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P18. Acute and hospital care

Detailed programme and abstracts

P18.1. Developing dementia-friendly hospitals in Denmark

NIELSEN Ann1, GLIPSTRUP Elsebeth2, TANNEBAEK Karen2, PETERSEN Mira Maria2, WALDEMAR Gunhild2

1Danish Dementia Research Centre, Copenhagen, Denmark, 2Danish Dementia Research Centre, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark

Background: People with dementia admitted to hospital care are at greater risk of complications. Several studies have shown increased morbidity, mortality and functional decline during hospitalization in patients with dementia.  With the aim of developing concepts for dementia-friendly hospital care in a Danish setting, we refined and tested a range of interventions within a two-year period.

Methods: Four study-sites at three hospitals were assigned to the intervention: a geriatric ward, a neurological ward and two acute wards. To improve patient safety and comfort during the hospital stay, the intervention focused on three aspects; a) education and training, b) organization of workflow and care pathways and c) environmental factors. We focused on initiatives possible to implement without or with only little additional costs. The evaluation included pre and post intervention questionnaires to staff and interviews with management, staff, patients and relatives. Pre and post intervention observations of organizational design and environmental factors were also performed. Observations and interviews prior to intervention were used to identify issues important to the intervention, whereas post intervention observations and interviews focused on the results achieved in the study period.

Results: The questionnaires and the interviews revealed that dementia-friendly initiatives were considered needed and well accepted among management, staff and relatives. The interviews and observations indicated that the following factors are important in successful delivery of dementia-friendly initiatives: 1) a multifocal approach where a shared understanding of patients with dementia works as a base for staff to improve organizational design and environmental factors, 2) a multidisciplinary approach including management on all levels and staff, 3) a shared focus on collaboration across wards in patient pathways from admission to discharge.

Conclusions: The interventions provided valuable knowledge regarding key aspects important for developing dementia-friendly hospitals. However, more studies are needed to examine the effects on quality of care.

P18.2. A matter of urgency: continence and technologies of indignity in the acute hospital setting

NORTHCOTT Andy1, FEATHERSTONE Katie2

1De Montfort University, Leicester, United Kingdom, 2Cardiff University, Cardiff, United Kingdom

Access to toilets is an essential and often urgent human need, yet within acute hospital settings becomes something frequently denied to people living with dementia. Many people living with dementia admitted to hospital are independently mobile and continent at home.  The hospital, however, is a site where a dementia diagnosis can lead to assumptions of immobility, frailty, and incontinence, and fears of risks, such as the potential for ‘falls’, and the importance of ensuring safety. This has significant impacts for people living with dementia, including the routine use of continence products, opportunities for independence denied, and the risk of developing functional incontinence during an admission. 

Within this paper we will discuss the features of the organisation and delivery of continence practices that inform these cultures of care and its consequences for people living with dementia and for ward staff. Drawing on 180 days of ethnographic research observing six wards within three hospitals (rural, urban, and metropolitan) in England and Wales, funded by the National Institute for Healthcare Research. The findings presented in this paper will examine the impacts of the timetables of bedside care, the priorities of the ward, the expectations of patients, and the communication of continence needs, all key features of ward life that inform the visibility and place of continence care within ward life. The continence practices observed had significant impacts on people living with dementia, raising serious questions about their rights and dignity during a hospital admission. 

P18.3. Cultures of care and the work of communicating the ‘rules of the ward’ to people living with dementia during a hospital admission and its consequences

FEATHERSTONE Katie1, NORTHCOTT Andy2

1Cardiff University, Cardiff, United Kingdom, 2De Montfort University, Leicester, United Kingdom

This paper examines the everyday cultures of care within hospital wards and the consequences for people living with dementia during an acute admission. It draws on a 5 year program of hospital ethnography (supported by the UK Department of Health via the National Institute for Healthcare Research) within acute wards in 8 hospitals across England and Wales, to provide a detailed examination of ward strategies and staff approaches to the care of this significant patient group at the bedside. 

Across these wards, we observed the rehearsal and duplication of a remarkably stable interactional performance during the routines of bedside care. Across these encounters, ward staff focussed on communicating the ‘rules of the ward’. The hospital ward is a site which has its own culture, and an established but unwritten set of “rules” that must be understood and learnt by all those entering it. Although these rules applied to all, we found their explicit reinforcement and emphasis in their communication to people living with dementia. A limited range of patient responses were viewed as acceptable and in accordance with these organisational rules. Failure to comply with these tacitly established rules could often have negative impacts for the person living with dementia.

