Caring for patients with dementia in a general hospital setting
This thesis is divided into three sections. Section one, the literature review, considers the experiences of general hospital staff caring for patients with dementia. 14 papers were included in the meta-synthesis. Five key themes were constructed from the analysis: the unknown and undesirable; constraints of the environmental and organisational context; emphasising the physical health of patients; recognising the benefits of person-centred care; and identifying the need for training. The synthesis identified how a lack of knowledge of dementia, particularly regarding behaviours that are considered challenging, can contribute to low staff confidence and negativity towards these patients. This, along with organisational constraints, can impact on ability to provide person-centred care. The benefits of dementia training have been recognised. Clinical and research implications of the findings are discussed. Section two, the empirical paper, considered the experiences of staff within general hospitals regarding the use of truth and deception when caring for patients with dementia. In particular, it explored their decision making processes when choosing whether to tell the truth or to deceive. A grounded theory methodology was used to construct a theoretical model of this process. The analysis identified how ‘triggers’ set in motion the need for a response. Various ‘mediating factors’ (including a lack of communication, the individual’s interpretation of their role and responsibility, and their ethical framework) influenced how staff chose to ‘respond’ to those triggers. Again, clinical and research implications have been recognised. Section three, the critical appraisal, offers a reflective account of the research journey. These reflections are organised into six categories that consider the researcher’s own decision-making processes when carrying out the empirical paper.
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