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Jensen AM, Wilson RL, Pedersen BD, Hounsgaard L, Tingleff EB. Nursing care of people with dementia in an orthopaedic acute care setting: An integrative literature review. J Clin Nurs 2022; 32:2298-2318. [PMID: 36229899 DOI: 10.1111/jocn.16557] [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: 09/13/2021] [Revised: 04/26/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This integrative literature review is to collect what is known about the care of people with dementia when they require a hospital admission for an orthopaedic surgical procedure and to contribute to developing an evidence-base to support nursing practice when caring for people with dementia in an orthopaedic setting. BACKGROUND People with a dementia diagnosis are increasingly common in acute orthopaedic care settings and the admission exposes people with dementia to risks during their hospital stay. In addition, nurses find people with dementia challenging to care for due to the complexity of dual conditions. Little is known specifically about the care requirements for people with dementia in orthopaedic settings. DESIGN Integrative literature review. METHODS An integrative literature review and qualitative deductive content analysis using McCormack and McCance's theoretical nursing framework (Person-Centred Nursing Framework) of nine studies were undertaken. The process of the review was guided by PRISMA checklist. RESULTS The care environment and resistance either in passive form, or through physical intervention, is common in orthopaedic nursing. Planning and delivering care for physical, cognitive and emotional needs is identified as being difficult, resulting in a lack of inclusion for patients, partly due to communication challenges. Finding ways to implement tailored care plans within standard ward routines proves difficult, and the consequence is a less than optimal care experience with adverse effects on patients characterised by an increase in dementia symptoms. CONCLUSIONS Care for people with dementia in an orthopaedic setting is complex. It needs to be further studied so that more evidence and supporting literature can contribute to improved care for this group of patients. RELEVANCE TO CLINICAL PRACTICE This study describes the complexity of providing fundamental care for people with dual conditions of dementia and orthopaedic injury and suggests opportunities for improvement.
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Affiliation(s)
- Anders M Jensen
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Research Centre for Health and Welfare Technology, VIA University College, Holstebro, Denmark
| | - Rhonda L Wilson
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia.,School of Nursing, Massey University, Auckland, New Zealand
| | - Birthe D Pedersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lise Hounsgaard
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ellen B Tingleff
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Research Unit Forensic Mental Health Psychiatric Department Middelfart (RFM) and CPS, Mental Health Services in the Region of Southern Denmark & Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,Nursing Education, Vejle, and Health Sciences Research Center, UCL University College, Svendborg, Denmark
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Abbott RA, Rogers M, Lourida I, Green C, Ball S, Hemsley A, Cheeseman D, Clare L, Moore D, Hussey C, Coxon G, Llewellyn DJ, Naldrett T, Thompson Coon J. New horizons for caring for people with dementia in hospital: the DEMENTIA CARE pointers for service change. Age Ageing 2022; 51:6691373. [PMID: 36057987 PMCID: PMC9441201 DOI: 10.1093/ageing/afac190] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- Rebecca A Abbott
- Address correspondence to: Dr Rebecca Abbott, Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK.
| | - Morwenna Rogers
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Ilianna Lourida
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK,Mental Health Research Group, University of Exeter Medical School, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Colin Green
- Health Economics Group, University of Exeter Medical School, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Susan Ball
- Health Statistics Group, PenARC, University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Anthony Hemsley
- Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | | | - Linda Clare
- Centre for Research in Aging and Cognitive Health, PenARC, University of Exeter Medical School, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Darren Moore
- Graduate School of Education, College of Social Sciences and International Studies, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | | | - George Coxon
- Pottles Court Care Home, Days-Pottles Lane, Exminster, Summercourt Care Home, Teignmouth, Exeter EX6 8DG, UK
| | - David J Llewellyn
- Mental Health Research Group, University of Exeter Medical School, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK,The Alan Turing Institute, London, UK
| | | | - Jo Thompson Coon
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
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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.
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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
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Gwernan-Jones R, Abbott R, Lourida I, Rogers M, Green C, Ball S, Hemsley A, Cheeseman D, Clare L, Moore DA, Hussey C, Coxon G, Llewellyn DJ, Naldrett T, Thompson Coon J. The experiences of hospital staff who provide care for people living with dementia: A systematic review and synthesis of qualitative studies. Int J Older People Nurs 2020; 15:e12325. [PMID: 32412167 DOI: 10.1111/opn.12325] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/30/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To systematically review and synthesise qualitative data from studies exploring the experiences of hospital staff who care for people living with dementia (Plwd). BACKGROUND In hospital, the number of Plwd continues to rise; however, their experiences of care remain problematic. Negative experiences of care are likely to contribute to poorer mental and physical health outcomes for Plwd while in hospital and after discharge. Experiences of the hospital staff who care for Plwd can also be poor or unrewarding. It is important to understand the experiences of staff in order to improve staff well-being and ultimately the experience of care for Plwd while in hospital. DESIGN Systematic review and evidence synthesis of qualitative research. DATA SOURCES We searched 16 electronic databases in March 2018 and completed forward and backward citation chasing. METHODS Eligible studies explored the experiences of paid and unpaid staff providing care in hospital for Plwd. Study selection was undertaken independently by two reviewers, and quality appraisal was conducted. We prioritised included studies according to richness of text, methodological rigour and conceptual contribution. We adopted approaches of meta-ethnography to analyse study findings, creating a conceptual model to represent the line of argument. FINDINGS Forty-five studies reported in 58 papers met the inclusion criteria, and of these, we prioritised 19 studies reported in 24 papers. The line of argument was that Institutions can improve staff experiences of care for Plwd by fostering person-centred care (PCC). PCC aligned with staff perceptions of 'good care'; however, staff often felt prevented from providing PCC because of care cultures that prioritised tasks, routines and physical health. Staff experienced conflict over the care they wanted to give versus the care they were able to give, and this caused moral distress. When staff were able to provide PCC, this increased experiences of job satisfaction and emotional well-being. CONCLUSIONS Person-centred care not only has the potential to improve the experience of care for Plwd and their carers, but can also improve the experiences of hospital staff caring for Plwd. However, without institutional-level changes, hospital staff are often unable to provide PCC even when they have the experience and knowledge to do so. IMPLICATIONS FOR PRACTICE Institutional-level areas for change include the following: training; performance indicators and ward cultures that prioritise psychological needs alongside physical needs; adequate staffing levels; inclusive approaches to carers; physical environments that promote familiarisation, social interaction and occupation; systems of documentation about individual needs of Plwd; and cultures of sharing knowledge across hierarchies.
