Understanding the everyday use of restrictive practices in the care of people living with dementia during a hospital admission: reducing inappropriate use, identifying good practice and alternative approaches to reduce risk and improve care
Award Number
NIHR132903Programme
Health and Social Care Delivery ResearchStatus / Stage
ActiveDates
22 March 2022 -24 August 2022
Duration (calculated)
00 years 05 monthsFunder(s)
NIHRFunding Amount
£1,004,511.28Funder/Grant study page
NIHRContracted Centre
The University of West LondonPrincipal Investigator
Professor Katie FeatherstonePI Contact
Katie.Featherstone@uwl.ac.ukPI ORCID
0000-0003-4999-8425WHO Catergories
Methodologies and approaches for risk reduction researchRisk reduction intervention
Disease Type
Dementia (Unspecified)CPEC Review Info
| Reference ID | 11 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | NIHR132903 |
|---|---|
| Status / Stage | Active |
| Start Date | 20220322 |
| End Date | 20220824 |
| Duration (calculated) | 00 years 05 months |
| Funder/Grant study page | NIHR |
| Contracted Centre | The University of West London |
| Funding Amount | £1,004,511.28 |
Abstract
People living with dementia are at significant risk of experiencing restrictive practices during an acute hospital admission. Restrictive practices refer to a range of practices including containment, restriction, seclusion, and restraint. A series of inquiries, NHS serious incident reviews, and media reports, all identify restrictive practices embedded within NHS ward cultures of care for older people and people living with dementia. This echoes the findings embedded within reviews examining acute care for people living with dementia and research exploring cultures of acute nursing care. These all identify a high reliance on restrictive practices in the care of people living with dementia, typically in response to perceived ‘agitation’, when viewed by staff as disruptive , and to minimise risk in the context of organisational pressures. Formal legal regimes and clinical rationales, emphasise restrictive practices to ensure safety, reduce risk, and prevent falls. However, they also take the form of a wider range of routine ward practices and cultures of control during the care of people living with dementia. Their use is associated with high levels of patient distress, increased risk of serious injury, delirium, and death. To date, no substantive empirical studies have examined the potentially significant use of routine restrictive practices in the care of people living with dementia in the acute setting. In response, the aims and objectives of this study are to examine everyday cultures of restrictive practices in the care of people living with dementia during an unscheduled acute hospital admission. By understanding the nature, rationales, and experiences of people living with dementia, their families, and ward staff, the objective is to identify evidence-based (and alternative) strategies in the care of PLWD that are achievable, safe, and transferrable. This is an ethnographic study (observation, ethnographic and in-depth interviews, documentary analysis), which will examine the organisation and delivery of everyday care people living with dementia receive within three NHS Trusts and Health Board chosen for diversity of demographic, geographic, and practice variables. Within each site, we will observe care within two acute wards where large numbers of people living with dementia are known to be admitted, and one allied dementia specialist mental health in-patient ward, where there are established expertise in the use of restrictive practices for people living with dementia when their behaviour is perceived as ‘challenging’. In total nine wards (six acute, three mental health) will be examined. During observation ethnographic interviews will be conducted with ward and dementia specialist staff, people living with dementia and their families, with further in-depth interviews with people living with dementia and their families after their discharge from hospital. Our analysis will inform the delivery of evidence-based strategies to support best practice and alternative approaches in the care of people living with dementia at ward level. We will translate the findings into open access training and NHS Service organisational interventions, which will be disseminated in collaboration with Improvement Cymru and Dementia UK.
Aims
The aims and objectives of this study are to examine everyday cultures of restrictive practices in the care of people living with dementia during an unscheduled acute hospital admission.