Feasibility for Nurses to Attain Person-Centred Dementia Care

This report critically reviews the feasibility of nurses providing person-centred care for older people with dementia within the acute hospital setting. The research, based on secondary sources, examines the challenges and potential of implementing person-centred care, which focuses on treating individuals with respect and dignity, considering their history, preferences, and lifestyle. The methodology includes a literature review using search terms related to person-centred care, dementia, and acute hospital settings, with inclusion and exclusion criteria to select relevant articles from databases like CINAHL and PubMed. The report also addresses limitations, ethical considerations, and constraints faced by the researcher, emphasizing the importance of confidentiality and proper citation. The literature review explores dementia's impact on memory and brain cells, highlighting the importance of person-centred care to improve patient outcomes. Recommendations are provided to enhance the feasibility of nurses attaining person-centred care, aiming to improve the quality of care for older people with dementia. The report concludes by emphasizing the need for strategies that support nurses in providing individualized care within the hospital environment.

Is it feasible for nurses to attain person centred care for
older people with dementia within the acute hospital
setting?
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CONTENTS
1. Title...................................................................................................................................................3
2. ABSTRACT.....................................................................................................................................4
3 . INTRODUCTION...........................................................................................................................6
4. METHODOLOGY...........................................................................................................................7
5. Possible Constraints and Ethical Consideration...............................................................................9
6. Literature review............................................................................................................................10
7. IMPLICATIONS AND RECOMMENDATIONS..........................................................................15
8. References......................................................................................................................................17
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1. TITLE
“To critically review whether it is feasible for nurses to attain person centred care for older
people with dementia within the acute hospital setting.”
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2. ABSTRACT
The overall report has been prepared by considering the aim that whether it is feasible for
nurses to attain person centred care for older people with dementia within the acute hospital setting.
The research was conducted by reviewing six to seven articles as the entire study was based on
secondary research. Different results obtained from interviews and observation was reviewed so
that the aim of research is fulfilled. Various articles have various findings and results but to sum up
all the literature it was concluded that if not best person centred approach is one of the best method
which can improve the condition of older patients who are suffering from dementia. In the last part
of the research paper various recommendations and implications were suggested which can
probably enhance the care services which are provided to dementia patients.
.
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3. INTRODUCTION
Background
In present time there are several types of diseases are spreading in which dementia is also
one of them. In this, dementia elates to decline in mental ability which gives impact on person's
daily life activities (Mackey and Gass, 2015). The dementia consists of the various types of
symptoms which are associated with decline in thinking skills and memory. These types of
symptoms also reduce the older people's ability in order to perform daily routine activities. In this,
person centred care considerer as an ideal approach and techniques in order to effectively care for
older people with dementia. The care homes require following the principles of person centred care.
The main motive of person centred care approach is to consider the person with dementia as an
individual (Panneerselvam, 2014). It does not focus on person's lost abilities and illness. Basically
person centred care means with treating the older people with dementia with both respect and
dignity rather than treating the person with the collection of behaviour and symptoms. At the time
of treating the dementia people, it firstly understands their culture, lifestyle, preferences, history,
hobbies and interests etc. For older people with dementia, this approach helps them in taking the
part in several activities so that they can enjoy (Neuman, and Robson, 2012). This is considered as
an effective method to prevent the symptoms and effect of dementia on older people. In respect to
this, it is quite feasible for nurse to attain the person centred care for older people with dementia
within the acute hospital settings (Myers, 2013).
Aims and Objectives
Aim
“To critically review whether it is feasible for nurses to attain person centred care for older people
with dementia within the acute hospital setting”.
Objectives:
Following are the objectives of research
 To identify the approach of person centred care for people who are suffering from dementia.
 To measure level of person centred care of people with dementia within acute hospital
settings
 To evaluate problems and possibilities associated with people who have encountered
dementia.
 To recommend strategies to increase the feasibility for nurses to attain person centred care
for older people with dementia
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Research question
PICO framework is one of the method which helps in formulating research question for the
studies. It also helps in answering them effectively. Literature strategies can also be designed by the
help of PICO framework.
P: Patients with dementia
I: Person centred approach of nurses
C: None
O: Treating dementia in acute hospital setting.