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Affiliation(s)
- Ruth Gwernan-Jones
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Rebecca Abbott
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Ilianna Lourida
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Colin Green
- Health Economics Group, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Susan Ball
- Health Statistics Group, PenCLAHRC, College of Medicine and Health, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | | | | | - Linda Clare
- Centre for Research in Aging and Cognitive Health, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Darren A Moore
- Graduate School of Education, College of Social Sciences and International Studies, St Luke's Campus, University of Exeter, Exeter, UK
| | | | | | - David J Llewellyn
- Mental Health Research Group, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK.,The Alan Turing Institute, London, UK
| | | | - Jo Thompson Coon
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
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5
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Older people's experiences in acute care settings: Systematic review and synthesis of qualitative studies. Int J Nurs Stud 2020; 102:103469. [DOI: 10.1016/j.ijnurstu.2019.103469] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/28/2019] [Indexed: 01/13/2023]
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Jensen AM, Pedersen BD, Wilson RL, Bang Olsen R, Hounsgaard L. Nurses’ experiences of delivering acute orthopaedic care to patients with dementia. Int J Older People Nurs 2019; 14:e12271. [DOI: 10.1111/opn.12271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/17/2019] [Accepted: 07/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anders Møller Jensen
- Department of Clinical Research, OPEN, Odense Patient data Explorative Network Odense University Hospital University of Southern Denmark Odense Denmark
- Faculty of Health Sciences, VIA Ageing & Dementia ‐ Center for Research VIA University College Holstebro Denmark
| | - Birthe D. Pedersen
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Rhonda L. Wilson
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Faculty of Health, School of Nursing, Midwifery and Public Health University of Canberra Bruce ACT Australia
- Department of Regional Health Research, Faculty of Health Sciences, Center for Psychiatric Nursing and Health Research University of Southern Denmark Odense Denmark
| | - Rolf Bang Olsen
- Department of Clinical Research, OPEN, Odense Patient data Explorative Network Odense University Hospital University of Southern Denmark Odense Denmark
- Faculty of Health Sciences, VIA Ageing & Dementia ‐ Center for Research VIA University College Holstebro Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Faculty of Health, School of Nursing, Midwifery and Public Health University of Canberra Bruce ACT Australia
- Department of Regional Health Research, Faculty of Health Sciences, Center for Psychiatric Nursing and Health Research University of Southern Denmark Odense Denmark
| | - Lise Hounsgaard
- Department of Clinical Research, OPEN, Odense Patient data Explorative Network Odense University Hospital University of Southern Denmark Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
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Reilly JC, Houghton C. The experiences and perceptions of care in acute settings for patients living with dementia: A qualitative evidence synthesis. Int J Nurs Stud 2019; 96:82-90. [PMID: 31345443 DOI: 10.1016/j.ijnurstu.2019.04.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Increasing numbers of people with dementia are presenting to acute care facilities for management of medical conditions and co-morbidities. They require an individual approach to care due to the confusion and disorientation which may accompany their illness. Current evidence syntheses on this topic explore how staff, family and carers view their care. This review aims to complement previous work in the area by exploring care from the perspective of the patient living with dementia. OBJECTIVES The aim of this qualitative evidence synthesis was to explore the experiences and perceptions of patients living with dementia on the care they receive in acute settings. DESIGN Qualitative evidence synthesis systematically draws the findings from individual studies together to create valid, reliable and meaningful evidence for healthcare policy development. Framework synthesis was utilised and guided by the VIPS framework; Values, Individualised, Perspective, and Social and psychological. The VIPS framework has previously been used for exploring staffs' views of care in the acute setting and provides guidance to caring for people with dementia. REVIEW METHODS Following screening, data were extracted and appraised using Critical Appraisal Skills Programme. Framework synthesis, incorporating thematic synthesis, was conducted and the confidence in findings was assessed using GRADE CERQual. DATA SOURCES Seven qualitative studies that explored care in acute hospitals as experienced or perceived by the person living with dementia. RESULTS The VIPS framework helped to capture views of care. Patients often experienced rushed and task- based approaches, poor communication, and exclusion in some cases. The environments were clearly unsuitable, sometimes exacerbating behaviours of concern, thus leading to unnecessary restraint due to an inability to protect this group. CONCLUSIONS Further research needs to be conducted in testing existing or developing new interventions to improve the physical environment, the systems of care and to provide more person-centred approaches to care. Organisational structures must ensure patients are cared for in a dementia friendly environment by a dementia trained workforce. At local level, involving support workers, eliminating unnecessary care practices, and facilitating individual choices of patients are recommended.
