Almost a year on from my last post here and I’ve done a lot of work on my developing my research proposal – reading, learning, literature reviewing – but sadly not a lot has changed for people with dementia in acute hospitals. My desire to improve the quality of care, especially at meal times has certainly grown.
As part of my research training I have had the privilege of completing some observations for another large study in an acute setting. This involve observing acute hospital wards at different times of day – not specifically meal times, but some of my slots covered that period.
Why a privilege? Because it is so rare for anybody actually working on the wards to stop and watch for a prolonged period. It isn’t until you pause and observe that you realise the extent of the problem.
My observations and reflections:
- Lack of meaningful activity or social stimulation is visible to a much greater extent than I realised. Sitting in a bay for 2 hours mostly produced results of very few staff interactions often lasting less than 1 minute.
- The routine and culture is mostly task focused, allowing little flexibility from the rigidity of the organisational structure. I say “allowing” because I know there are thousands of nurses out there who are fantastic, who wish they could do more but are restricted by various pressures of the acute setting and the NHS.
- Again, I noticed how staff pressures result in inadequate assistance at meal times: people with food they cannot reach, sat in awkward positions in the bed unable to bring the food to their mouth, struggling with packets and wrappers eventually giving up, asleep throughout the whole period. People with dementia were seen to be particularly vulnerable at this time, often ignoring the food for whatever reason or not getting the assistance they needed meaning full or half empty plates taken away when the staff were scheduled to take it away.
The resounding complaint of being “short staffed” is constantly ringing in my ears – yes it is highly likely this does contribute to quality of care at meal times.
Is it going to change? I don’t know.
What I do know is, there is scope for better quality within what we already have– what I really want to do is work within our restricted, stretched, task focused, short staffed system and see how we can change with the resources we have.
So, here’s the summary of what I plan to do:
- Observations of meal times using Dementia Care Mapping. This will be used to measure people’s well-being and engagement during the meal time, and to gather and in-depth picture of what may influence the meal time experience. What a great opportunity to stop and stare.
- Build a model of areas which influence the eating process for people with dementia on acute hospital wards. This will aid in conceptualizing the problems. I hope it can be used to improve care through education and training for health care staff.
- Interview staff about the tools currently used to encourage eating and drinking, and what they see their roles as in this process. I look forward to developing from there.
Next step… ethics approval.
Naomi is a NIHR Clinical Doctoral Research Fellow in Dementia Care and Occupational Therapist supported by NIHR CLAHRC Wessex
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This Blog has also been published on the UK care guide website