Table 1 Subgroup A: Needs and experiences
Author, year, country | Aim | Design | Participants | Outcomes | Findings | Conclusions | MMAT-score |
|---|---|---|---|---|---|---|---|
Borbasi et.al 2006, Australia [25] | Explore nurses’ and health care professionals’ experiences of managing patients with dementia in hospitals | Qualitative design using semi-structured interviews | 23 health care professionals with different roles and professions in 3 large teaching hospitals | In-depth subjective accounts of caring for a patient with dementia in an acute setting, Characteristics of actual practice and participants’ thoughts on best practice. | Five themes emerged: The Built Environment, The Organization System, Key Players, Current Management, Ideal Management. | Dementia raises awareness about: The risks imposed by buildings designed on the premise of the medical model, The struggle for health professionals lacking skills to provide resource-intensive dementia care, The need for an organization-wide approach to the development of best-practice principles supported by staff from the top of the organization. | 4 |
Clissett et al. 2013, UK [26] | Explore the potential of current approaches to care in acute settings to enhance personhood in older adults with dementia | A qualitative design using non-participant observations of care and interviews after discharge concerning the experiences of patients with cognitive impairment | 29 patients with cognitive impairment | The current experiences of people with dementia, family carers, and co-patients during hospitalisation for acute illness | Health care professionals in acute settings were not taking advantage of all opportunities to sustain personhood for people with dementia. | There is a need for the concept of person-centred care to be valued at the level of both the individual and the organisation/team for people with dementia to have appropriate care in acute settings. | 4 |
Ernst et al. 2019, Switzerland [27] | Investigate health professionals’ (HP) care provision to persons with cognitive impairment and associated challenges | A concurrent, cross-sectional mixed method design. Online survey and 4 focus group interviews | 339 (HP) working in acute geriatrics wards and general internal medicine wards in 2 urban hospitals: registered nurses, physicians, nurse assistants, social workers, therapists, dieticians, and others | Extent to which HP perceived their care provision to be person-centered and evidence-based, and experience distress in looking after this patient group. HP’s experience of care provision | More than half of the HP reported to act always or very frequently in person-centered and evidence-based ways, and 2/3 experienced challenging behaviors as moderately to very distressing. HP working in acute geriatric wards demonstrate statistically significant higher levels of person-centered and evidence-based care provision, and lower distress. Their caring practices pertained to building a relationship, addressing specific needs, involving family members, and working collaboratively | Findings suggest that geriatric models of care delivery support staff in meeting the needs of persons with cognitive impairment. HP require an acute care culture that values relational, collaborative and coordinated care as essential to patient safety and quality of care and supports the consistent implementation of evidence-based practices for this patient group. | 3 |
Hung et al. 2017, Canada [28] | To explore hospital environment from the perspectives of patients with dementia | Qualitative action research design using go-along interviews, video recording, and participant observation | 5 participants (3 men and 2 women) aged 65–84 with a diagnosis of dementia | Opinions and perspectives of patients with dementia about the hospital environment | Four interlinked themes: A place of enabling independence, A place of safety, A place of supporting social interactions, A place of respect. | Patient participant provided useful insights and pointed out practical solutions for improvement. | 4 |
Jensen et al. 2019, Denmark [29] | To investigate how oral medicine was administered to hip fracture patients with Alzheimer’s disease during acute hospital stay | Qualitative design using participant observation as a passive observer | 3 patients with Alzheimer’s disease aged 87–95 years | Activities related to caring | Two major themes: Concealed medication, Dialogue and engagement on medicine intake. | Careful handover of information on person-centred dementia care can play an important role in making hospital stays more dementia friendly. | 4 |
Jensen et al. 2019, Denmark [30] | Investigate nurses’ experiences of caring for people with dementia | Qualitative interviews. Hermeneutic phenomenological research methods | 8 nurses with various levels of expertise in an acute orthopaedic ward | Nurses’ experiences | Two major themes with sub-themes: Nurse communication and patient information: -Drowning in the electronic patient record Somatic priority -Hospital environment -Care compromise: preconceived ideas and frustrations -Calm and adaptive -Sentiment and willingness to learn -Variations to standardised care | Orthopaedic nurses should work to adopt a positive attitude, and person-centred approach, towards dementia care. Electronic patient record should be supplemented by oral dissemination to some extent, as information, plans of action and knowledge about the care situation has a tendency to drown in chronological data presentation | 4 |
