The Experience of Hospitalisation for People Living With Dementia: A Qualitative Exploration of How Context Shapes Experiences

INTRODUCTION

Dementia has become an increasingly pressing issue in healthcare systems, and acute care settings such as hospitals have been shown to be particularly problematic for people living with dementia. People living with dementia are hospitalised at higher rates than those without and often have poor experiences and outcomes of hospitalisation. To support the evolution of hospital systems to better meet the needs of people living with dementia, it is important to consider the relationship between the context of the hospital and the experiences of people living with dementia and their caregivers. The term context refers to the environment and conditions that shape experiences and includes elements such as policies, procedures, design and social norms. A greater understanding of the relationship between the hospital context and the experiences of people living with dementia will support the future development of interventions to modify contextual elements to improve the experiences of people living with dementia. Our aim was to explore the relationship between the experiences of people living with dementia and their caregivers in hospital, and the contextual elements of the hospital.

METHODS

In this interpretive descriptive study, we conducted interviews with people living with dementia and caregivers of people living with dementia about their experiences in hospital. Interviews were conducted with people living with dementia (n = 3), caregivers of people living with dementia (n = 8) and one dyad of a person living with dementia and their caregiver (n = 1) about the hospitalisation of the person living with dementia. Using inductive and deductive methods of analysis, we describe contextual factors that shape their experiences.

RESULTS

Our findings demonstrate how the hospital context shaped the experiences of people living with dementia and their caregivers while the person living with dementia was hospitalised. The themes reflect elements of the hospital context: communication systems, the value of caregivers, the focus on acute physical needs, staff capacity, the physical environment and normalised practices. The findings suggest that there are aspects of the hospital context that can be modified to influence the experiences of people living with dementia and their caregivers.

CONCLUSION

This study demonstrates how the context of hospital shapes the experiences of people living with dementia and their caregivers and points to aspects of the context that health system leaders could explore to begin to improve the capacity of hospitals to support people living with dementia.

IMPLICATIONS FOR PRACTICE

The study provides evidence of the need for health system leaders and practitioner to explore how the hospital context shapes the experiences of people wtih dementia and their caregivers, and begins to explore ways that contextual changes can improve their experiences.

Becoming partners in rehabilitation with patients in intensive care: physiotherapists' perspectives

PURPOSE

Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting.

METHODS

A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software.

RESULTS

Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care.

CONCLUSIONS

Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others.

Life story templates in dementia care: Ambiguous direction and purpose

BACKGROUND

The use of life stories in dementia care has been described as a way of seeing every person as an individual, looking beyond their dementia. Life stories have become synonymous with high-quality care, while in Sweden their mere existence in dementia care settings is taken to indicate quality in national comparisons. Such life stories are often standardised, generated by a family member answering predetermined questions in a template.

AIM AND METHODS

Using a constructionist approach, this study will (1) chart what versions of a person's life story the templates produce, and (2) establish the intended purpose of such life stories, as communicated by the templates. This study departs from the assumption that life story templates communicate something about the conceptions of people living with dementia. The thematic analysis used data comprising 30 blank templates, totalling about 1,700 questions.

FINDINGS

The life story templates were found to generate two very different versions of the individual: (1) a person before symptoms of dementia or (2) a patient with dementia. We also found contradictions about what information should be included, whose life story it was, and the intended use.

DISCUSSION

Despite strong pressure on dementia care providers to collect life stories from residents, the life story templates they use are without clear direction, ideology, or purpose. The lack of direction is key given that life stories can be considered actants that shape assumptions about people with dementia and construct realities in dementia care settings. We highlight the need to develop ethical guidelines for life story template design, matched with guidelines for their intended use.

Person-centred oral hydration care for older people with dementia admitted to acute hospital wards: Empirical research qualitative

AIMS AND OBJECTIVES

To conduct an in-depth exploration of oral hydration care provided to people living with dementia in acute hospital wards, using a person-centred care framework.

BACKGROUND

Oral hydration care is an important, yet rarely explored aspect of fundamental care for people with dementia admitted to acute hospitals. Using person-centred care as a conceptual framework we investigated how oral hydration care is delivered for people living with dementia in acute hospital wards.

DESIGN

A qualitative, multiple-case study. The cases were three acute wards in one hospital.

METHODS

Direct observation of care for 13 people with dementia (132 h), semistructured interviews with ward staff (n = 28), ward leaders (n = 4), organisational leaders (n = 5), people with dementia (n = 6), their relatives (n = 5), documentary analysis of clinical inpatient records (n = 26) and relevant hospital policies. Data were analysed using framework analysis.

