Caring for people with dementia in hospital: findings from a survey to identify barriers and facilitators to implementing best practice dementia care

2016 ◽  
Vol 29 (3) ◽  
pp. 467-474 ◽  
Author(s):  
Joanne Tropea ◽  
Dina LoGiudice ◽  
Danny Liew ◽  
Carol Roberts ◽  
Caroline Brand
Keyword(s):  
Best Practice ◽  
Quality Care ◽  
Hospital Setting ◽  
Hospital Staff ◽  
Dementia Care ◽  
Perceived Barriers ◽  
Barriers And Enablers ◽  
People With Dementia ◽  
Multidisciplinary Staff ◽  
Survey Responses

ABSTRACTBackground:Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care.Methods:A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey. The survey collected data about the respondents’ current role, work area, and years of experience, their perceived level of confidence and knowledge in dementia care and common symptoms of dementia, barriers and enablers to implementing best practice dementia care, job satisfaction in caring for people with dementia, and to rate the hospital's capacity and available resources to support best practice dementia care.Results:A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low.Conclusion:The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.

scholarly journals Admiral Nursing—A Model of Specialist Dementia Care in Acute Hospitals

2020 ◽  
Vol 6 ◽  
pp. 237796082095267
Author(s):  
Zena Aldridge ◽  
Emily Oliver ◽  
Hannah Gardener ◽  
Karen Harrison Dening
Keyword(s):  
Hospital Care ◽  
Quality Care ◽  
Hospital Staff ◽  
Dementia Care ◽  
Acute Hospital ◽  
Acute Hospital Care ◽  
Complex Needs ◽  
People With Dementia ◽  
Health And Social Care ◽  
Acute Hospitals

Introduction The rising prevalence of dementia has led to increased numbers of people with dementia being admitted to acute hospitals. This demand is set to continue due to an increasingly older population who are likely to have higher levels of dependency, dementia, and comorbidity. If admitted to the hospital, people with dementia are at higher risk of poor outcomes during and following a hospital admission. Yet, there remains a significant lack of specialist support within acute hospitals to support people with dementia, their families and hospital staff. Methods Admiral Nurses are specialists that work with families affected by dementia and provide consultancy and support to health and social care colleagues to improve the delivery of evidenced based dementia care. Historically, Admiral Nurses have predominantly been based in community settings. In response to the increasing fragmentation of services across the dementia trajectory, the Admiral Nurse model is evolving and adapting to meet the complex needs of families impacted upon by dementia inclusive of acute hospital care. Results The Admiral Nurse acute hospital model provides specialist interventions which improve staff confidence and competence and enables positive change by improving skills and knowledge in the provision of person-centred dementia care. The role has the capacity to address some of the barriers to delivering person centred dementia care in the acute hospital and contribute to improvements across the hospital both as a result of direct interventions or influencing the practice of others. Conclusion Improving services for people with dementia and their families requires a whole system approach to enable care coordination and service integration, this must include acute hospital care. The increasing numbers of people with dementia in hospitals, and the detrimental effects of admission, make providing equitable, consistent, safe, quality care and support to people with dementia and their families a national priority requiring immediate investment. The inclusion of Admiral Nursing within acute hospital services supports service and quality improvement which positively impacts upon the experience and outcomes for families affected by dementia.

scholarly journals Improving emotional well-being for hospital-based patients with dementia

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stephanie Petty ◽  
Amanda Griffiths ◽  
Donna Maria Coleston ◽  
Tom Dening
Keyword(s):  
Nursing Staff ◽  
Hospital Care ◽  
Personal Information ◽  
Hospital Setting ◽  
Well Being ◽  
Hospital Staff ◽  
Content Type ◽  
Hospital Nursing ◽  
People With Dementia ◽  
Hospital Resources

Purpose Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting. Design/methodology/approach A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis. Findings Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes. Research limitations/implications The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research. Originality/value In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.

Alzheimer's Association Quality Care Campaign and professional training initiatives: improving hands-on care for people with dementia in the U.S.A.

