Results
Lack of Knowledge and Training.
The knowledge and training of healthcare workers on dementia care are vital in the provision of evidence-based practice. Cowdell(2010) undertook a qualitative study based on an ethnographic approach in exploring the experiences of patients and nursing staff regarding the care received by older people in an acute setting. The data collection was often undertaken from three wards providing specialist and critical care to older people in the South of England. The finding highlighted a lack of training and knowledge among healthcare workers regarding dementia care. Notably, the nurses relied on personal philosophies, lacked skills, and were unattracted to care for dementia. Additionally, the study emphasized that nurses were only confident in providing physical care but were short in skills concerning providing psychological care. Due to the inadequacy in the scope of the skillset of the nurses, the patients had unpleasant hospital experience as they were not assisted with personal hygiene and were uncertain about their future.
Additionally, Byers and France(2008) undertook qualitative research based on a hermeneutic phenomenological approach. The study assessed the experience of a nine registered nurse in caring for dementia in an acute setting. The survey findings highlighted incidences of frustrations and exhaustion among the registered nurse as occasioned by staff constraints, lack of knowledge on how to handle complex needs of dementia, and a feeling of pity among the nurses when they fail to provide the necessary care. Additionally, the study indicated frustration and experience in their care of dementia often grew extended to their family, an aspect that is not pleasant and can lead to family disability.
Houghton et al. (2016) undertook literature reviews of nine studies based on a secondary research approach. The study sought to explore the experiences and perceptions of healthcare workers regarding the care for adult dementia patients in acute settings. The findings indicated that acute settings had healthcare workers who lacked the appropriate training and knowledge of administering all the aspects of physical, medical, and psychological care to dementia patients, thereby making acute care setting an inappropriate place for the care of dementia. Similarly, the findings indicated stereotyping of patients with dementia and inadequate resources available that inhibits healthcare staff’s ability to provide holistic and evidence-based care for the elderly with dementia conditions. These findings were in congruence with a qualitative secondary study that sought to describe nurses’ experience in an acute care setting for adult dementia patients(Pinkert et al., 2017). The findings have shown that the nurses were uncertain of the care approaches and diagnostic tests for patients with dementia. The nurses had no experience in working with dementia patients and often attempted to alter routines in adjusting to dementia care. Moreover, the nurse reported that they had no education and skills in dementia care and felt insecure
in their care and interaction with people suffering from dementia.
Further still, a Fukuda et al. (2015) undertook primary qualitative research using focused group interviews in exploring the challenges faced by nurses in providing care to patients with dementia in acute hospital settings. The findings indicated that the nurses lacked the communication skill of addressing dementia patients regarding their care. They were also inadequate in terms of experience and training in caring for dementia. conNotably, in understanding the symptoms of dementia among their patients. The healthcare workers feel conflicted due to the short time provided for exercising the nursing care that has the potential to erode effective communication between the patients and their families. The confliction harmed the practicing collaborative care that is a vital ingredient in patient-centered and individualized attention.
Additionally, Clearly and Doody(2016), undertook primary research applying a qualitative phenomenological approach in investigating the experience of nurses in the care of elderly dementia patients with intellectual disability. The study employed a semi-structured interview and audio recording data from a purposed sampled research participant. The study results showed that healthcare workers had difficulty understanding the signs and symptoms of dementia in people with intellectual disabilities. Eriksson and Saveman(2002), undertook a primarily qualitative study based on phenomenology hermeneutics. The study sought to describe the experience and difficulties associated with care to dementia patients. The study finding amplified the lack of knowledge and time by the nurse in undertaking appropriate cate to the dementia patients. The results also indicated that lack of resources in the support in the care of dementia leaves the nurses helpless in advancing their skills and knowledge in administering effective care to the dementia patients. Finally, Edberg et al. (2008) undertook a focused group qualitative study across Sweden, UK, and Australia in exploring the experience of strain among the nursing staff in their care for dementia patients. The findings indicate that even though nurses often strive to give their best to enhance the quality of care for dementia patients, lack of knowledge in psychological care for dementia significantly impedes the quality of their care they can achieve. Similarly, poor management support deterred their goal of making holistic care to dementia patients.
These findings from the various studies discussed were incongruence that lack of knowledge and training significantly impacts the nurses in recognition symptoms. It also heightened the nurses’ challenges in offering appropriate diagnosis, prescription of necessary intervention, impedes communication with patients, providing psychological care, and overall eroding the quality of their care. Though physical treatment and medical treatments are equally important for patients with dementia, psychological treatment is a very vital aspect in enhancing effective care. Despite the robust methodological choice by the various studies reviewed, there is inadequacy of primary qualitative studies testing and evaluating the causal relationship between the multiple factors affecting knowledge and training and their impacts on the quality of care to dementia patients. This shortcoming often eliminated through undertaking primary research that has the capability of testing the level of statistical significance of the various research variables discussed and how their confounding relationship would impact the quality of care delivered.
