An Interpretive Ethnography: Nursing Culture for People with Dementia and Behavioral and Psychological Symptoms of Dementia in the Acute Care Environment

Abstract

Objectives: Acute care nurses care for people with dementia (PWD) who suffer from behavioral and psychological symptoms of dementia (BPSD) in care environments that may worsen BPSD. The purpose of this study is to understand the nursing culture of care that exists for PWD with BPSD, and align this culture of care with the theory of person-centered dementia care (PCC). Methods: An interpretive ethnography approach was used, and data was collected on a general medicine unit at one acute hospital through 75 hours of participant observation and five semi-structured interviews with registered nurses and licensed practical nurses. Data was thematically analyzed. Results: A number of facilitators (teamwork, creativity, knowing the person, care plans, flexibility) and barriers (time constraints, safety, restraint use) for prevision of PCC to PWD and BPSD were identified. The culture of care for PWD with BPSD is shaped by formal protocols, informal protocols or unwritten rules, and beliefs about PWD and the nurses’ role in acute care. Nurses’ ability to provide PCC is limited by the incompatibility between the needs of the PWD and the acute care environment, and risk-averse safety culture that promotes physical safety over the needs and wants of the PWD. Conclusion: PWD with BPSD should be supported outside of the acute care environment when possible. The acute care environment needs to become more dementia friendly, and nurses need support and permission on a systems and individual level to re-conceptualize the meaning of risk for PWD with BPSD.