4. METHODOLOGY
The overall study is based on critically analysing whether it is feasible for nurses to attain
person centred approach for older people with dementia in acute hospital settings (Ormston,
and et.al, 2014). Literature review will be conducted which can be defined as reviewing all
the scholarly papers and articles so that main purpose of the study is served.
Research philosophy: Positivism philosophy will be used in this research because apart from being
objective the overall study is based on subjective part of the research (Davis and et.al, 2014).
It will help in providing in depth research so that desired results are obtained.
Research protocol: One of the most important purposes of the research is to provide a clear
transparent review of all the literatures so that different search terms can be searched which
are relevant to all the articles and studies (MarchHinckley and et.al, 2013). It also includes
all the inclusion and exclusion criteria so that proper articles are selected.
Search terms: To search articles which are based on the studies it is very necessary to design
several search terms so that it matches with the studies (Abner and et.al, 2015). There are
certain terms which are mentioned below which will help in searching articles
TERM 1: Person centred approach, nurses
TERM 2: Dementia, acute hospital settings
Database sources: There are various types of data bases sources which will help in deriving all the
necessary articles so that study is completed in effective manner (Stokes, Davis and Koch, 2012).
Several database sources are CINAHL, PubMed, British Index library, Google scholar, Emerald
insight, BioMed central, Cochrane Library and science direct. These all data base contains various
articles which are related to different topics and subjects so critical evaluation can be done in more
appropriate manner (Miles, Huberman and Saldana, 2013).
Inclusion and exclusion criteria: These two criterions are very important to be considered when
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selecting articles for the study (Murtagh and Heck, 2012) . This also plays a very important role in
determining which study is appropriate for the chosen topic or which should not be included in the
literature review. There are several concepts of inclusion and exclusion criteria which are discussed
below.
Inclusion criteria: With the help of this criterion it is very easy to decide which articles
should be included and which articles or research papers are not relevant to the studies (Dunn,
2014). For successfully completing the ongoing study it is very important to include all those
articles which are published in English language. Based on the search terms all articles were
selected so that it is able to match all the study (Mandic and et.al, 2013). All the articles which were
published before five years should not be included in the so that study is updated. All the articles
which were published before the year 2005 should not be included. All those articles which are
published in any other language other than English will also be excluded from the study (Insel and
et.al, 2015). In order to conduct study in proper way all the articles should be selected from correct
databases such as CINAHL, Google scholar, Emerald insight and science direct.
Exclusion criteria: This criterion also helps in excluding all the articles which are not
relevant to the studies or which are not able to match the search terms which are mentioned in the
studies (Paton and et.al, 2014). Based on exclusion criteria, all those articles which are published
before 2005 will not be included in the studies. This is helpful because it selects only those articles
which have updated study materials in their research papers. If an article which is selected does not
have proper aims and objectives mentioned in them then it will also be rejected and will not be
added in the studies (Vaismoradi, Turunen and Bondas, 2013). Also the articles and research papers
which are not published in English language will be clearly excluded from the studies.
Data Analysis: Before including any article or research paper in the study all the journal papers will
be peer reviewed by author and researchers so that they are able to have a clear view about all the
selected articles (Chen, Chiang and Storey, 2012). They will consider all the participants who are
taking part in the study. If family history, medical history or any records of the patients are missing
then they will not be included in the study. Only those articles will be selected in which all the
participants have complete medical history and consent from their family member to participate in
the research (Weiskopf and Weng, 2013).
CASP Tool: It is one of the most effective tools which are used to determine or evaluate the
validity, reliability and standards of all the articles which are selected for the study. It is helpful in
designing relevant question which can help in analysing relevancy and accuracy of all the results
and findings which are drawn from research (Borgman, 2012).
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5. POSSIBLE CONSTRAINTS AND ETHICAL CONSIDERATION
Limitation
Researcher has been faced various difficulties while conducting this research. He/She has
been faced the issue regarding limitation of time, resources and experience (Chan and et.al, 2014).
