Care practices of older people with dementia in the surgical ward: A questionnaire survey

Abstract

Objectives:The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward.Methods:The data were collected from nursing staff (n = 191) working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items), specific characteristics of older people with dementia in a surgical ward (24 of items), specific characteristics of their care in a surgical ward (66 of items) and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items).Results:The questions which measure the nursing staff’s own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient’s state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients’ attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients’ challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything.Conclusion:The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs.

Nurses' Experiences in Caring for Older Adults With Responsive Behaviors of Dementia in Acute Care

“…Dementia care was perceived by nurses as consuming additional resources such as time and staff when these resources were already scarce in acute medical units. Other studies have also found that inadequate staffing and heavy workload in hospital led to poor quality of care for clients living with dementia ( Byers & France, 2008 ; Hynninen et al., 2016 ). Nurses in the current study also felt that acute medical environments did not provide enough stimulation for older adults with dementia in terms of therapeutic activities and human interaction.…”

“…When older adults with dementia receive care in hospital, 75% of this population will experience responsive behaviors at least once ( Sampson et al., 2014 ). The hospital environment may trigger responsive behaviors among older adults with dementia ( Sampson et al., 2014 ) and lead to feelings of distress, insecurity, anxiety, and fear ( Baille, Cox, & Merritt, 2012 ; Hynninen, Saarnio, & Elo, 2016 ). Hospitalization heightens the sensitivity of clients with dementia to responsive behaviors due to being in an environment with numerous triggers (e.g., noise and poor lighting) and receiving care from staff who have limited knowledge of their preferences ( Schindel Martin et al., 2016 ).…”

Low investment non-pharmacological approaches implemented for older people experiencing responsive behaviours of dementia

“…Over half a million Canadians are affected by dementia ( Alzheimer’s Society of Canada, 2016 ). Approximately 25% of hospital beds are occupied by older people with dementia seeking care for acute illnesses ( Hynninen et al., 2016 ). Compared to the general population, people with dementia in hospitals experience poorer nutrition and function, higher risk of death and delirium, and increased risk of falls related to responsive behaviours ( Mukadam & Sampson, 2010 ; Sampson et al., 2009 , 2014 ; Zhu et al., 2015 ).…”

“…These behaviours are present in response to pain, fear, hunger, or thirst. The hospital environment may trigger responsive behaviours for people with dementia due to an unfamiliar environment ( Sampson et al., 2014 ) and cause feelings of distress, insecurity, anxiety, and fear ( Hynninen et al., 2016 ).…”

“…These approaches often require structured education and knowledge translation support for nurses which is not always provided in an acute care environment. In working with resources at hand, nurses have been found to use perfunctory non-pharmacological strategies (e.g., distraction techniques, asking what is bothering a client, turning on the TV) to address responsive behaviours in surgical settings ( Hynninen et al., 2016 ). These types of activities are not personally meaningful to an individual compared to tailored therapeutic activities.…”