The Fife Dementia Strategy: 2010 – 2020 - The Knowledge Network

4.11 Hospital & Acute Care
AIM
People with dementia who have medical needs requiring hospital care
are cared for in a suitable environment by well trained staff that are
skilled in working with people with complex needs such as those of
someone with dementia. Support will be available from a multidisciplinary
Old Age Psychiatry Liaison Service, and all patients are given an appropriate
assessment which leads to a care pathway suited to their needs.
RECOMMENDATIONS TO ACHIEVE THIS
4.11.1 Hospitals and clinical staff work to implement changes to the
environment and care practices which have been shown to improve the
experience of people with confusion in the hospital.
While in Accident & Emergency and acute care people with dementia are
exposed to an increased number of stimuli and an unfamiliar environment,
often all at once. These environments are busy and noisy with the constant
sounds of people talking, telephones ringing, alarms going off, doors opening,
and various individuals asking questions and performing care tasks. For
patients with dementia the exposure to these stimuli and the change in routine
can result in the patient experiencing significant distress. This distress may be
communicated through behaviours that are seen as disruptive or challenging
for care staff.
As highlighted in recent guidance issued by the Scottish Government 67 , a
number of practices can improve the experience of people with dementia in
the hospital including: ensuring all older people with apparent confusion are
given an appropriate psychological and physical assessment, ensuring each
person is introduced upon each entry, providing simple explanations of what
they are doing and why, minimising the number of staff carrying out a
procedure, minimising the number of bed moves made, and appointing a key
staff member to work with the individual with dementia whenever possible.
Staff are often faced with additional tasks when caring for someone with
dementia as not only must they respond to the person’s physical care needs,
but must also become involved in the management of the individuals
psychological needs including behaviours such as walking and vocalisation.
These behaviours impact on the nurses, the outcomes for the person with
dementia, and they also frequently impact on the care and outcomes of others
within the hospital environment 68 . All staff working and interacting with
patients in the hospital will receive dementia awareness training, with those
67 Scottish Government (2009). Recognising the Needs of People with Dementia in NHS
Accident and Emergency Departments: Supporting guidance. Edinburgh.
68 Moyle W, Olorenshaw R, Wallis M & Borbasi S (2002). Best practice for the management of
older people with dementia in the acute care setting: a review of the literature. International
Journal of Older People Nursing. 3: 121-130.
77