Nursing interventions to improve care of people living with dementia in hospital: A mixed methods systematic review

The Effectiveness of Nursing Interventions in Hospital: An Umbrella Review

AIM

The aim of this umbrella review was to summarise the existing evidence on the effectiveness of nursing interventions targeted at adult patients in hospitals.

DESIGN

Existing systematic reviews were synthesised.

DATA SOURCES

The literature search was conducted in PubMed, CINAHL Complete, and the Cochrane Library by two of the authors until June 6th 2024 without a time limit.

METHODS

A total of 2652 records were identified. After screening the titles and abstracts, 2421 records were excluded. Then two records were excluded as they were not retrieved, and 125 records were excluded during full-text review as they did not meet the inclusion criteria. Finally, 11 reviews (141 original studies) were included in the quality assessment and were analysed narratively.

RESULTS

The most commonly used interventions were educational, followed by preventive, observative, or combinations of various interventions. All interventions were targeted at the care of somatic patients. The interventions lacked detailed descriptions of their content and duration. Nursing interventions were found to reduce anxiety, depression, disorder symptoms, pain intensity, length of hospital stay, serious adverse effects, mortality, infections and pressure ulcer prevalence.

CONCLUSIONS

There is limited high-quality evidence on the effectiveness of nursing interventions used by nurses at hospital settings. While nursing interventions can improve hospital patient outcomes, more high-quality systematic reviews and meta-analyses are needed. Only preventive interventions (such as pressure ulcer prevention and use of early warning scores) consistently showed positive effects and are relatively easy to implement in hospital nursing practice. Other interventions are not yet widely integrated into standard care in hospitals. It is necessary to study the cost-effectiveness of nursing interventions.

NO PATIENT OR PUBLIC CONTRIBUTIONS

This umbrella review did not include any patient or public involvement.

REPORTING METHOD

This umbrella review of systematic reviews adheres to the PRISMA statement.

Role of a Dementia Virtual Reality App in Developing Situated Empathy, Attitude and Person-Centred Care-A Qualitative Approach

BACKGROUND

The demands of any health education programme including nurse education would benefit from innovative ways to support students learning in an effective and efficient manner. Such approaches resonate particularly when caring for older people living with dementia, due to multifactorial manifestations of the condition, patients' difficulty in articulating their needs and the potential for negative care outcomes. Empathy is an important part of understanding dementia and is also recognised as a complex and multidimensional concept.

OBJECTIVE

This study investigated the impact of undergraduate nursing students' 15-min use of the Experience Dementia in Singapore (EDIS) virtual reality app in their tutorial lesson for developing their empathy, changing their attitude and increasing their sensitivity for person-centred care of people with dementia.

METHOD

We carried out content and thematic analysis of data anonymously collected via the in-class learning activities at the start and at the end of the lesson.

RESULTS

All participating students (n = 89, 89% response rate) achieved their learning goal to experience a first-person perspective and gain insights into needs and care for persons living with dementia. The results showed students transitioned from having mainly knowledge foremost in their mind, to more empathetic and care related thoughts when delivering care to persons living with dementia. The experience made more students aware of how they could communicate care, make environmental modifications to support and develop an attitude of person-centred care for persons living with dementia and their families. The analysis resulted in four themes: (1) immersive learning-walking in the shoes of the person living with dementia (2) feelings evoked from the first-person perspective (3) little things, big impact; little things, positive impact; and (4) communicating care.

CONCLUSION

The EDIS virtual reality app was an efficient and effective way for students to develop essential elements, especially empathy, as well as positive attitudes and sensitivity towards person-centred care for those living with dementia.

IMPLICATIONS FOR PRACTICE

The first-hand experience the VR app offers allows students to challenge pre-conceived perceptions about older people and those living with dementia. As such, it is a versatile tool that can be incorporated into a variety of study and training programmes for students, professionals and caregivers who provide care or care solutions for persons living with dementia and their families.

The Experience of Hospitalisation for People Living With Dementia: A Qualitative Exploration of How Context Shapes Experiences

INTRODUCTION

Dementia has become an increasingly pressing issue in healthcare systems, and acute care settings such as hospitals have been shown to be particularly problematic for people living with dementia. People living with dementia are hospitalised at higher rates than those without and often have poor experiences and outcomes of hospitalisation. To support the evolution of hospital systems to better meet the needs of people living with dementia, it is important to consider the relationship between the context of the hospital and the experiences of people living with dementia and their caregivers. The term context refers to the environment and conditions that shape experiences and includes elements such as policies, procedures, design and social norms. A greater understanding of the relationship between the hospital context and the experiences of people living with dementia will support the future development of interventions to modify contextual elements to improve the experiences of people living with dementia. Our aim was to explore the relationship between the experiences of people living with dementia and their caregivers in hospital, and the contextual elements of the hospital.

METHODS

In this interpretive descriptive study, we conducted interviews with people living with dementia and caregivers of people living with dementia about their experiences in hospital. Interviews were conducted with people living with dementia (n = 3), caregivers of people living with dementia (n = 8) and one dyad of a person living with dementia and their caregiver (n = 1) about the hospitalisation of the person living with dementia. Using inductive and deductive methods of analysis, we describe contextual factors that shape their experiences.

RESULTS

Our findings demonstrate how the hospital context shaped the experiences of people living with dementia and their caregivers while the person living with dementia was hospitalised. The themes reflect elements of the hospital context: communication systems, the value of caregivers, the focus on acute physical needs, staff capacity, the physical environment and normalised practices. The findings suggest that there are aspects of the hospital context that can be modified to influence the experiences of people living with dementia and their caregivers.

CONCLUSION

This study demonstrates how the context of hospital shapes the experiences of people living with dementia and their caregivers and points to aspects of the context that health system leaders could explore to begin to improve the capacity of hospitals to support people living with dementia.

IMPLICATIONS FOR PRACTICE

The study provides evidence of the need for health system leaders and practitioner to explore how the hospital context shapes the experiences of people wtih dementia and their caregivers, and begins to explore ways that contextual changes can improve their experiences.