We explore these ‘rules’ and their enactment and reinforcement, to provide ways of uncovering aspects of ward cultures, the social standing and understandings of people living with dementia, and the recognition and attribution of this diagnostic category during an acute admission. 

P18.4. 10 years of Alzheimer Scotland Dementia Nurse Consultants: building bridges between Scottish Government, the NHS and the charitable sector

SKINNER Helen1, MASTERS Hugh2, MCCRIMMON Tilda3

1NHS Fife, Kirkcaldy, United Kingdom, 2Alzheimer Scotland, Edinburgh, United Kingdom, 3NHS 24, Glasgow, United Kingdom

Background: Since 2011, Alzheimer Scotland, Scottish Government, and every NHS Health Board in Scotland have been collaborating to fund a Nurse Consultant (ASDNC) post focused on acute hospital care in every region in Scotland.

Aim: Through individual and collective responsibility, the key aim of the Nurse Consultants was to deliver the commitments in Scotland’s National Dementia Strategies which called for action to improve the experience of people with dementia, their families and carers in acute care and specialist dementia settings.

Objectives:

  • To implement the 10 Dementia Care Actions in Hospital;
  • To shift the paradigm of care for people with dementia in hospital settings;
  • To develop actions to reduce delayed discharges, avoidable admissions and inappropriately long stays in hospital and demonstrate impact;
  • To influence and advise on national dementia policies and strategies.

Participants/methods: This presentation draws on the key reports, achievements and impact areas of the Alzheimer Scotland Dementia Nurse Consultant group from 2015-2020, including during the COVID-19 pandemic, and sets out a dynamic action plan for future improvements. 

Key Findings: The presentation highlights:

  • The value of a co-ordinated national high-level nurse consultant group;
  • The need for a multi-pronged approach and the value of working with the 1000 Dementia Champions in Scotland;
  • The improvements to the experience of care for each of the 10 dementia care actions for hospital across the domains of Nurse Consultants: expert practice, professional leadership and consultancy, education training and development, and practice and service development;
  • The value of a specific ASDNC focus on NHS24 emergency and crisis care.

Conclusion: Whilst there is clear evidence of improvement associated with the role of the ASDNC there remain significant system challenges to reducing delayed discharges, avoidable admissions and inappropriately long stays in hospital.

P18.5. Nurses' experiences of delivering acute orthopaedic care to patients with dementia

JENSEN Anders Møller1, HOUNSGAARD Lise2, WILSON Rhonda3, PEDERSEN Birthe2, OLSEN Rolf4

1VIA University College, Holstebro, Denmark, 2University of Southern Denmark, Odense, Denmark, 3The University of Newcastle, Ourimbah, Australia, 4-, Odense, Denmark

Background and aim: Nurses who care for acute patients with dementia in a hospital setting report a variety of challenges in regard to meeting the complex needs of their patients, but little attention have been given to care in the orthopaedic wards. This study investigates nurses’ experiences of caring for people with dementia, in an acute orthopaedic hospital ward setting.

Methods: This qualitative study employs hermeneutic phenomenological research methods. Eight Danish nurses were interviewed in an orthopaedic ward about their experiences in caring for orthopaedic patients with dementia. Nurses with various levels of expertise were selected for interview so that a full range of nursing experiences could inform the research study. The interviews followed an intense participant observation period at the ward.

Results: The results of the study revealed two major themes: “Nurse communication and patient information” and “Care compromise”, with three and four sub‐themes, respectively. These findings are used to illustrate how, and why, nurses’ experiences of caring for patients with dementia contribute a discontentment and negative preconceived perception by some nurses towards their acute care of patients with dementia. The results are discussed in the context of Interactional Nursing Practice theory and describe the challenges experienced by acute care orthopaedic nurses who care for patients with dementia.

Conclusion: Orthopaedic nurses find it challenging and professionally difficult to provide person‐centred care for patients with dementia during an acute orthopaedic hospital admission. Orthopaedic nurses should work to adopt a positive attitude, and person‐centred approach, towards dementia care. It is also recommended that the electronic patient record should be supplemented by oral dissemination to some extent, as information, plans of action and knowledge about the care situation for patients with dementia tends to drown in chronological data presentation.

 

 
 

Last Updated: Tuesday 30 June 2020

 

 
  • Acknowledgements

    The 30th AE Conference received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe gratefully acknowledges the support of all conference sponsors.
  • European Union
  • Roche
 
 

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