For doing this investigation in proper and effective manner, investigator handle all these limitations
in appropriate way. With respect to the limited resources, author has used computer, internet, MS
Office and printer. By using these resources, researcher conducts the study properly. Use of
computer and internet also has been helped researcher in completing study in proper time (Bazeley,
2013). In the limited time, author has read journals, magazines, articles, books, websites, previous
researcher, etc for getting proper knowledge and information related to the dementia and person
centred approach. These techniques have helped author in fulfilling the limitation of experience. On
the other hand, for managing the time properly and conducting whole research investigator divides
each and every process and strategy with the deadline (Williams, Brown and Onsman, 2012). It has
resulted to finishing the investigation properly and in given time period. All the factors used by the
investigator are appropriate and right which helped him/her in doing overall study in effective and
efficient manner. Author has used all the limitations by handling them in proper way and at right
place.
Ethical Considerations:
It is important for researchers to follow ethical considerations while conducting
investigation (Jarke and et.al, 2013). Author has used proper ethical considerations into the research
for working legally. While conducting investigation, author has kept the information of the
participants safe and secure. For working ethically, researcher has signed the contract with
respondents for keeping their personal information safe and confidential ( Markelj and et.al, 2012).
This helped investigator in getting trust and proper information about the dementia and person
centred approach. Along with this, author has used proper citations and references in the
investigation. This has resulted to prevent study from plagiarism. On the other hand, the results of
the investigation accurately represent the outcome of observation and primary information
(MarchHinckley and et.al, 2013). No manipulation has been done by the researcher in the obtained
information. In addition, author has made sure that his/her personal biases and opinions do not get
in the way of overall study. All the interviews and questionnaires have been filled under the
condition of anonymity (Davis and et.al, 2014). With reference to the ethical considerations,
researcher has not taken advantages of the easy to access groups. He/she has been analysed the
required participants properly for collecting appropriate and correct information. Along with this,
researcher has taken proper permission of the patients on whom he/she wants to conduct
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investigation (Miles, Huberman and Saldana, 2013).
6. LITERATURE REVIEW
According to the research article of Clissett and et.al, 2013, dementia is type of disease which
gives impact on people's memory (Clissett and et.al, 2013). In contrast to this, (Surr, and et.al,
2016) describe that loss of memory directly relates with the result of aging not the presence of any
type of disease. In same manner, Evans and et.al, 2015 explores in research article that, symptoms
of dementia diseases cases with the damage in the cells of brain (Griffiths and et.al, 2015). In
agreed manner it also describes the cause of dementia in people due to damage of neurons in brain
which declines the ability of memory and thinking skills (Brown and et.al, 2016). As per analysis of
(Griffiths and et.al, 2015) stated that risks related to dementia relates with the age, family history,
high blood pressure, cholesterol and excessive alcohol consumption etc. (Banks and et.al, 2014). On
the other hand (Pulsford, Duxbury and Carter, B, 2016) has stated that “Dementia shows major
impact on the physical and emotional factors of the person suffering from it. It results to cause
cognitive disabilities because it makes elder people dependent and vulnerable (McCance and et.al,
2013). Loss of cognitive functions results to loss of self care and ability to live a good and safe life”
(). This research paper will aim to help all the dementia patients and workers to identify needs and
requirements of patients who are living alone. The overall study was based on two stages
exploratory studies in which interviews were conducted and data were also collected by observation
basis. (Yoon and et.al, 2015). Has stated that “people who are suffering from dementia utilize
different objects and spaces in their home, so that they are able to re-enact various identities from
past history”. By the help of Delphi technique all the interpretations and thematic interviews were
converted into thematic result so that they can be translated with the help of different tools
(Goldberg and et.al, 2016).
Seven people who have encountered dementia were included in the study so that results can
be reviewed accordingly. There were mainly three rounds which were used to analyse all the
healthcare professionals and participants who have taken part in the study (van Wyk, P.M.Stewart
and McGilton, 2014). Eighteen expert healthcare officials were questioned on the basis of person
centred approach in which six participant’s qualified round three. The tool which was used for
analysing the person centred approach in dementia care. It helped in addressing all the issues related
to impediments and effective care services which have been furnished to all the patients who are
suffering from dementia (Allen, Ottmann and Roberts, 2013). There were many factors which
proved to be positive related to the person centred approach in acute hospital care setting. It was
approach of simplicity, person centeredness and applicability of all the resources in the healthcare
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settings. Apart from positivity there was sense of negativity which was also included in
practicability, risk management, gender difference and terminology (Phillips and et.al, 2013).
