Dementia care in acute hospitals—A qualitative study on nurse managers’ perceived challenges and solutions

Abstract

Aim The aim of this study was to explore the perceived challenges of nurse managers when caring for patients with dementia in acute hospitals and identify possible solutions to address these challenges. Background Although dementia care in acute hospitals is suboptimal, few solutions have been identified. Multi‐level factors need to be considered to promote changes in practice. Method Two focus groups were held with sixteen nurse managers responsible for eleven acute medical wards in Malta. Deductive qualitative analysis using an adapted version of McKinsey 7‐S model was used as an a priori framework to categorize the perceived challenges and solutions. Results The nursing managers identified a number of organizational challenges that have a direct impact on the quality of care of patients with dementia. They also suggested a number of solutions such as realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles. Conclusion This study highlight the complexity of improving dementia care in hospitals and continues to show that a system‐wide approach is needed. Implications for Nursing Management Understanding the challenges and identifying possible solutions can help hospital staff provide better person‐centred dementia care.

What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature

“…Too much emphasis was perceived and observed to be given on what staff considered as safety needs at the expense of other needs. The patient’s need for social contact and self-esteem such as dignity and respect were often ignored and this led to patients felling devalued Hospital staff have to be more aware of holistic needs of patients with dementia in acute settings and the way care is delivered in order to make up for these unmet needs, thus facilitating person-centred care 2 Scerri et al 2020, Malta [ 36 ] Explore the perceived challenges of nurse managers when caring for patients with dementia and identify possible solutions to address these challenges Qualitative study using focus groups 16 nurse managers responsible for 11 acute medical wards Challenges and possible solutions to address these challenges Organizational challenges with direct impact on the quality of care were identified. Suggested solutions were realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles The study highlights the complexity of improving dementia care in hospitals and continues to show that a system-wide approach is needed 3 …”

“…has distinguishable features and a view of the outdoors, and 2) staff's experience of the physical environment as a barrier for patient safety. Experiences and needs of patients with dementia related to the physical environment in acute hospital wards were described from the perspective of staff [25,29,[33][34][35][36] persons with dementia [28,34,46], family carers [34] and by observations [31,35]. The studies demonstrate the importance of an environment that enables independence for people with cognitive impairment by making it easier to navigate the surroundings.…”

“…The studies demonstrate the importance of an environment that enables independence for people with cognitive impairment by making it easier to navigate the surroundings. The physical environment in acute hospital wards was described as chaotic, noisy, crowded and potentially confusing for people with cognitive impairment, [29,31,35,36] and a dementia friendly design with homelike environment was highly recommended for better orientation [33]. Windows were important to orientate patients in time and space [25,34].…”

“…Windows were important to orientate patients in time and space [25,34]. Distinguishable features were needed [25,36], as some environmental conditions represented problems for patients with dementia. Bathrooms located too far from the bay area made it difficult for patients with orientation difficulties to find their way to the toilets [25].…”

“…The identified studies took, the perspective of staff, [25,29,32,33,36,40] people with dementia and informal caregivers [32,34] and included observation [32]. According to staff's experiences, the time they spent with patients with dementia made a real difference to the patients' well-being because vigilant and continual observation and assessment were crucial for the patient to experience safety, especially at night [25].…”