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Routines of resistance: An ethnography of the care of people living with dementia in acute hospital wards and its consequences

Routines of resistance: An ethnography of the care of people living with dementia in acute hospital wards and its consequences
Routines of resistance: An ethnography of the care of people living with dementia in acute hospital wards and its consequences
Background

There is little research examining resistance, refusal or rejection of care by people living with dementia within acute hospital wards despite the prevalence of dementia in adult hospital populations.

Objectives

To explore the ways in which resistance to care manifests within the acute setting and is understood, classified and subsequently managed by ward staff.

Design

Ethnography

Setting

Acute medical units and trauma and orthopaedic wards in five NHS hospitals in England and Wales.

Participants

People living with dementia and nursing team members (registered nurses and healthcare assistants) on participating wards.

Methods

Observational fieldwork and ethnographic interviews collected over a period of 20 months (155 days of non-participant observation (minimum 2 h, maximum 12 h, total hours: 680) focusing on staff delivering care to patients with dementia. Interviewees included patients, visitors, and staff working on and visiting the ward. Data collection and analysis drew on the theoretical sampling and constant comparison techniques of grounded theory.

Results

We found that resistance to care by people living with dementia was a routine and expected part of everyday care in the participating acute hospital settings. The timetabled rounds of the ward (mealtimes, medication rounds, planned personal care) significantly shaped patient and staff experiences and behaviours. These routinized ward cultures typically triggered further patient resistance to bedside care. Institutional timetables, and the high value placed on achieving efficiency and reducing perceived risks to patients, dictated staff priorities, ensuring a focus on the delivery of essential everyday planned care over individual patient need or mood in that moment. Staff were thus trapped into delivering routines of care that triggered patterns of resistance.

Conclusions

Nursing staff struggle to respond to the needs of people living with dementia in acute care settings where the institutional drivers of routines, efficiency and risk reduction are not mediated by clinical leadership within the ward. Cycles of resistance in response to organisationally mandated timetables of care can result in poor care experiences for patients, and emotional and physical burnout for staff. More research is needed into how institutional goals can be better aligned to recognise the needs of a key hospital population: people living with dementia.
0020-7489
1-8
Featherstone, Katie
2bbc49e6-1ceb-4aff-8734-7b1f81f2339b
Northcott, Andy
4a869769-3129-42dd-a58a-804c6b366e97
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd
Featherstone, Katie
2bbc49e6-1ceb-4aff-8734-7b1f81f2339b
Northcott, Andy
4a869769-3129-42dd-a58a-804c6b366e97
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd

Featherstone, Katie, Northcott, Andy and Bridges, Jackie (2019) Routines of resistance: An ethnography of the care of people living with dementia in acute hospital wards and its consequences. International Journal of Nursing Studies, 1-8. (doi:10.1016/j.ijnurstu.2018.12.009).

Record type: Article

Abstract

Background

There is little research examining resistance, refusal or rejection of care by people living with dementia within acute hospital wards despite the prevalence of dementia in adult hospital populations.

Objectives

To explore the ways in which resistance to care manifests within the acute setting and is understood, classified and subsequently managed by ward staff.

Design

Ethnography

Setting

Acute medical units and trauma and orthopaedic wards in five NHS hospitals in England and Wales.

Participants

People living with dementia and nursing team members (registered nurses and healthcare assistants) on participating wards.

Methods

Observational fieldwork and ethnographic interviews collected over a period of 20 months (155 days of non-participant observation (minimum 2 h, maximum 12 h, total hours: 680) focusing on staff delivering care to patients with dementia. Interviewees included patients, visitors, and staff working on and visiting the ward. Data collection and analysis drew on the theoretical sampling and constant comparison techniques of grounded theory.

Results

We found that resistance to care by people living with dementia was a routine and expected part of everyday care in the participating acute hospital settings. The timetabled rounds of the ward (mealtimes, medication rounds, planned personal care) significantly shaped patient and staff experiences and behaviours. These routinized ward cultures typically triggered further patient resistance to bedside care. Institutional timetables, and the high value placed on achieving efficiency and reducing perceived risks to patients, dictated staff priorities, ensuring a focus on the delivery of essential everyday planned care over individual patient need or mood in that moment. Staff were thus trapped into delivering routines of care that triggered patterns of resistance.

Conclusions

Nursing staff struggle to respond to the needs of people living with dementia in acute care settings where the institutional drivers of routines, efficiency and risk reduction are not mediated by clinical leadership within the ward. Cycles of resistance in response to organisationally mandated timetables of care can result in poor care experiences for patients, and emotional and physical burnout for staff. More research is needed into how institutional goals can be better aligned to recognise the needs of a key hospital population: people living with dementia.

Text
Routines of resistance: an ethnography of the care of people living with dementia in acute hospital wards and its consequences - Accepted Manuscript
Restricted to Repository staff only until 2 January 2020.
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More information

Accepted/In Press date: 7 December 2018
e-pub ahead of print date: 2 January 2019

Identifiers

Local EPrints ID: 426857
URI: https://eprints.soton.ac.uk/id/eprint/426857
ISSN: 0020-7489
PURE UUID: 7495ee49-2f37-4504-99a5-7cc21827de32
ORCID for Jackie Bridges: ORCID iD orcid.org/0000-0001-6776-736X

Catalogue record

Date deposited: 14 Dec 2018 17:30
Last modified: 19 Jul 2019 16:48

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