The responses of healthcare professionals to the admission of people with cognitive impairment to acute hospital settings: an observational and interview study

Aims and objectives: To explore the responses of healthcare professionals to the admission of people with cognitive impairment to the acute hospital setting.

Background: While improving care for people with dementia has been identified as a national priority, providing appropriate care in acute hospitals for people with comorbid cognitive impairment presents challenges to healthcare professionals.

Design: Based on the principles of ethnography, this was a qualitative interview and nonparticipation observational study.

Methods: Seventy-two hours of nonparticipant observations of care together with semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had a cognitive impairment. Interviews and observations were conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework.

Results: The results identified a core problem, 'disruption', and a core process, 'gaining or giving a sense of control to cope with disruption'. Healthcare professionals respond to the disruption in three ways: by acting to preserve the personhood of the individual; by seeking to protect themselves from the stresses associated with caring for the person with cognitive impairment; and by suspending the personhood of the individual.

Conclusion: Where healthcare professionals acted to suspend the personhood of the patient, they appeared to be demonstrating signs of 'burnout'.

Relevance to clinical practice: There is a need both to challenge poor practice and for positive development work with healthcare professionals who work in acute hospitals with people with dementia and cognitive impairment so that they are equipped with the skills, emotional resilience and organisational support to be effective in meeting the needs of people with dementia and cognitive impairment.