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.