Browsing by Author "Harrison Dening, K."

Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    Advance Care Planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy
    (Sage, 2019-05-03) de Vries, Kay; Banister, E.; Harrison Dening, K.; Ochieng, B.
    Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of Advance Care Planning by this group across a number of countries where Advance Care Planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote Advance Care Planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape Advance Care Planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities; and to promote older peoples’ ability to enact moral agency in making such decisions.
  • No Thumbnail Available
    ItemOpen Access
    Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study.
    (Health Services and Delivery Research, 2019-03) Featherstone, Katie; Northcott, Andy; Harden, J.; Harrison Dening, K.; Bridges, J.; Bale, S.; Tope, R.
    Background The acute hospital setting has become a key site of care for people living with dementia. The Department of Health recognises that as many as one in four acute hospital beds in the UK will be occupied by a person living with dementia at any given time. However, people living with dementia are a highly vulnerable group within the hospital setting and following an acute admission their functional abilities can deteriorate quickly and significantly. Detailed research is required to understand the role and needs of healthcare staff caring for this patient population and to explore what constitutes ‘good care’ for people living with dementia within the acute setting. