Routines of resistance: An ethnography of the care of people living with dementia in acute hospital wards and its consequences.
Dementia
Ethnography
Hospitals
Medication compliance
Nursing staff Hospital
Patient autonomy
Patient compliance
Professional-patient relations
Treatment refusal
Journal
International journal of nursing studies
ISSN: 1873-491X
Titre abrégé: Int J Nurs Stud
Pays: England
ID NLM: 0400675
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
07
09
2018
revised:
30
11
2018
accepted:
07
12
2018
pubmed:
27
1
2019
medline:
18
2
2020
entrez:
26
1
2019
Statut:
ppublish
Résumé
There is little research examining resistance, refusal or rejection of care by people living with dementia within acute hospital wards despite the prevalence of dementia in adult hospital populations. To explore the ways in which resistance to care manifests within the acute setting and is understood, classified and subsequently managed by ward staff. Ethnography SETTING: Acute medical units and trauma and orthopaedic wards in five NHS hospitals in England and Wales. People living with dementia and nursing team members (registered nurses and healthcare assistants) on participating wards. Observational fieldwork and ethnographic interviews collected over a period of 20 months (155 days of non-participant observation (minimum 2 h, maximum 12 h, total hours: 680) focusing on staff delivering care to patients with dementia. Interviewees included patients, visitors, and staff working on and visiting the ward. Data collection and analysis drew on the theoretical sampling and constant comparison techniques of grounded theory. We found that resistance to care by people living with dementia was a routine and expected part of everyday care in the participating acute hospital settings. The timetabled rounds of the ward (mealtimes, medication rounds, planned personal care) significantly shaped patient and staff experiences and behaviours. These routinized ward cultures typically triggered further patient resistance to bedside care. Institutional timetables, and the high value placed on achieving efficiency and reducing perceived risks to patients, dictated staff priorities, ensuring a focus on the delivery of essential everyday planned care over individual patient need or mood in that moment. Staff were thus trapped into delivering routines of care that triggered patterns of resistance. Nursing staff struggle to respond to the needs of people living with dementia in acute care settings where the institutional drivers of routines, efficiency and risk reduction are not mediated by clinical leadership within the ward. Cycles of resistance in response to organisationally mandated timetables of care can result in poor care experiences for patients, and emotional and physical burnout for staff. More research is needed into how institutional goals can be better aligned to recognise the needs of a key hospital population: people living with dementia.
Sections du résumé
BACKGROUND
BACKGROUND
There is little research examining resistance, refusal or rejection of care by people living with dementia within acute hospital wards despite the prevalence of dementia in adult hospital populations.
OBJECTIVES
OBJECTIVE
To explore the ways in which resistance to care manifests within the acute setting and is understood, classified and subsequently managed by ward staff.
DESIGN
METHODS
Ethnography SETTING: Acute medical units and trauma and orthopaedic wards in five NHS hospitals in England and Wales.
PARTICIPANTS
METHODS
People living with dementia and nursing team members (registered nurses and healthcare assistants) on participating wards.
METHODS
METHODS
Observational fieldwork and ethnographic interviews collected over a period of 20 months (155 days of non-participant observation (minimum 2 h, maximum 12 h, total hours: 680) focusing on staff delivering care to patients with dementia. Interviewees included patients, visitors, and staff working on and visiting the ward. Data collection and analysis drew on the theoretical sampling and constant comparison techniques of grounded theory.
RESULTS
RESULTS
We found that resistance to care by people living with dementia was a routine and expected part of everyday care in the participating acute hospital settings. The timetabled rounds of the ward (mealtimes, medication rounds, planned personal care) significantly shaped patient and staff experiences and behaviours. These routinized ward cultures typically triggered further patient resistance to bedside care. Institutional timetables, and the high value placed on achieving efficiency and reducing perceived risks to patients, dictated staff priorities, ensuring a focus on the delivery of essential everyday planned care over individual patient need or mood in that moment. Staff were thus trapped into delivering routines of care that triggered patterns of resistance.
CONCLUSIONS
CONCLUSIONS
Nursing staff struggle to respond to the needs of people living with dementia in acute care settings where the institutional drivers of routines, efficiency and risk reduction are not mediated by clinical leadership within the ward. Cycles of resistance in response to organisationally mandated timetables of care can result in poor care experiences for patients, and emotional and physical burnout for staff. More research is needed into how institutional goals can be better aligned to recognise the needs of a key hospital population: people living with dementia.
Identifiants
pubmed: 30679033
pii: S0020-7489(18)30268-2
doi: 10.1016/j.ijnurstu.2018.12.009
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
53-60Subventions
Organisme : Department of Health
ID : 15/136/67
Pays : United Kingdom
Organisme : Department of Health
ID : HS&DR/13/10/80
Pays : United Kingdom
Informations de copyright
Copyright © 2018. Published by Elsevier Ltd.