Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study

摘要: Background The acute hospital setting has become a key site of care for people living with dementia. Department Health and Social Care recognises that as many one in four beds the UK will be occupied by person dementia at any given time. However, are highly vulnerable group within setting. Following an admission, their functional abilities can deteriorate quickly significantly. Detailed research is required to understand role needs health-care staff caring this patient population explore what constitutes ‘good care’ Objectives focus study was common but poorly understood phenomenon setting: refusal resistance care. Our questions were ‘How do ward respond everyday being cared on wards?’ ‘What perspective patients carers?’. Design This ethnography informed symbolic interactionist tradition, focusing understanding how action meaning constructed In-depth evidence-based analysis enabled us responded follow consequences actions. Setting carried out 155 days (over 18 months) 10 wards five hospitals across England Wales, which purposefully selected represent range types, geographies socioeconomic catchments. Participants In addition general observations, participants took part directly study, contributing 436 ethnographic interviews. Ten detailed case studies also undertaken Results We identified high levels among wards. Every observed resisted some point during admission. Limitations included potential Hawthorne or researcher effect influence data collection establishing generalisability findings. Conclusions Ward typically interpreted feature diagnosis, overshadowed person. response organisation delivery rational person’s present ontology perceptions. response, nurses assistants used multiple interactional approaches combined repetitive language completing essential body, itself had containment restraint bed bedside. These trigger resistance, creating cycles stress patients, families staff. findings have development simple, no-cost innovations organisational level. A further examining continence settings. Funding National Institute Research Services Delivery programme.