Low investment non-pharmacological approaches implemented for older people experiencing responsive behaviours of dementia

Abstract

Introduction The acute care setting is not ideal for older people with dementia; responsive behaviours may be triggered when care is delivered within a strange environment by staff with limited knowledge of life history and personal preferences. Responsive behaviours (e.g., yelling, hitting, restlessness) are used by older people with dementia to communicate their needs and concerns. It is unknown whether non-pharmacological approaches used by nurses support the development of a meaningful interpersonal relationship between nurses and older people with dementia. Aims: The aims of this study were to explore: (a) the types of low investment non-pharmacological approaches (e.g., music, social activities) used by nurses caring for older people experiencing responsive behaviours of dementia in acute medical settings and (b) the factors that influence the decisions of these nurses to implement these approaches. Methods We present a qualitative secondary analysis of data from a primary study using Thorne’s interpretive description approach. Interviews were conducted with 11 nurses and four allied health professionals from acute medical settings in Canada. A qualitative secondary data analytic approach was used, specifically analytic expansion, and experiential thematic analysis. Findings: egardless of the educational preparation of nurses, the decision to use specific types of low investment non-pharmacological approaches were influenced by the perfunctory development of the interpersonal relationships in acute care hospitals. The factors that led nurses to use limited approaches (e.g., turning on the TV and providing a newspaper) were lack of dementia care education and attending to other acutely ill clients. Conclusions: This study revealed that nurses in acute medical settings require greater practice growth to deliver relational care which is crucial to supporting older people with dementia. Nurses need education and knowledge translation support to use creative low investment non-pharmacological approaches with the intent on upholding the quality of life older people with dementia.

Implementing Gentle Persuasive Approaches dementia education for staff on in-patient medicine units: A program evaluation

“…These are all general communication strategies taught in first year training courses, rather than dementia-specific competencies. A small number of participants realised it was important to repeat requests more than once, use short and simple phrases, and offer explanations, offer choice, and involve the patient directly in care activities, as explicated in dementia communication and activity guidelines published for many years but have become part of professional vernacular to the degree that these terms are meaningless and indiscernible in practice ( Nissenboim & Vroman, 1998 ; Rau, 1993 ; Yous, Ploeg et al, 2020a ; Yous, Schindel Martin et al, 2020b ; Zgola, 1999 ).…”

“…Sessions during which GPA techniques can be reviewed and reinforced by in-house GPA certified coaches will be important for the sustainability of GPA knowledge and best practice skills in the future. This is particularly important given prior studies showing that improvements in person-centred dementia care practice often are not sustained long-term without regular reinforcement of training ( Yous, Ploeg et al, 2020a ; Yous, Schindel Martin et al, 2020b ). Lastly, provision of equipment to engage patients experiencing responsive behaviours in preferred activities would be useful for staff in acute hospital settings.…”

“…Lastly, provision of equipment to engage patients experiencing responsive behaviours in preferred activities would be useful for staff in acute hospital settings. Activities such as these mitigate boredom from social isolation and a program wherein volunteers facilitate such activities using purchased equipment would provide staff and families with the means to provide non-pharmacological interventions ( Yous, Ploeg et al, 2020a ; Yous, Schindel Martin et al, 2020b ).…”

“…Despite a growing body of knowledge about best practices supporting patients with responsive behaviours ( Legere et al, 2017 ; Livingston et al, 2014 ), few hospital staff receive formal education on aetiologies of and strategies for responding to responsive behaviours ( Doherty & Collier, 2009 ; Fessey, 2007 ; Turner et al, 2017 ). Consequently, when patients experience responsive behaviours, staff provide a limited set of effective supports ( Yous, Ploeg et al, 2020a ; Yous, Schindel Martin et al, 2020b ).…”

Performing One-Session Cognitive Stimulation to Interact with Patients with Dementia in a Hospital for Mood Improvement: A Retrospective Single-Arm Cohort Study

“…Hospitals are not equipped to provide the best care for patients with dementia [7]. Therefore, developing support and a friendly environment for patients with dementia in hospitals is important [8].…”