Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review

Abstract

ObjectivesTo identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.DesignA realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.Data sourcesPubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.Eligibility criteriaStudies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.ResultsPhase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.ConclusionsThis review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.Trial registration numberCRD42015017562.

A Multicomponent Model to Improve Hospital Care of Older Adults with Cognitive Impairment: A Propensity Score–Matched Analysis

“…Some studies have found that CO practices may be harmful for patients and the sitters themselves, highlighting the urgent need to better understand the role of sitters . A recent review from the United Kingdom on dementia‐friendly interventions to improve the care of people with dementia admitted to hospitals highlights that educational interventions should focus on person‐centered care and opportunites for staff to share their experiences addressing behavioral and psychological symptoms . Our intervention supports this finding by providing extensive didactic and hands‐on training for PES and staff education.…”

Dementia nursing competency in acute care settings: A concept analysis

“…Thus, PaWD find the acute care environment unusual because medical treatment is the highest priority, and an environment filled with medical equipment can make PaWD uncomfortable. Nurses develop a positive, home-like, friendly FIGURE 1 Literature review flowchart atmosphere to facilitate interconnections with PaWD (Borbasi et al, 2006;Haak, 2009;Handley, Bunn, & Goodman, 2017;Hynninen et al, 2014;Page & Hope, 2013;Rushton et al, 2016). Furthermore, nurses play a role in setting a social environment that provides social resources to connect PaWD with their communities; this can improve PaWD's daily lives in their communities after discharge (Borbasi et al, 2006;de Vries, 2013;Hynninen et al, 2014;Josefsson et al, 2008;Luke et al, 2008;Tan et al, 2017).…”

“…Knowledge of the theoretical underpinnings of dementia allows nurses to apply and progress the competency (Chang et al, 2009;Chater & Hughes, 2012;Handley et al, 2017;Tan et al, 2017) and can help nurses obtain better information on providing appropriate dementia nursing care (Elliot & Adams, 2011). Further, as clinical specialists, the knowledge is also required to continually progress through levels of clinical expertise-from novice, through to expert-which is associated with improving the quality of dementia nursing care (Borbasi et al, 2006;Chater & Hughes, 2012;Crabtree & Mack, 2010;Elliot & Adams, 2011;Handley et al, 2017;Iliffe et al, 2010;Josefsson et al, 2008;Lin et al, 2012).…”

The experience of hospital staff in applying the Gentle Persuasive Approaches to dementia care

“…Effective approaches to make sustainable change are needed. Research indicates that training alone is not sufficient to influence staff to change practice (Handley, Bunn, & Goodman, ). Hospital staff need protected times and spaces for continuous team learning and knowledge adaption (Hung, Phinney, Chaudhury, & Rodney, ).…”