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Affiliation(s)
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.
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The impacts of family involvement on general hospital care experiences for people living with dementia: An ethnographic study. Int J Nurs Stud 2019; 96:72-81. [PMID: 31053337 DOI: 10.1016/j.ijnurstu.2019.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND A quarter of people in general hospitals have dementia. Limited existing studies suggest that hospital care experiences of people living with dementia, and the involvement of their families in care, may be suboptimal. OBJECTIVES The objectives of this study were to explore how family involvement impacts upon experiences of hospital care for people living with dementia. DESIGN A qualitative ethnographic study. METHODS Ethnographic data were collected from two care of older people general hospital wards. Data were collected via observations, conversations and interviews with people living with dementia, families and staff. In total, 400 hours of observation and 46 interviews were conducted across two 7-9 month periods. RESULTS People living with dementia could experience a lack of connection on multiple levels - from pre-hospital life as well as life on the wards - where they could spend long periods of time without interacting with anyone. There was great variation in the degree to which staff used opportunities to involve families in improving connections and care. When used, the knowledge and expertise of families played a crucial role in facilitating more meaningful interactions, demonstrating how person-centred connections and care are possible in busy hospital settings. Despite such benefits, the involvement of families and their knowledge was not routine. Care was required to ensure that family involvement did not override the needs and wishes of people living with dementia. CONCLUSIONS This study demonstrates the benefits of involving families and their knowledge in care, advocating for family involvement, alongside the involvement of people living with dementia, to become a more routine component of hospital care.
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Featherstone K, Northcott A, Harden J, Harrison Denning K, Tope R, Bale S, Bridges J. Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07110] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The acute hospital setting has become a key site of care for people living with dementia. The Department of Health and Social Care recognises that as many as one in four acute hospital beds in the UK will be occupied by a person living with dementia at any given time. However, people living with dementia are a highly vulnerable group within the hospital setting. Following an acute admission, their functional abilities can deteriorate quickly and significantly. Detailed research is required to understand the role and needs of health-care staff caring for this patient population and to explore what constitutes ‘good care’ for people living with dementia within the acute setting.
Objectives
The focus of this study was a common but poorly understood phenomenon within the acute setting: refusal and resistance to care. Our research questions were ‘How do ward staff respond to resistance to everyday care by people living with dementia being cared for on acute hospital wards?’ and ‘What is the perspective of patients and their carers?’.
Design
This ethnography was informed by the symbolic interactionist research tradition, focusing on understanding how action and meaning are constructed within a setting. In-depth evidence-based analysis of everyday care enabled us to understand how ward staff responded to the care needs of people living with dementia and to follow the consequences of their actions.
Setting
This ethnography was carried out on 155 days (over 18 months) in 10 wards within five hospitals across England and Wales, which were purposefully selected to represent a range of hospital types, geographies and socioeconomic catchments.
Participants
In addition to general observations, 155 participants took part directly in this study, contributing to 436 ethnographic interviews. Ten detailed case studies were also undertaken with people living with dementia.
Results
We identified high levels of resistance to care among people living with dementia within acute hospital wards. Every person living with dementia observed within an acute hospital ward resisted care at some point during their admission.
Limitations
Limitations identified included the potential for the Hawthorne or researcher effect to influence data collection and establishing the generalisability of findings.
Conclusions
Ward staff typically interpreted resistance as a feature of a dementia diagnosis, which overshadowed the person. However, resistance to care was typically a response to ward organisation and delivery of care and was typically rational to that person’s present ontology and perceptions. In response, nurses and health-care assistants used multiple interactional approaches that combined highly repetitive language with a focus on completing essential care on the body, which itself had a focus on the containment and restraint of the person in their bed or at their bedside. These approaches to patient care were a response to resistance but also a trigger for resistance, creating cycles of stress for patients, families and ward staff. The findings have informed the development of simple, no-cost innovations at the interactional and organisational level. A further study is examining continence care for people living with dementia in acute hospital settings.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Andy Northcott
- School of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Jane Harden
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | | | - Sue Bale
- Aneurin Bevan University Health Board, Newport, UK
| | - Jackie Bridges
- School of Health Sciences, University of Southampton, Southampton, UK
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10
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Jensen AM, Pedersen BD, Olsen RB, Wilson RL, Hounsgaard L. "If only they could understand me!" Acute hospital care experiences of patients with Alzheimer's disease. DEMENTIA 2018; 19:2332-2353. [PMID: 30587029 DOI: 10.1177/1471301218820483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with dementia as co-morbidity find hospital stays challenging, because the focus is primarily on the somatic cause for the admission, with less emphasis on the needs pertaining to dementia-related support and care. This results in poorer holistic outcomes, compared to patients without dementia, and an increased cost for the healthcare sector and, society as a whole. The quest is to make hospitals a dementia-friendly context, because this is likely to lead to better patient outcomes for people with dementia generally; however, further research is required to understand where gains may be made in this regard. This study conducted participant observation research strategies to follow patient journeys with Alzheimer's disease admitted to orthopaedic wards, to learn about their experiences as patients. Longitudinal data were gathered by following patients on both day and evening shifts within a specialist orthopaedic hospital ward, commencing at patient admission and concluding at time of discharge. The data were interpreted from a phenomenological-hermeneutic perspective, inspired by Ricoeur's interpretation theory. The study revealed a communication style among nurses who failed to take into account the comprehensive needs of patients with dementia, in terms of timely information exchange and clinical relevance. Patients expressed the desire to be more fully engaged in the care decision-making, together with indicating their appreciation of the work of the health professionals who cared for them. The data revealed that the process of getting to know the patient at the beginning of every shift left little room to alleviate patients' experienced distress, caused by being in hospital. This resulted in patients who were less involved in the caring situation, or, if a patient took the initiative to act, intentions ended up being misinterpreted as disruptive behaviour. The findings have relevance for staff and ward management who are interested to strive to enhance the patient journey as a dementia-friendly hospital.
