School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2RD, United Kingdom. Electronic address: https://twitter.com/Jessica_Beaver.
School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2RD, United Kingdom. Electronic address: https://twitter.com/se_goldberg.
Int J Nurs Stud. 2020 Jul;107:103589. doi: 10.1016/j.ijnurstu.2020.103589. Epub 2020 Apr 16.
People living with dementia may call out repetitively, sometimes called disruptive vocalisation, or verbal agitation. In literature and policy, patients who call out repetitively are assumed to be expressing an unmet need, which should be met. Yet there has been little systematic study of this patient group in an acute hospital setting.
To better understand patients who call out repetitively and to identify what care looks like in an acute hospital setting.
Ethnography.
Ten acute geriatric medical wards in two hospitals.
30 cognitively impaired patients who were calling out repetitively, and 15 members of hospital staff.
Semi-structured interviews with hospital staff, 150 h of ward observations and informal conversations with staff, scrutiny of medical and nursing documentation, and measures of patient health status.
Patients who called out were moderately or severely cognitively impaired, often had delirium, were very physically disabled, and many were approaching the end of life. Most hospital staff were found to hold contradictory views: that calling out represents distress or unmet need, but that nothing can be done to alleviate the calling out. During informal conversations, most staff also tended to say that they intuitively recognised when intervening was likely to alleviate calling out. During observations, many staff appeared to and spoke of the ability to 'block' calling out. As a result we argue that social, emotional and physical needs may get overlooked. We argue that some calling out is due to a need that is unmeetable. We also found that while staff would talk about strategies for identifying need, observations and hospital documentation did not support evidence of systematic attempts to identify potential need.
Calling out repetitively within a hospital setting is difficult for staff to understand and to respond to. This is because many of these patients are severely cognitively impaired, often immobile and dependent on their professional carers. We argue that a form of socialised care futility is communicated between staff and is used to rationalise becoming unresponsive to calling-out. We explain this phenomenon as resulting from two protective mechanisms: defence of staff's professional identity as competent practitioners; and defence of staff as having personal morality. Socialised care futility risks good quality care, therefore systematic strategies to assess and manage possible need should be developed, even if calling out remains irresolvable in some cases.
患有痴呆症的人可能会反复呼喊，这种情况有时被称为破坏性发声或言语激越。在文献和政策中，反复呼喊的患者被认为是在表达未得到满足的需求，而这种需求应该得到满足。然而，在急性医院环境中，针对这一患者群体的系统性研究却很少。
更好地了解反复呼喊的患者，并确定在急性医院环境中应提供何种护理。
民族志。
两家医院的 10 个急性老年医学病房。
30 名认知障碍患者，他们反复呼喊；15 名医院工作人员。
对医院工作人员进行半结构化访谈，在病房观察 150 小时，并与工作人员进行非正式交谈，仔细审查医疗和护理记录，并评估患者的健康状况。
反复呼喊的患者认知功能中度或重度受损，常伴有谵妄，身体非常残疾，许多人处于生命末期。大多数医院工作人员持有相互矛盾的观点：他们认为呼喊代表痛苦或未满足的需求，但无法采取任何措施来减轻呼喊。在非正式对话中，大多数工作人员也倾向于表示，他们凭直觉认为干预可能会减轻呼喊。在观察过程中，许多工作人员似乎能够并谈到了“屏蔽”呼喊的能力。因此，我们认为社会、情感和身体需求可能会被忽视。我们认为，有些呼喊是由于无法满足的需求所致。我们还发现，尽管工作人员会谈论识别需求的策略，但观察结果和医院记录并不支持系统地尝试识别潜在需求的证据。
在医院环境中，反复呼喊对工作人员来说难以理解和回应。这是因为这些患者中的许多人认知功能严重受损，常常无法移动且依赖专业护理人员。我们认为，工作人员之间传达了一种形式的社会化护理无效性，并将其用于合理化对呼喊无反应的行为。我们将这种现象解释为源于两种保护机制：捍卫工作人员作为有能力的从业者的专业身份；以及保护工作人员的个人道德。社会化护理无效性可能会影响高质量的护理，因此应制定系统的策略来评估和管理可能的需求，即使在某些情况下呼喊仍然无法解决。
