Should I stay or should I go? How healthcare professionals close encounters with people with dementia in the acute hospital setting

Bibliographic Data

ID4906595
AuthorsRachel Allwood (0000-0002-5600-302X, University of Nottingham), Rebecca Allwood, Alison Pilnick (0000-0003-0987-8760, University of Nottingham, corresponding author), Robert O''Brien (0000-0003-0300-8430, University of Nottingham), Rebecca O''Brien, Rebecca O'Brien, Sarah Goldberg (0000-0001-5109-798X, University of Nottingham), Robin Harwood (0000-0002-4920-6718, Nottingham University Hospitals NHS Trust), Rowan H Harwood, Suzanne Beeke (0000-0002-6772-2820, University College London)
Year2017
Volume191
Pages212-225
Publication date2017-10-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2017.09.014
PMID28934622
OpenAlexW2752797990
LanguageEN
Citations received17
References cited31

Around a quarter of hospital beds in the UK are occupied by patients living with dementia (PWD), and communication impairments are common across all types of dementia, often exacerbated by the hospital environment. Unsurprisingly, healthcare professionals (HCPs) report particular challenges in caring for this patient group, whilst trying to recognise and value their personhood as per the underpinning ethos of person-centred care. However, whilst there is a growing body of research that underlines the importance of communication in dementia care, there is far less that actually examines this communication in real time interaction. Suggestions and pointers for good communication do exist, but these do not tend to be empirically derived, and sometimes conflict with empirical findings. This paper focuses on a specific area of interaction which has previously received very little attention: the way in which healthcare encounters are ended or closed. There is potentially a conflict between a pressure to manage a patient as efficiently as possible, and endeavouring to ensure person-centred care and deal with communication difficulties arising from dementia. Using conversation analysis, we examined forty-one video recordings of HCP/PWD interactions collected from an acute inpatient ward. We identify three phenomena around which there were recurring troubles in our dataset: 'open-ended pre-closings', 'mixed messages' and 'non specifics and indeterminate terms'. We conclude that moves towards closing an encounter that appear intuitive to HCPs as competent interactants, and that may represent best practice in other healthcare settings, may in fact serve to confuse a PWD and create difficulties with closings. Our findings underline the importance of examining best practice guidance as it is actually talked into being, using approaches which can unpack the interactional detail involved. They also emphasise the importance of context in the analysis of healthcare delivery, to avoid a 'one size fits all' approach

Acute care · Acute hospital · Dementia · Health care · Health professionals · Political science · Education, Healthcare and Sociology Research · Language, Discourse, Communication Strategies · Medicine · Mental Health and Patient Involvement · Nursing · Psychology

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