybrid, Integrated, People-Centred Health Services model for acute and community health care was identified. We found the Scaling Integrated Care in Context model for measuring integrated care development within health-care systems.

Conclusion

Few studies have investigated integrated acute-care models incorporating integrative health services for older adult inpatients. Existing acute-care models including integrative medicine should be explored further, and new, more inclusive models should be developed.

Dementia Training for Nurses in Acute Care Settings: Impacts and Barriers

BACKGROUND

The provision of consistent, high-quality dementia care training for healthcare professionals in acute care hospital settings has been largely overlooked until recent years.

PURPOSE

This study was designed to investigate the effect of current healthcare professional dementia care training courses on related knowledge, attitudes, and self-efficacy in hospital nurses and to understand their training-related experiences, willingness, and perceived barriers.

METHODS

Using a cross-sectional design, 201 nurses were recruited from a teaching medical center in Taiwan. A questionnaire was developed by the researchers to evaluate knowledge, attitudes, and self-efficacy related to caring for people with dementia and to elucidate participant experiences and preferences regarding dementia care training courses. Five academic and clinical dementia care experts held three content validity evaluation rounds for the developed questionnaire. Inferential statistics were used to compare the knowledge, attitudes, and self-efficacy related to caring for people with dementia between participants who had and had not attended a dementia care training course.

RESULTS

Nearly all (96.5%) of the participants had prior experience caring for people with dementia, but only 25.9% and 7.0% respectively reported haven taken basic and advanced healthcare professional dementia care training courses. Those who had taken either the basic or advanced course earned higher mean knowledge scores than those who had taken neither ( p = .009 and p = .027, respectively). Time constraints and scheduling conflicts were identified as the major barriers to attending dementia care training ( n = 164, 81.6%).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The participants who had attended either the basic or advanced healthcare professional dementia care training course were found to have better dementia care knowledge than those who had not. Stakeholders should work to further reduce the barriers faced by nurses to attending essential dementia care training.

New horizons for caring for people with dementia in hospital: the DEMENTIA CARE pointers for service change

Approximately two-thirds of hospital admissions are older adults and almost half of these are likely to have some form of dementia. People with dementia are not only at an increased risk of adverse outcomes once admitted, but the unfamiliar environment and routinised practices of the wards and acute care can be particularly challenging for them, heightening their confusion, agitation and distress further impacting the ability to optimise their care. It is well established that a person-centred care approach helps alleviate some of the unfamiliar stress but how to embed this in the acute-care setting remains a challenge. In this article, we highlight the challenges that have been recognised in this area and put forward a set of evidence-based 'pointers for service change' to help organisations in the delivery of person-centred care. The DEMENTIA CARE pointers cover areas of: dementia awareness and understanding, education and training, modelling of person-centred care by clinical leaders, adapting the environment, teamwork (not being alone), taking the time to 'get to know', information sharing, access to necessary resources, communication, involving family (ask family), raising the profile of dementia care, and engaging volunteers. The pointers extend previous guidance, by recognising the importance of ward cultures that prioritise dementia care and institutional support that actively seeks to raise the profile of dementia care. The pointers provide a range of simple to more complex actions or areas for hospitals to help implement person-centred care approaches; however, embedding them within the organisational cultures of hospitals is the next challenge.