Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
BMJ Open. 2013 Dec 20;3(12):e004198. doi: 10.1136/bmjopen-2013-004198.
To examine in depth carers' views and experiences of the delivery of patient care for people with dementia or delirium in an acute general hospital, in order to evaluate a specialist Medical and Mental Health Unit (MMHU) compared with standard hospital wards. This qualitative study complemented the quantitative findings of a randomised controlled trial.
Qualitative semistructured interviews were conducted with carers of patients with cognitive impairment admitted to hospital over a 4-month period.
A specialist MMHU was developed in an English National Health Service acute hospital aiming to deliver the best-practice care. Specialist mental health staff were integrated with the ward team. All staff received enhanced training in dementia, delirium and person-centred care. A programme of purposeful therapeutic and leisure activities was introduced. The ward environment was optimised to improve patient orientation and independence. A proactive and inclusive approach to family carers was encouraged.
40 carers who had been recruited to a randomised controlled trial comparing the MMHU with standard wards.
The main themes identified related closely to family carers' met or unmet expectations and included activities and boredom, staff knowledge, dignity and fundamental care, the ward environment and communication between staff and carers. Carers from MMHU were aware of, and appreciated, improvements relating to activities, the ward environment and staff knowledge and skill in the appropriate management of dementia and delirium. However, communication and engagement of family carers were still perceived as insufficient.
Our data demonstrate the extent to which the MMHU succeeded in its goal of providing the best-practice care and improving carer experience, and where deficiencies remained. Neither setting was perceived as neither wholly good nor wholly bad; however, greater satisfaction (and less dissatisfaction) with care was experienced by carers from MMHU compared with standard care wards.
深入探讨照顾者在综合医院为痴呆或谵妄患者提供护理的观点和经验，以评估专科医疗和心理健康病房（MMHU）与标准病房的差异。这项定性研究是一项随机对照试验的补充。
在 4 个月期间，对因认知障碍而住院的患者的照顾者进行了半结构化的定性访谈。
在英国国家卫生服务体系的一家急症医院设立了一个专科 MMHU，旨在提供最佳实践护理。精神科专业人员与病房团队整合。所有员工都接受了痴呆症、谵妄和以患者为中心的护理方面的强化培训。引入了有针对性的治疗和休闲活动计划。优化病房环境以提高患者的方向感和独立性。鼓励采取积极和包容的方式来对待家庭照顾者。
40 名被招募参加比较 MMHU 与标准病房的随机对照试验的照顾者。
确定的主要主题与家庭照顾者的期望相符或不符，包括活动和无聊、员工知识、尊严和基本护理、病房环境以及员工和照顾者之间的沟通。来自 MMHU 的照顾者意识到并赞赏与活动、病房环境以及员工在适当管理痴呆症和谵妄方面的知识和技能相关的改进。然而，他们仍认为沟通和与家庭照顾者的互动不足。
我们的数据表明，MMHU 在提供最佳实践护理和改善照顾者体验方面取得了多大程度的成功，以及在哪些方面仍存在不足之处。两种环境都被认为既不完全好也不完全坏；然而，与标准护理病房相比，来自 MMHU 的照顾者对护理的满意度更高（不满度更低）。
