Browsing by Person "Kelly, Fiona"
Now showing 1 - 20 of 24
- Results Per Page
- Sort Options
Item A narrative review of staff views about dementia care in hospital through the lens of a systems framework(SAGE Publications, 2022-12-29) Duah-Owusu White, Mary; Kelly, FionaBackground: Significant numbers of people with dementia are admitted into acute settings. They are likely to face poor health outcomes during hospitalisation. There is the need to fully understand the care provided to people with dementia through novel methods such a systems approach (i.e. human interactions, policy, environment and equipment). Aim: The aim of this literature review is to explore hospital practitioners’ views on dementia care and to analyse findings using a systems approach. Methods: We conducted a narrative review of primary studies that examined dementia care in acute settings. We analysed a total of 33 papers using Thomas and Harden’s thematic synthesis guidelines. Results: Thirty-three papers met the inclusion criteria for the review. The findings were as follows: (1) staff-patient relationships (e.g. coping with difficult behaviour), (2) staff–family relationships (e.g. the benefits of involving families in patient care), (3) staff–staff relationships (e.g. building a robust multidisciplinary team), (4) staff–patient care decisions (e.g. decisions directly related to the patient), (5) the environment (e.g. difficulty in adjusting to the hospital environment), (6) policies (e.g. hospital bureaucratic processes) and (7) equipment (e.g. pain assessment tools). Conclusion: The paper revealed multidimensional challenges in the provision of dementia care within hospitals. We conclude that training programmes, hospital policies and processes aimed at improving outcomes for patients with dementia should adopt a systems approach which focuses on the relational, environmental, procedural and instrumental aspects of the hospital system.Item Can a systems approach reduce adverse outcomes in patients with dementia in acute settings? (innovative practice)(SAGE, 2017-11-03) Duah-Owusu White, Mary; Vassallo, Michael; Kelly, Fiona; Nyman, SamuelPeople with dementia experience adverse outcomes such as pressure sores during their stay in acute hospitals. The application of a systems approach in an acute setting places an emphasis on the patient's journey in addition to the organisational factors that are present within a hospital context. This article draws upon principles obtained from a theoretical model, which was extracted from the work of Edwards (1972), Hawkins (1987) and Zecevic et al. (2007), in order to illustrate how the application of a novel systems approach (human interaction, environment, equipment and policy) could be used in acute hospital settings to reduce adverse health outcomes by using an imaginary patient with dementia.Item The context, mechanisms and outcomes of intergenerational programmes involving people living with dementia in Scotland: A realist, qualitative study(SAGE Publications, 2025-02-13) Emond, Heather; Kelly, FionaIntergenerational programmes, involving activity-based interventions designed to promote mutually beneficial interactions between participants, have been used in Scotland and further afield as a means of generating social inclusion between different age groups. There is growing interest in the potential outcomes of intergenerational programmes for people living with dementia in particular, with policy in Scotland recognising that people living with dementia and their carers may be at greater risk of loneliness and social isolation. Given this interest, there is a need to explore what ‘intergenerational best practice’ may look like for people living with dementia. Using data from semi-structured interviews with thirteen stakeholders involved in intergenerational practice and/or dementia policymaking, this study explored the contextual factors, mechanisms, and outcomes of intergenerational programmes in the Scottish context. Stakeholders perceived the concerns of carers, perceptions of risk, along with inaccessible venues and transportation to be important contextual factors. Mechanisms that helped ensure programmes offered full and appropriate participation opportunities included ongoing, flexible programme planning; the provision of purpose and roles; and the use of older participants’ preferences, lived experience, and personhood. Overall intergenerational programmes were perceived to have the potential to promote beneficial outcomes for older participants living with dementia in Scotland.Item Coproduction of knowledge for practice through a participatory action research and process evaluation project (Lydia Osteoporosis Project 2, LOP 2)(BioMed Central, 2018-08-17) Smith, Margaret Coulter; Schrag, Anthony; Kelly, Fiona; Pearson, Claire; Bacigalupo, AlisonBackground - Participatory action research (PAR) is active, collaborative and seeks to develop knowledge from everyday occurrences (Reason and Bradbury 2013). A creative movement workshop developed from the Lydia Osteoporosis PAR Project 2 (LOP 2) and enabled volunteer local research collaborators and participants to articulate new practice knowledge.Item Designing a Spoken Dialogue Interface to an Intelligent Cognitive Assistant for People with Dementia(Sage, 2015-08-14) Wolters, Maria; Kelly, Fiona; Kilgour, JonathanIntelligent cognitive assistants support people who need help performing everyday tasks by detecting when problems occur and providing tailored and context-sensitive assistance. Spoken dialogue interfaces allow users to interact with intelligent cognitive assistants while focusing on the task at hand. In order to establish requirements for voice interfaces to intelligent cognitive assistants, we conducted three focus groups with people with dementia, carers, and older people without a diagnosis of dementia. Analysis of the focus group data showed that voice and interaction style should be chosen based on the preferences of the user, not those of the carer. For people with dementia, the intelligent cognitive assistant should act like a patient,encouraging guide, while for older people without dementia, assistance should be to the point and not patronising. The intelligent cognitive assistant should be able to adapt to cognitive decline.Item Dichotomising dementia: Is there another way?