1
|
Hoffmann E, Andersen PT, Mogensen CB, Prinds C, Primdahl J. Relatives' negotiations with healthcare professionals during older people's admission in an emergency department: An ethnographic study. Nurs Open 2023; 10:6381-6389. [PMID: 37312450 PMCID: PMC10416047 DOI: 10.1002/nop2.1886] [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: 10/22/2021] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Relatives are recognised as important for older patients' care and treatment. Variations in relatives' opportunities to negotiate the quality and continuity of older people's care and treatment can potentially lead to inequality in older people's access to care and treatment. AIM This study aimed to examine relatives' opportunities and strategies for negotiation with health care professionals (HCPs) during the admission of older people to emergency departments in Denmark. MATERIALS AND METHODS We planned a qualitative ethnographical study employing a hermeneutic approach. Observations focused on social situations and interactions between relatives and HCPs. The analysis was guided by qualitative content analysis. RESULTS The analysis derived one main theme, attitude to action, containing three subthemes: frustration obtaining access, presenting the case and a powerful relationship. Being active appeared to be essential to achieving possibilities for negotiation with HCPs. DISCUSSION Inspired by Bourdieu, habitus, doxical values and institutional logics of relatives seem to affect their opportunities to negotiate with HCPs during older people's admission to an emergency department. CONCLUSION Active and proactive relatives seem to have better opportunities to negotiate with HCPs during older people's acute hospital admission than reactive, passive and hesitant relatives. The logic of public management and the medical profession seem to dominate and influence doxa in the EDs and put special demands on the relatives. This imbalance constitutes a risk of inequality in older people's access to health.
Collapse
Affiliation(s)
- Eva Hoffmann
- University College South DenmarkAabenraaDenmark
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- OPEN, Open Patient data ExplorativeRegion of Southern DenmarkOdenseDenmark
| | | | - Christian Backer Mogensen
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
| | - Christina Prinds
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
- Research Unit of Obstetrics and GynaecologyUniversity of Southern DenmarkOdenseDenmark
| | - Jette Primdahl
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
- Danish Hospital for Rheumatic DiseasesUniversity Hospital of Southern DenmarkSønderborgDenmark
| |
Collapse
|
2
|
Factors Predicting Older Patients' Family Involvement by Nursing Staff in Hospitals: The View of Hospital Nurses in Israel. Healthcare (Basel) 2022; 10:healthcare10101921. [PMID: 36292368 PMCID: PMC9602099 DOI: 10.3390/healthcare10101921] [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] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
According to the family-centered approach, the involvement of family in the care of hospitalized older patients is a crucial element of quality care. Active involvement of family in care by the nursing staff depends on different factors, including attitudes towards the importance of family in the care and perception of the interactions with the family. This study aims to identify the factors predicting staff behavior of involving the family in the care process. A cross-sectional study was conducted among 179 nursing staff at a hospital, using a self-report questionnaire examining staff attitudes towards the importance of family in care, the perception of the interactions with the family (family behavior, communication and conflicts), and staff behavior toward family involvement. The findings point out the importance that staff attitudes have on their behavior in the active involvement of family in the care of older patients. Staff behavior of family involvement was predicted by their perceptions of the family (as conversational partners and having their own resources), less conflicts with the family, and staff academic education. Staff behavior toward family is influenced by their attitude and staff–family relationships. Educational programs should emphasize the importance of family, as well as dealing with conflicts.
Collapse
|
3
|
Supporting families of patients with dementia at end-of-life in hospital. Collegian 2022. [DOI: 10.1016/j.colegn.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
4
|
Greskötter JM. [Relatives of patients with dementia as a link and mediator in acute care hospitals]. Z Gerontol Geriatr 2021; 54:651-658. [PMID: 33877443 PMCID: PMC8551104 DOI: 10.1007/s00391-021-01892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The needs of patients with dementia can hardly be met in an organization- and process-oriented acute care hospital. In order to create a successful interaction between patients and hospital staff, the importance of relatives as a link and mediator is considered. OBJECTIVE From publications on similar topics, it is deduced which conditions relatives need in order to be able to act as a link and mediator. MATERIAL AND METHODS A systematic search was conducted in the databases of Medline (PubMed), Cochrane, CINAHL, and GeroLit. RESULTS From the available literature, the reasons for the accompaniment by relatives can be outlined, their activities in the acute care hospital can be described and hindering and supporting factors can be presented. CONCLUSION Relatives already act as a link and mediator between patients with dementia and hospital staff. In doing so they act as advocates for the patient and are available to the professionals as experts and advisors. To accomplish this task, there are conditions that support or hinder the mediation activity.
