Inpatient care for people with dementia: implications for person-centred practice
Award Number
08/1819/222Programme
Health and Social Care Delivery ResearchStatus / Stage
CompletedDates
2 June 2008 -31 December 2009
Duration (calculated)
01 years 06 monthsFunder(s)
NIHRFunding Amount
£291,197.00Funder/Grant study page
NIHRContracted Centre
The University of NottinghamPrincipal Investigator
Professor Justine SchneiderPI Contact
justine.schneider@nottingham.ac.ukWHO Catergories
Models across the continuum of careTools and methodologies for interventions
Disease Type
Dementia (Unspecified)CPEC Review Info
| Reference ID | 80 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | 08/1819/222 |
|---|---|
| Status / Stage | Completed |
| Start Date | 20080602 |
| End Date | 20091231 |
| Duration (calculated) | 01 years 06 months |
| Funder/Grant study page | NIHR |
| Contracted Centre | The University of Nottingham |
| Funding Amount | £291,197.00 |
Abstract
The research design could be described as ‘critical ethnography’, due to the element of participation on the part of the research subjects, the ward staff, in focus groups and individual interviews. The proposed study is basically ethnographic, with data gathered primarily through participant observation, although this will be supplemented by some quantitative, contextual information and qualitative data derived from focus groups and individual interviews. We will also conduct secondary analysis of data routinely gathered in the Trust: carers’ questionnaires evaluating the wards, and Dementia Care Mapping data pertaining to the settings studied. The research will be undertaken in three different inpatient wards for older people with dementia, in the same Trust. One is in a large, teaching hospital in an urban setting (23 beds). A second has been purpose built on another site in the same city (22 beds, including a 9 bed challenging behaviour unit). The third is in a community hospital in a small, former mining town (10 beds). The sites vary in several respects. This diversity will contribute to the generalisability of our findings to other settings. Each will have a researcher working part-time as a health care assistant, across all shifts. The researcher will undertake intensive participant observation for three months, code and analyse this, then re-enter the workplace part-time for a further three months to validate the findings, and to interview staff individually (N=30) and in focus groups (up to 9). Analysis: The researchers’ data will be interpreted in the light of assessments of the care environments through dementia care mapping and carers’ questionnaires. This will be a collaborative process of analysis, which includes the academic applicants, NHS stakeholders (managers, clinicians and staff representative) carers, a representative of the local Alzheimer’s Society, and (we hope) an Inpatient Forum representative from another area. Outputs: We plan to feed back findings to the wider Trust, and to make recommendations about the recruitment, training and development, supervision and support of staff in these settings and in similar situations. We will also formulate hypotheses for further research concerning this workforce, patient care and patient/service user outcomes.
Plain English Summary
The number of people living with dementia is increasing. It is expected that over a million people in the UK will have this condition by 2021. Numbers of people with dementia who are admitted to general hospitals are also increasing with as many as one in four beds now occupied by people with dementia. Concerns have repeatedly been raised about the quality of inpatient care that people with dementia receive. Enquiries into poorly performing hospitals have highlighted the mismanagement of frail elderly people with dementia. A recent national audit of inpatient care for people with dementia found that many people do not receive a comprehensive assessment of their needs and that carers are not sufficiently involved during the admission or in planning for discharge from hospital. As a result, people with dementia often spend longer in hospital than those without this condition and are more likely to be readmitted to hospital following their discharge. In recent years efforts have been made to improve the quality of inpatient care that people with dementia receive. These efforts include better training for staff, use of specialist nurses and expansion of mental health liaison teams. Changes have also been made to the design of wards and some units have been set up that specialise in treating people with dementia. While studies based in single wards or hospitals have shown that it is possible to improve the quality of inpatient care for people with dementia, we have very little understanding of the impact of these changes at a national level and there is a pressing need to understand why some hospitals deliver more effective care to people with dementia than others. The National Audit of Dementia will be repeated in 2015/16 and we believe that this provides an ideal opportunity to address these issues. While the aim of the audit is to highlight differences in quality of inpatient care across hospitals, we believe that the data provide an important opportunity to examine which aspects of the organisation and delivery of services have an impact on the quality of care that people receive. Audit information will identify the best and worst performing hospitals and we will then interview front-line staff, managers and people with dementia and their carers in these hospitals to understand how systems and resources can be used to deliver high quality care. Plans for this project have been developed in collaboration with those who use and provide acute care for people with dementia. We will set up a project advisory group and a patient and carer reference group that will help make sure that future stages of the project also take the views of managers, clinicians, patient and carers into account. This will help ensure that our results can have a direct bearing on the way that services are managed and improved in the future. We will publicise the results of this research through papers published in journals that clinicians and service managers read. We will also send summaries of the project findings to service commissioners and representatives of Strategic Clinical Networks. The results of the study will also be used to strengthen the design of future rounds of the National Audit of Dementia and will feed into practice guidelines through the strong links we have with professional bodies and NHS England via the National Clinical Director for Dementia (who is a co-applicant on the study).
Aims
The aim of this study is to understand the experiences of staff working directly with older people with dementia in three contrasting inpatient settings. We will focus on what motivates their work and what sustains or hampers them. By interpreting these findings in relation to other perspectives (patterns of patient care, the views of relatives and standards on stress management at work) we will identify ways to improve staff wellbeing and to promote the implementation of person-centred practice. We expect also to generate testable hypotheses linking patient outcomes to staff wellbeing.