Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
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Item Understanding the hospital discharge planning process for medical patients with dementia(Informa UK Limited, 2023-10-21) Duah-Owusu White, Mary; Kelly, Fiona; Vassallo, Michael; Nyman, Samuel R.Background: Poor hospital discharge processes can result in the readmission of patients and potentially increase the stress levels of carers. Therefore, this study sought to understand the factors related to the discharge planning process for patients with dementia. Methods: The researchers interviewed 32 carers of patients with dementia and 20 hospital staff who worked on medical wards in a United Kingdom (UK) hospital. The semi-structured interviews were analysed thematically using a systems theory (patient–carer–staff relationships, hospital equipment and policies). Results: The findings indicated that the following factors could either have a positive or negative impact on discharge planning: patient (e.g. cognitive capacity), carer (e.g. preconceived ideas about care homes), staff (e.g. communication skills), policy (e.g. procedures such as discharge meetings), equipment (e.g. type of service provider delivering the equipment) and the wider social context (e.g. availability of specialist dementia beds in care homes). Conclusion: It is important for hospital staff to adopt a systems perspective and to integrate the different elements of the hospital system when planning for patients’ discharge.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 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 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 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 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.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 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.