scholarly journals Identifying features associated with higher-quality hospital care and shorter length of admission for people with dementia: a mixed-methods study

2020 ◽  
Vol 8 (22) ◽  
pp. 1-92
Author(s):  
Rahil Sanatinia ◽  
Mike J Crawford ◽  
Alan Quirk ◽  
Chloe Hood ◽  
Fabiana Gordon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Health Services ◽  
Quantitative Data ◽  
Inpatient Care ◽  
Qualitative Data ◽  
Hospital Staff ◽  
Mixed Methods Study ◽  
General Hospitals ◽  
People With Dementia

Background Concerns have repeatedly been expressed about the quality of inpatient care that people with dementia receive. Policies and practices have been introduced that aim to improve this, but their impact is unclear. Aims To identify which aspects of the organisation and delivery of acute inpatient services for people with dementia are associated with higher-quality care and shorter length of stay. Design Mixed-methods study combining a secondary analysis of data from the third National Audit of Dementia (2016/17) and a nested qualitative exploration of the context, mechanism and outcomes of acute care for people with dementia. Setting Quantitative data from 200 general hospitals in England and Wales and qualitative data from six general hospitals in England that were purposively selected based on their performance in the audit. Participants Quantitative data from clinical records of 10,106 people with dementia who had an admission to hospital lasting ≥ 72 hours and 4688 carers who took part in a cross-sectional survey of carer experience. Qualitative data from interviews with 56 hospital staff and seven carers of people with dementia. Main outcome measures Length of stay, quality of assessment and carer-rated experience. Results People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission. This is a challenging task when patients have complex needs, and requires named staff to take responsibility for co-ordinating the discharge and effective systems for escalating concerns when obstacles arise. When trust boards review delayed discharges, they can identify recurring problems and work with local stakeholders to try to resolve them. Carers of people with dementia play an important role in helping to ensure that hospital staff are aware of patient needs. When carers are present on the ward, they can reassure patients and help make sure that they eat and drink well, and adhere to treatment and care plans. Clear communication between staff and family carers can help ensure that they have realistic expectations about what the hospital staff can and cannot provide. Dementia-specific training can promote the delivery of person-centred care when it is made available to a wide range of staff and accompanied by ‘hands-on’ support from senior staff. Limitations The quantitative component of this research relied on audit data of variable quality. We relied on carers of people with dementia to explore aspects of service quality, rather than directly interviewing people with dementia. Conclusions If effective support is provided by senior managers, appropriately trained staff can work with carers of people with dementia to help ensure that patients receive timely and person-centred treatment, and that the amount of time they spend in hospital is minimised. Future work Future research could examine new ways to work with carers to co-produce aspects of inpatient care, and to explore the relationship between ethnicity and quality of care in patients with dementia. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 22. See the NIHR Journals Library website for further project information.

The role of health services and systems

2019 ◽  
pp. 95-105
Author(s):  
Navneet Kapur ◽  
Robert Goldney
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Services ◽  
Suicide Prevention ◽  
Inpatient Care ◽  
Systems Of Care ◽  
General Hospitals ◽  
Societal Problems

This chapter discusses health services and systems of care and suicide prevention. Although suicide and suicidal behaviour are sometimes seen as societal problems, health services have a key role to play. The majority of those who die by suicide have a psychiatric disorder at the time of death. Many individuals have been in contact with health services prior to suicide. Primary care, general hospitals, and specialist mental health services are all important. Service-wide changes such as crisis provision, dual-diagnosis services, and serious incident reviews can contribute to suicide prevention. Focusing on safety in particular settings (e.g. inpatient care) can also be highly effective. Clinical guidelines can improve the quality of care and outcomes for patients, but implementation is key. Safer systems of care, with a number of interventions introduced simultaneously, may help to reduce suicide.

scholarly journals How Singing can Help People With Dementia and Their Family Care-Partners: A Mixed Studies Systematic Review With Narrative Synthesis, Thematic Synthesis, and Meta-Integration

