Work system influences on nursing staff capacity for relational dementia care on medicine for older persons wards: an ethnographic study

Abstract

There is a paucity of research studies that provide an in-depth exploration into the care for people with dementia on Medicine for Older Persons wards, particularly focusing on the provision of relational care and the effect of the work system on nursing staffs capacity to do so. The purpose of this study was to address this gap in the knowledge base.

This thesis describes a research study that aimed to explore the work system factors of Medicine for Older Persons wards and identify how these factors influence nursing staff capacity to provide relational care for people with dementia. Ethnographic research methodology was adapted to explore the culture of the three wards that participated in this study. A range of data collection methods were used including unstructured observations, informal conversations, semi-structured interviews and reflexive notes, followed by thematic analysis between January 2017 and March 2018.

The findings identify that the capacity for relational care does not sit with nursing staff themselves but relies to a great extent on the organisational context in which the nursing work takes place. Organisational priorities, temporal routines, and predetermined task duration shaped by organisational targets all have a significant impact on the way in which nursing staff organise their work. Organisational priorities do not include relational care and the time that nursing staff are able to spend building relationships with patients, particularly patients with dementia, is reduced as a consequence.

These findings echo what is already known in the evidence base, with more recent research by others (Featherstone et al. 2018) highlighting how routines dictate the care for people with dementia on acute admissions units and orthopaedic wards. However, through providing an in-depth picture of the mechanisms by which the nursing work system shapes the care that nurses are able to provide, this research suggests that routinised care is also predominating on specialist Medicine for Older People wards and impacting on the care experiences in the same way, despite the expertise that this workforce are thought to uphold.

The study has made both unique empirical and theoretical contributions but has also led to the development of recommendations for future practice. Most importantly the results provide evidence that any further research looking to improve relational care should start with the organisation. Nursing staff are aware of how to provide relational care, however, due to the organisational context in which their work is completed, they have no capacity to provide it. Relational care needs to be given the same priority as physical care, especially for patients with dementia and unless improvements to relational care is addressed at an organisational level, it is unlikely that nursing staff capacity for relational care for people with dementia will improve.

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Identifiers

ORCID for Emily Charlotte Oliver: orcid.org/0000-0002-2507-3869

ORCID for Ruth Bartlett: orcid.org/0000-0002-3412-2300

ORCID for Jacqueline Bridges: orcid.org/0000-0001-6776-736X

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