Medication and care in Alzheimer’s patients in the acute care setting: A qualitative analysis

Abstract

The acute hospital admission of patients with dementia is associated with poor outcome and higher costs. Much of our knowledge on how hospital stays are experienced by patients and staff is generated from short and fragmented data collections, in which the significance of knowledge about day-to-day care might be overlooked, and might partly explain why the poor outcome for this group of patients is not fully understood. This study used participant observation to follow patients with Alzheimer's disease admitted to orthopaedic wards after fall incidents. To gather longitudinal data, patients were followed during day and evening shifts, from admission to discharge. The data were interpreted from a phenomenological-hermeneutic perspective, inspired by Ricoeur's interpretation theory. The data showed that, despite having little specific knowledge about dementia care, staff were able to gather information about the patient's needs and wishes relevant to administrating medicine in a person-centred way. However, much of this valuable information was lost between shifts or became hidden among the overwhelming amount of information in electronic patient records. As a consequence, much of the knowledge about individual patients' needs and wishes had to be collected all over again at every shift. The study concludes that careful handover of information on person-centred dementia care can play an important role in making hospital stays more dementia-friendly.

Nurses’ experiences of delivering acute orthopaedic care to patients with dementia

“…The nurses invited to the group interviews were purposefully selected because they were identified as frequently involved in caring for patients with dementia during the previous patient observational study (Jensen, Pedersen, Olsen, & Hounsgaard, ; Jensen, Pedersen, Olsen, Wilson, & Hounsgaard, ). Therefore, the number of nurses with relevant experiences for this study is few; however, their experiences provide rich data relevant to the topic under investigation.…”

“…This study was embedded within a wider study Jensen et al (, ). While it is possible that our prior knowledge derived from other study phases may have influenced analysis, we consider that this is mitigated with the primary investigator and data collector for the study who was from the public health discipline.…”

The experiences of hospital staff who provide care for people living with dementia: A systematic review and synthesis of qualitative studies

“…Despite many examples of good care, prioritised papers predominantly reported that the care provided was seen as being in opposition to good care, because of priorities imposed by wards or institutions, insufficient time or knowledge about dementia and/or limited personal knowledge of a Plwd (Berg et al, 1998;Bryon et al, 2010;Byers & France, 2008;Carr et al, 2011;Clissett et al, 2014;Digby et al, 2018;Dowding et al, 2016;Edvardsson et al, 2012;Goldberg et al, 2014;Jensen et al, 2017;Nilsson et al, 2016;Norman, 2006). However, one study (Bailey, Scales, Lloyd, Schneider, & Jones, 2015) demonstrated the complexities of characterising care, arguing against the use of dichotomised concepts, and another study suggested that connections between staff and Plwd occurred along a continuum (Kelley et al, 2019).…”

“…[Clinical Nurse Consultant, p421, author edits] (Moyle et al, 2011) A number of studies found that systems for sharing information that fostered PCC such as personal preferences and backgrounds of Plwd, and individual approaches to managing responsive behaviour, were non-existent, were not consistently maintained (Dowding et al, 2016;Jensen et al, 2017;Nilsson et al, 2013Nilsson et al, , 2016 or were difficult to access, I don't think we have a set heading that we document beneath. Instead you have to search in the text if you want to get information about the patient's cognition.…”

“…I have certainly walked out of showers and felt 'no way, someone else needs to take over.' [Nurse,p52] (Nilsson et al, 2016) Staff:patient ratios and ward expectations of staff often underestimated the complex care Plwd needed, and meant that staff sometimes experienced conflicting priorities (Bailey et al, 2015;Bryon et al, 2010;Jensen et al, 2017) and/or did not have enough time to provide good care (Byers & France, 2008;Clissett et al, 2014;Nilsson et al, 2016). This could cause frustration and distress, I'm starting to take care of my patients the way the hospital is dictating to me to take care of them because that is the way it is.…”