Caring connections with older persons with dementia in an acute hospital setting – a hermeneutic interpretation of the staff nurse's experience

Abstract

Despite the contextual limitations of the acute setting, the importance of knowing and respecting the person with dementia and the centrality of relationship as the medium within which caring is experienced is demonstrated. However, nurses lack specific knowledge on which to base care. Further research is therefore recommended to identify how care which promotes the integrity of the person with dementia may be effectively operationalized across the acute care setting.

Impact of a person-centred dementia care training programme on hospital staff attitudes, role efficacy and perceptions of caring for people with dementia: A repeated measures study

“…Similarly Dewing and Dijk (2014) highlight that poor outcomes for people with dementia in acute hospitals result from a tension between prioritising medical treatment versus the delivery of person-centred dementia care, exacerbated by the fact there is insufficient understanding of what person-centred care is and a lack of staff knowledge and skills to deliver such care. This is supported by Nolan (2006) who found acute hospital nurses in Ireland expressed a desire to care for people with dementia in a person-centred way, but lacked the knowledge to base such care on.…”

Capacity for Care: Meta-Ethnography of Acute Care Nurses’ Experiences of the Nurse-Patient Relationship

“…I think it is like a plastic shield that you put up and I think if you stick at it long enough and you're in the job long enough, it becomes a natural way (Mackintosh 2007, p.986) Critical care nurses frustrated that their intimate knowledge of the patient did not influence physician treatment plan (Halcomb et al 2004, Gutierrez 2005, De Bal et al 2006, Hov et al 2007 Critical care nurses more likely to report moral distress associated with contributing to unnecessary suffering (Sö derberg et al 1999, Hopkinson et al 2003, Halcomb et al 2004, Gutierrez 2005, De Bal et al 2006, Calvin et al 2007, Hov et al 2007) Nurses on general wards more likely to report frustrations in building and sustaining relationships (Sö derberg et al 1999 Disengagement from the nurse-patient relationship Avoiding over-involvement with patients (Hopkinson et al 2003, De Bal et al 2006, Nolan 2006 Reluctance to return to work (Gutierrez 2005) Being a different person at work (Mackintosh 2007) Avoiding certain patients and families (Gutierrez 2005) Reluctance to care for patients at all (Gutierrez 2005) Block out feelings/try to forget (Hov et al 2007) Frustrated aspirations lead to stress, burnout, patient abuse (Nordam et al 2005) Ignoring patients (Eriksson & Saveman 2002) Other studies reflected this disengagement:…”

“…Contributing to unnecessary patient suffering -unable to relieve suffering, or implementing curative treatment plan with which they don't agree (Sö derberg et al 1999, Hopkinson et al 2003, Halcomb et al 2004, Gutierrez 2005, De Bal et al 2006, Calvin et al 2007, Hov et al 2007 Patient autonomy is constrained by factors outside of nurses' control (Eriksson & Saveman 2002, Nolan 2006 Inadequate care (Eriksson & Saveman 2002, Nordam et al 2005 realized. Following a situation where a physician sited an intravenous cannula into a patient's arm against her clearly expressed wish, a nurse in Gutierrez's (2005) study reflects that not acting as the patient's advocate had a deleterious impact on her relationship with the patient:…”

“…Providing information, guidance and support to patient decision-making (Kociszewski 2003, Quinn 2003, De Bal et al 2006, Hawley & Jensen 2007 (Quinn 2003, Wilkin & Slevin 2004 Providing information, guidance and support to patient decision-making (Kociszewski 2003, Quinn 2003, De Bal et al 2006, Hawley & Jensen 2007 Reconciling perspectives between patients, families and clinicians (Calvin et al 2007, Hov et al 2007 Being an advocate for patient (Sö derberg et al 1999, Kociszewski 2003, 2004, Gutierrez 2005, Nordam et al 2005, De Bal et al 2006, Nolan 2006, Calvin et al 2007, Hawley & Jensen 2007 him he was dying, which he asked me to, I hadn't been there when he was dying, which I felt, I might have liked to have been, or to have some part of it and that my last interaction was, I was too busy to stop (Quinn 2003, p.169) Findings suggest that there are particular patient groups that prompt greater distress. Patients who are dying prompt emotional distress in nurses as they bear witness to the suffering of patients and families (Hopkinson & Hallett 2002, Quinn 2003, Kociszewski 2004, Wilkin & Slevin 2004, Calvin et al 2007, Hov et al 2007, Mackintosh 2007) but moral distress can be triggered when nurses perceive that they are contributing to unnecessary additional suffering, either by implementing a treatment plan with a curative focus with which they do not agree, or because they are unable to relieve suffering because of factors outside of their control (Table 5).…”

“…Unique position with patients and families because of prolonged contact (Quinn 2003, Halcomb et al 2004, Gutierrez 2005, Hov et al 2007 Being 'present' in the relationship (Sö derberg et al 1999, Kociszewski 2003, 2004, Quinn 2003, Wilkin & Slevin 2004, Gutierrez 2005, Nordam et al 2005, De Bal et al 2006, Nolan 2006, Hawley & Jensen 2007 Knowing the individual: Nature of engagement enables nurse to get to know patient (Halcomb et al 2004, Gutierrez 2005, De Bal et al 2006, Hawley & Jensen 2007 Intimate knowledge of the patient and family (Kociszewski 2003, 2004, Halcomb et al 2004, Wilkin & Slevin 2004, Nordam et al 2005, De Bal et al 2006, Nolan 2006, Hawley & Jensen 2007 Involving patients in their care:…”