Delivering dementia care differently—evaluating the differences and similarities between a specialist medical and mental health unit and standard acute care wards: a qualitative study of family carers’ perceptions of quality of care

Abstract

ObjectivesTo examine in depth carers’ views and experiences of the delivery of patient care for people with dementia or delirium in an acute general hospital, in order to evaluate a specialist Medical and Mental Health Unit (MMHU) compared with standard hospital wards. This qualitative study complemented the quantitative findings of a randomised controlled trial.DesignQualitative semistructured interviews were conducted with carers of patients with cognitive impairment admitted to hospital over a 4-month period.SettingA specialist MMHU was developed in an English National Health Service acute hospital aiming to deliver the best-practice care. Specialist mental health staff were integrated with the ward team. All staff received enhanced training in dementia, delirium and person-centred care. A programme of purposeful therapeutic and leisure activities was introduced. The ward environment was optimised to improve patient orientation and independence. A proactive and inclusive approach to family carers was encouraged.Participants40 carers who had been recruited to a randomised controlled trial comparing the MMHU with standard wards.ResultsThe main themes identified related closely to family carers’ met or unmet expectations and included activities and boredom, staff knowledge, dignity and fundamental care, the ward environment and communication between staff and carers. Carers from MMHU were aware of, and appreciated, improvements relating to activities, the ward environment and staff knowledge and skill in the appropriate management of dementia and delirium. However, communication and engagement of family carers were still perceived as insufficient.ConclusionsOur data demonstrate the extent to which the MMHU succeeded in its goal of providing the best-practice care and improving carer experience, and where deficiencies remained. Neither setting was perceived as neither wholly good nor wholly bad; however, greater satisfaction (and less dissatisfaction) with care was experienced by carers from MMHU compared with standard care wards.

Patients’ experiences of in-hospital care when nursing staff were engaged in a practice development programme to promote person-centredness: A narrative analysis study

“…Despite data indicating the presence of shared clinical decision making forums in the hospital wards, the patients in our study found that they were denied an active role in reaching decisions about issues that were important to them. Research conducted by Spencer et al (2013) indicates the value that patients and family carers place on opportunities for active engagement and involvement in hospital care. Failures of the ward staff to share information with the patients in our study provoked feelings of frustration.…”

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

“…Seven 72,92,102,125,132,148,162 were qualitative studies, one 107 was a mixed study including a review and a qualitative study, three 93,99,153 were reviews and two 20,94 were questionnaire studies. Three studies 20,94,102 focused on people with dementia and diabetes, two 72,93 focused on those with dementia and VI, one 89 looked at those with dementia and deafness, one 92 focused on those with dementia and cancer, two 148,153 looked at family carers' views on medication management and four 99,107,125,132 looked at the needs of people with dementia in general hospitals. Literature on the experiences of older people with dementia in acute general hospitals has highlighted shortcomings in the care provided, the attitudes and training of staff, and the physical environment and problems with care cultures.…”

Comorbidity and dementia: a scoping review of the literature

“…Six were qualitative [27,37,54,62,70], one was a mixed study including a review and qualitative study [42], two were reviews [28,34] and two were questionnaire studies [29,47]. Three studies focused on people with dementia and diabetes [29,37,47], two visual impairment [28,54], one deafness [24], one cancer [27] and four on the needs of people with dementia in general hospitals [34,42,62,70].…”