Research: Getting To Know Me - exploring the impact of using a personal profile tool on the attitudes of nurses providing care for people with dementia in a general hospital setting
2016/82 - Ruth Mantle
Dementia is a worldwide concern and it is estimated that there are over ‘46 million people living with dementia’ and that this number is anticipated to climb to ‘131.5 million by 2050’ (Prince et al., 2015). There are roughly 90,000 people living with dementia in Scotland (Alzheimer Scotland, 2016) and it is expected that this will double over the next 25 years (Scottish Government, 2013).
Over the last fifteen years there has been increased interest in the care of people with dementia admitted into general hospital settings and it is estimated that up to 25% of all beds in a general hospital with 500 beds are now occupied by people living with dementia (Royal College of Psychiatrists, 2005; Alzheimer’s Society, 2009). What is more, there continues to be concerns about the care of people with dementia admitted into hospital and evidence that poorer outcomes are experienced including deterioration of physical health and functioning, increased distressed behaviour, longer lengths of stay and that they are more likely to be transferred to a care home on discharge even if they were admitted from home (Alzheimer Society, 2009; Banks et al., 2014; Bridges and Wilkinson, 2011; Cowdell, 2010; Mental Welfare Commission for Scotland, 2010; NHS Confederation, 2010).
The English and Scottish national dementia strategies in the UK (Department of Health, 2009; Scottish Government, 2010 and 2013) acknowledge the importance of improving general hospital care, and highlight the need to deliver care that is person-centred to help improve the experience for people with dementia admitted into hospital. In addition, national reports such as the Francis report (2013) have highlighted key concerns regarding how older people including people with dementia are cared for in hospital. In his report, Robert Francis, the QC in charge of reviewing the Mid-Staffs enquiry, reported that the values and experiences of staff, particularly nurses, play a critical role in improving the experience for people in their care (Bridges and Wilkinson, 2011).
Negative attitudes from healthcare staff towards people with dementia in general hospital settings can adversely impact the quality of care given and contribute towards poor outcomes for the person during and beyond their stay in hospital (Eriksson and Saveman, 2002 ; Jacelon, 2002 ; Moyle et al., 2008; Nilsson et al., 2012. Consequently, it is essential to understand what influences staff attitudes and if present, how negative attitudes towards people with dementia in their care can be addressed.
This research is important in the field of dementia as it investigates the impact of a person-centred tool on nurse attitudes caring for people with dementia in hospital. There is a greater understanding about person-centred care but still limited studies exploring its practical application and evidence of efficacy of outcomes, (McCormack, 2004; Dewing and Dijk, 2016) particularly for people with dementia cared for in a general hospital setting.
One of the key roles of my job as the dementia nurse consultant for the health board I work for is to support the implementation of the dementia care standards (Scottish Government, 2011) in its general hospitals and to help support staff, particularly nurses to improve the experience for people with dementia admitted into our care. Sadly I have first-hand experience both professionally and personally of the negative impact that an admission into a general hospital can have for a person living with dementia and I am keen to understand how we can remedy this situation. Research into the care of people with dementia in a general hospital setting, shows that nurse attitudes have been identified as a barrier to giving good care. The ‘Getting To Know Me’ (GTKM) personal profile tool was launched in Scotland to help to enhance the care given to people with dementia admitted into a general hospital. However there is a lack of knowledge as to how the use of person-centred tools such as a personal profile tool, can help to facilitate positive attitudes. This study aimed to explore the impact of the GTKM personal profile tool on nurse attitudes in relation to caring for people with dementia in a general hospital.
The research conducted as part of study towards an MSc in Dementia with the University of Edinburgh, followed a mixed methodology approach which used the Framework Analysis Method. Ten qualified nurses working on general hospital wards where the GTKM tool was in use were recruited through a non-probability approach using purposive sampling. Semi-structured interviews were undertaken face-to-face and through the use of Skype and each participant completed a questionnaire which incorporated the validated ‘Approaches to Dementia Questionnaire’.
This research shows that nurses see the value in using the GTKM to help facilitate a greater understanding about the person they care for and findings suggest that it can positively influence nurse attitudes and promote a person with dementia’s sense of personhood. This study has also contributed to the field of dementia by revealing a tension between the theory of person-centred care for people with dementia and the practical application of tools such as the GTKM in general hospital settings and the reality of delivering care within a culture that is dominated by a bio-medical approach. Future research is needed to understand how the GTKM can inform the delivery of person-centred care; the impact on the person with dementia and family and on the interdependence of relationships between healthcare staff, family and the person.