Care for older people with a dementia in acute hospital settings

If nurses plan and approach older people with dementia with positive values, and learn from the person's communication through their behaviour, the outcomes for all parties can be improved. The vignette has offered one example, but also demonstrates that there are no failure-proof ways of communicating, and sometimes nurses need to learn through trial and error. Only in this way can they become more skilled in their interventions to facilitate rather than manage challenging behaviours. Avoidance and ignorance do not help in either the short term or the long term. The good news is that single interventions are successful 45 per cent of the time and multiple interventions, as shown in Box 2, are more successful (Bair et al 1999).     

Older people with dementia in acute settings

This article suggests that screening and assessing for dementia can be incorporated into nurses' roles, as can a range of strategies to address some of the common challenges that nurses face when working with older people with cognitive impairment in acute settings.     

Supporting families of patients with dementia at end-of-life in hospital

IntroductionThere are barriers to implementing person-and family-centred end-of-life care for people with dementia in hospitals. Nursing care for people with dementia is enhanced through family involvement. However, families report unmet needs during admissions contributing to distress and dissatisfaction. Furthermore, little is known about families’ needs during end-of-life care for people with dementia in hospital.AimThis study examined perceptions of interpersonal care during end-of-life for patients with dementia.MethodsThis research used a qualitative approach framed through a social constructionist and complex systems theoretical frameworks. Hospital clinicians (n = 20) and bereaved family members (n = 12) of deceased patients with dementia participated in semi-structured interviews focussing on recent end-of-life care experiences.FindingsAn overarching theme of maintaining connections highlights the need to support patient and family bonds at end-of-life. Although clinicians often presumed families had experienced the social loss of a relative due to dementia, most families described continued bonds. Despite clinicians’ insights into caregiver grief, several families reported unmet bereavement support needs. Clinicians and families sought to personalise end-of-life through affirming signs of patients’ presence, working collaboratively to achieve comfort, personalising basic care interventions and offering gestures of hospitality.ConclusionEnd-of-life care for people with dementia and their families is improved when clinicians personalise patient care interventions using creative and simple strategies. Families feel comforted through humanistic care that acknowledges their unique relationship with the patient. However, it is vital to integrate grief and loss psychoeducation during end-of-life care to address families unmet bereavement needs following patient death.     

Achieving dignity for older people with dementia in hospital

The quality of care for people with dementia in general hospital settings has attracted widespread concern. While organisation-wide strategies are needed to address many of the issues, the nursing role is critical to articulating and promoting good practice. This article focuses on promoting dignity for older people with dementia and offers a number of strategies to help individual nurses and nursing teams reflect on and promote good practice.     

Redesigning wards to support people with dementia in hospital

The Enhancing the Healing Environment programme is a nurse-led initiative, devised by charity the King's Fund, to encourage staff to work in partnership with patients to improve the environment in which they deliver care. This article explores projects that have developed as part of the programme that focus on dementia and acute care. A case study of work undertaken at Bradford Royal Infirmary is included to show the benefits to staff and patients of improving their surroundings.     

Improving the care of people with dementia in hospital

The Dementia Champions Programme was set up in NHS Dumfries and Galloway, Scotland, to equip nurses with the skills and knowledge to improve the care of people with dementia in hospital. Nurses who complete the programme are known as dementia champions. This article describes the multi-faceted, educational approach to improving the care of adults with dementia.     

A systematic review of interventions to improve acute hospital care for people with dementia

The aim of this study was to provide an overview of interventions targeting hospital care of patients with dementia. We conducted a systematic review, including interventional study designs. We searched five electronic databases, conducted a hand search and performed citation tracking. To assess risk of bias, we used Cochrane Collaboration's tool, ROBANS and AMSTAR. We narratively summarized the outcomes.The findings of twenty studies indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types. Educational programmes were the most reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving some patient-related outcomes.However, current evidence is insufficient to declare which interventions are effective in improving dementia care in acute hospitals. Future research should focus on relevant patient and family caregiver outcomes and must consider the complexity of the interventions when evaluating them.     

Aggressive behaviour by people with dementia in residential care settings: a review

This paper considers the phenomenon of aggressive behaviour perpetrated by people with dementia in residential care settings. Aggressive behaviour is defined in the context of people with dementia, and the problem of ascertaining the incidence of aggression among people with dementia is discussed. The emotional impact of assaults on nurses and other professionals is highlighted, and differing perspectives on the causation of aggressive behaviour are considered. Management strategies derived from the physical/pharmacological; environment management; behaviour modification and person-centred approaches are reviewed. Our conclusion is that while certain strategies appear to reflect good and common sense practice, in particular those deriving from the person-centred approach, there is no clear research evidence for the general effectiveness of any one management approach, and each has drawbacks of a practical or ethical nature. There is also little empirical information about how professional carers actually manage aggressive behaviour in practice.     

