Wednesday, 5 July 2017

New Study - In Submission

Understanding continence in acute settings for people with dementia: raising awareness and improving care 

Submitted September 2016 to the NIHR HS&DR researcher led funding stream (£505,000). Awaiting outcome.

There are ongoing concerns about the institutionalized discrimination and the lack of dignity in the provision of current continence care people with dementia receive within general hospital wards within reviews and enquiries (Care Quality Commission, 2013) and among families and carers (Alzheimer's Society, 2009). This study brings rigour to improving the humanity as well as the effectiveness of continence care.

Going to the toilet in private is one of the most fundamental measures of human dignity, and incontinence can impact on feelings of being a person and their wider social status. When people with dementia are admitted to hospital wards, this requires the assistance of nurses or health care assistants. During our current study examining what happens when patients with dementia refuse hospital care, we have noticed that toileting is an important trigger that can lead to significant distress for patients (if immediate toileting assistance needs are not met), for families (who see their loved one in undignified circumstances) and for other patients (who may become afraid by the other person’s distress) and can increase the potential for dehumanization (staff not recognizing the person or their needs). When a patient with dementia is in hospital, it is often usual for staff to use incontinence pads or to insert a urinary catheter rather than help the person to go to the toilet. This is often because continence problems are a risk factor for falls. However, catheters can lead to significant risks of infection (that can become life-threatening) and not being able to independently go to the toilet, can reduce their opportunities to regain mobility and independence. This means that hospitals may be causing incontinence in patients with dementia.

Our consultations with carers identified that they had a lot of anger about continence care when their partner with dementia was in hospital. There was a general belief that catheterisation of patients with dementia was often for convenience, due to staff shortages, to prevent wet beds, and to reduce calls for help.  Many reported that their partner with dementia, who was continent, became classified as incontinent within days of admission and required catheterisation. 

In response, our study will conduct detailed research observing how ward staff and clinical teams care for patients with dementia during their admission. We will describe how toileting practices and routines impact on the care of people with dementia in acute hospital wards within three hospitals in different parts of England and Wales. During our observations we will carry out in-depth case studies of patients and interview them and their families about their experiences. Because there is very little published research on continence care for patients with dementia in hospitals, we will also review the literature to identify successful strategies used in other care settings. This will help us to bring together the knowledge that exists on how to promote the best ways to  care for the toileting needs of patients with dementia in hospital wards.

At the end of the project we will provide a detailed understanding of how hospital care could change to improve care and the experiences of patients and their families. We will use this detailed research to develop new training, ward interventions and information for hospital staff and families. Our goal is to improve everyday care in all hospitals for patients with dementia.

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