Nursing

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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, Fiona
Background: 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.
Using a systems perspective to understand hospital falls among patients with dementia
(Elsevier, 2022-09-26) Duah-Owusu White, Mary; Kelly, Fiona; Vassallo, Michael; Nyman, Samuel R.
Background Falls are a frequent event among older adults with dementia during their hospital stay. This qualitative study explores the factors contributing to falls in this population using a systems perspective. Methods Semi-structured interviews were conducted with 32 carers of patients with dementia and 20 hospital staff who worked on medical wards. Interview transcripts were analysed thematically using a systems framework. Results The themes generated from this falls research were factors related to the: patient (e.g. their physical health), carer (e.g. their ability to re-call a patient's past medical history), staff (e.g. teamwork), hospital policies (e.g. transfer of patients between wards), the hospital environment (e.g. lack of observation side rooms for infectious patients who are at risk of falls on some wards) and the use of hospital equipment (e.g. walking aid). Conclusion We recommend that future hospital falls intervention programmes need to be supported by a credible systems approach aiming to improve patient outcomes in relation to falls prevention.
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, Samuel
People 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.

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