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The patient with dementia in sub-acute geriatric rehabilitation hospitals: a critical ethnography

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thesis
posted on 26.03.2017, 22:34 authored by Robin Digby
Introduction
   This study investigated the care of people with dementia in sub-acute geriatric rehabilitation hospitals. Sub-acute care encompasses rehabilitation, palliative care, geriatric evaluation and management (GEM) and psychogeriatric care (Australian Institute of Health and Welfare, 2012b, p. 13) and is known as intermediate care in the United Kingdom (Nancarrow, 2007). The patients in sub-acute geriatric rehabilitation facilities have complex needs associated with chronic medical conditions related to ageing, and treatment is delivered by a multidisciplinary team. It has been previously reported that people with dementia can deteriorate cognitively and physically while in hospital are poorly supported by the hospital system (Australian Institute of Health and Welfare, 2015), have a negative experience of care (Cowdell, 2010b), and that nurses find caring for people with dementia a stressful experience (Griffiths, Knight, Harwood, & Gladman, 2014).
   Aims
   The aim of this study was to explore the experiences of people with dementia and nurses in sub-acute geriatric rehabilitation hospitals in order to offer a critical perspective of the widely reported poor care received by such patients. A further aim was to focus attention on the cultural and organisational factors which influenced care.
   Method
   This study used a qualitative design employing critical ethnography as the methodology. The data was collected in five wards in two metropolitan hospitals in Melbourne, Australia in 2014. Conversational semi-structured interviews were conducted with 30 inpatients with dementia and 29 nurses who volunteered to participate. In addition 120 hours of observation took place in the wards and patient progress notes and documentation was examined.
   Findings
   The findings of this study indicated that patients with dementia felt alienated in the hospital environment, were bored, homesick and often did not know why they were there. Nurses reported feeling over-worked, poorly supported and under-prepared educationally for the role. Nurse and patient participants described the efficiency-driven organisational focus as having a detrimental effect on caring practices. This view has also led many nurses to see patients with dementia as unworthy, and the patients themselves to feel alienated.
   Conclusion
   As the number of people with dementia in the community continues to rise, a focus on supporting patients and the nurses who care for them in sub-acute care is critical in order to concurrently improve the outcomes for patients and job satisfaction for the nurses.

History

Principal supervisor

Allison Williams

Additional supervisor 1

Susan Lee

Year of Award

2017

Department, School or Centre

Nursing and Midwifery

Course

Doctor of Philosophy

Degree Type

DOCTORATE

Faculty

Faculty of Medicine, Nursing and Health Sciences