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Affiliation(s)
- Anders Møller Jensen
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; VIA Ageing & Dementia - Center for research, Faculty of Health Sciences, VIA University College, Denmark
| | - Birthe D Pedersen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Rhonda L Wilson
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Faculty of Health Sciences, Department of Regional Health Research, Center for Psychiatric Nursing and Health Research, University of Southern Denmark, Odense, Denmark
| | - Lise Hounsgaard
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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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.
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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
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12
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Godfrey M, Young J, Shannon R, Skingley A, Woolley R, Arrojo F, Brooker D, Manley K, Surr C. The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Improving the care of people with dementia on acute hospital wards is a policy priority. Person-centred care is a marker of care quality; delivering such care is a goal of service improvement.
Objectives
The Person, Interactions and Environment (PIE) Programme comprises an observation tool and a systematic approach to implement and embed a person-centred approach in routine care for hospitalised patients with dementia. The study aims were to evaluate PIE as a method to improve the care of older people with dementia on acute hospital wards, and develop insight into what person-centred care might look like in practice in this setting.
Methods
We performed a longitudinal comparative case study design in 10 purposively selected wards in five trusts in three English regions, alongside an embedded process evaluation. Data were collected from multiple sources: staff, patients, relatives, organisational aggregate information and documents. Mixed methods were employed: ethnographic observation; interviews and questionnaires; patient case studies (patient observation and conversations ‘in the moment’, interviews with relatives and case records); and patient and ward aggregate data. Data were synthesised to create individual case studies of PIE implementation and outcomes in context of ward structure, organisation, patient profile and process of care delivery. A cross-case comparison facilitated a descriptive and explanatory account of PIE implementation in context, the pattern of variation, what shaped it and the consequences flowing from it. Quantitative data were analysed using simple descriptive statistics. A qualitative data analysis employed grounded theory methods.
Results
The study furthered the understanding of the dimensions of care quality for older people with dementia on acute hospital wards and the environmental, organisational and cultural factors that shaped delivery. Only two wards fully implemented PIE, sustaining and embedding change over 18 months. The remaining wards either did not install PIE (‘non-implementers’) or were ‘partial implementers’. The interaction between micro-level contextual factors [aspects of leadership (drivers, facilitators, team, networks), fit with strategic initiatives and salience with valued goals] and meso- and macro-level organisational factors were the main barriers to PIE adoption. Evidence suggests that the programme, where implemented, directly affected improvements in ward practice, with a positive impact on the experiences of patients and caregivers, although the heterogeneity of need and severity of impairment meant that some of the more visible changes did not affect everyone equally.
Limitations
Although PIE has the potential to improve the care of people with dementia when implemented, findings are indicative only: data on clinical outcomes were not systematically collected, and PIE was not adopted on most study wards.