(Wiley, 2017-06-30) McParland, Patricia; Kelly, Fiona; Innes, Anthea; Higgs, Paul; Gilleard, ChrisThis article discusses the reduction of the complex experience of dementia to a dichotomised ‘tragedy’ or ‘living well’ discourse in contemporary Western society. We explore both discourses, placing them in the context of a successful ageing paradigm, highlighting the complex nature of dementia and the risks associated with the emergence of these arguably competing discourses. Specifically, we explore this dichotomy in the context of societal understandings and responses to dementia. We argue for an acceptance of the fluid nature of the dementia experience, and the importance of an understanding that recognises the multiple realities of dementia necessary for social inclusion to occur. Such an acceptance requires that, rather than defend one position over another, the current discourse on dementia is challenged and problematised so that a more nuanced understanding of dementia may emerge; one that fully accepts the paradoxical nature of this complex condition.Item Dichotomising dementia: is there another way?(John Wiley & Sons Ltd, 2017-02-08) McParland, Patricia; Kelly, Fiona; Innes, AntheaThis article discusses the reduction of the complex experience of dementia to a dichotomised 'tragedy' or 'living well' discourse in contemporary Western society. We explore both discourses, placing them in the context of a successful ageing paradigm, highlighting the complex nature of dementia and the risks associated with the emergence of these arguably competing discourses. Specifically, we explore this dichotomy in the context of societal understandings and responses to dementia. We argue for an acceptance of the fluid nature of the dementia experience, and the importance of an understanding that recognises the multiple realities of dementia necessary for social inclusion to occur. Such an acceptance requires that, rather than defend one position over another, the current discourse on dementia is challenged and problematised so that a more nuanced understanding of dementia may emerge; one that fully accepts the paradoxical nature of this complex condition.Item Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach(BioMed Central, 2015-04-21) Dawson, Alison; Bowes, Alison; Kelly, Fiona; Velzke, Kari; Ward, RichardBackground This paper synthesises research evidence about the effectiveness of services intended to support and sustain people with dementia to live at home, including supporting carers. The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards. However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes. Methods Systematic searches of relevant electronic bibliographic databases crossing medical, psychological and social scientific literatures (CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science) in November 2012 were followed by structured review and full-text evaluation processes, the latter using methodology-appropriate quality assessment criteria drawing on established protocols. Results Of 131 publications evaluated, 56 were assessed to be of 'high' quality, 62 of 'medium' quality and 13 of 'low' quality. Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence conclusions Thematic analysis revealed multiple gaps in the evidence base, including in relation to take-up and use of self-directed support by people with dementia, use of rapid response teams other multidisciplinary approaches, use of technology to support community dwelling people with dementia, and support for people without access to unpaid or informal support.Item Haven: Sharing receptive music listening to foster connections and wellbeing for people with dementia who are nearing the end of life, and those who care for them(Sage, 2018-10-11) Garabedian, Claire E.; Kelly, FionaThis paper reports on research exploring the effects of music played for 12 dyads: a care home resident (‘resident’) with dementia and someone closely connected to him/her (‘carer’). Six individualised music interventions (3 live and 3 pre-recorded) were played by the first author on solo cello within five Scottish non-NHS care homes. All interventions were video-recorded. Semi-structured interviews with carer participants, key staff, and managers explored their responses to interventions. Thick descriptions of video recordings and interview transcripts were thematically coded using Nvivo. A key finding was that structural elements of the interventions combined with characteristics of the music played facilitated an internalised experience of ‘haven’; sonically transporting listeners away from their present reality and fulfilling the basic human needs for inclusion, comfort, identity, occupation and attachment.Item How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review(BMC, 2022-04-22) Marulappa, Nidhi; Anderson, Natalie N.; Bethell, Jennifer; Bourbonnais, Anne; Kelly, Fiona; McMurray, Josephine; Rogers, Heather L.; Vedel, Isabelle; Gagliardi, Anna R.Background: Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Methods: We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. Results: We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. Conclusion: Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture.Item I want to feel at home': establishing what aspects of environmental design are important to people with dementia nearing the end of life(BioMed Central, 2015-05-12) Fleming, Richard; Kelly, Fiona; Stillfried, GillianBackground: The design of environments in which people with dementia live should be understandable, reinforce personal identity and maintain their abilities. The focus on supporting people with dementia to live well has omitted considering the needs or wishes for a supportive physical