Objectives and brief methodology
There is much evidence to suggest that care standards for people with dementia in general hospitals could be improved. Methods to describe the experiences of people with dementia are required to guide improvements. The research objective was to develop and feasibility-test a method for directly observing patient experiences suitable for multi-site use in the National Audit of Dementia. This aimed to complement the quantitative aspects of the clinical audit (such as a checklist of policies and procedures) by providing staff with the opportunity to observe what actually occurs for patients at the micro-level.
There were three main stages:
- The development of the pilot observational method, based on the research literature and stakeholder consultation.
- Pilot studies in seven NHS acute Trusts and modification.
- Roll-out for the national audit.
Results and impact of research
A preliminary observational tool was developed, based on a literature review and consumer input, to evaluate key elements of person-centred care in relation to Personalised care, Interactions with staff and the Environment(PIE).
Following a preparatory training workshop, clinical leads in seven NHS Trusts (elderly care, medical, surgical wards) used PIE. 76 patients in18 wards were observed. The pre-stated minimum requirements for data collection were fulfilled (at least 4hrs ward observation of 5-10 patients to include a morning and meal-time, and the completion of reflection and action planning datasheets). PIE was reported to be easy to use and particularly helpful in enabling staff to view care from the patient perspective (“it’s like having a story unfolding in front of your eyes”; “you don’t always experience that as a member of staff because you’ve got your own priorities”). Analysis of the datasheets showed that staff gave rich, descriptive and honest accounts of patients’ experiences, thereby providing a valid basis for the generation of ideas for action e.g. to provide a more stimulating environment, improve use of person-centred information and improve team-working at meals. Staff recommendations were incorporated into the guidance for using the tool in the national audit.
The PIE observational method was used by ward staff with 608 patients in 43 Trusts (105 wards) for the national audit (3). A qualitative analysis to compare and contrast the observational findings within and across wards was undertaken. Only 5 out of 105 wards provided evidence of multi-components of person-centred care observed at the interface of care delivery. In these ‘exemplar’ wards – and more typically observed in ‘pockets’ of person-centred practice across wards – the quality of communication between staff and patients was revealed to be especially critical for providing a person-centred experience for patients. This was defined as an approach that both addressed their social and emotional needs (such as for orientation or reassurance) and their ability to participate in the processes of care (such as hygiene or eating and drinking) essential to their recovery. A framework for the steps that need to be taken by wards to improve communicative practices was defined. For example, a ward ethos to interact with patients at every opportunity and using information about the patient as a person to guide care interactions. It is hoped that hospital wards might draw on the national audit findings to assess where they currently stand and where improvements might be made in relation to elements of communication with people with dementia.
July 2008 to July 2011
Eligible patients included people who have a formal diagnosis of dementia and those identified by staff as having possible dementia (on the basis that if the staff identify someone as such, then the care delivered to them will be the same as to a person with a confirmed diagnosis).
Royal College of Psychiatrists’. Report of the National Audit of Dementia Care in General Hospitals 2011. Editors: Young J, Hood C, Woolley R, Gandesha A, Souza R. Commissioned by HQIP. http://www.rcpsych.ac.uk/PDF/NATIONAL%20REPORT%20-%20Full%20Report%201201122.pdf
Healthcare Quality Improvement Partnership