Research implications
Further research is required to identify more precisely the skill mix and resources necessary to provide person-focused care to hospitalised people with dementia, across the spectrum of need, including those with moderate and severe impairment. Implementing innovations to change practices in complex organisations requires a more in-depth understanding of the contextual factors that have an impact on the capacity of organisations to absorb and embed new practices.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Mary Godfrey
- Academic Unit of Elderly Care and Rehabilitation, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Bradford Institute for Health Research (BIHR), Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rosemary Shannon
- Bradford Institute for Health Research (BIHR), Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ann Skingley
- Sidney de Haan Research Centre for Arts and Health, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Rosemary Woolley
- Bradford Institute for Health Research (BIHR), Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Frank Arrojo
- Patient and public involvement representative, Alzheimer’s Society Research Network
| | - Dawn Brooker
- Association for Dementia Studies, Institute of Health and Society, University of Worcester, Worcester, UK
| | - Kim Manley
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- England Centre for Practice Development, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Claire Surr
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
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13
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Witham G, Haigh C. Narrative intelligence in nursing: Storying patient lives in dementia care. Nurs Inq 2018; 25:e12244. [DOI: 10.1111/nin.12244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Gary Witham
- Department of Nursing; Manchester Metropolitan University; Manchester UK
| | - Carol Haigh
- Department of Nursing; Manchester Metropolitan University; Manchester UK
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14
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Burgstaller M, Mayer H, Schiess C, Saxer S. Experiences and needs of relatives of people with dementia in acute hospitals—A meta‐synthesis of qualitative studies. J Clin Nurs 2018. [DOI: 10.1111/jocn.13934] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Melanie Burgstaller
- Department of Nursing Science University of Vienna Vienna Austria
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
| | - Hanna Mayer
- Department of Nursing Science University of Vienna Vienna Austria
| | - Cornel Schiess
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
| | - Susi Saxer
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
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15
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Prato L, Lindley L, Boyles M, Robinson L, Abley C. Empowerment, environment and person-centred care: A qualitative study exploring the hospital experience for adults with cognitive impairment. DEMENTIA 2018; 18:2710-2730. [DOI: 10.1177/1471301218755878] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is acknowledged that there are many challenges to ensuring a positive hospital experience for patients with cognitive impairment. The study (‘Improving hospital care for adults with cognitive impairment’) aimed to explore the positive and negative experiences of older adults with cognitive impairment (dementia and delirium) and their relatives and/or carers, during an acute hospital stay, from admission to discharge, using a qualitative, case study methodology. Six participants with cognitive impairment, eight relatives and 59 members of the health care team were recruited. Data was collected via ethnographic, observational periods at each stage of the hospital journey and through the use of semi-structured interviews with relatives, carers and health care staff including: medical staff; nursing staff; physiotherapists and ward managers. Interpretive phenomenological analysis was used to facilitate data analysis. 52 hours 55 minutes of ethnographic observations and 18 interviews with ward staff and relatives were undertaken. Three superordinate themes emerged from the data as crucial in determining the quality of the hospital experience: valuing the person; activities of empowerment and disempowerment and the interaction of environment with patient well-being. Whether the patient’s hospital experience was positive or negative was powerfully influenced by family involvement and ward staff actions and communication. Participants identified a requirement for a ward based activity service for patients with cognitive impairment. Further research must be undertaken focusing on the development of ward based activities for patients with cognitive impairment, alongside a move towards care which explores measures to improve and expand relative involvement in hospital care.
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Affiliation(s)
- Laura Prato
- Newcastle University, Campus for Ageing and Vitality (former Newcastle General Hospital), Newcastle Upon Tyne, UK
| | - Lyndsay Lindley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Miriam Boyles
- Newcastle University, Campus for Ageing and Vitality (former Newcastle General Hospital), Newcastle Upon Tyne, UK
| | - Louise Robinson
- Newcastle University, Campus for Ageing and Vitality (former Newcastle General Hospital), Newcastle Upon Tyne, UK
| | - Clare Abley
- Newcastle University, Campus for Ageing and Vitality (former Newcastle General Hospital), Newcastle Upon Tyne, UK
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16
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Jensen AM, Pedersen BD, Olsen RB, Hounsgaard L. Medication and care in Alzheimer's patients in the acute care setting: A qualitative analysis. DEMENTIA 2017; 18:2173-2188. [PMID: 29192513 DOI: 10.1177/1471301217743306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The acute hospital admission of patients with dementia is associated with poor outcome and higher costs. Much of our knowledge on how hospital stays are experienced by patients and staff is generated from short and fragmented data collections, in which the significance of knowledge about day-to-day care might be overlooked, and might partly explain why the poor outcome for this group of patients is not fully understood. This study used participant observation to follow patients with Alzheimer’s disease admitted to orthopaedic wards after fall incidents. To gather longitudinal data, patients were followed during day and evening shifts, from admission to discharge. The data were interpreted from a phenomenological-hermeneutic perspective, inspired by Ricoeur's interpretation theory. The data showed that, despite having little specific knowledge about dementia care, staff were able to gather information about the patient’s needs and wishes relevant to administrating medicine in a person-centred way. However, much of this valuable information was lost between shifts or became hidden among the overwhelming amount of information in electronic patient records. As a consequence, much of the knowledge about individual patients’ needs and wishes had to be collected all over again at every shift. The study concludes that careful handover of information on person-centred dementia care can play an important role in making hospital stays more dementia-friendly.
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Affiliation(s)
- Anders Møller Jensen
- Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Faculty of Health Sciences, VIA University College, Denmark
| | - Birthe D Pedersen
- Department of Clinical Research, University of Southern Denmark, Denmark
| | | | - Lise Hounsgaard
- Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
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17
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Swarbrick CM, Sampson E, Keady J. Notes from the hospital bedside: reflections on researcher roles and responsibilities at the end of life in dementia. QUALITY IN AGEING AND OLDER ADULTS 2017. [DOI: 10.1108/qaoa-09-2016-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore some of the ethical and practical dilemmas faced by an experienced researcher in undertaking research with a person with dementia (whom we have called Amy). Amy died shortly after a period of observation had ended and the family subsequently consented to the data being shared.
Design/methodology/approach
This individual case study presentation was nested within a larger study conducted in England and Scotland between 2013 and 2014. The overall aim of the main study was to investigate how healthcare professionals and informal carers recognised, assessed and managed pain in patients living with dementia in a range of acute settings.