Although results of research and finding rely on intuitive and ethical appeal but there is an existing
problem with person centred approach in patients who are suffering from dementia.
The concept of person centred approach is very compelling and is likely to produce many positive
effects if it is implemented practically in acute healthcare practice (Fukuda, Shimizu and Seto,
2015). But the procedure of person centred approach is very tangible and enduring structures are
required to translate all the service related expertise process into practical action. With the help of
Delphi technique the tool was able to address the fundamental aspects of person centred approach
because it will help in devising different types of meaningful activities. (Clissett and et.al, 2013).
According to the research article it has been stated that “this has been considered as one of the most
potentially valuable resource which can respond to different aspects of person centred approach, but
it is very difficult to implement this in real life.
In yet another research article the aim mainly focussed on identification of person centred
care has been one of the most ideal approach for treating patients with dementia. In long stay care
settings it is very necessary to implement different types of international policies which can be
incorporated in acute settings (Surr, and et.al, 2016). However international policies which are
designed with respect to dementia care should be based on principles of person centred approach so
that interventions to sustain personhood are designed accordingly. In this article data was collected
through different sources (Evans and et.al, 2015). With the help of Kitwood’s five dimension of
personhood framework, main objectives were found so that that research is conducted in a proper
way. The aim of the article is to evaluate and explore the ways in which current approaches for care
can be implemented so that personhood in dementia care patients is enhanced (Griffiths and et.al,
2015). In the given articles all the participants were collected through different sources such as
patients who have been encountered dementia, family persons who are taking care of them and co-
patients who are sharing same rooms with the person who is suffering from mental disorders. They
were involved in the study to analyse the core elements of person centred care in patients who are
being treated of dementia (Brown and et.al, 2016). Patients were selected from two major
healthcare units of UK which were situated in East Midlands. Patients were basically old age
citizens who were reported to be suffering from various illnesses and admitted in general medical
unit. There were also some individuals who belonged to orthopaedic wards in the hospital (Pulsford,
Duxbury and Carter, B, 2016).
In the overall study based on various conditions and specificities a total of 34 patients along
with their relatives were recruited so that study can be performed in proper manner (McCance and
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et.al, 2013). All the patients who were recruited in the study were more than 70 years. Through a
screening test it was analysed that all the patients suffered from acute or chronic mental disorder at
the time of recruitment. Out of 34 patients who were selected for the studies 29 were reported to be
suffering from cognitive impairment (Yoon and et.al, 2015). The study was based on conducting a
72-hour non participant observational analysis which was followed by 30 formal cares
complemented interviews for all the 29 patients who were cognitively impaired. The analysis was
based on Kitwood’s model of personhood so that inclusion, attachment, comforts level and
occupation level is tested (Goldberg and et.al, 2016). Although there were many positive aspects of
the study and good practice that was available in the acute hospital setting but it failed to grasp all
the necessary opportunities which were very important for sustaining personhood for all the people
who are suffering from dementia. For effectively implementing the person centred approach in
practical action it is very necessary for both individual and organisation level to understand the
concept of person centred approach so that people with dementia are given proper care in the
healthcare settings (van Wyk, P.M.Stewart and McGilton, 2014).
Person centred approach has been increasingly advocated that it is one of the best practice
that has improved the concept of health and services in acute hospital settings (Goldberg and et.al,
2016). The concept understands the needs of a person who is admitted in healthcare setting for the
treatment of various illness and diseases in them. However the concept of acute in-patient hospital
service and their biomedical tradition are far more different from the person centred care that is
being provided to patients who are suffering from dementia (Allen, Ottmann and Roberts, 2013).
