Implementing Person-Centred Dementia Care in a Rehabilitation Hospital through an Appreciation Inquiry Approach
2017
Scerri, A. (2017). Implementing person-centred dementia care in a rehabilitation hospital through an appreciative inquiry approach. (Doctoral dissertation).
Alzheimer's disease -- Patients -- Care
Patient-centred health care
Appreciative inquiry
Background: The quality of care of persons with dementia in hospital settings is far from optimal and can be very challenging, partly because staff are untrained in person-centred dementia care. Training and staff development has been shown to positively influence staff and patient outcomes, although staff may not be empowered enough to translate what they have learned into practice. Methods: The aim of this study was to develop and evaluate using a pre-test-post-test design, a facilitation program on person-centred dementia care in two geriatric hospital wards through an appreciative inquiry approach. The attitudes and perceived self-efficacy of all staff in both wards and the quality of care of ten patients with dementia admitted in the two wards, was collected using Dementia Care Mapping, and compared with the data obtained immediately following the program and four months after. Positive care experiences/stories as obtained from the staff members and relatives of persons with dementia were collected and analysed. Open-ended questions were asked to encourage care workers to narrate positive care experiences when the care was perceived to be at its best and to identify what made these experiences possible. Interviews were audio-taped and transcribed whilst data was analysed thematically. Eventually staff working in the same wards attended six workshops during which they were guided to build an understanding of person-centred dementia care partly adapted from their own stories as derived from the interviews and how to develop action plans to implement this type of care. Findings: Based on the interviews with the hospital staff and family members of persons with dementia, positive care experiences were developed within five care processes namely; building a relationship between the ‘extended’ dementia care triad, providing ‘quality time’ and ‘care in time’, going the ‘extra mile’, attending to the psychosocial needs and attending to the physical needs with a ‘human touch’. Factors facilitating these positive care experiences included personal attributes of care workers; organisational, environmental and contextual factors. Hospital staff favourably commented about the AI approach used. Staff attitudes towards persons with dementia significantly improved following the workshops whilst the number of staff-patient interactions that enhanced the psychological need for comfort doubled and remained so after four months. Moreover, staff worked collaboratively to develop a strategic vision and action plans, some of which were implemented in practice. Conclusion: A facilitation program in person-centred dementia care using an appreciative inquiry approach improved staff attitudes towards persons with dementia and encouraged inter-professional collaboration to develop and implement dementia care practices in hospital wards. Exploring positive care experiences using the Discovery phase of appreciative inquiry helped in understanding the meaning of quality dementia care from the perspective of the stakeholders involved. Finally, the study showed that using an AI approach, learning about dementia care can be facilitated by combining person-centred dementia care theories and models with the practical knowledge obtained from the staff own stories.
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