Assessing the impact of dementia inclusive environmental adjustment in the emergency department

Abstract

Objectives Acute hospitals, in particular the emergency department, can be disorienting for people living with dementia. As part of a larger project to improve care for people living with dementia, dementia-inclusive modifications were made to two emergency department bays in a large acute care hospital in Ireland. Modifications to spatial configuration included noise reduction, altered lighting and the addition of an orientation aid and fixed seating for relatives. Method A mixed methods approach was employed with both service user and service provider perspectives explored (survey of service providers ( n = 16) and interviews with family carers ( n = 10) at one time point and interviews with service providers ( n = 8 and n = 5) and key stakeholders ( n = 3) as well as audit data (at two time points) to evaluate the impact of the modifications made to the emergency department. Results Orientation and navigation within the modified bays were improved though technical issues with the orientation aid were highlighted. Further user information on the functionality of the adjustable lighting would be required to maximise its benefits. This lighting and use of calming colours, together with the addition of noise-reduction bay screens, served to reduce sensory stimulation. The provision of adequate space and seating for family carers was extremely beneficial. The removal of unnecessary equipment and use of new structures to store relevant clinical equipment were other positive changes implemented. A number of challenges in the design development of the modified bays were highlighted, as well as ongoing broader environmental challenges within the emergency department environment. Conclusion The findings suggest that the modified bays contributed positively to the experience of people living with dementia and their families in the emergency department.

Acute hospital staff’s attitudes towards dementia and perceived dementia knowledge: a cross-sectional survey in Ireland

“…It is estimated that about one-third of older people in acute Irish hospitals may have dementia [7][8][9]. However, the acute hospital setting can often be experienced as disorientating and stressful by people living with dementia and previous research has indicated that this can result in adverse health and functional outcomes including the provision of insufficient care [9][10][11][12][13][14][15][16][17][18][19]. Furthermore, limited knowledge and understanding of dementia among general hospital staff, coupled with organisational constraints on a busy hospital ward and traditional task approaches to care within acute settings, can contribute to negative attitudes towards people living with dementia and challenges to the ability to provide personcentred care [11,13,14,20,21].…”

“…This creates a culture of care where patient safety and risk are prioritized over patient dignity, care is disease/illness orientated and people living with dementia are seen as a low priority [13,14]. In addition, there is a lack of understanding and knowledge of person-centred care within the acute hospital setting [13] resulting in poorer experiences and outcomes for people living with dementia [9][10][11][12][13][14][15][16][17][18][19].…”

Acute hospital staff’s attitudes towards dementia and perceived dementia knowledge: a cross-sectional survey in Ireland

“…This creates a culture of care where patient safety and risk are prioritized over patient dignity, care is disease/illness orientated and people with dementia are seen as a low priority (13,14). In addition, there is a lack of understanding and knowledge of person-centred care within the acute hospital setting (13) resulting in poorer experiences and outcomes for people with dementia (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Acute hospital staff’s attitudes towards dementia and perceived dementia knowledge: a cross-sectional survey in Ireland

“…It is estimated that about one-third of older people in acute Irish hospitals may have dementia (7)(8)(9). However, the acute hospital setting can often be experienced as disorientating and stressful by people living with dementia and previous research has already indicated that this can result in adverse health and well-being (10)(11)(12)(13)(14)(15)(16)(17)(18). Furthermore, limited knowledge and understanding of dementia among general hospital staff, coupled with organisational constraints on a busy hospital ward and traditional task approaches to care within acute settings, can contribute to negative attitudes towards people living with dementia and challenges to the ability to provide person-centered care (10,12,19,20).…”