There are numerous tools which accurately measure the intensity and extent to which patient
centred care is perceived in acute- in patient healthcare units. But this research paper has basically
aimed at translating the English version of Person-centred care of older people with cognitive
impairment in acute care scale (POPAC) to another parameter in order to determine different type of
psychometric properties involved in the sample of acute hospital staff members (Phillips and et.al,
2013) have stated that more the person centred approach in acute hospital care services where the
staff members recognised the bio-physiological needs of older patients, more improved outcomes
will be achieved. Contrary to this (Pulsford, Duxbury and Carter, B, 2016) Has stated that apart
from person centred approach the strong medical team mainly focuses on utilizing the medical
routine system and organisational efficiency which is build up in acute in-patient hospital centres.
The philosophy of the research paper aims at identifying the psychosocial medical needs of older
patients specially the one who is suffering from cognitive impairment. It will be helpful in
accompanying the needs of older and cognitively impaired individuals. There are several
complications which have been linked to the disease centred approach and not the person centred
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tapproach. Due to this there are many consequences which are produced such as pressure from the
higher authority, incompatibility, malnutrition, functional decline, delirium, longer stay in the
hospital wards and increased mortality rate due to different reasons (Fukuda, Shimizu and Seto,
2015). In the methodology part of research article it has been stated that 15 items of POPAC were
selected and translated into cross sectional sample of Swedish acute care staff. Performance of the
entire selected item was evaluated though calculating the means internal consistency by Cronbach’s
alpha on total and on subscale levels (Evans and et.al, 2015). Rest of the parameter such as temporal
stability was assessed with the help of correlation developed by Pearson’s product and intra-class
correlation which were maintained between test and retest scores.
The results drawn from the above article states that Swedish version of POPAC is able to provide
tentatively construct-valid and reliable contribution which can measure the extent of acute hospital
care services in the hospital (Banks and et.al, 2014). This will help in facilitating person centred
approach for all the older patients who are suffering from cognitive impairment and dementia. In
the conclusion part of the research it has been stated that POPAC has played a very important role
in improving the healthcare conditions of people who are suffering from dementia (Mackey and
Gass, 2015). This has helped in enabling measures by comparing the results of practice
developments with the areas that need improvements.
In another research article the main aim is to critically explore the concepts of care
management that has been employed in handling all the patients who are suffering from dementia
(Pulsford, Duxbury and Carter, B, 2016). In accordance to the care management and engagement it
is necessary to ensure that different policies are developed so that effective care services are
provided to them. But if a hospital and care centre does not have proper policies and legislations
then there are chances that conflicts and disputes may occur. For avoiding all these tensions and
conflicts it is important to develop certain structures and strategies which may help in improving the
delivery of care services to older citizens. This article has been selected after peer reviewing all the
articles after identifying various data base sources and search terms. Various sources such as
PubMed, Cochrane, science direct and Google scholar were used so that relevant articles can be
selected. The overall study was conducted by featuring the process of interviews and observations.
Patients who have encountered dementia were selected from three hospitals and they were
interviewed on the basis of different questionnaires by different individuals (McCance and et.al,
2013). Then they were observed for more than a week to address their activities in different manner.
Care persons, family members and other healthcare professionals who were involved in the care
management were also interviewed so that they can also be able to express their views about person
centred approach about care given to dementia patients in acute hospital care settings. Different
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research literatures were being reviewed which also identified six main components of care
management such as care giving to all the older people, sharing of information, shared decision
making , education, and feedbacks received from carers and patient care transitions (van Wyk,
P.M.Stewart and McGilton, 2014). After reviewing the results of research article it was concluded
that all that all the hospitals and care centres should be capable of adopting more consistent and
comprehensive approaches in treating all the individuals so that the needs and requirements of all
older age citizens with dementia are identified. The integrated model that is developed in this
research article will help the entire nurse and other healthcare professionals to develop strategies
and framework so that care providers are ready to work for older patients in acute hospitals settings
(Allen, Ottmann and Roberts, 2013).
In recent times it has been estimated that more than 35 million people are living with
dementia in worldwide. More than 7, 00,000 people are suffering from dementia in UK and 570,000
in England (Phillips and et.al, 2013). The main aim of the research paper is to present a thematic
review of literature which can mainly focus on acute care of older people who are living with
conditions of dementia. This article will also provide recommendations and strategies which will
help in developing strategies that enhance the person centred approach in older patients with
dementia. No specific model will be considered to enhance the person of but it is one of the general
notions that consider that if not best, it will surely provide better quality service to all patients in
acute hospital care (Pulsford, Duxbury and Carter, B, 2016). In order to avoid duplication of all the
papers it is necessary to include only those papers which are not considered in earlier studies. An
overall theme was designed which stated different types of consequences of being in hospitals.