2009 ◽  
Vol 21 (S1) ◽  
pp. S25-S33 ◽  
Author(s):  
Elizabeth Gould ◽  
Peter Reed
Keyword(s):  
Professional Training ◽  
Quality Care ◽  
Dementia Care ◽  
Direct Care ◽  
Care Staff ◽  
Distinct Component ◽  
Term Care ◽  
People With Dementia ◽  
Hands On ◽  
Care Training

ABSTRACTIn the U.S.A., direct care workers and licensed practical nurses are the professionals who provide the most hands-on care to people with dementia in nursing homes and residential care facilities – yet they do not receive adequate training in dementia care. Dementia care training needs to be universal with all disciplines at all levels of care. Even though there is variability on recommended hours and content, most studies emphasize the importance of dementia care training as a distinct component of required training for any professional or paraprofessional working in long-term care. In 2005, the Alzheimer's Association launched its Quality Care Campaign to improve dementia care through state and federal advocacy; consumer education and empowerment; and staff training. This paper describes the effectiveness of Alzheimer's Association training as measured by knowledge gained and providers' intention to change their behavior immediately after attending the training.Overall, findings indicated that the participants responded positively to evidence-based training in dementia care that emphasized the importance of (i) leadership, (ii) team communication and collaboration, (iii) support and empowerment of direct care staff, (iv) awareness and practice of specific dementia care issues, (v) resident and family involvement in care, and (vi) professional self-care.

scholarly journals What factors affect paramedics’ involvement of people with dementia in decisions about their care? A qualitative study

2021 ◽  
Vol 5 (4) ◽  
pp. 1-8
Author(s):  
Esme Choonara ◽  
Julia Williams
Keyword(s):  
Best Practice ◽  
Dementia Care ◽  
Research Approach ◽  
Best Interest ◽  
Individual Interviews ◽  
Ethical Frameworks ◽  
Lack Of Information ◽  
People With Dementia ◽  
Generic Qualitative ◽  
The Impact

<sec id="s1">Background: Paramedics are frequently called to people with dementia, but decision making can be challenging due to lack of information or difficulties in assessment. Best-practice dementia care should be holistic and involve people with dementia in decisions as far as possible. </sec> <sec id="s2">Aims: To explore how paramedics make decisions when attending people with dementia, with a particular focus on factors that impact on how, and to what degree, paramedics involve people with dementia in these decisions. </sec> <sec id="s3">Methods: A generic qualitative research approach was used. Data were collected through semi-structured individual interviews with seven paramedics. The interviews were recorded and transcribed verbatim and subsequently analysed using thematic analysis. </sec> <sec id="s4">Results: Four themes were identified that all touched on challenges to delivering person-centred care. Themes identified were: 1) paramedics’ differing approaches to assessing capacity and making best interest decisions; 2) communication and developing a rapport; 3) interconnections with others important to the person with dementia; and 4) the impact of paramedics’ values and attitudes. </sec> <sec id="s5">Conclusion: The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This study highlights how paramedics’ values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics with the skills and ethical frameworks needed to deliver high quality dementia care. </sec>

Assessment and management of dementia in the general hospital setting

2014 ◽  
Vol 24 (3) ◽  
pp. 205-218 ◽  
Author(s):  
Inderpal Singh ◽  
Amrita Varanasi ◽  
Kathryn Williamson
Keyword(s):  
General Hospital ◽  
Staff Training ◽  
Medical Training ◽  
Oldest Old ◽  
Quality Care ◽  
Hospital Setting ◽  
Ageing Population ◽  
People With Dementia ◽  
The Uk ◽  
Training And Support

SummaryPopulations are ageing worldwide. The prevalence of dementia will rise exponentially with the oldest old the most rapidly growing segment of society. Caring for this ageing population with dementia, many of whom will have multiple chronic and disabling diseases, will be a challenge to healthcare systems, particularly general hospitals. At any one time, a quarter of acute hospital beds in the UK are in use by people with dementia. Delivery of high-quality care to this growing and vulnerable population must be high on any health service agenda.Current medical training not only generates relatively low numbers of geriatricians and specialists with interest in dementia, but also there is a lack of appropriate training in assessment and management of dementia. There remains huge need for better staff training and support to provide safe, holistic and dignified dementia care. Here we explore various key features for non-specialist assessment and management of older people with dementia in the general hospital setting.

scholarly journals Using Video-Reflexive Ethnography to Engage Hospital Staff to Improve Dementia Care

