Dementia awareness training as a single strategy will not improve dementia care in hospitals or outcomes for patients, a new study from the University of Hertfordshire, published in the online journal BMJ Open today (Monday 17 July 2017), highlights.
The research, funded by the Alzheimer’s Society, reviewed approaches to make hospital environments more dementia friendly. The report found that in addition to dementia awareness training, it is important for senior team members with specific expertise in dementia care to work closely with hospital staff to support the continued development of skills in this area and promote their use among patients.
Greater recognition of the changes to staff roles and responsibilities when caring for patients with dementia, and a flexible approach – that can accommodate the known limitations of ward routines – is also necessary to meet the needs of patients with dementia.
Changes must be endorsed by senior management, to give staff permission and confidence to adapt practices to provide good dementia care.
The report also found that strategies to help staff understand behaviour that challenges them as communication of an unmet need can encourage staff to take action to help reduce distress, as well as enable patients to be more independent.
Researchers interviewed key stakeholders and carried out a comprehensive literature review of interventions aimed at improving hospital care for people living with dementia. The report highlights six interconnected concepts which can enable effective dementia care in hospitals:
1) Where behaviour that challenges staff is understood as communication of an unmet need – via training, information about the patient and support from experts in dementia care – staff will feel able to respond to the patient’s needs.
2) Training which promotes understanding and empathy towards people living with dementia helps staff to understand the importance of making changes to care and encourages them to take more time with people living with dementia.
3) Clinical experts who convey to staff the priorities and standards for dementia care which are endorsed by the organisation, can support staff to develop skills in dementia care and help staff feel confident in their ability to adapt care practices.
4) Supporting staff to have confidence to organise care provision around the needs of the patient was linked to responsive, person-centred care. This helped staff to recognise and address unmet needs and distress, thereby improving patient wellbeing.
5) Time constraints and staffing resources limit staff capacity to provide good dementia care. Employing staff to assess cognitive abilities, provide therapeutic activities and supervise social mealtimes can help to meet patients’ psychological, emotional and social needs.
6) Building staff confidence to address patient risk in a person-centred way that supports a person’s abilities, choices and independence can improve mobility, reduce patient distress, and increase patient and carer satisfaction
Understanding complexity of caring for people with dementia
Melanie Handley, lead author of the report, from the University of Hertfordshire, said:
“There is increasing recognition that hospital staff and services need to understand the complexity of caring for and treating people living with dementia. At any one time, 25% of hospital beds are used by people living with dementia, rising to a higher proportion on some wards. Healthcare outcomes for people living with dementia are variable across the country and are inequitable when compared to outcomes for people without cognitive impairments.”
“Our findings suggest that training as a single strategy is not enough to influence staff to adapt the care they provide for people living with dementia, to meet their needs. Rather we have highlighted six propositions which can run alongside one another to help deliver comprehensive care and positive patient outcomes.
“Importantly, managerial endorsement for staff to work flexibly within their role, utilising practices and resources that enable them to get to know the person, will help staff to recognise and address signs of distress and implement best practice in dementia care.
“We also found the need for access to experts in dementia care who can advise and encourage staff to provide good care for people living with dementia. In studies where this was adopted, experts with authority were able to communicate new expectations for standards of care and changes to procedures, validating the priorities for care and legitimising staffs’ adaption of care practices accordingly.”
Dr Doug Brown, Director of Research at Alzheimer’s Society, said:
“Sadly we know that dementia care in hospitals in extremely variable. An Alzheimer’s Society investigation in 2016 found that only 2% of people affected by dementia felt, in their experience, that all hospital staff understood the specific needs of people with dementia. While we are actively campaigning to change this, it’s exciting to see that research we are funding is lighting the way for better care in hospitals.
“The findings from this study show that better support from senior colleagues with dementia expertise can help staff to put training into practice and ultimately deliver better outcomes for people with dementia. The next step, and where this will truly make a difference for people affected by dementia, is to get hospitals across the country to commit to providing appropriate dementia training for all staff and senior dementia specialists within hospital trusts. We hope to achieve this through Dementia Action Alliance Dementia-Friendly Hospital Charter, which already has over 100 hospitals signed up.”