title: Healthcare staffs' experiences and perceptions of caring for people with dementia in the acute setting: Qualitative evidence synthesis.
abstract: BACKGROUND
  Dementia is a global issue, with increasing prevalence rates impacting on health services internationally. People with dementia are frequently admitted to hospital, an environment that may not be suited to their needs. While many initiatives have been developed to improve their care in the acute setting, there is a lack of cohesive understanding of how staff experience and perceive the care they give to people with dementia in the acute setting.
  
  
  OBJECTIVE
  The aim of this qualitative synthesis was to explore health care staffs' experiences and perceptions of caring for people with dementia in the acute setting. Qualitative synthesis can bring together isolated findings in a meaningful way that can inform policy development.
  
  
  METHODS
  A screening process, using inclusion/exclusion criteria, identified qualitative studies that focused on health care staff caring for people with dementia in acute settings.
  
  
  METHODS
  Twelve reports of nine studies were included for synthesis. Data extraction was conducted on each report by two researchers.
  
  
  METHODS
  Framework synthesis was employed using VIPS framework, using Values, Individualised, Perspective and Social and psychological as concepts to guide synthesis. The VIPS framework has previously been used for exploring approaches to caring for people with dementia. Quality appraisal was conducted using Critical Appraisal Skills Programme (CASP) and NVivo facilitated sensitivity analysis to ensure confidence in the findings.
  
  
  RESULTS
  Key themes, derived from VIPS, included a number of specific subthemes that examined: infrastructure and care pathways, person-centred approaches to care, how the person interacts with their environment and other patients, and family involvement in care decisions. The synthesis identified barriers to appropriate care for the person with dementia. These include ineffective pathways of care, unsuitable environments, inadequate resources and staffing levels and lack of emphasis on education and training for staff caring for people with dementia.
  
  
  CONCLUSIONS
  This review has identified key issues in the care of people with dementia in the acute setting: improving pathways of care, creating suitable environments, addressing resources and staffing levels and placing emphasis on the education for staff caring for people with dementia. Recommendations are made for practice consideration, policy development and future research. Leadership is required to instil the values needed to care for this client group in an effective and personcentred way. Qualitative evidence synthesis can inform policy and in this case, recommends VIPS as a suitable framework for guiding decisions around care for people with dementia in acute settings.
authors.affiliation: School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland. Electronic address: catherine.houghton@nuigalway.ie.
authors.forename: Catherine
authors.initials: C
authors.lastname: Houghton
authors.affiliation: School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland. Electronic address: kathy.murphy@nuigalway.ie.
authors.forename: Kathy
authors.initials: K
authors.lastname: Murphy
authors.affiliation: University of Worcester Association for Dementia Studies, Institute of Health and Society, University of Worcester, United Kingdom. Electronic address: d.brooker@worc.ac.uk.
authors.forename: Dawn
authors.initials: D
authors.lastname: Brooker
authors.affiliation: School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland. Electronic address: dympna.casey@nuigalway.ie.
authors.forename: Dympna
authors.initials: D
authors.lastname: Casey
mesh_terms: D003704:Dementia / Q000451:nursing*; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D036301:Qualitative Research
keywords: Acute care; Dementia; Framework synthesis; Person-centred care; Qualitative evidence synthesis; VIPS