Discovering what works well : exploring quality dementia care in hospital wards using an appreciative inquiry approach

Abstract

Aims and objectives: To explore the quality dementia care in two geriatric hospital wards using appreciative inquiry with formal care workers and family members of inpatients with dementia. Background: Care models such as person-centred and relationship-centred care have been developed to explain what ‘quality’ dementia care should be. However, their usefulness and relevance to clinicians has been questioned. Design: Using an exploratory qualitative design within an appreciative inquiry framework, 33 care workers working in a geriatric hospital and 10 family members of patients with dementia were interviewed. Methods: Open-ended questions were asked to encourage care workers to narrate positive care experiences when the care was perceived to be at its best and to identify what made these experiences possible. Interviews were audio-taped and transcribed whilst data were analysed thematically using a qualitative data analysis software to assist in data management. Results: Positive care experiences can be understood within five care processes, namely building a relationship between the ‘extended’ dementia care triad, providing ‘quality time’ and ‘care in time’, going the ‘extra mile’, attending to the psychosocial needs and attending to the physical needs with a ‘human touch’. Factors facilitating these positive care experiences included personal attributes of care workers, and organisational, environmental and contextual factors. Conclusions: This study provides an alternative and pragmatic approach to understanding quality dementia care and complements the body of knowledge on factors influencing dementia care practices in hospitals. Relevance to clinical practice: By understanding the components of quality dementia care and how these can be achieved from different stakeholders, it is possible to develop strategies aimed at improving the care offered to patients with dementia in hospitals.