2021 ◽  
Vol 12 ◽  
Author(s):  
Zara Thompson ◽  
Felicity A. Baker ◽  
Jeanette Tamplin ◽  
Imogen N. Clark
Keyword(s):  
Quality Of Life ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Well Being ◽  
Narrative Synthesis ◽  
Thematic Synthesis ◽  
People With Dementia ◽  
Care Partners ◽  
The Impact

Background: Recent research on the efficacy of music-based interventions for people with dementia have focused on specific outcomes and methods, and singing has been noted as a particularly beneficial activity. However, due to heterogeneity of research methods, there is a need to synthesise the findings of both quantitative and qualitative research in order to better understand both the impact and potential mechanisms of singing for people in this population.Method: This systematic review included quantitative, qualitative and mixed-methods studies, and analysed these using a systematic mixed-studies synthesis (with a results-based convergent approach). Quantitative and qualitative data were initially synthesised using a narrative synthesis and thematic synthesis method, respectively, before a final meta-integration method was used to synthesise common themes across the two data forms.Results: Electronic and hand search strategies revealed 1,815 relevant studies, 40 of which met the full eligibility criteria. Narrative synthesis of quantitative data revealed six key outcome areas (quality of life; psychological well-being; cognition; engagement; activities of daily living; care-partner well-being), and thematic synthesis of qualitative data generated seven themes relating to the impact and mechanisms of singing (pragmatic elements; social benefits; mood; identity; memory; flow-on effects; and relationships). Meta-integration identified four key areas relating to the impact and mechanisms of singing for people with dementia and care-partners: psychological well-being, quality of life, cognition, and care-partner well-being.Conclusion: Results from the syntheses suggest that singing can positively impact the lives of people with dementia and their care-partners, although due to heterogeneity of study design and outcome measures, it is difficult to draw conclusions based on quantitative data alone. Qualitative data provides further context and insights from participant perspectives, and when integrated with quantitative data, contextual factors that may influence the benefits that participants experience from singing are revealed.

scholarly journals Mixed or Complementary Messages: Making the Most of Unexpected Assessment Results

2016 ◽  
Vol 77 (2) ◽  
pp. 197-211 ◽  
Author(s):  
Phil Jones ◽  
Julia Bauder ◽  
Kevin Engel
Keyword(s):  
Mixed Methods ◽  
Action Research ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Important Research ◽  
Action Research Project ◽  
Research Project ◽  
Research Literacy ◽  
Initial Results

Grinnell College participated in ACRL’s first cohort of Assessment in Action (AiA), undertaking a mixed-methods action research project to assess the effectiveness of librarian-led research literacy sessions in improving students’ research skills. The quantitative data showed that the quality of students’ sources did not markedly improve following a research literacy session, while the qualitative data indicated that many students were able to state and describe important research concepts they learned. This article profiles the development of Grinnell’s AiA project and discusses how Grinnell’s librarians responded when the initial results led to more questions rather than to satisfactory answers.

scholarly journals Two concepts of community in the Niger Delta

2017 ◽  
Vol 10 (3) ◽  
pp. 254-269 ◽  
Author(s):  
Nwamaka Okeke-Ogbuafor ◽  
Tim Gray ◽  
Selina Stead
Keyword(s):  
Sense Of Place ◽  
Niger Delta ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Strong Sense ◽  
Content Type ◽  
Solid Foundation ◽  
Attachment To Place ◽  
Poor Communities

