Jelinski Dana, Reich Krista, Lang Eddy, Holroyd-Leduc Jayna, Goodarzi Zahra
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services-Calgary Zone, Calgary, AB, Canada.
Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services-Calgary Zone, Calgary, AB, Canada.
CJEM. 2025 Apr;27(4):285-293. doi: 10.1007/s43678-025-00862-0. Epub 2025 Feb 13.
Patients living with dementia are complex and visit the emergency department (ED) more frequently than other populations. There is a knowledge gap regarding challenges in care delivery for these patients from the perspective of interdisciplinary healthcare providers. The aim of this study was to identify the barriers and facilitators to caring for people living with dementia in the ED as perceived by healthcare providers to gain a deeper understanding of current care gaps and inform best care practices.
Semi-structured interviews were conducted with healthcare providers to understand their experiences in caring for people living with dementia in the ED. Healthcare providers currently employed within in a Calgary zone ED and with experience in caring for people living with dementia in the ED were eligible for participation. The Framework Method based on the Theoretical Domains Framework and the Behavior Change Wheel was used in the analysis to inform change interventions by addressing key factors that influence behavior.
A total of 11 providers participated. Key facilitators to care included collaborative team approaches; collateral information from care partners, EMS, and care homes; geriatric medicine staff; addressing non-medical needs; and person-centered care. Key barriers to care included the ED environment encompassing challenges with lack of resources, staff, and time constraints; deteriorating cognition and behavioral challenges; and a lack of dementia-specific guidance and training.
This study highlights key issues in emergency care delivery at the system, unit, provider, and patient levels for people living with dementia through the analysis of healthcare provider experiences. Environmental context and resources, skills, and social/professional role and identity were key domains correlating to the major barriers and facilitators in these findings. Key opportunities for change are identified through which targeted interventions and policies may address dementia-related care gaps within the ED context.
痴呆症患者情况复杂，比其他人群更频繁地前往急诊科（ED）就诊。从跨学科医疗服务提供者的角度来看，在为这些患者提供护理方面存在哪些挑战，目前仍存在知识空白。本研究的目的是确定医疗服务提供者所认为的在急诊科护理痴呆症患者的障碍和促进因素，以便更深入地了解当前的护理差距，并为最佳护理实践提供参考。
对医疗服务提供者进行半结构化访谈，以了解他们在急诊科护理痴呆症患者的经验。目前受雇于卡尔加里地区急诊科且有在急诊科护理痴呆症患者经验的医疗服务提供者有资格参与。分析采用基于理论领域框架和行为改变轮的框架方法，通过解决影响行为的关键因素来为变革干预提供信息。
共有11名提供者参与。护理的关键促进因素包括协作团队方法；来自护理伙伴、紧急医疗服务（EMS）和养老院的间接信息；老年医学工作人员；满足非医疗需求；以及以患者为中心的护理。护理的关键障碍包括急诊科环境，存在资源不足、人员短缺和时间限制等挑战；认知能力下降和行为问题；以及缺乏针对痴呆症的指导和培训。
本研究通过分析医疗服务提供者的经验，突出了痴呆症患者在系统、科室、提供者和患者层面的急诊护理中的关键问题。环境背景和资源、技能以及社会/职业角色和身份是与这些研究结果中的主要障碍和促进因素相关的关键领域。确定了关键的变革机会，通过这些机会，有针对性的干预措施和政策可以解决急诊科环境中与痴呆症相关的护理差距。
