Research Results - Nurses cariDementia on Inpatient Psychiatric Units

[SLThomasRN]

Research Results - Knowledge and Perceptions of Psychiatric Nurses on Caring for Patients with Advanced Dementia on an Inpatient Psychiatric Unit

As the population ages, it is expected that the number of people with dementia will increase dramatically. 90% of them will have behavioral problems at some time in their lives. Many of them are cared for in their own homes or in nursing homes, but will need inpatients hospitalization at some time. Psychiatric units often take these patients because of the behavioral problems, even though the units are designed for the psychiatric patients with other psychiatric diagnoses. Nurses find it challenging to care for patients with advanced dementia while at the same time caring for the more independent psychiatric patients. This qualitative study was done to study the knowledge and perceptions of nurses on caring for patients with advanced dementia on an inpatient psychiatric unit.

The research question was: What challenges do psychiatric nurses face when providing care to patients with advanced dementia?

The following six questions were asked in the survey:

1. What is the greatest challenge you face when caring for a patient with advanced dementia on an inpatient psychiatric unit?

2. What other challenges do you face when caring for a patient with advanced dementia?

3. How could the nurses care for patients with advanced dementia, while still providing a quality program for the other psychiatric patients?

4. What are the benefits or risks to the patient with advanced dementia when he/she is admitted to an inpatient psychiatric unit?

5. What training should be given to staff - RN's, LPN's, CNA's - on caring for patients with advanced dementia?

6. What would be most helpful to you when caring for patients with advanced dementia on an inpatient psychiatric unit?

When the data was analyzed, the responses fell into four categories with several themes identified. Some of the themes crossed over into more than one category. See the table below.

[TABLE=class: MsoTableLightShading]

[TR]

[TD] Categories

[/TD]

[TD] Staffing

[/TD]

[TD] Safety

[/TD]

[TD] Challenges

[/TD]

[TD] Educational Needs

[/TD]

[/TR]

[TR]

[TD] Themes

[/TD]

[TD] Not enough staff to keep them safe

[/TD]

[TD] Risk of violence by other patients

[/TD]

[TD] Need a dedicated unit for dementia patients

[/TD]

[TD] Dealing with violence

[/TD]

[/TR]

[TR]

[TD]

[/TD]

[TD] Uneducated staff members

[/TD]

[TD] Fall risk due to environmental issues/poor lighting

[/TD]

[TD] Programming not geared for dementia

[/TD]

[TD] Disease progression and treatment

[/TD]

[/TR]

[TR]

[TD]

[/TD]

[TD] Staff for acuity

[/TD]

[TD] Environment not safe

[/TD]

[TD] Placement problems result in longer stays

[/TD]

[TD] Pharmacology

[/TD]

[/TR]

[TR]

[TD]

[/TD]

[TD] Not enough staff for 1:1 with patients

[/TD]

[TD] Staff assaulted by patients

[/TD]

[TD] Keeping them safe

[/TD]

[TD] Delirium vs Dementia

[/TD]

[/TR]

[TR]

[TD]

[/TD]

[TD] Need of support for staff

[/TD]

[TD] Not enough staff to keep them safe

[/TD]

[TD]

[/TD]

[TD] Assisting with ADL's, snacks, hygiene

[/TD]

[/TR]

[/TABLE]

There is no doubt that the numbers of patients with dementia is increasing dramatically with 90% of these experiencing some behavioral problems at some time in their lives. Many of these patients will end up in the hospital and in psychiatric units because there is no place else for them to go. Nurses are concerned about their safety and frustrated with the lack of adequate, trained staff to care for these patients.

Since only 20% of nurses have any dementia-specific training and there are no national standards for nursing care of dementia patients, there should be specialized training on all aspects of dementia care.