Improving the hospital environment for people with dementia

Abstract

This article is the third in a series presenting examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. The hospital environment is often disorientating for people with dementia and can be particularly distressing when a patient is admitted in an emergency. Subsequent ward moves can also be disruptive and confusing, especially if they take place out of hours. Two NHS trusts aimed to improve the experience for patients with dementia by addressing the physical environment along with practical aspects of care provision at different stages in the hospital journey. The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust in Norfolk enhanced its emergency department environment by redesigning four bays and an observation area to be dementia-friendly. The hospital has supported these changes by providing dementia awareness training for all staff in these areas. Walsall Healthcare NHS Trust focused on minimising ward moves by implementing procedures to identify patients who should not be moved. Since introducing the new process, adherence has been good and there have been fewer ward moves.

The Views of Domestic Staff and Porters when Supporting Patients with Dementia in the Acute Hospital: An Exploratory Qualitative Study

“…Improvements may need to be made in the availability of relevant dementia training for all ancillary staff, especially those new to the work to incorporate topics such as supporting patients by acknowledging their personhood, supporting them in distressing or challenging behaviour and enhancing patient and staff emotional wellbeing. All these needs were highlighted by the participants in this present study and are supported by other research focussing on the nursing workforce (Bray, Evans, Bruce, Carter, Brooker, Milosevic, & Woods, 2015; Robinson et al., 2015). Roles and responsibilities in responding to distressing or challenging behaviour on the wards should be understood and this present study suggests that particular efforts are needed to ensure the safety and wellbeing of patients with dementia when temporarily leaving the ward areas.…”

“…Recommended strategies for making environments more dementia friendly include clear signage, contrasting colours on frames around windows and doors and reduced noise and a need for purposeful activity (Bray, Evans, Bruce, Carter, Brooker, Milosevic, & Robinson, 2015). Participants in this present study commented that the environments varied and often seemed to depend on the ward leadership or culture.…”

Can a systems approach reduce adverse outcomes in patients with dementia in acute settings? (innovative practice)

“…How can the hospital ward be improved to help reduce adverse outcomes amongst patients with dementia? This may be enhanced by critically evaluating the organisational and physical design of the hospital environment (Bray et al, 2015; The King’s Fund, 2014).…”

“…A simple adaptation of the hospital environment to make it dementia friendly can include decreasing transfers between and within wards (Bray et al, 2015) and the reduction of noise in an unfamiliar acute setting (The King's Fund, 2014). The ward environment can, with a commitment from management and front care staff, be designed to minimise adverse 5 outcomes.…”

Visual identifier systems for patients with cognitive impairment in healthcare settings: A survey of practice in UK hospitals

“…dementia) (Mukadam & Sampson, 2011). Worldwide, estimates of the prevalence of dementia in acute hospital populations range from 15 to 42 per cent (Bray et al, 2015;Jackson et al, 2017).…”