Based on this theme another seven sub themes were discussed such as care environment, cultures of
care services, attitudes which are challenging to people suffering from dementia conditions
(Griffiths and et.al, 2015). There are different types of consequences that arise when a person is
being admitted in hospital which is not dementia friendly to them. The acute hospital conditions for
dementia patients are very challenging in both physical and emotional context. Major consequences
of being in hospital care centres for longer period of time leads to poor detection and diagnosis,
longer stays in hospital, higher rate of deaths due to various mental disorders and functional decline
of the hospital (Pulsford, Duxbury and Carter, B, 2016). Other consequences can be disorientation
in spatial concept, malnutrition, dehydration and increased dependency on healthcare providers to
patients who are suffering from dementia.
Generally it has been noted that environment and physical layout of the hospital is not designed in a
way that can support dementia patients in such cases they feel disoriented. It is very important to
develop certain strategies that can improve the conditions and environment of hospitals which can
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be easily adapted by patients with dementia (Evans and et.al, 2015). It is important to focus on
current issues related to dementia in wider context so that dementia strategies can be developed.
Hence it can be concluded that for providing better care services it is very important to integrate
person centred approach so that dementia patients are furnished with proper care and services
(Clissett and et.al, 2013) .
7. IMPLICATIONS AND RECOMMENDATIONS
All the staff members who are present in general hospitals for the care of dementia patients
have different roles to play (Allen, Ottmann and Roberts, 2013). It is very necessary to identify
various leadership styles for all dementia patients in order to prioritize care to older patients. All
health and social care managers who are employed in general hospital care settings should be able
to maintain the coordination and integration all the work agencies who are involved in providing
care services to all the patients who are suffering from dementia. They should follow and agree with
all the policies and procedures so that they are given joint quality care services to them (Fukuda,
Shimizu and Seto, 2015). They should work towards combined care systems so that they are able to
take into account changing needs and requirements of all the service users and patients. They should
also actively encourage of how can conditions of wards and environment can be enhanced so that
patients are not confused about different things which are going in the hospital (Goldberg and et.al,
2016). Many staff members have suggested that the floors and footpaths which are leading to
bathrooms and toilets of hospital should be painted with dark colour so that indication is marked in
better way. Environmental conditions of all the hospitals which have in-patient dementia individuals
should be improved so that anxiety, confusion and depression are reduced in them (McCance and
et.al, 2013).
All the staff members who are assigned for taking care of older people should be well
equipped with technical skills and knowledge so that they are able to provide effective care services
to all the old age people (Brown and et.al, 2016). If they are not equipped with knowledge they
should be trained with the help of training and inductive programs so that they are able to manage
mental health and diagnosis properly. For reducing down the stigma and trauma of patients it is very
necessary for all healthcare providers to understand the needs and requirements of older citizens
who have encountered dementia. For providing better care services in acute hospital care settings it
is important to establish a strong relationship between patients and healthcare professionals so that
they are able to integrate policies and rules which can improve health conditions in them (Brown
and et.al, 2016). One of the most important recommendations is that a hospital care centres should
adopt effective strategies so that well-being and health of all the individuals is enhanced. It also
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helps in supporting in stressful conditions when a person is not able to react because of dementia
conditions. Both verbal and non-verbal mode of communication can be used in interacting with
older patients. In certain conditions it is observed that people who are suffering from dementia are
not treated in a proper way and are sometimes pushed to limits of copying different activities (Yoon
and et.al, 2015). This is the time when their behaviour starts fluctuating and disturbed. In such cases
it is very necessary to understand the personal choice of an individual so that they are able to fulfil
needs and desires of older patients. In many cases it is very necessary to ensure that if dementia
patients have any other physical deformity then they should also be treated for them (Griffiths and
et.al, 2015).
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8. REFERENCES
Books and Journals
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