2018 ◽  
Vol 5 ◽  
pp. 233339361878509 ◽  
Author(s):  
Lillian Hung ◽  
Alison Phinney ◽  
Habib Chaudhury ◽  
Paddy Rodney
Keyword(s):  
Hospital Setting ◽  
Hospital Staff ◽  
Dementia Care ◽  
Staff Nurses ◽  
Medical Unit ◽  
Culture Of Learning ◽  
Person Centered Care ◽  
Health Practitioners ◽  
Centered Care ◽  
Staff Engagement

In this article, we discuss how video-reflexive ethnography may be useful in engaging staff to improve dementia care in a hospital medical unit. Seven patients with dementia were involved in the production of patient-story videos, and fifty members of staff (nurses, physicians, and allied health practitioners) participated in video-reflexive groups. We identified five substantial themes to describe how video-reflexive groups might contribute to enacting person-centered care for improving dementia care: (a) seeing through patients’ eyes, (b) seeing normal strange and surprised, (c) seeing inside and between, (d) seeing with others inspires actions, and (e) seeing with the team builds a culture of learning. Our findings suggest that video reflexivity is not only useful for staff engagement but also effective in enhancing team capacity to enact person-centered care in the hospital setting.

scholarly journals Evaluation and Effectiveness of a Two-Day Dementia Training Program for Hospital Staff Working in an Emergency Department

2021 ◽  
pp. 1-14
Author(s):  
Julia Schneider ◽  
Jennifer Miller ◽  
Winfried Teschauer ◽  
Andreas Kruse ◽  
Birgit Teichmann
Keyword(s):  
Emergency Department ◽  
Organizational Performance ◽  
Training Program ◽  
Qualitative Content Analysis ◽  
Hospital Setting ◽  
Hospital Staff ◽  
Individual Performance ◽  
Working Environment ◽  
Structured Interviews ◽  
People With Dementia

Background: Entering the hospital via an emergency department (ED) is a pivotal moment in the life of people with dementia (PwD) and often starts an avoidable downward spiral. Therefore, it is required to further educate ED staff to raise awareness of the needs of PwD. Although there are many studies about existing dementia training programs for the hospital setting, empirical evidence for the ED setting and cross-level training evaluations are lacking. Objective: The study aims to evaluate a two-day dementia training course for ED staff on the outcome levels of learning, individual performance, and organizational performance. Furthermore, the study examines whether the training fulfilled participants’ expectations. Methods: Mixed methods were used to assess data from head nurses, nursing, and administrative staff working in EDs. We conducted semi-structured interviews three weeks before (N = 18) and eight months after (N = 9) the training. Questionnaire data were assessed before the training, three months, and six months after the training (N = 44). A qualitative content analysis was conducted to analyze qualitative data; quantitative data was described descriptively. Results: The intervention seems to be effective on both learning and individual performance levels. However, we did not observe any changes in the organizational performance. The training program met attendees’ expectations only partly. The working environment of EDs needs to be taken more into account. Conclusion: Hospital staffs’ expectations of a dementia training program depend on the work area in which they operate. Results support the implementation of intervention bundles to enable sustainable cross-level changes.

scholarly journals Improving care for people with dementia: development and initial feasibility study for evaluation of life story work in dementia care

2016 ◽  
Vol 4 (23) ◽  
pp. 1-298 ◽  
Author(s):  
Kate Gridley ◽  
Jenni Brooks ◽  
Yvonne Birks ◽  
Kate Baxter ◽  
Gillian Parker
Keyword(s):  
Feasibility Study ◽  
Best Practice ◽  
Social Care ◽  
Life Story ◽  
Good Practice ◽  
Dementia Care ◽  
Care Staff ◽  
Care Homes ◽  
Staff Attitudes ◽  
People With Dementia