The Unsuitability of the acute settings in the dementia care
Acute care settings environment, as highlighted by the current studies, are often served by nurses who lack training and knowledge in the care and management of dementia. This lack of knowledge and training renders acute settings an unsuitable environment for the elderly’s responsibility with dementia. The unsupportive healthcare environment would worsen the patients’ medical condition as opposed to improving their wellbeing, which is a core purpose for the hospital admission. In a primarily qualitative study by Cowdell(2010), patients highlighted that they encountered frightening, disturbing, and noisy experience in their hospital treatment. Such an experience highlights a hospital setting that is unsuitable for the care of their dementia conditions. Similarly, Nolan(2007), a primary qualitative study, confirmed the difficulty in caring for patients with dementia in acute settings as caused by limitations imposed by the environment condition. These limitations include inadequate resources, poor collaboration between the multidisciplinary team, and prioritization of the physical need of the patients at the expense of psychological needs. These limitations impeded the realization of positive treatment outcomes.
Further still, a literature review by Houghton et al. (2016) pointed out that acute care settings are not the ideal for the treatment of dementia as there is often staffing shortage to support the delivery of appropriate care to dementia patients. The deficiency leads to the few available healthcare workers who often focus more on physical needs than psychological needs. Psychological needs are vital in the treatment of dementia patients because it has a high potential of improving the patient’s wellbeing. Moreover, the finding highlighted poor resource allocation in acute care settings towards the nurses’ support in enabling them to provide evidence-based care to dementia patients. Pinkert et al. (2017) undertook a qualitative secondary study that sought to describe the nurses’ experience of caring for people with dementia in an acute care setting. According to the nurses, the hospital was the wrong place for the treatment of dementia conditions. The hard routines in the hospital setup made it difficult to offer agile care to dementia patients and provide hindrances in the standardization of hospital care. These findings, as supported by Cowdell(2010), pointed out that ward routines are prioritized instead of adherence to individualized care. Similarly, the patients indicated that they received unpleasant care in hospital care and were concerned about their care plans. These results show that hospitalization of dementia patients would not improve their wellbeing is the decisive ingredient for positive treatment outcome as instituted.
Additionally, primary qualitative research by Fukuda et al. (2015) indicated that in the treatment of dementia, the nurses needed holistic support of the family members that could not exercise in a hospital setting. Also, the hospital has restrictions on medical treatment, and the environmental parameters often curtail the holistic provision of care to dementia patients. The nurses felt conflict concerning the ecological setting that could not provide them with adequate time and appropriate communication strategies to support effective collaboration between dementia patients and their families in effecting patient-centered and evidence-based care. Finally, Eriksson and Saveman(2002) highlighted a similar primary qualitative study that the nurses often feel powerless in the face of inadequate resources to support effective care in the acute care setting. The nurse felt that acute design settings are not made appropriate for the care of dementia, which makes the nurses that assign the responsibility of dementia care in the acute setting to be subject to pressure due to increased demand for their work. The respondents
were in support of a collaborating working model among the multidisciplinary working in acute care settings.
The various studies discussed highlighted the Unsuitability of acute settings in the care of dementia. The inadequacy acute care setting arises from several factors. These factors are inadequate management support, insufficient resources, shortage of nurses, and lack of team among the MDT team in acute care. Other factors include missing holistic family support and the hospital operation procedures that restrict ward to routines, thereby curtailing the agility among the nurse in providing patient-centered and evidence-based practice in the care for dementia patients. However, despite the application of primary qualitative research design by most the studies discussed, their findings could be enhanced through the incorporation of primary quantitative study that can undertake the causal analysis of the factors that make acute setting unfavorable in the care for dementia.
Challenging behavior and Emotions.
The challenges with the behavior and emotions of dementia patients often have adverse negative impacts on the care delivery of the nurse. Similarly, the nurse’s unpleasant experience in the care of dementia patients also has adverse effects on their emotions, thereby affecting the quality of care they deliver. A primary qualitative study by Byers and France(2008) highlights the challenges experienced in the responsibility for dementia patients that often make the healthcare workers extend their frustration at work to their family at home. The problems have adverse effects on family harmony and could lead have negative social impacts in the family setup. These findings were reinforced by a study by Nolan(2007). His findings alluded that nurses often feel safe when dealing with non-aggressive dementia patients because they have tolerable behavior that allows effective care delivery instead of aggressive ones that could disrupt their care process.
Further still, the findings of a literature study by Houghton et al. (2016), highlighted that healthcare most often views the care for dementia conditions to be dull, emotionally draining and unrewarding, thereby making it unattractive to most caregivers. They often pose a challenge in the decision by new practitioners who may feel interested and would opt to specialize in dementia care. Similar sentiments were highlighted in the primary qualitative research by Pinkert et al. (2017). The finding of the study posits that confusion and agitation demonstrated among dementia patients often leave the nurses helpless, thereby impacting negatively on the quality of their care.
