Goldberg S E, Whittamore K H, Pollock K, Harwood R H, Gladman J R F
University of Nottingham, Division of Rehabilitation and Ageing, Queens Medical Centre, Nottingham NG7 2UH, UK.
University of Nottingham, Division of Rehabilitation and Ageing, Queens Medical Centre, Nottingham NG7 2UH, UK; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham NG7 2UH, UK.
Int J Nurs Stud. 2014 Oct;51(10):1332-43. doi: 10.1016/j.ijnurstu.2014.02.002. Epub 2014 Feb 15.
Around half of people aged over 70 years admitted as an emergency to general hospital have dementia, delirium or both. Dissatisfaction is often expressed about the quality of hospital care. A Medical and Mental Health Unit was developed to provide best practice care to cognitively impaired older patients. The Unit was evaluated by randomised controlled trial compared to standard care wards. Part of this evaluation involved structured non-participant observations of a random sub-sample of participants and the recording of field notes.
The aim of this paper is to compare and contrast the behaviours of staff and patients on the Medical and Mental Health Unit and standard care wards and to provide a narrative account that helps to explain the link between structure, process and reported outcomes.
Field notes were analysed using the constant comparison method.
A large hospital within the East Midlands region of the United Kingdom.
Patient participants were aged over 65, and identified by Admissions Unit physicians as being 'confused'. Most patients had delirium or dementia.
Sixty observations (360 h) were made between March and December 2011. Cognitively impaired older patients had high physical and psychological needs, and were cared for in environments which were crowded, noisy and lacked privacy. Staff mostly prioritised physical over psychological needs. Person-centred care on the Medical and Mental Health Unit was mostly delivered during activity sessions or meal times by activities coordinators. Patients on this unit were able to walk around more freely than on other wards. Mental health needs were addressed more often on the Medical and Mental Health Unit than on standard care wards but most staff time was still taken up delivering physical care. More patients called out repetitively on the Unit and staff were not always able to meet the high needs of these patients.
Care provided on the Medical and Mental Health Unit was distinctly different from standard care wards. Improvements were worthwhile, but care remained challenging and consistent good practice was difficult to maintain. Disruptive vocalisation may have been provoked by concentrating cognitively impaired patients on one ward.
在综合医院急诊收治的70岁以上老人中，约半数患有痴呆、谵妄或两者皆有。人们常对医院护理质量表示不满。为此设立了一个医疗与心理健康科室，为认知受损的老年患者提供最佳护理。与标准护理病房相比，该科室通过随机对照试验进行评估。此次评估的一部分内容包括对随机抽取的部分参与者进行结构化非参与式观察，并记录现场笔记。
本文旨在比较和对比医疗与心理健康科室及标准护理病房中工作人员和患者的行为，并提供一种叙述性描述，以帮助解释结构、过程与报告结果之间的联系。
采用持续比较法对现场笔记进行分析。
英国东米德兰兹地区的一家大型医院。
患者参与者年龄在65岁以上，由入院科室医生认定为“神志不清”。大多数患者患有谵妄或痴呆。
2011年3月至12月期间进行了60次观察（共360小时）。认知受损的老年患者有较高的生理和心理需求，他们在拥挤、嘈杂且缺乏隐私的环境中接受护理。工作人员大多将生理需求置于心理需求之上。医疗与心理健康科室的以人为本护理大多由活动协调员在活动时段或用餐时间提供。该科室的患者比其他病房的患者能更自由地走动。与标准护理病房相比，医疗与心理健康科室对心理健康需求的关注更为频繁，但大多数工作人员的时间仍用于提供生理护理。该科室有更多患者反复呼喊，工作人员并不总能满足这些患者的高需求。
医疗与心理健康科室提供的护理与标准护理病房明显不同。改进是值得的，但护理工作仍然具有挑战性，难以保持始终如一的良好做法。将认知受损患者集中在一个病房可能引发了干扰性发声。