Working in long-term care settings for older people with dementia: nurses' aides

Aim. This paper reports a study exploring the reasons for continuing to work among nurse aides who cared for older people with dementia in long‐term care settings in Taiwan. Background. High nurse aide turnover has been a major problem for many managers of long‐tem care facilities in Taiwan. Most studies on nurse aide turnover have focused on the factors on why they left, but little is known about their reasons for continuing to work in long‐term care settings in Taiwan. Methods. A qualitative research design was used. Sixteen nurse aides were interviewed individually using a semi‐structured interview guide and content analysis was used to identify the major themes in the data. Results. Five major themes emerged from interview data: monetary needs, relationships with residents, working environment, training opportunities and gratification (listed in order of frequency of occurrence). Conclusion. Nurse aides face challenges in caring for the increased number of older people with cognitive impairment and it is important to assess their perspectives towards their work in the changing environment. The findings suggest that it is essential for nursing managers to assess nurse aides’ needs to increase job retention and to improve the quality of resident care in long‐term care settings. Relevance to clinical practice. Careful appraisal of prospective nurse aides’ attitudes, regular training programmes in dementia care, adequate staffing and equipment, performance‐based pay rises and subsidized training are practical retention strategies for these nurse aides.     

Support for carers of people with dementia during hospital admission

The aim of this study was to help develop support services for carers of people with dementia on admission to a district general hospital. Qualitative methodology was used in the form of individual semistructured interviews. These interviews suggest that service developments need to take into account the individual need of each carer. Identified themes included communication, vulnerability of the carers and the need to develop a therapeutic relationship with the carer as well as the person with dementia. Recommendations for change include a letter introducing the dementia specialist nurse to be given to carers, a poster in wards across the trust to support the letter; and workshops on dementia care for staff with emphasis on the need to work in partnership with informal carers.     

The care of older people with dementia in acute hospitals

cowdell f. (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 5 , 83–92. Aim. To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals. Background. The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses. Method. An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom. Findings. Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this. Conclusion. Bourdieu’s Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice. Relevance to clinical practice. It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken.     

Supporting mental health nurses to address the physical health needs of people with serious mental illness in acute inpatient care settings

There is overwhelming evidence that the physical health needs of those with serious mental illness have been neglected by health service professionals. Mental health nurses (MHNs) could play a key role in meeting these needs particularly during hospital admissions, yet they are uncertain about their role, have variable levels of confidence and lack appropriate skills and training. This study investigated MHNs' views and practices of physical health management for adults receiving acute inpatient treatment and found a difference between MHNs' perceived responsibility and their practice, which highlighted a need for role clarification and further skills training.     

The care of older people with a delirium in acute care settings

This article suggests that nurses should play a major part in the screening, assessment and management of delirium in older people in acute settings.     

Using sense-making theory to aid understanding of the recognition,assessment and management of pain in patients with dementia in acute hospital settings

BackgroundThe recognition, assessment and management of pain in hospital settings is suboptimal, and is a particular challenge in patients with dementia. The existing process guiding pain assessment and management in clinical settings is based on the assumption that nurses follow a sequential linear approach to decision making. In this paper we re-evaluate this theoretical assumption drawing on findings from a study of pain recognition, assessment and management in patients with dementia.AimTo provide a revised conceptual model of pain recognition, assessment and management based on sense-making theories of decision making.MethodsThe research we refer to is an exploratory ethnographic study using nested case sites. Patients with dementia (n = 31) were the unit of data collection, nested in 11 wards (vascular, continuing care, stroke rehabilitation, orthopaedic, acute medicine, care of the elderly, elective and emergency surgery), located in four NHS hospital organizations in the UK. Data consisted of observations of patients at bedside (170 h in total); observations of the context of care; audits of patient hospital records; documentary analysis of artefacts; semi-structured interviews (n = 56) and informal open conversations with staff and carers (family members).FindingsExisting conceptualizations of pain recognition, assessment and management do not fully explain how the decision process occurs in clinical practice. Our research indicates that pain recognition, assessment and management is not an individual cognitive activity; rather it is carried out by groups of individuals over time and within a specific organizational culture or climate, which influences both health care professional and patient behaviour.ConclusionsWe propose a revised theoretical model of decision making related to pain assessment and management for patients with dementia based on theories of sense-making, which is reflective of the reality of clinical decision making in acute hospital wards. The revised model recognizes the salience of individual cognition as well as acknowledging that decisions are constructed through social interaction and organizational context. The model will be used in further research to develop decision support interventions to assist with the assessment and management of patients with dementia in acute hospital settings.     

Central venous catheter infection in adults in acute hospital settings

As well as the human cost, central venous catheter (CVC)-related bloodstream infections significantly inflate hospital costs, mainly through increased length of stay in hospital, particularly in intensive care. This literature review appraises recent research on measures used to minimize CVC-related infection and compares it with current best practice. Randomized controlled trials and systematic reviews published on the subject between 2000 and 2005 were reviewed, concentrating on non-tunnelled, short-term CVCs in the acute hospital setting. The new evidence mainly backs up current best practice. However, skin disinfection could be improved by using alcoholic chlorhexidine followed by aqueous povidone-iodine before CVC insertion. Also, alcoholic chlorhexidine is the preferred solution for cleaning the hubs/connectors before accessing the CVC. Good hand hygiene and quality control and education programmes are vital to improve patient care. More research is needed to clarify the effectiveness of certain interventions and technologies, such as antimicrobial CVCs.