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The liminality of the patient with dementia in hospital
Author(s) -
Digby Robin,
Lee Susan,
Williams Allison
Publication year - 2018
Publication title -
journal of clinical nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.94
H-Index - 102
eISSN - 1365-2702
pISSN - 0962-1067
DOI - 10.1111/jocn.13869
Subject(s) - liminality , dementia , feeling , thematic analysis , nursing , medicine , health care , psychology , qualitative research , disease , social psychology , sociology , social science , pathology , anthropology , economics , economic growth
Aims and objectives The aim was to explore the experiences of people with dementia in subacute geriatric rehabilitation hospitals to critically evaluate the care received by such patients. Background Globally, the number of people with dementia is growing and is expected to impact progressively more on health systems. People with dementia can become deconditioned and deteriorate in cognitive function while in hospital. The unfamiliar environment and people can cause the person to become disorientated, which then leads to behavioural symptoms which complicate care. Design Critical ethnography. Methods Methods included observation with field notes and 30 audio‐recorded conversational interviews with patients with dementia in an Australian subacute care setting. Data were collected in May–December 2014, transcribed verbatim and analysed using thematic analysis. Results The central theme identified that patients with dementia described a liminal experience and felt like outsiders in the hospital environment. This was supported by the subthemes of not understanding why they were being kept in hospital, feeling lost in the space, bored, anxious about discharge plans and lacking intersubjective relationships. Many felt imprisoned by the locked wards. There was little evidence of nursing care delivered in an empathetic person‐centred way. Nurses were busy and engaged with the patients only superficially. Conclusions People with dementia can have a liminal experience and feel like outsiders in this environment, which does not cater for the specific needs of this patient group. It should be acknowledged that people with dementia require additional resources. A caring nurse–patient relationship is fundamental to the patient experience. Nurses require further support and education about dementia in order to deliver quality care to this patient group. Relevance to clinical practice These findings will influence nurse leaders to advocate for improved resources for nurses to provide appropriate care for patients with dementia in subacute geriatric hospitals. The clinical practice of nurses needs to be supported with education, pyschological and material support to improve the therapeutic environment for patients with cognitive impairment resulting from dementia.