RESULTS

Four themes were identified: (1) The acute hospital: oral hydration is obscured and not prioritised (2) Overshadowing of oral hydration at ward level (3) Siloed nature of hydration roles (4) Strategies for, and barriers to, delivering person-centred oral hydration care.

CONCLUSIONS

This study combines the concept of person-centred care and oral hydration care for people living with dementia admitted to acute hospital wards, demonstrating that person-centred hydration care was complex and not prioritised.

RELEVANCE TO CLINICAL PRACTICE

Nurses should consider means of improving prioritisation and cohesive delivery of person-centred hydration care in acute hospital wards.

Film as cooperative endeavour: The promises for people living with dementia, their relatives, caregivers and aged care staff

Creative expression by people living with dementia and their families and carers can improve communication and relationships and strengthen relational personhood. The transition to residential aged care from living at home with dementia is a time of 'relocation stress", and a time when additional psychosocial supports like these might be particularly beneficial. This article reports on a qualitative study that explored how a co-operative filmmaking project functioned as a multifaceted psychosocial intervention, and explored its potential impacts on relocation stressors. Methods included interviews with people living with dementia who were involved in the filmmaking, and their families and close others. Staff from a local day centre and residential aged care home also took part in interviews, as did the filmmakers. The researchers also observed some of the filmmaking process. Reflexive thematic analysis techniques were used to generate three key themes in the data: Relationship building; Communicating agency, memento and heart; Being visible and inclusive. The findings reveal challenges regarding privacy and the ethics of public screenings, as well as the pragmatics of using short films as a communication tool in aged care settings. We conclude that filmmaking as a cooperative endeavour holds promise to mitigate relocation stressors by: improving family and other relationships during challenging times for family and for people living with dementia; providing opportunities for new self-narratives derived from relational subjectivities; supporting visibility and personhood; and improving communication once in residential aged care. This research has relevance for communities who are looking to support dynamic personhood and improve the care of people living with dementia.

Barriers and facilitators to the use of personal information documents in health and social care settings for people living with dementia: A thematic synthesis and mapping to the COM-B framework

INTRODUCTION

People living with dementia experience communication difficulties. Personal information documents, or healthcare passports, enable communication of information essential for the care of a person with dementia. Despite the potential for providing person-centred care, personal information documents are not ubiquitously used. The Capability Opportunity Motivation-Behaviour (COM-B) model can be used to understand factors determining individuals' behaviours.

OBJECTIVES

This study aimed to identify the barriers to and facilitators of the use of healthcare passports for people living with dementia through a systematic review methodology.

METHODS

A systematic search of six electronic databases was undertaken. Grey literature was searched using three databases. All study types reporting barriers to or facilitators of the use of personal information documents in the care of adults living with dementia in high-income countries were included. Study quality was assessed using the NICE Quality Appraisal Checklist. Thematic synthesis was used to develop descriptive themes, which were subsequently mapped to the COM-B framework.

RESULTS

Nineteen papers were included. Themes included training, awareness, embedding the process in norms and appreciating the value of the personal information documents. A broad range of barriers and facilitators was identified within each COM-B domain.

CONCLUSION

This framework provides a starting point for evidence-informed initiatives to improve the use of personal information documents in the care of people with dementia.

PATIENT AND PUBLIC CONTRIBUTION

This is a review of studies and did not involve patients or the public. Review results will guide evaluation of a local personal information document, which will be designed with input from the Dementia Champions Network (includes carers and other stakeholders).

The components of personal passports for people living with dementia in an acute healthcare setting: an integrative review

AIM

To explore the components of personal passports for people living with dementia in an acute healthcare setting.

BACKGROUND

Globally, supporting people with dementia poses a prominent health and social care challenge. Importance for people with dementia in an acute healthcare setting includes social relationships and communication with healthcare staff. A personal passport is an international initiative designed to support the personhood of the person living with dementia.

METHODS

This integrative review is based on the methodology of Whittmore and Knafl (2005). The Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were adhered to. A database search of PubMed, MEDLINE, CINAHL, Scopus and EBSCO databases was systematically performed.

RESULTS

This integrative review identified nine research studies on the components of personal passports that met the inclusion and exclusion criteria. A constant comparative method of data analysis identified five key pivotal themes: person-centredness, communication, family/carer involvement, education and leadership.

CONCLUSION

The use of personal passports supports the provision of person-centred care for people living with dementia through enhancing the well-being of both the person and their families/caregivers.

RELEVANCE TO CLINICAL PRACTICE

Personal passports are an important document and should be determined by the person with dementia, their care needs and the caregiver's role in meeting these needs.