Patients with dementia often have a poor experience of care in hospitals. Some hospitals are better than others, almost certainly, thanks to improvements in dementia-friendly hospital care, appropriate staff training and dementia awareness raising; however certain problems may persist in the best of NHS institutions.
A recent report covers detailed qualitative (ethnographic) research exploring the phenomenon of resistance, refusal or rejection of care by people living with dementia on wards on five acute NHS hospitals in England and Wales. Hospitals are places with routine-based ward cultures involving timetabled mealtimes, medication rounds, planned personal care etc. but such routine ward cultures are often found to trigger patient resistance in this patient group; commonly resulting in less than satisfactory outcomes for all parties:
“Cycles of resistance in response to organisationally mandated timetables of care can result in poor care experiences for patients, and emotional and physical burnout for staff”.
The researchers advise:
- Recognising that people living with dementia are a significant population within acute wards.
- Recognising the need to train acute staff appropriately.
- Recognising the potentially adverse impact of fixed timetables of care.
- Improving the understanding of refusal and resistance to care.
- Developing appropriate responses; reducing use of patient restraint.
- Challenging low expectations of ward staff concerning people living with dementia.
Refusal and resistance. [Online]: The Patient Experience Library, August 13th 2019.
This relates to:
Featherstone, K. Northcott, A. [and] Harden, J. [et al] (2019). Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Southampton: NIHR Journals Library / Health Services Delivery Research. March 2019; Vol.7(11).
Possibly also of interest, from members of the same team:
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Featherstone, K. Northcott, A. [and] Bridges, J. (2019). Routines of resistance: an ethnography of the care of people living with dementia in acutehospital wards and its consequences. International Journal of Nursing Studies. August 2019; Vol.96: pp.53-60.
Poorer Outcomes Arising From Hospitlisation of the Cognitively-Impaired: on Every Front?
Basic context – room for continuing improvement:
“Cognitive impairment is associated with an increased risk of adverse outcomes in hospitalised older people with an unscheduled admission, by increasing hospital mortality, extending hospital stays and increasing frequency of readmissions”.
Fogg, C. Meredith, P. [and] Culliford, D. [et al] (2019). Cognitive impairment is independently associated with mortality, extended hospital stays and early readmission of older people with emergency hospital admissions: a retrospective cohort study. International Journal of Nursing Studies. August 2019; Vol.96: pp.1-8.