environment of those who are nearing the end of their lives. Using a combination of focus groups and a Delphi survey, this study explored the views of people with dementia, family carers and professionals on what aspects of the physical environment would be important to support a good quality of life to the very end. Methods: Three focus groups were carried out in three cities along the East Coast of Australia using a discussion guide informed by a literature review. Focus groups comprised recently bereaved family carers of people with dementia (FG1), people with dementia and family carers of people with dementia (FG2) and practitioners caring for people with dementia nearing or at the end of their lives (FG3). Focus group conversations were audio-recorded with participants' consent. Audio files were transcribed verbatim and analysed thematically to identify environmental features that could contribute to achieving the goal of providing a comfortable life to the end. A list of design features derived from analysis of focus group transcripts was distributed to a range of experts in the dementia field and a consensus sought on their appropriateness. From this, a set of features to inform the design of environments for people with dementia nearing the end of life was defined. Results: Eighteen people took part in three focus groups: two with dementia, eleven current or recently bereaved family carers and five practitioners. There were differences in opinion on what were important environmental considerations. People with dementia and family carers identified comfort through engagement, feeling at home, a calm environment, privacy and dignity and use of technology to remain connected as important. For practitioners, design to facilitate duty of care and institutional influences on their practice were salient themes. Twenty one experts in the dementia field took part in the survey to agree a consensus on the desirable features derived from analysis of focus group transcripts, with fifteen features agreed. Conclusions: The fifteen features are compatible with the design principles for people with dementia who are mobile, but include a stronger focus on sensory engagement. We suggest that considering these features as part of a continuum of care will support good practice and offer those with dementia the opportunity to live well until the end and give their families a more positive experience in the last days of their lives together.Item “Like A Dance”: Working creatively with healthcare practitioners to explore mobility and osteoporosis(Intellect, 2019-12-01) Smith, Margaret Coulter; Schrag, Anthony; Kelly, Fiona; Pearson, ClaireCollaborations between health sciences and creative arts can generate insights into complex health phenomena. This article describes a creative workshop derived from an action research project that aimed to raise awareness of fracture risk in health practitioners supporting people with Osteoporosis. The creative workshop aimed to provide opportunities for practitioners within the action research community to create new knowledge as well as share their practice insights. The article considers the notion of creative arts as a physical, embodied process that can facilitate learning by enabling tacit knowledge to be made explicit. Rather than applying an instrumental approach to arts within healthcare, the workshop became a mechanism for the convergence of ideas, disciplines and support structures and provided a learning environment where old beliefs could be challenged, practice insights shared and new knowledge constructed. We discuss the workshop development and outputs and suggest the utility of this approach for collaborative learning.Item Living with dementia in hospital wards: a comparative study of staff perceptions of practice and observed patient experience(Wiley, 2016-01-20) Innes, Anthea; Kelly, Fiona; Scerri, Charles; Abela, StephenAims and objectives. To ascertain the experiences, attitudes and knowledge of staff working in two Maltese hospital wards and the observed experiences of people with dementia living there. To examine the impact of recommendations made in October 2011 for improving the psychosocial and physical environments of the wards 1 year later. Background. There is an increasing policy recognition of the need for a better trained and educated dementia care workforce and of ensuring that the environmental design of care settings meets the needs of people with dementia. Design and methods. At both time points, three established and validated data collection methods evaluated (i) staff/patient interaction and patient experience, (ii) the extent to which the wards met dementia friendly principles and (iii) staff views about their work environment and their perceptions about their practice. Sixteen (five male and 11 female) patients with dementia and 69 staff in the two wards participated in the study. Results. We noted small but important changes; however, the physical and psychosocial environments of the wards did not always align to current recommendations for dementia care, with staff perceptions of care delivery not always reflecting the observed experiences of care of those living with dementia. Conclusions. Comparing staff questionnaire data with observational methods offered a unique opportunity to understand multiple perspectives in a complex hospital setting. Incorporating these perspectives into staff and management feedback allowed for recommendations that recognised both patient-centred values and staff constraints.Item Pain assessment and management in care homes: Understanding the context through a scoping review(BMC, 2021-07-18) Pringle, Jan; Mellado, Ana Sofia Alvarado Vázquez; Haraldsdottir, Erna; Kelly, Fiona; Hockley, JoBackground: Internationally, 2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the contexts that might influence its management. Methods: Scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment and/or management, for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were also