Purpose This paper aims to understand what two apparently contrasting concepts of communality and place attachment say about the quality of community life in the Niger Delta. Design/methodology/approach The research for this paper relied on extensive qualitative and quantitative data: qualitative data were collected from five oil-rich and three oil-poor communities across Ogoniland, while quantitative data were collected from four of these communities. Thematic content analysis was used to interpret the qualitative data, while the quantitative data were analysed through Excel. Findings Most participants from both oil-rich and oil-poor communities strongly reject a social sense of communality and strongly endorse a geographical sense of place. Practical implications The wider implication of this finding is that proponents of community development (CD) have a choice between either the cynical option of noting that Ogoni’s strong sense of place means that they will tolerate limited CD, or the noble option of noting that Ogoni’s strong sense of place is a solid foundation on which to build sustainable CD by empowering citizens to create their own future. Originality/value The originality of this study is twofold. First, it shows the complexity of people’s sense of community encompassing widely different and possibly contradictory elements. Second, it reveals the strength and persistence of people’s attachment to place despite its physical shortcomings.

scholarly journals Companion Animal Type and Level of Engagement Matter: A Mixed-Methods Study Examining Links between Companion Animal Guardianship, Loneliness and Well-Being during the COVID-19 Pandemic

Animals ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 2349
Author(s):  
Heather Clements ◽  
Stephanie Valentin ◽  
Nicholas Jenkins ◽  
Jean Rankin ◽  
Nancy R. Gee ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Quantitative Data ◽  
Online Survey ◽  
Qualitative Data ◽  
Companion Animals ◽  
Well Being ◽  
Companion Animal ◽  
Mixed Methods Study ◽  
The Impact ◽  
Mental Well Being

To reduce the spread of COVID-19, countries worldwide placed limitations on social interaction, which is anticipated to have severe psychological consequences. Although findings are inconsistent, prior research has suggested that companion animals may positively influence human well-being and reduce loneliness. In the context of COVID-19, this has important implications, as companion animal guardians may be less negatively affected by the pandemic. The primary aim of this research was to investigate the influence of companion animals on mental well-being and loneliness during the pandemic, with specific interest in the role of ornamental fishes. A mixed-methods study was conducted, using an international sample. Quantitative data were collected via an online survey (n = 1199) and analysed using robust hierarchical multiple regression analyses; the influence of level of engagement with companion animals was examined for dogs, cats and ornamental fishes. There was no evidence that companion animal guardianship was associated with loneliness and mental well-being during the pandemic but spending more time engaging physically or socially with dogs (and to a lesser extent cats) was generally associated with poorer outcomes. Qualitative data were collected through open-ended survey responses (n = 757) and semi-structured interviews (n = 25) and analysed using reflexive thematic analysis. Two themes were developed—one related to companion animals as providers of social and emotional support, and the other to companion animals as providers of purpose and perspective. Concerns regarding the impact of the pandemic on animal welfare were also identified. Compared to other animal types, more participants expressed indifference regarding the impact of their fishes on their well-being during the pandemic, possibly because fishes cannot provide comfort via physical touch. The findings of this study reflect the wider field of human–animal interaction; although qualitative data suggest guardians believe their companion animals are a positive influence in their lives, there is little convincing quantitative data to support these beliefs. This highlights the need to refine theories regarding which aspects of companion animal guardianship may influence human well-being; the findings from this research may be useful in the refinement of such theories.

Norway

2019 ◽  
pp. 211-218
Author(s):  
Knut Engedal
Keyword(s):  
Quality Of Life ◽  
Health Services ◽  
Welfare State ◽  
Family Caregivers ◽  
Residential Care ◽  
Healthcare Professionals ◽  
Tax System ◽  
People With Dementia ◽  
At Home

Norway has 5 million inhabitants, of whom 200,000 are aged above 80 years. The country is a welfare state, with a tax system covering most health services for its citizens. It is estimated that 78,000 people in Norway suffer from dementia, of whom 60% live at home and the remainder in residential care. In 2007, the first National Dementia Plan was launched (2007–2015), and the second in 2016 (2016–2020). The main goals of the two Plans are to develop services across the country to improve the care and quality of life for all people with dementia and their family caregivers, as well as increase the knowledge of dementia among healthcare professionals. In addition, the Plans also aim to improve awareness of dementia in society as a whole and to develop and implement measures to help create a more dementia-friendly society.