Kelley et al. 2019, UK [31] | Explore how family involvement impacts upon experiences of hospital care for people living with dementia | A qualitative ethnographic study using observations, conversations and interviews over two 7–9 month periods | 12 dyads of people living with dementia and their families and staff on 2 care of older people acute hospital wards in 2 cities: a rehabilitation ward and a general hospital ward | Experiences of hospital care for people living with dementia | Patients could experience a lack of connection on multiple levels, and long periods of time without interacting with anyone. There was great variation in the degree to which staff used opportunities to involve families in improving connections and care. When used, the knowledge and expertise of families played a crucial role in facilitating more meaningful interactions. Involvement of families and their knowledge was not routine. Care was required to ensure that family involvement did not override the needs and wishes of people living with dementia | This study demonstrates the benefits of involving families and their knowledge in care, advocating for family involvement, alongside the involvement of people living with dementia, to become a more routine component of hospital care. | 3 |
Moyle et.al 2011, Australia [32] | To explore management of older people with dementia in an acute hospital setting | A descriptive qualitative design using semi-structured interviews with staff | 13 staff working in acute medical or surgical wards in a large hospital | Experiences of staffs’ role in the care of people with dementia | The overarching theme of paradoxical care and inconsistent approaches to care emphasised safety at the expense of well-being and dignity. | Staff education and environmental resources may improve the current situation so that people with dementia receive care that takes into account their individual needs and human dignity. | 2 |
Pinkert et al. 2018, Germany and Austria [33] | Describe nurses’ experience in caring for people with dementia in acute hospital | Qualitative secondary analysis (content analysis). Focus group discussions and expert interviews | 57 nurses from 4 hospitals in Austria, 42 nurses from 5 hospitals in Germany | Nurses’ experience in caring for people with dementia | Nurses face great uncertainty in caring for people with dementia and reacts in different ways to address this uncertainty. Even for nurses who provide some form of person-centred care, the hospital environment imposes several contextual constraints. Main theme: Alterations in nursing care routines: -Sticking to routines -Becoming involved -Breaking routines -Establishing normality | Hospitals must minimise constraints to give every nurse the chance to perform person-centred care. It is important to sensitise nurses and give them sufficient training and education to enable them to care for people with dementia | 3 |
Prato et.al. 2019, UK [34] | Explore the experiences of older adults with cognitive impairment and their relatives during an acute hospital stay | A qualitative case study design using ethnographic, non-participant observations of the patients and semi-structured interviews with their relatives and the health care staff involved in their care | 6 patients with cognitive impairment, 8 relatives, and 59 members of the health care team | Experiences of older adults with cognitive impairment and their relatives during an acute hospital stay | Three themes emerged determining the quality of the hospital experience: Valuing the person, Activities of empowerment and disempowerment, and The interaction of environment with patient well-being. | Ward-based activities for patients with cognitive impairment are needed alongside a move towards care that explores measures to improve and expand relative involvement in hospital care. | 4 |
Scerri et al. 2018, Malta [35] | Categorise the perceived and observed needs of persons with dementia and to explore whether these needs are being or have been met | Qualitative study using semi-structured interviews and observation of routine care using Dementia Care mapping | 13 persons with dementia admitted in 3 acute medical wards | Participants’ experiences of their hospital stay, whether these needs were perceived to have been met. | Basic needs such as toileting, feeding etc. were not always met. The largest gap between met and unmet needs was found in patients who were either under constant observation or unable to communicate. Too much emphasis was perceived and observed to be given on what staff considered as safety needs at the expense of other needs. The patient’s need for social contact and self-esteem such as dignity and respect were often ignored and this led to patients felling devalued | Hospital staff have to be more aware of holistic needs of patients with dementia in acute settings and the way care is delivered in order to make up for these unmet needs, thus facilitating person-centred care | 2 |
Scerri et al. 2020, Malta [36] | Explore the perceived challenges of nurse managers when caring for patients with dementia and identify possible solutions to address these challenges | Qualitative study using focus groups | 16 nurse managers responsible for 11 acute medical wards | Challenges and possible solutions to address these challenges | Organizational challenges with direct impact on the quality of care were identified. Suggested solutions were realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles | The study highlights the complexity of improving dementia care in hospitals and continues to show that a system-wide approach is needed | 3 |