Collapse
Affiliation(s)
- Jasmin M Greskötter
- Department für Pflegewissenschaft, Universität Witten/Herdecke, Witten, Deutschland.
| |
Collapse
|
5
|
Hoffmann E, Andersen PT, Mogensen CB, Prinds C, Primdahl J. Relatives' negotiation power in relation to older people's acute hospital admission: A qualitative interview study. Scand J Caring Sci 2021; 36:1016-1026. [PMID: 34156115 DOI: 10.1111/scs.13012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/30/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Acutely admitted older people are potentially vulnerable and dependent on relatives to negotiate and navigate on their behalf. AIM This study aimed to explore relatives' experiences of their interactions with healthcare professionals during acute hospital admission of older people to derive themes of importance for relatives' negotiations with these professionals. METHOD A qualitative design was applied. Relatives of acutely admitted older people at two emergency departments in Denmark were interviewed (n = 17). The qualitative content analysis was guided by Graneheim and Lundman's concepts. RESULTS The analysis derived four themes: (a) Mandate, (b) Incentive, (c) Capability and (d) Attitude to taking action. These four sources of relatives' negotiation power can be illustrated in the MICA model. CONCLUSION Four themes were identified as important sources of relatives' negotiation power. Since the four sources of power potentially change according to the situation, relatives' negotiation power seems to be context dependent.
Collapse
Affiliation(s)
- Eva Hoffmann
- University College South Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative, Region of Southern Denmark, Odense, Denmark
| | | | - Christian Backer Mogensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Christina Prinds
- University College South Denmark, Aabenraa, Denmark.,Research Unit of Obstetrics and Gynecology, University of Southern Denmark, Odense, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| |
Collapse
|
6
|
Gwernan-Jones R, Lourida I, Abbott RA, Rogers M, Green C, Ball S, Hemsley A, Cheeseman D, Clare L, Moore D, Burton J, Lawrence S, Rogers M, Hussey C, Coxon G, Llewellyn DJ, Naldrett T, Thompson Coon J. Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Being in hospital can be particularly confusing and challenging not only for people living with dementia, but also for their carers and the staff who care for them. Improving the experience of care for people living with dementia in hospital has been recognised as a priority.
Objectives
To understand the experience of care in hospital for people living with dementia, their carers and the staff who care for them and to assess what we know about improving the experience of care.
Review methods
We undertook three systematic reviews: (1) the experience of care in hospital, (2) the experience of interventions to improve care in hospital and (3) the effectiveness and cost-effectiveness of interventions to improve the experience of care. Reviews 1 and 2 sought primary qualitative studies and were analysed using meta-ethnography. Review 3 sought comparative studies and economic evaluations of interventions to improve experience of care. An interweaving approach to overarching synthesis was used to integrate the findings across the reviews.
Data sources
Sixteen electronic databases were searched. Forwards and backwards citation chasing, author contact and grey literature searches were undertaken. Screening of title and abstracts and full texts was performed by two reviewers independently. A quality appraisal of all included studies was undertaken.
Results
Sixty-three studies (reported in 82 papers) were included in review 1, 14 studies (reported in 16 papers) were included in review 2, and 25 studies (reported in 26 papers) were included in review 3. A synthesis of review 1 studies found that when staff were delivering more person-centred care, people living with dementia, carers and staff all experienced this as better care. The line of argument, which represents the conceptual findings as a whole, was that ‘a change of hospital culture is needed before person-centred care can become routine’. From reviews 2 and 3, there was some evidence of improvements in experience of care from activities, staff training, added capacity and inclusion of carers. In consultation with internal and external stakeholders, the findings from the three reviews and overarching synthesis were developed into 12 DEMENTIA CARE pointers for service change: key institutional and environmental practices and processes that could help improve experience of care for people living with dementia in hospital.
