When people living with dementia say ‘no’: negotiating refusal in the acute hospital setting.

摘要: A quarter of UK acute hospital beds are occupied by people living with dementia (PLWD). Concerns have been raised both policy makers and carers about the quality communication between staff PLWD. PLWD may experience impairments such as word finding difficulties, limited ability to construct coherent narratives difficulties understanding others. Since much healthcare delivery occurs through talk, professionals (HCPs) likely increased barriers. Consistent this, HCPs report stress reduced job satisfaction associated difficulty communicating face these challenges whilst striving deliver person-centred care, respecting autonomy wishes patient before them. However, best practice recommendations in field tend not be based on actual interactional evidence. This paper investigates recurring around HCP requests carry out health social care tasks subsequent reluctance or refusal part Using conversation analysis, we examined 41 video recordings HCP/PLWD interactions collected across three inpatient wards. We identify nature refusals, any mitigation offered, explore preceding them terms entitlement contingency. also which precede agreement a course action. conclude that several features can seen acceptance, principally use higher requests, lowering contingencies. Our findings underline importance examining contextual detail involved negotiation healthcare, here leads an how design impact important activity being carried out. They emphasise power analytic methods areas frequent trouble previously articulated.