Care of patients with dementia in an acute trauma and orthopaedics unit

Abstract

Aim To increase awareness of the needs of patients with dementia in the trauma and orthopaedics unit of one acute hospital, and to collaborate with staff on the unit to identify ways of improving the care experienced by these patients and their families. Method An action research approach was used and three action research cycles were completed. Data were obtained retrospectively for 20 patients with dementia who were admitted to the unit for treatment. Deficiencies in the care of these patients were identified and related to communication, pain management and the recognition of delirium. In response, a dementia toolkit was developed by nurses and implemented on the unit to improve the care of patients with dementia. Findings Comparison of pre-implementation and post-implementation audit results indicated a significant improvement in all aspects of care for patients with dementia in the trauma and orthopaedics unit, as a result of the implementation of the dementia toolkit. Education and training were provided to staff on the ward to ensure the toolkit was implemented appropriately. Conclusion It is important to consider the specific needs of patients with dementia in acute care settings, not only the primary reason for their admission. The involvement and inclusion of staff in determining what change was needed on the unit, how change would be undertaken and the positive effects of change, demonstrates how action research can inform and improve clinical practice.

Nurses’ experiences of delivering acute orthopaedic care to patients with dementia

“…Edvardsson, Sandman, & Rasmussen () point out that good hospital design alone is not a solution for creating dementia‐friendly hospitals, noting that the contribution of a visible presence of a warmly engaged and friendly staff in the acute care setting also contributes to a positive practical impact for patients with dementia, and helps them to feel a sense of ease, as if they were in a home‐like environment. While McCorkell et al () suggest that nurses have an important role in the harnessing and inclusion of information collected from the patient's family about the patient's usual routines for hygiene, meals, calming influences and agitation triggers as well as dislikes, discomfort and pain behaviours. These can be communicated to the healthcare team in the form of a dementia‐friendly toolkit to equip healthcare professionals, families and the patient to achieve optimal care outcomes (McCorkell et al, ).…”

“…While McCorkell et al () suggest that nurses have an important role in the harnessing and inclusion of information collected from the patient's family about the patient's usual routines for hygiene, meals, calming influences and agitation triggers as well as dislikes, discomfort and pain behaviours. These can be communicated to the healthcare team in the form of a dementia‐friendly toolkit to equip healthcare professionals, families and the patient to achieve optimal care outcomes (McCorkell et al, ).…”

“…Lastly, a wide array of education programmes for nurses involved in acute dementia care have succeeded with a range of positive clinical outcomes, raising the awareness of dementia and encouraging a positive shift in perceptions and attitudes towards patients with dementia (Banks et al, ; Wesson & Chapman, ; Anthony et al 2016; McCorkell et al, ). Thus, while it has been established that nurses’ negative perceptions about people with dementia results in poor person‐centred care for people with dementia, these attitudes are amenable to change through education, adequate staffing and sufficient time to deliver care to people with dementia.…”

“…There is some evidence to support the notion that a managerial focus on financial and productivity targets negatively influences the capacity of nurses to conduct person‐centred dementia care in the acute care setting (Clissett et al, ). The flow of information about individual patient needs and ps has been stressed as an important aspect in caring for people with dementia in the acute clinical setting (McCorkell et al, ), but where health and well‐being communication and documentation are poorly implemented in the clinical setting; then, this exacerbates the challenges that are experienced for nurses, and for patients with dementia (Chater & Hughes, ; Gladman et al, ).…”

“…They are more likely to experience pain, thirst, fear and over‐stimulation, partly due to a difficulty in communication with the staff (Bridges & Wilkinson, ). There is evidence to suggest that health professionals often fail to interpret the nonverbal communication cues to adequately meet the needs of acute care patients with dementia, and this group of patients with dementia‐related cognitive impairment often experience heightened distress, fear and are unable to verbalise their needs effectively (Dewing & Dijk, ; Heath, Sturdy, & Wilcock,; McCorkell, Harkin, McCrory, Lafferty, & Coates, ). Additionally, health professionals are noted to misinterpret agitation by the patient with dementia as a disruptive behaviour, rather than a means of communicating pain or thirst (Elliot & Adams, ).…”