Limitations
Few of the studies explored experience from the perspectives of people living with dementia. The measurement of experience of care across the studies was not consistent. Methodological variability and the small number of intervention studies limited the ability to draw conclusions on effectiveness.
Conclusions
The evidence suggests that, to improve the experience of care in hospital for people living with dementia, a transformation of organisational and ward cultures is needed that supports person-centred care and values the status of dementia care. Changes need to cut across hierarchies and training systems to facilitate working patterns and interactions that enable both physical and emotional care of people living with dementia in hospital. Future research needs to identify how such changes can be implemented, and how they can be maintained in the long term. To do this, well-designed controlled studies with improved reporting of methods and intervention details to elevate the quality of available evidence and facilitate comparisons across different interventions are required.
Study registration
This study is registered as PROSPERO CRD42018086013.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 43. See the NIHR Journals Library website for further project information. Additional funding was provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
Collapse
Affiliation(s)
- Ruth Gwernan-Jones
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ilianna Lourida
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca A Abbott
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Colin Green
- Health Economics Group, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susan Ball
- Health Statistics Group, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | | | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Darren Moore
- Graduate School of Education, College of Social Sciences and International Studies, University of Exeter, Exeter, UK
| | - Julia Burton
- Alzheimer’s Society Research Network Volunteers, c/o University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sue Lawrence
- Alzheimer’s Society Research Network Volunteers, c/o University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | | | | | - David J Llewellyn
- Mental Health Research Group, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
- The Alan Turing Institute, London, UK
| | | | - Jo Thompson Coon
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
7
|
Watkins S, Murphy F, Kennedy C, Graham M, Dewar B. Caring for older people with dementia in the emergency department. ACTA ACUST UNITED AC 2020; 29:692-699. [PMID: 32579444 DOI: 10.12968/bjon.2020.29.12.692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Admission to an emergency department (ED) may expose the older person with dementia to a range of negative consequences, including a deterioration in their behavioural symptoms. The authors conducted a review of primary research relating to the experiences of older people with dementia, their carers and ED nurses, to understand how these experiences might inform nursing practice. METHODS Integrative review with a search of the electronic databases of Medline, CINAHL and PSYCHINFO using specified inclusion and exclusion criteria. RESULTS Three themes were identified: carers and older people with dementia-waiting and worrying; nurses juggling priorities; and strategies for improvement-taking a partnership approach. CONCLUSION Older people with dementia may be exposed to disparities in treatment in the ED. A practice partnership between carers and ED nurses may help to prevent this. ED nurses need support to blend technical- and relationship-centred care. Participatory research exploring the experiences of older people with dementia, their carers and ED nurses is needed.
Collapse
Affiliation(s)
- Sarah Watkins
- Advanced Nurse Practitioner (Acute Medicine) Candidate and PhD Candidate, Emergency Department, University Hospital Limerick, Ireland
| | - Fiona Murphy
- Professor of Clinical Nursing, Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Catriona Kennedy
- Professor of Community Nursing, School of Nursing and Midwifery, Robert Gordon University, Aberdeen
| | - Margaret Graham
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Belinda Dewar
- Professor of Practice Improvement, School of Health and Life Sciences, University of the West of Scotland, Hamilton, South Lanarkshire
| |
Collapse
|
8
|
Slatyer S, Aoun SM, Hill KD, Walsh D, Whitty D, Toye C. Caregivers' experiences of a home support program after the hospital discharge of an older family member: a qualitative analysis. BMC Health Serv Res 2019; 19:220. [PMID: 30971236 PMCID: PMC6458630 DOI: 10.1186/s12913-019-4042-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ageing global population has seen increasing numbers of older people living with chronic health problems, declining function, and frailty. As older people seek to live out their years at home, family members, friends and neighbours (informal caregivers) are increasingly relied upon for support. Moreover, pressured health systems and shorter hospital length of stay mean that informal caregivers can find themselves supporting the older person who is still unwell after discharge. The Further Enabling Care