The nursing experience of caring for patients living with dementia and co-morbidities on surgical wards in the acute healthcare setting

Background. The complex needs of patients living with dementia and co-morbidities and the consequent growing burden on the healthcare system necessitates consideration of new ways of delivering care in the acute setting. Patients living with dementia are high users of acute care, but have poorer clinical outcomes and higher rates of mortality and adverse events in hospitals, when compared to the general population. Care of this vulnerable group is complex and time-consuming, as well as physically and emotionally demanding on nursing staff. This presents challenges to nursing staff in the acute setting. Aims. This study had four aims to: (i) explore the attitudes of nursing staff providing care to patients living with dementia and co-morbidities on surgical wards in the acute setting; (ii) measure the extent to which care was perceived by nursing staff to be patient-centred; (iii) measure the satisfaction of nursing staff with providing patient-centred care; and (iv) identify barriers and facilitators to the provision of patient-centred care to patients living with dementia and co-morbidities on surgical wards in an acute setting. Method. A mixed-method study design was used to explore the experience of nursing staff caring for patients living with dementia and co-morbidities on surgical wards in an acute healthcare setting. Participants were purposively chosen from three acute surgical wards in a tertiary metropolitan teaching hospital.Each participant completed three questionnaires and a semi-structured interview. A total of 13 registered nurses were recruited. Results. The nurses were found to have a positive attitude towards patients with dementia. They recognised the importance of establishing communication and a bond with these patients to address their unique needs and to provide patient-centred care. However, many nurses expressed frustration and stress at not being able to provide this care on the acute surgical ward. Nurses' satisfaction with providing patient-centred care was dependent on the amount of support received from the organisation in terms of resources, such as adequate staffing, and the ward environment. Barriers identified included a lack of time and resources to provide patient-centred care and a lack of training to acquire the skills needed to care for this vulnerable group. Facilitators to patient-centred care included strategies or 'work-arounds' to provide safe care and extra nursing staff, called patient specials, who provided constant patient supervision. Conclusion. Despite the significant relationship between the nursing staff-patient experiences, there is a lack of research focusing on the staff experience of providing patient-centred care to patients living with dementia and co-morbidities on surgical wards in the acute setting. Understanding the nursing staff experience of providing patient-centred care in this setting and using this knowledge to develop and improve systems to support excellence in care is needed.