screened, and website searches carried out of key organisations. Conversations with 16 local care home managers were included to gain an understanding of their perspective. Results: Inclusion criteria were met by 109 studies. Three overarching themes were identified: Staff factors and beliefs - in relation to pain assessment and management (e.g. experience, qualifications) and beliefs and perceptions relating to pain. Pain assessment – including use of pain assessment tools and assessment/management for residents with cognitive impairment. Interventions - including efficacy/effects (pharmaceutical/non pharmaceutical), and pain training interventions and their outcomes. Overall findings from the review indicated a lack of training and staff confidence in relation to pain assessment and management. This was particularly the case for residents with dementia. Conclusions: Further training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way.Item Research and education to understand fire risks associated with dementia: A collaborative case study (innovative practice)(SAGE, 2018-08-01) Heward, Michelle; Kelly, FionaThis article reports on outcomes from the evaluation of a collaborative project between a University and a Fire and Rescue Service where research and education were developed to inform understanding of fire risks associated with dementia. Project outcomes were determined using a mixed-methods approach (survey, reports, statistics, case studies, course evaluation forms). Main outputs were a research report that identified dementia-specific fire risks and safety strategies, and an education package for Fire and Rescue Service staff and volunteers. The evaluation demonstrates the value of collaborative partnerships to develop understanding of risks pertinent to particular vulnerable groups and research-informed education.Item Review: Family perceptions of care at the end of life in UK nursing care homes(SAGE, 2018-02-15) Kelly, FionaItem Scaffolding and working together: a qualitative exploration of strategies for everyday life with dementia(Oxford University Press, 2017-12-20) McCabe, Louise; Robertson, Jane; Kelly, FionaBackground: Living with dementia has been described as a process of continual change and adjustment, with people with dementia and their families adopting informal strategies to help manage everyday life. As dementia progresses, families increasingly rely on help from the wider community and formal support. Methods: This paper reports on a secondary analysis of qualitative data from focus groups and individual interviews with people with dementia and their carers in the North of England. In total 65 people with dementia and 82 carers took part in the research: 26 in interviews and 121 in focus groups. Focus group and interview audio recordings were transcribed verbatim. A qualitative, inductive, thematic approach was taken for data analysis. Findings: The paper applies the metaphor of scaffolding to deepen understanding of the strategies used by families. Processes of scaffolding were evident across the data where families, communities, professionals and services worked together to support everyday life for people with dementia. Within this broad theme of scaffolding were three sub-themes characterising the experiences of families living with dementia: doing things together; evolving strategies; and fragility and fear of the future. Conclusions: Families with dementia are resourceful but do need increasing support (scaffolding) to continue to live as well as possible as dementia progresses. More integrated, proactive work is required from services that recognises existing scaffolds and provides appropriate support before informal strategies become unsustainable; thus enabling people with dementia to live well for longer.Item A social citizenship lens to describe one person’s experience of living with dementia in Scotland(Dunedin Academic Press, 2019-10-24) McKillop, J.; Kelly, Fiona; Nedlund, Ann-Charlotte; Bartlett, Ruth; Clarke, CharlotteItem Technologies to support community-dwelling persons with dementia: an INTERDEM position paper on issues regarding development, usability, (cost-) effectiveness, deployment and ethics(JMIR Publications, 2017-01-16) Meiland, F.; Innes, A.; Mountain, G.; Robinson, L.; van der Roest, H.; Garcia-Casal, A.; Gove, D.; Rene Thyrian, J.; Evans, S.; Droes, R.; Kelly, Fiona; Kurz, A.; Casey, D.; Szczesniak, D.; Denning, T.; Craven, M.; Span, M.; Felzmann, H.; Tsolaki, M.; Franco-Martin, M.Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit.Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies;barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.Item The nourishing soil of the soul-: The role of horticultural therapy in promoting well-being in community-dwelling people with dementia(Sage, 2015-12-23) Noone, Sarah; Innes, Anthea; Kelly, Fiona; Mayers, AndyTwo-thirds of people with dementia reside in their own homes; however, support for community dwelling people with dementia to continue to participate in everyday activities is often lacking,resulting in feelings of depression and isolation among people living with the condition. Engagement in outdoor activities such as gardening can potentially counteract these negative experiences by enabling people with dementia to interact with nature, helping to improve their physical and psychological well-being. Additionally, the collaborative nature of community gardening may encourage the development of a sense of community, thereby enhancing social integration. Despite increasing evidence supporting its therapeutic value for people with dementia in residential care, the benefits of horticultural therapy have yet to be transposed into a community setting. This paper will examine the theoretical support for the application of horticultural therapy in dementia care, before exploring the potential of horticultural therapy as a means of facilitating improved physical and psychological well-being and social integration for people living with dementia within the community.