The responses of healthcare professionals to the admission of people with cognitive impairment to acute hospital settings: an observational and interview study.
OBJECTIVE
To explore the responses of healthcare professionals to the admission of people with cognitive impairment to the acute hospital setting.


BACKGROUND
While improving care for people with dementia has been identified as a national priority, providing appropriate care in acute hospitals for people with comorbid cognitive impairment presents challenges to healthcare professionals.


METHODS
Based on the principles of ethnography, this was a qualitative interview and nonparticipation observational study.


METHODS
Seventy-two hours of nonparticipant observations of care together with semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had a cognitive impairment. Interviews and observations were conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework.


RESULTS
The results identified a core problem, 'disruption', and a core process, 'gaining or giving a sense of control to cope with disruption'. Healthcare professionals respond to the disruption in three ways: by acting to preserve the personhood of the individual; by seeking to protect themselves from the stresses associated with caring for the person with cognitive impairment; and by suspending the personhood of the individual.


CONCLUSIONS
Where healthcare professionals acted to suspend the personhood of the patient, they appeared to be demonstrating signs of 'burnout'.


CONCLUSIONS
There is a need both to challenge poor practice and for positive development work with healthcare professionals who work in acute hospitals with people with dementia and cognitive impairment so that they are equipped with the skills, emotional resilience and organisational support to be effective in meeting the needs of people with dementia and cognitive impairment.
School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK.
Philip
P
Clissett
Davina
D
Porock
Rowan H
RH
Harwood
John R F
JR
Gladman
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003072:Cognition Disorders / Q000451:nursing / Q000523:psychology*; D003704:Dementia / Q000451:nursing / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D010343:Patient Admission
acute care; cognitive impairment; delirium; dementia; gerontology; hospitals; nursing; personhood; qualitative approaches