Findings
The presented case study of Amy raises three critical reflection points: (i) Researcher providing care, i.e. the place and positioning of compassion in research observation; (ii) What do the stories mean? i.e. the reframing of Amy's words, gestures and behaviours as (end of) life review, potentially highlights unresolved personal conflicts and reflections on loss; and (iii) Communication is embodied, i.e. the need to move beyond the recording of words to represent lived experience and into more multi-sensory methods of data capture.
Originality/value
Researcher guidance and training about end of life observations in dementia is presently absent in the literature and this case study stimulates debate in a much overlooked area, including the role of ethics committees.
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18
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Ashton C, Manthorpe J. The Views of Domestic Staff and Porters when Supporting Patients with Dementia in the Acute Hospital: An Exploratory Qualitative Study. DEMENTIA 2017; 18:1128-1145. [PMID: 28463027 DOI: 10.1177/1471301217707085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is increasing recognition that very many hospital patients have dementia but there are many concerns about the quality of care and support they receive. Consequently there have been numerous calls for hospital staff to have dementia training. While cleaning or domestic staff and porters form considerable parts of the hospital workforce they are infrequently considered in discussions of dementia care training and practice. This exploratory study aimed to investigate the experiences of domestic staff and porters working in an acute hospital setting who are in contact regularly with patients with dementia. Semi-structured interviews were undertaken in 2016 with seven domestic staff and five porters in one English acute hospital to investigate their views and experiences. Data were analysed thematically by constant comparison technique and theoretical sampling. Themes were identified and realistic concepts developed. Participants observed that caring attitudes and behaviour in their encounters with patients with dementia are important but challenging to put into practice. Several would have valued more information about dementia. Some noted situations in the hospital stay that seemed particularly difficult for patients with dementia such as travelling to different parts of the hospital for treatments. The study suggests the need for improving the dementia-related knowledge and skills of all non-clinical staff especially those new to the NHS. The impact of witnessing dementia symptoms and distress on emotional well-being requires further research so that ancillary staff can improve the hospital stay of patients with dementia.
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Affiliation(s)
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, UK
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19
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Digby R, Lee S, Williams A. The experience of people with dementia and nurses in hospital: an integrative review. J Clin Nurs 2017; 26:1152-1171. [PMID: 27322590 DOI: 10.1111/jocn.13429] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To identify and examine existing research exploring how people with dementia and nurses view acute hospital care. BACKGROUND Admission to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. Adverse behavioural and health outcomes can result. Dementia adds complexity to patient care. Inability to deliver appropriate care is a source of stress and frustration for nurses. METHODS Integrative review of the literature 2005-2015 reporting the experience of people with dementia and nurses caring for them in an acute hospital setting (n = 24). RESULTS Hospitals focus on acute medical care; consequently people with dementia are considered low priority and a disruption to normal routine. Risk management often takes priority over patient dignity. People with dementia are stigmatised. Families have significant roles to play in the care of a person with dementia in hospital but are often excluded. Nurses struggle to complete even basic patient care, and focus on tasks often at the expense of specific patient needs. Support for nurses is lacking. The job satisfaction of nurses caring for people with dementia is poor. CONCLUSIONS Nurses require improved education and support to care for patients with dementia. Hospitals must focus on genuine caring concurrently with rapid discharge requirements, risk mitigation and fiscal restraint. More research is needed to inform the development of appropriate care for people with dementia in hospitals. RELEVANCE TO CLINICAL PRACTICE Nurses must understand the complex needs of people with dementia in hospital. Nurse education about dementia, practical support, strong clinical leadership and role-modelling is needed. Empathy for patients regardless of diagnosis must remain a core attribute of nurses. Current hospital culture requires wider system review to mitigate against stigmatisation of patients with dementia.
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Affiliation(s)
- Robin Digby
- Monash University, Frankston, Vic., Australia
| | - Susan Lee
- Nursing and Midwifery, Peninsula Campus, Monash University, Frankston, Vic., Australia
| | - Allison Williams
- Monash Nursing Academy, Clayton Campus, Monash University, Clayton, Vic., Australia
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20
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Moonga J, Likupe G. A systematic literature review on nurses' and health care support workers' experiences of caring for people with dementia on orthopaedic wards. J Clin Nurs 2016; 25:1789-804. [PMID: 26991944 DOI: 10.1111/jocn.13158] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES To review literature on nurses' and health care workers' experiences of caring for people with dementia on orthopaedic wards. BACKGROUND Dementia is a condition that affects a large number of the older population worldwide. It is estimated that there are 47·5 million people worldwide living with dementia with 4·6 million new cases being diagnosed annually. This number is said to increase to 75·6 million by 2030 and triple by 2050. It is also acknowledged that older people are at a greater risk of falls that are a devastating problem causing a tremendous amount of morbidity, mortality and use of health care services (Rubestein, Age and Ageing, 35, 2006, 37). Falls usually result from identified risk factors such as weakness, unsteady gait, confusion and certain medication. Therefore, it is reasonable to assume that a large population of older people suffering from dementia may be admitted to orthopaedic wards with various injuries. Nurse and support health workers may experience a range of difficulties when caring for this population of patients. DESIGN A systematic review. METHODS An extensive literature search using; CINAHL, MEDLINE, Academic Search Complete, National Health Service Evidence, websites like Department of Health, Dementia and Alzheimer's Society. RESULTS The search generated several articles on dementia in general, however, only 14 articles dealing with care of these people in an acute hospital setting were found. No studies dealing with the care of people with dementia on orthopaedic wards were found; therefore, this review has taken a generalist nature and applies the findings to orthopaedic wards. The main themes identified from the review were: challenging behaviour and unsuitable care environment; lack of education on dementia; strain from nursing patients with dementia; and ethical dilemmas arising from care of people with dementia. CONCLUSION It would be an over-simplification to say that the care of people with dementia on medical wards is the same as the care of trauma patients with dementia. Therefore, there is a need for a study to explore nurses' and health care worker's experiences of caring for trauma patients with dementia on orthopaedic wards. RELEVANCE TO CLINICAL PRACTICE The results of this study could provide guidance on the effective care of people with dementia on orthopaedic wards.