P4-276: Health services development research with people with dementia: Key features, factors, and learning from a multi-site, mixed methods study

2015 ◽  
Vol 11 (7S_Part_19) ◽  
pp. P891-P891
Author(s):  
Michael Bowen ◽  
Rosa Pepe ◽  
Sarah Buchanan ◽  
David Edgar ◽  
Lesley Hall ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Services ◽  
Mixed Methods Study ◽  
Development Research ◽  
People With Dementia ◽  
Key Features

scholarly journals Quality of care for people with dementia in general hospitals: national cross-sectional audit of patient assessment

2014 ◽  
Vol 14 (5) ◽  
pp. 490-494 ◽  
Author(s):  
Renata Souza ◽  
Aarti Gandesha ◽  
Chloe Hood ◽  
Robert Chaplin ◽  
John Young ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Patient Assessment ◽  
Cross Sectional ◽  
General Hospitals ◽  
People With Dementia

scholarly journals Early morbidities following paediatric cardiac surgery: a mixed-methods study

2020 ◽  
Vol 8 (30) ◽  
pp. 1-192
Author(s):  
Katherine L Brown ◽  
Christina Pagel ◽  
Deborah Ridout ◽  
Jo Wray ◽  
Victor T Tsang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Surgery ◽  
Health Services ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Mixed Methods Study ◽  
Feeding Problems ◽  
Developmental Assessment ◽  
Routine Monitoring

Background Over 5000 paediatric cardiac surgeries are performed in the UK each year and early survival has improved to > 98%. Objectives We aimed to identify the surgical morbidities that present the greatest burden for patients and health services and to develop and pilot routine monitoring and feedback. Design and setting Our multidisciplinary mixed-methods study took place over 52 months across five UK paediatric cardiac surgery centres. Participants The participants were children aged < 17 years. Methods We reviewed existing literature, ran three focus groups and undertook a family online discussion forum moderated by the Children’s Heart Federation. A multidisciplinary group, with patient and carer involvement, then ranked and selected nine key morbidities informed by clinical views on definitions and feasibility of routine monitoring. We validated a new, nurse-administered early warning tool for assessing preoperative and postoperative child development, called the brief developmental assessment, by testing this among 1200 children. We measured morbidity incidence in 3090 consecutive surgical admissions over 21 months and explored risk factors for morbidity. We measured the impact of morbidities on quality of life, clinical burden and costs to the NHS and families over 6 months in 666 children, 340 (51%) of whom had at least one morbidity. We developed and piloted methods suitable for routine monitoring of morbidity by centres and co-developed new patient information about morbidities with parents and user groups. Results Families and clinicians prioritised overlapping but also different morbidities, leading to a final list of acute neurological event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, surgical infection and prolonged pleural effusion. The brief developmental assessment was valid in children aged between 4 months and 5 years, but not in the youngest babies or 5- to 17-year-olds. A total of 2415 (78.2%) procedures had no measured morbidity. There was a higher risk of morbidity in neonates, complex congenital heart disease, increased preoperative severity of illness and with prolonged bypass. Patients with any morbidity had a 6-month survival of 81.5% compared with 99.1% with no morbidity. Patients with any morbidity scored 5.2 points lower on their total quality of life score at 6 weeks, but this difference had narrowed by 6 months. Morbidity led to fewer days at home by 6 months and higher costs. Extracorporeal life support patients had the lowest days at home (median: 43 days out of 183 days) and highest costs (£71,051 higher than no morbidity). Limitations Monitoring of morbidity is more complex than mortality, and hence this requires resources and clinician buy-in. Conclusions Evaluation of postoperative morbidity provides important information over and above 30-day survival and should become the focus of audit and quality improvement. Future work National audit of morbidities has been initiated. Further research is needed to understand the implications of feeding problems and renal failure and to evaluate the brief developmental assessment. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 30. See the NIHR Journals Library website for further project information.

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