There have also been incidences of hostile communication between the patients and the healthcare staff. The missing communication results in caregivers undergoing mi through an unpleasant experience. The experience affects them negatively on the quality of their care delivery (Cowdell, 2010).
According to a study by Cleary and Doody(2016) on the experience of nurses in dealing with older dementia patients with intellectual disability, the findings highlighted that the healthcare staff is not confident in dealing with various behaviours, as demonstrated by dementia patients. They further emphasized that caring for patients with an intellectual disability is strenuous. They cannot comprehend any rational instructions and must be assisted in accomplishing all their daily functioning. These findings were congruent with the outcome of Erikson and Saveman(2002), which pointed out the mental and physical drain the nurse goes through when working with patients who do not understand or cooperate with the treatment options being implemented.
The discussed studies highlighted the challenges experienced by the nurse arise caring for aggressive and confused dementia patients, consideration of dementia care as a dull and unrewarding medical specialty, the existence of hostile communication settings,
and working with intellectually disabled patients that do not comprehend any rational instructions and must be assisted in their daily functioning. These aspects emotionally drain the healthcare workers and negatively impact the quality of the care they deliver to dementia patients. The finding supports collaborative work by all the MDTs in enhancing effective care to dementia patients. In this instance, the primary quantitative study could offer triangulation in validating the research findings and in analyzing the causal effects of the various factors posing a challenge to the nurses in their care and how their confounding effect would impact the quality of care to the dementia patients.
Implementation of the findings(400 words)
As highlighted in this integrated literature review, the studies relied wholly on qualitative research in exploring the experience of nurses in the care of elderly patients with dementia in an acute setting. The findings indeed highlight that the nurses in acute care settings often lack knowledge and training in the care and management of dementia. The lack is experience and training is demonstrated through several aspects including poor recognition symptoms and in the undertaking of diagnosis, administration of inappropriate intervention, poor communication skills, and lack of knowledge on psychological responses to dementia patients. Given that acute care often focuses on physical and medical care, these nurses often fall short of skills in psychological care, which is vital for people with dementia. Similarly, the findings highlighted that under-resourced, poor work relationship, understaffed, missing family support, and missing agility in care of dementia as witnessed in acute care settings makes it unpleasant for treatment of dementia patients.
Additionally, the behavioral and emotional challenges in the care of dementia often emanate from various factors including working with aggressive and confused dementia patients, dull and unrewarding dementia care as for nursing practice, the existence of hostile communication between the patients and nurses, working with intellectually disabled patients who require assistance in undertaking daily functioning, and the existence of non-collaborative MDTs in the acute care setting for dementia. These challenges adversely affect the quality of care.
Despite the reviewed studies focusing more on the primary qualitative data in their research methodology, the study findings’ validity and reliability could be enhanced through undertaking a triangulation study based on a primary quantitative survey. Generally, quantitative can conduct path analysis in evaluating the causal relationship between the various research themes and how their confounding effects impact the quality of care for dementia patients.
As indicated in this review, the current practice in dementia patients’ care recommends hospital admission for dementia patients in an acute care setting. However, the practice does not address the shortfall in training and knowledge, and the practice has not transformed acute healthcare settings to be suitable in the care of dementia. It further still has not provided solutions in addressing the behavioral and emotional challenges facing nurses in the responsibility for dementia patients.
In referring to the findings of this study, the study proposes the inclusion of training and knowledge of dementia care in the training curriculum and placement practice for healthcare workers undergoing training. Similarly, the study seeks to improve the acute settings in supporting effective care for dementia through resource mobilization, support of collaboration and teamwork, responsive and agile care responses. Finally, the study seeks to provide avenues for addressing the behavioral and emotional challenges that deter nurses in delivering effective care through the incorporation of psychological care to the patients. These proposals positively impact the service users through improvement in their quality of care, wellbeing, quality of life, and a reduction of hospital re-admission incidences.
However, for successfully implementing this proposal, there must be goodwill of the UK government through the Department of Health(DoH), NICE and NHS in support and framework for holistic implementation. Similarly, the patient, healthcare practitioners, and the family members of the patients must commit to the improvement of dementia care through the implementation of the proposed practices.
Conclusion(100 words)
This review critically discussed the experience of nurses in the care of dementia patients under three domains including inadequate knowledge and training in the responsibility for dementia, Unsuitability of the environment of acute settings in the care of dementia patients and the challenges faced by a nurse that arise from behaviours and emotions of the dementia patients. Improving on these domains have positive impacts in improving the quality of care administered to dementia patients. As per this study, there is a need to incorporate training and experience of dementia care in both training curricula and placement practice. Similarly, the acute care settings must be enhanced and made attractive for dementia patients’ care through the allocation of resources, appropriate staffing levels, reduction of restrictions, and improvement of communication. Finally, challenges on behavior and emotions could be address through proper training on psychology treatment.