Living with dementia in hospital wards: a comparative study of staff perceptions of practice and observed patient experience

Abstract

Comparing staff questionnaire data with observational methods offered a unique opportunity to understand multiple perspectives in a complex hospital setting. Incorporating these perspectives into staff and management feedback allowed for recommendations that recognised both patient-centred values and staff constraints.

Using appreciative inquiry to implement person-centred dementia care in hospital wards

“…Staff and family members were asked to narrate an experience or experiences during which they felt satisfied with the care being provided to a person with dementia in the hospital. The findings of these interviews are reported elsewhere (Innes, Kelly, Scerri and Abela, 2016). Five key themes were identified following thematic analysis of the positive care experiences of staff namely; 'building a relationship between the 'extended' dementia care triad', providing 'quality time' and 'care in time', going the 'extra mile', attending to the psychosocial needs and 'attending to the physical needs with a 'human touch'.…”

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

“…Acute care for people living with dementia, therefore, cannot be conceived of as peripheral to, or disruptive of, the routine work of ward staff, but is a central feature of it. 23,24,29,30 As well as the health event that precipitated acute admission, these patients were in advanced older age and had multiple health problems; they were physically frail and had care networks that were often fragile. Achieving a 'balance of care' 54 in an acute setting required the delivery of clinical, therapeutic and personal care based on an understanding of the interaction between these multiple and complex needs, including cognitive impairment, and how they mediated the process of recovery.…”

“…21,22 The dominance of older people on acute wards and the prevalence of dementia among those hospitalised means that care delivery to people with a cognitive impairment is a litmus test of the quality of hospital care. Yet, despite the frequency with which people with dementia utilise acute care, evidence from systematic reviews, 21,22 recent in-depth studies 18,23,24 and national audits 25,26 suggests that the needs of people in this group are often under-recognised and inadequately addressed.…”

“…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.…”

“…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.…”