Scerri Anthony, Scerri Charles, Innes Anthea
Department of Nursing, Faculty of Health Sciences, University of Malta, Malta.
Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Malta.
Dementia (London). 2020 Aug;19(6):1997-2017. doi: 10.1177/1471301218814383. Epub 2018 Nov 27.
It is acknowledged that the needs of persons living with dementia admitted in acute hospitals are not always met. Previous studies have focused on the perceived needs of professional caregivers or family members whilst the voices of patients with dementia in acute hospitals have not been extensively reported. This may have contributed to the under-recognition of the needs of persons living with dementia. The aim of this study was to categorise the perceived and observed needs of persons with dementia admitted in acute medical wards and to explore whether these needs are being or have been met. Thirteen people with dementia in three medical wards, who could verbally communicate with the researcher, were purposively selected as research participants. Semi-structured interviews were conducted to elicit each participant's experiences of their hospital stay and whether their needs were perceived to have been/are being met. Moreover, routine care with the same participants was observed using Dementia Care Mapping. Maslow's Hierarchy of Needs was used as a framework to categorise care needs. Our findings demonstrate that basic needs such as toileting, feeding, drinking, continence and comfort were not always met. Moreover, the largest gap between met and unmet needs was found in patients who were either under constant observation or unable to communicate. Too much emphasis was perceived and observed to be given on what staff considered as safety needs at the expense of other needs. The patients' need for social contact and self-esteem such as dignity and respect were often ignored and this led to patients feeling devalued. Hospital staff have to be more aware of the holistic needs of patients with dementia in acute settings and the way care is delivered in order to make up for these unmet needs, thus facilitating person-centred care.
人们认识到，急症医院中痴呆症患者的需求并不总是能得到满足。以往的研究主要关注专业护理人员或家庭成员所感知到的需求，而急症医院中痴呆症患者的声音却没有得到广泛报道。这可能导致了对痴呆症患者需求的认识不足。本研究的目的是对急症内科病房中痴呆症患者所感知和观察到的需求进行分类，并探讨这些需求是否正在或已经得到满足。在三个内科病房中，有13名能够与研究人员进行口头交流的痴呆症患者被有目的地选为研究参与者。进行了半结构式访谈，以了解每位参与者的住院经历以及他们是否认为自己的需求已经/正在得到满足。此外，还使用痴呆症护理图谱对相同参与者的日常护理进行了观察。马斯洛需求层次理论被用作对护理需求进行分类的框架。我们的研究结果表明，诸如如厕、喂食、饮水、大小便失禁护理和舒适等基本需求并不总是能得到满足。此外，在持续观察或无法交流的患者中，需求满足与未满足之间的差距最大。人们认为并观察到，工作人员过于强调他们所认为的安全需求，而牺牲了其他需求。患者对社交接触以及自尊（如尊严和尊重）的需求往往被忽视，这导致患者感到自己被轻视。医院工作人员必须更加了解急症环境中痴呆症患者的整体需求以及护理的提供方式，以弥补这些未满足的需求，从而促进以患者为中心的护理。
