Abstract
The aim of the present study was to address the challenges faced by staff in an acute rural hospital in Australia when providing person-centred care for patients with dementia and/or delirium. This was done by training volunteers to provide personal support to these patients, then measuring the outcomes of this intervention. Volunteers were given training, then allocated patients with dementia/delirium or at risk of delirium. A quasi-experimental pre-post design assessed outcomes of the intervention. Quantitative measures were clinical outcome data for the 64 patients who passed through the program; questionnaire data related to the stress and attitudes of the 18 participating nurses; and attitudes, knowledge and confidence of the 18 volunteers. Qualitative measures assessed acceptability and feasibility of the intervention to staff and volunteers. There was a significant reduction over time in length of stay for patients, and an increase in the use of analgesic medications. Only one patient fell while volunteers were on duty. There were no effects on the stress of nursing staff or their attitudes to dementia. Volunteers gained significantly in confidence and attitudes to dementia. The program was highly acceptable, with 96% of staff and 100% of volunteers perceiving the program as beneficial for patients, staff and volunteers. The program has continued and is now being expanded to other rural sites. It is feasible to introduce and then sustain a relatively inexpensive program to improve quality of care for people with dementia and/or delirium in an acute rural hospital. Reasons for the program's effectiveness are canvassed in the paper, but further research is needed to investigate the effectiveness of a similar program in urban hospitals.
Highlights
The aim of the present study was to address the challenges faced by staff in an acute rural hospital in Australia when providing person-centred care for patients with dementia and/or delirium
A quasi-experimental pre–post design was employed between May and December 2009, in a 63-bed rural acute hospital located on the far south coast of New South Wales (NSW)
The beginning of the project was regarded as valid baseline data because the skills and confidence of the volunteers were expected to improve as they gained experience and the project bedded in
Summary
The aim of the present study was to address the challenges faced by staff in an acute rural hospital in Australia when providing person-centred care for patients with dementia and/or delirium. This was done by training volunteers to provide personal support to these patients, measuring the outcomes of this intervention. In the rural Australian coastal location of this study, retirement migration has led to an exponentially increased ageing demographic, with dementia prevalence greater than the average for the Australian state of New South Wales (NSW)[2,3] This has implications for current and future health service demand and models of care[4]. The resulting psychological effects on the person with dementia can be fear, anxiety, increased confusion and onset or increase in the behavioural and psychological symptoms of dementia (BPSD)[6,7,8]
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