BackgroundImproving dementia care quality is an urgent priority nationally and internationally. Life story work (LSW) is an intervention that aims to improve individual outcomes and care for people with dementia and their carers. LSW gathers information and artefacts about the person, their history and interests, and produces a tangible output: the ‘life story’.ObjectiveTo establish whether or not full evaluation of LSW was feasible.DesignMixed-methods feasibility study.MethodsIn-depth interviews and focus groups explored experiences of LSW and best practice with people with dementia, family members and dementia care staff. A systematic review explored best practice and theories of change for LSW. These stages helped to identify the outcomes and resources to explore in the feasibility study. A representative sample survey of health and social care dementia care providers in England established LSW practice in different settings. A survey of a self-selected sample of family members of people with dementia explored how LSW is experienced. Two small outcome studies (stepped-wedge study in six care homes and pre-test post-test study in inpatient specialist dementia care wards) explored the feasibility of full evaluation of LSW in these settings.SettingsSurvey: generalist and specialist care homes; NHS dementia care settings; and community dementia services. Feasibility study: care homes and NHS inpatient dementia care wards.ParticipantsNHS and social care services, people with dementia, family carers, care home staff and NHS staff.InterventionsLSW.Main outcome measuresSpread of LSW and good practice, quality of life (QoL) for the person with dementia and carers, relationships between people with dementia and family carers, staff attitudes about dementia, staff burnout, resource use and costs.Review methodsNarrative review and synthesis, following Centre for Review and Dissemination guidelines.ResultsGood practice in LSW is identifiable, as are theories of change about how it might affect given outcomes. Indicators of best practice were produced. LSW is spreading but practice and use vary between care settings and are not always in line with identified good practice. Two different models of LSW are evident; these are likely to be appropriate at different stages of the dementia journey. The feasibility study showed some positive changes in staff attitudes towards dementia and, for some people with dementia, improvements in QoL. These may be attributable to LSW but these potential benefits require full evaluation. The feasibility work established the likely costs of LSW and highlighted the challenges of future evaluation in care homes and inpatient dementia care settings.LimitationsThere was insufficient evidence in the literature to allow estimation of outcome size. We did not carry out planned Markov chain modelling to inform decisions about carrying out future evaluation because of the dearth of outcome data in the literature; low levels of data return for people with dementia in the hospital settings; lack of detected effect for most people with dementia; and questions about implementation in the research settings.ConclusionsLSW is used across different health and social care settings in England, but in different ways, not all of which reflect ‘good practice’. This large, complex study identified a wide range of challenges for future research, but also the possibility that LSW may help to improve care staff attitudes towards dementia and QoL for some people with dementia.Future workFull evaluation of LSW as an intervention to improve staff attitudes and care is feasible with researchers based in or very close to care settings to ensure high-quality data collection.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

03  What factors affect paramedics’ involvement of people with dementia in decisions affecting their care? A qualitative study

2020 ◽  
Vol 37 (10) ◽  
pp. e3.1-e3
Author(s):  
Esme Choonara
Keyword(s):  
Decision Making ◽  
Social Constructivism ◽  
Best Practice ◽  
Dementia Care ◽  
Research Approach ◽  
Best Interest ◽  
Complex Needs ◽  
Ethical Frameworks ◽  
People With Dementia ◽  
The Impact

BackgroundParamedics are frequently called to people with dementia due to high rates of co-morbidities and complex needs, but decision making can be challenging due to lack of information or difficulties in assessment. Best-practice dementia care should be holistic and involve people with dementia in decisions as far as possible. A small number of qualitative studies have looked at paramedics’ decision-making in relation to dementia, but these studies have not specifically investigated the involvement of people with dementia in decisions. This study aimed to explore how paramedics make decisions when attending people with dementia, with a particular focus on understanding the factors that impact on whether, how, and to what degree paramedics involve people with dementia in decisions about their care.MethodsA generic qualitative research approach was used, informed by social constructivism and by the researcher’s commitment to the concept of ‘personhood’ in dementia care. Data were collected through semi-structured individual interviews with seven paramedics, each lasting between 40 and 80 minutes. The interviews were recorded and transcribed verbatim and subsequently analysed using thematic analysis.ResultsFour themes were identified that all touched on challenges to delivering person-centred care for people with dementia. Themes identified were: 1. Paramedics’ differing approaches to assessing capacity and making best interest decisions. 2. Communication and developing a rapport. 3. Interconnections with others important to the person with dementia. 4. The impact of paramedics’ values and attitudes.ConclusionThe involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This study highlights how paramedics’ values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics with the skills and ethical frameworks needed to deliver high quality dementia care.

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