The immediate needs of relatives during the hospitalisation of acutely ill older relatives

“…Literature that has considered hospitalisation and the needs of relatives more generally, has highlighted the disruption to family members associated with a prolonged hospital stay [18], the need to work out ‘hospital rules’ and then follow them [19], and the feelings of disempowerment that can arise from the experience [20]. Family members also made judgements about the quality of care [21], the ability and suitability of individual members of staff [22], and sometimes worried about what might be happening in the hospital when they were not there [23]. …”

Section: Discussionmentioning

confidence: 99%

Why are family carers of people with dementia dissatisfied with general hospital care? a qualitative study

et al. 2012

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BackgroundFamilies and other carers report widespread dissatisfaction with general hospital care for confused older people.MethodsWe undertook a qualitative interviews study of 35 family carers of 34 confused older patients to ascertain their experiences of care on geriatric and general medical, and orthopaedic wards of a large English hospital. Transcripts were analysed using a grounded theory approach. Themes identified in interviews were categorised, and used to build a model explaining dissatisfaction with care.ResultsThe experience of hospital care was often negative. Key themes were events (illness leading to admission, experiences in the hospital, adverse occurrences including deterioration in health, or perceived poor care); expectations (which were sometimes unrealistic, usually unexplored by staff, and largely unmet from the carers’ perspective); and relationships with staff (poor communication and conflict over care). Expectations were influenced by prior experience. A cycle of discontent is proposed. Events (or ‘crises’) are associated with expectations. When these are unmet, carers become uncertain or suspicious, which leads to a period of ‘hyper vigilant monitoring’ during which carers seek out evidence of poor care, culminating in challenge, conflict with staff, or withdrawal, itself a crisis. The cycle could be completed early during the admission pathway, and multiple cycles within a single admission were seen.ConclusionPeople with dementia who have family carers should be considered together as a unit. Family carers are often stressed and tired, and need engaging and reassuring. They need to give and receive information about the care of the person with dementia, and offered the opportunity to participate in care whilst in hospital. Understanding the perspective of the family carer, and recognising elements of the ‘cycle of discontent’, could help ward staff anticipate carer needs, enable relationship building, to pre-empt or avoid dissatisfaction or conflict.

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“…Listening to family carers and using the knowledge they have of the person with dementia is probably the single most practical recommendation to be made from this data. Information needs include details about the hospital, the illness and its consequences (Higgins & Joyce , Spichiger , Thune‐Boyle et al . ).…”

Section: Discussionmentioning

confidence: 99%

Experiences of family carers of older people with mental health problems in the acute general hospital: a qualitative study

Clissett

Porock

Harwood

et al. 2013

Journal of Advanced Nursing

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Aims. To explore the experiences of family carers of people with cognitive impairment during admission to hospital. Background. Providing appropriate care in acute hospitals for people with co-morbid cognitive impairment, especially dementia or delirium or both, is challenging to healthcare professionals. One key element is close working with family members. Design. Qualitative interview study. Methods. Semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had co-morbid cognitive impairment. Interviews conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework. Findings. The findings elaborate a core problem, 'disruption from normal routine' and a core process, 'gaining or giving a sense of control to cope with disruption'. Family carers responded to disruption proactively by trying to make sense of the situation and attempting to gain control for themselves or the patient. They tried to stay informed, communicate with staff about the patient and plan for the future. The interaction of the core problem and the core process resulted in outcomes where family members either valued the support of hospital staff and services or were highly critical of the care provided. Conclusion. Family carers are not passive in the face of the disruption of hospitalization and respond both by trying to involve themselves in the care and support of their relative and by trying to work in partnership with members of staff. Nurses need to foster this relationship conscientiously.

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The immediate needs of relatives during the hospitalisation of acutely ill older relatives

Cited by 18 publications

References 37 publications

Adult family member experiences during an older loved one's delirium: a narrative literature review

Adult family member experiences during an older loved one's delirium: a narrative literature review

Why are family carers of people with dementia dissatisfied with general hospital care? a qualitative study

Experiences of family carers of older people with mental health problems in the acute general hospital: a qualitative study

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