at Home (FECH) program was developed as a nursing outreach intervention designed to systematically address support needs of family caregivers of older people after hospital discharge to sustain their home-based caregiving. The objective of this study was to explore the experiences of informal caregivers who participated in the FECH program after an older family member's discharge from hospital. METHODS The study employed a qualitative descriptive design. Caregivers of older people discharged home from a Medical Assessment Unit in an Australian hospital who were included in the program were interviewed to explore their experiences and perceptions of the FECH program. Data were audio-recorded, transcribed, and subjected to thematic analysis. RESULTS Twenty-one family caregivers (81% female, aged 25-89 years) participated in the interviews. Themes emerging were 'The experience of caregiving'; 'The experience of receiving FECH program support'; and 'Caregivers' suggestions for improvement'. Caregivers indicated that reflective discussions with the FECH nurse enabled them to recognise the complexity of the caregiving role and determine aspects where they needed support. Caregivers valued guidance from the FECH nurse in accessing information and resources, which helped them to feel more connected to support, more prepared to care for the older person and themselves, and more secure in the caregiving role. CONCLUSIONS Caregivers' experiences indicated that the structured reflective FECH discussions prompted thought and provided guidance in navigating health and care systems. The FECH program appears to offer a means to address the practical, physical and psychosocial needs of informal caregivers as partners in person-centred health and social care. TRIAL REGISTRATION ANZCTR Trial ID: ACTRN126140011746773 .
Collapse
Affiliation(s)
- Susan Slatyer
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, 6150, Australia. .,School of Nursing, Midwifery and Paramedicine, Curtin University , GPO Box U1987, Perth, Western Australia, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital , Hospital Avenue, Nedlands, Western Australia, 6009, Australia.
| | - Samar M Aoun
- School of Psychology & Public Health, La Trobe University, Boondoora, 3086, Victoria, Australia.,Perron Institute for Neurological and Translational Science, Verdun Street, Nedlands, Western Australia, 6009, Australia
| | - Keith D Hill
- Faculty of Health Sciences, Curtin University , GPO Box U1987, Perth, 6845, Western Australia, Australia
| | - Debbie Walsh
- Medical Division, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - Dee Whitty
- Medical Division, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University , GPO Box U1987, Perth, Western Australia, 6845, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital , Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| |
Collapse
|
9
|
Scerri A, Scerri C, Innes A. The perceived and observed needs of patients with dementia admitted to acute medical wards. DEMENTIA 2018; 19:1997-2017. [PMID: 30482091 DOI: 10.1177/1471301218814383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is acknowledged that the needs of persons living with dementia admitted in acute hospitals are not always met. Previous studies have focused on the perceived needs of professional caregivers or family members whilst the voices of patients with dementia in acute hospitals have not been extensively reported. This may have contributed to the under-recognition of the needs of persons living with dementia. The aim of this study was to categorise the perceived and observed needs of persons with dementia admitted in acute medical wards and to explore whether these needs are being or have been met. Thirteen people with dementia in three medical wards, who could verbally communicate with the researcher, were purposively selected as research participants. Semi-structured interviews were conducted to elicit each participant's experiences of their hospital stay and whether their needs were perceived to have been/are being met. Moreover, routine care with the same participants was observed using Dementia Care Mapping. Maslow's Hierarchy of Needs was used as a framework to categorise care needs. Our findings demonstrate that basic needs such as toileting, feeding, drinking, continence and comfort were not always met. Moreover, the largest gap between met and unmet needs was found in patients who were either under constant observation or unable to communicate. Too much emphasis was perceived and observed to be given on what staff considered as safety needs at the expense of other needs. The patients' need for social contact and self-esteem such as dignity and respect were often ignored and this led to patients feeling devalued. Hospital staff have to be more aware of the holistic needs of patients with dementia in acute settings and the way care is delivered in order to make up for these unmet needs, thus facilitating person-centred care.
Collapse
Affiliation(s)
- Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Malta
| | - Charles Scerri
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Malta
| | - Anthea Innes
- Faculty of Social Sciences, University of Stirling, Salford Institute for Dementia, University of Salford, Manchester, UK
| |
Collapse
|