DISRUPTIONS, DISCONTINUITIES AND DISPERSIONS: ETHNOGRAPHIC FINDINGS ON DISJUNCTURES IN ORGANISING ORTHOPAEDIC WARD PRACTICES IN DEMENTIA CARE

Abstract

Current literature reports increasing use of Enhanced recovery Pathways (ERPs) which aim to bring evidence based medicine to bear to plan a sequence of events which can maximise throughput, productivity and quality in areas of practice. However, when patients who are living with dementia are admitted, usual care will then encompass multiple types of disjunctures to practice (disruptions and discontinuities and dispersions) for both patients and staff. As part of a large research Programme (PERFECTED), we aimed to identify key components of usual practice observed in the context of activity on acute orthopaedic hospital wards, and also to identify how delirium and/or dementia impact on practice. We used ethnographic observations framed by social science perspectives to inform the development of an ERP in this setting. Routine “public” care activities in orthopaedic ward setting were observed over 4 weeks in 3 locality sites in acute hospitals where hip-fracture patients experiencing cognitive impairment were admitted. Our findings specified multiple types and circumstances of disjunctures encountered when patients who are living with dementia came to be included in ward activities, together with their impacts on usual practice and the variety of staff responses. Such practice dilemmas, impacts and responses to such disjunctures are known but not systematically identified in relation to staff, patient and family carer accommodations within this setting. Detailing and assessing their specific impact on maintaining clinical care can contribute practice-based knowledge to underpin the development of an ERP in orthopaedic settings. After attending this session participants will gain knowledge of the value of ethnographic observations in health science research, how disjunctures can arise in acute settings, and how ERPs can be situated in usual care practices.