Falling behind: a substantive theory of care for older people with cognitive impairment in acute settings

Nilsson, Anita; Rasmussén, Birgit H.; Edvardsson, David

doi:10.1111/jocn.12177

Cited by 40 publications

(142 citation statements)

References 42 publications

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“…51,52 Cognitively impaired patients remaining on an acute psychiatric care unit present a major concern, mainly because these settings are often unable to adequately meet these patients' needs. 53,54 Finally, 8 patients in the nonacute group had a total hospital LOS of greater than 100 days, with 1 patient staying as long as 153 days. For the longest hospitalizations, a thorough chart review revealed 2 main reasons explaining the prolonged stays.…”

Section: 349mentioning

confidence: 99%

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

et al. 2015

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Objective: To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds.Methods: This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed.Results: A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). Conclusions:Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients. W W W Caractéristiques et besoins des patients psychiatriques dont le séjour à l'hôpital est prolongéObjectif : Décrire les caractéristiques et les besoins, avant l'hospitalisation, au moment de l'admission, durant le premier mois, au 30 e jour d'hospitalisation et après le congé de l'hôpital de patients psychiatriques occupant des lits de soins actifs.Méthode : Cette étude d'observation prospective a été menée dans 2 hôpitaux de soins tertiaires. Les patients adultes hospitalisés dans une unité psychiatrique pendant 30 jours ont été identifiés. Les données ont été recueillies dans leurs dossiers médicaux et par des entrevues avec leur équipe de soins de santé. La catégorisation du statut aigu et non aigu au 30 e jour se fondait sur l'évaluation des professionnels de la santé. Des analyses descriptives et univariées ont été exécutées.Résultats : Un total de 262 patients ont été identifiés (âge moyen 45 ans), dont 66 % vivaient à la maison et 11 % étaient sans abri. Plus de la moitié étaient cognitivement déficients et quelques-uns avaient des besoins médicaux spéciaux. Quatre-vingt

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Section: 349mentioning

confidence: 99%

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

et al. 2015

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“…These include inflexible care routines that privilege the performance of medical and physical care tasks over time spent with patients, 27,28 and physical environments that are difficult to navigate. 21,22,25 The nature and quality of staff interactions with patients has been regarded as problematic, with staff encounters that are primarily task focused and involve limited engagement of the person at a personal level; [17][18][19]21,22,24,25,[29][30][31][32][33] and communication practices that are poorly responsive to the emotional needs of patients 17,[21][22][23][24][25]27,[30][31][32] and/or lead to a failure to 'see' and act on behavioural cues that might indicate distress or pain. 34,35 Studies have reported stigmatising and negative attitudes towards people with dementia among some staff and that such patients should not be admitted to acute wards.…”

Section: Care Of Hospitalised Older People With Dementiamentioning

confidence: 99%

“…34,35 Studies have reported stigmatising and negative attitudes towards people with dementia among some staff and that such patients should not be admitted to acute wards. 27,[29][30][31][32] Often conveyed as ensuring their safety and that of other patients, the consequence is to see people with dementia as 'other'. Conversely, staff with knowledge of dementia express lower perceived strain in caring for a person with dementia and less negative attitudes.…”

Section: Care Of Hospitalised Older People With Dementiamentioning

confidence: 99%

“…Conversely, staff with knowledge of dementia express lower perceived strain in caring for a person with dementia and less negative attitudes. 32 Research with caregivers has reported inadequate support for their relative with nutrition and hydration, 17 both risk factors for delirium; 36 the person with dementia not being treated with dignity and respect; 17,22,24,27,37,38 and limited engagement in decision-making, for both the person with dementia and the caregiver. 17,22,37 A key factor, contributing to poor care delivery from UK studies, is lack of knowledge and skill in dementia care.…”

Section: Care Of Hospitalised Older People With Dementiamentioning

confidence: 99%

“…23,24,29,31,32,54 Two 20,54 drew out components of good practice from observation, interviews and conversations with patients. Tolson et al, 54 employing critical incident interviewing with patients (possible with only a small number) and caregivers, identified four themes within a temporal frame around which components of quality practice could be delineated.…”

Section: Practice Of Person-centred Care On Acute Wardsmentioning

confidence: 99%

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The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

Godfrey

Young

Shannon

et al. 2018

Health Serv Deliv Res

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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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Nurse competence provides more individuality in the care of older hospitalized people

et al. 2022

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Aim The aim of the study was to assess Registered Nurses' perceptions of general nurse competence, patient‐centred care competence, and individuality in the care of older patients and to explore their associations. Design A descriptive correlative survey. Methods Data were collected using questionnaires at one Finnish university hospital during winter 2016–2017 amongst Registered Nurses (n = 223) and analyzedd statistically using descriptive and inferential statistics (ANOVA, Pearson's correlations coefficients) and path analysis. Results Registered Nurses assessed their general competence, patient‐centred care competenc,e and individuality in the care of older patients at a good level. The Path model confirmed general nurse competence was a predictor of patient‐centred care competence, which in turn was a predictor of individuality in the nursing care of older patients. The novelty lies in empirical confirmation of the association between nurse competence and individuality in the care. Increasing competence may enhance individuality in the care of older people and enable interventions to support care outcomes.

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Falling behind: a substantive theory of care for older people with cognitive impairment in acute settings

Abstract: The proposed substantive theory can be used to critically examine current ward practices and routines, and the extent to which these support or inhibit high-quality person-centred care for older patients with known or unknown cognitive impairments.

Cited by 40 publications

References 42 publications

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

Nurse competence provides more individuality in the care of older hospitalized people

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