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21
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Chaudhury H, Hung L, Rust T, Wu S. Do physical environmental changes make a difference? Supporting person-centered care at mealtimes in nursing homes. DEMENTIA 2016; 16:878-896. [DOI: 10.1177/1471301215622839] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Drawing on therapeutic physical environmental design principles and Kitwood’s theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents’ mealtime experience and staff practice in two care units. Method The research design involved pre- and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre- and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change.
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Affiliation(s)
| | | | - Tiana Rust
- University of Alberta, Edmonton, AB, Canada
| | - Sarah Wu
- Simon Fraser University, Vancouver, BC, Canada
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22
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POROCK DAVINA, CLISSETT PHILIP, HARWOOD ROWANH, GLADMAN JOHNR. Disruption, control and coping: responses of and to the person with dementia in hospital. AGEING & SOCIETY 2015; 35:37-63. [PMID: 25878366 PMCID: PMC4301214 DOI: 10.1017/s0144686x13000561] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 11/07/2022]
Abstract
This qualitative study aimed to gain insight into the experience of hospitalisation from the perspectives of the older person with dementia, their family care-giver and other patients sharing the ward (co-patients). Non-participant observation of care on 11 acute hospital wards was supplemented by 39 semi-structured interviews with 35 family care-givers and four co-patients following discharge. Constant comparative analysis produced the core problem facing all those involved: disruption from normal routine meaning that the experience of hospitalisation was disrupted by the presence and behaviour of the person with dementia. Disruption adversely affected the person with dementia, triggering constructive, disengaged, distressed and neutral behaviours. Using Kitwood's model of person-centred care, these behaviours were interpreted as attempts by the person with dementia at gaining a sense of control over the unfamiliar environment and experience. Family care-givers' lives and experiences both inside and outside the hospital were disrupted by the hospitalisation. They too attempted to gain a sense of control over the experience and to give a sense of control to the patient, co-patients and staff. Co-patients experienced disruption from sharing space with the person with dementia and were left feeling vulnerable and sometimes afraid. They too attempted to gain a sense of control over their situation and give some control by helping the person with dementia, the family care-giver and the staff.
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Affiliation(s)
- DAVINA POROCK
- Institute for Person-Centered Care, State University of New York at Buffalo, USA
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, UK
| | - PHILIP CLISSETT
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, UK
| | - ROWAN H. HARWOOD
- Health Care for Older People, Nottingham University Hospitals NHS Trust, UK
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23
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Dewing J, Dijk S. What is the current state of care for older people with dementia in general hospitals? A literature review. DEMENTIA 2014; 15:106-24. [PMID: 24459188 DOI: 10.1177/1471301213520172] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper summarises a literature review focusing on the literature directly pertaining to the acute care of older people with dementia in general hospitals from 2007 onwards. Following thematic analysis, one overarching theme emerged: the consequences of being in hospital with seven related subthemes. Significantly, this review highlights that overall there remains mostly negative consequences and outcomes for people with dementia when they go into general hospitals. Although not admitted to hospital directly due to dementia, there are usually negative effects on the dementia condition from hospitalisation. The review suggests this is primarily because there is a tension between prioritisation of acute care for existing co-morbidities and person-centred dementia care. This is complicated by insufficient understanding of what constitutes person-centred care in an acute care context and a lack of the requisite knowledge and skills set in health care practitioners. The review also reveals a worrying lack of evidence for the effectiveness of mental health liaison posts and dementia care specialist posts in nursing. Finally, although specialist posts such as liaison and clinical nurse specialists and specialist units/shared care wards can enhance quality of care and reduce adverse consequences of hospitalisation (they do not significantly) impact on reducing length of stay or the cost of care.
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Affiliation(s)
- Jan Dewing
- East Sussex NHS Trust & Canterbury Christ Church University, UK
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24
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Jurgens FJ, Clissett P, Gladman JRF, Harwood RH. Why are family carers of people with dementia dissatisfied with general hospital care? A qualitative study. BMC Geriatr 2012; 12:57. [PMID: 23006826 PMCID: PMC3509004 DOI: 10.1186/1471-2318-12-57] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 09/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Families and other carers report widespread dissatisfaction with general hospital care for confused older people. METHODS We undertook a qualitative interviews study of 35 family carers of 34 confused older patients to ascertain their experiences of care on geriatric and general medical, and orthopaedic wards of a large English hospital. Transcripts were analysed using a grounded theory approach. Themes identified in interviews were categorised, and used to build a model explaining dissatisfaction with care. RESULTS The experience of hospital care was often negative. Key themes were events (illness leading to admission, experiences in the hospital, adverse occurrences including deterioration in health, or perceived poor care); expectations (which were sometimes unrealistic, usually unexplored by staff, and largely unmet from the carers' perspective); and relationships with staff (poor communication and conflict over care). Expectations were influenced by prior experience. A cycle of discontent is proposed. Events (or 'crises') are associated with expectations. When these are unmet, carers become uncertain or suspicious, which leads to a period of 'hyper vigilant monitoring' during which carers seek out evidence of poor care, culminating in challenge, conflict with staff, or withdrawal, itself a crisis. The cycle could be completed early during the admission pathway, and multiple cycles within a single admission were seen. CONCLUSION People with dementia who have family carers should be considered together as a unit. Family carers are often stressed and tired, and need engaging and reassuring. They need to give and receive information about the care of the person with dementia, and offered the opportunity to participate in care whilst in hospital. Understanding the perspective of the family carer, and recognising elements of the 'cycle of discontent', could help ward staff anticipate carer needs, enable relationship building, to pre-empt or avoid dissatisfaction or conflict.
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Affiliation(s)
- Fiona J Jurgens
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Philip Clissett
- School of Nursing, University of Nottingham, Nottingham, NG7 2UH, UK
| | - John RF Gladman
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH, UK
- Health Care for Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Rowan H Harwood
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH, UK
- Health Care for Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH, UK
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25
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Chater K, Hughes N. Strategies to deliver dementia training and education in the acute hospital setting. J Res Nurs 2012. [DOI: 10.1177/1744987112446242] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims and objectives: This UK study aimed to generate new ideas about training strategies for healthcare staff caring for people with dementia in the acute hospital setting. Background: A review of related literature exposed topical debate regarding current educational deficits, yet revealed few examples of the implementation of training initiatives for practising healthcare professionals. Design: A descriptive qualitative approach was used. Methods: Data were generated using two focus groups comprised of Staff Nurses (four) and Healthcare Assistants (three) working in a mixed gender acute elderly care unit in the North of England. Dialogues explored individuals’ experiences of delivering care to people with dementia hospitalised with physical illnesses and, usefully, their thoughts about learning in the workplace. Results: Four broad categories emerged from transcript-based analysis: learning about dementia; learning about the person; learning from each other; learning from specialists. Specific recommendations included the improvement of staff preparedness through fundamental training, improved flow of information about individuals, dementia-specialist input for situation-based advice, and structured opportunities to reflect on practice. Conclusion: The National Dementia Strategy for England emphasises the pressing need to improve care for people with dementia when they are admitted to hospital with physical illness, and highlights the importance of staff education in contributing to improved care. This study provides an insider view from a potential target population of such healthcare providers regarding their perceived educational needs. Relevance to clinical practice: The results of this study point the way forward to practical and achievable ways of increasing and improving knowledge about dementia, and enhancing skills in caring for people who are cognitively impaired, among general hospital staff.
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Affiliation(s)
| | - Nic Hughes
- Lecturer in Nursing, University of Leeds, UK
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Abstract
AIM To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals. BACKGROUND The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses. METHOD An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom. FINDINGS Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this. CONCLUSION Bourdieu's Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice. RELEVANCE TO CLINICAL PRACTICE It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken.
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Affiliation(s)
- Fiona Cowdell
- Centre for Wellbeing and Quality of Life, Bournemouth University, Bournemouth, UK.
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Bridges J, Flatley M, Meyer J. Older people's and relatives' experiences in acute care settings: systematic review and synthesis of qualitative studies. Int J Nurs Stud 2009; 47:89-107. [PMID: 19854441 DOI: 10.1016/j.ijnurstu.2009.09.009] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/11/2009] [Accepted: 09/20/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore older people's and their relatives' views on and experiences of acute health care. DESIGN Systematic procedures were used for study selection and data extraction and analysis. A comparative thematic approach to synthesis was taken with a number of features adopted from the literature on meta-ethnography. DATA SOURCES Worldwide grey and published literature written in English between January 1999 and June 2008 identified from databases: CINAHL, Medline, British Nursing Index, EMBASE Psychiatry, International Bibliography of the Social Sciences, PsychINFO, and AgeInfo. REVIEW METHODS We conducted a systematic review and synthesis of qualitative studies describing older patients' and/or their relatives' experiences of care in acute hospital settings. 42 primary studies and 1 systematic review met the inclusion criteria. RESULTS A number of themes emerged. The quality of technical care is often taken for granted by older patients, and good or bad experiences are described more in terms of relational aspects of care. Older patients in hospital may feel worthless, fearful or not in control of what happens, especially if they have impaired cognition, or communication difficulties. Three key features of care consistently mediated these negative feelings and were linked to more positive experiences: "creating communities: connect with me", "maintaining identity: see who I am" and "sharing decision-making: include me". CONCLUSION These findings highlight the perspectives of older people and their relatives on the delivery of personalized and dignified care in acute settings. They lend support to previous calls for relationship-centred approaches to care and provide a useful experience-based framework for practice for those involved in care for older people.
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Affiliation(s)
- Jackie Bridges
- City University London, School of Community and Health Sciences, Philpot Street, Whitechapel London E1 2EA, UK.
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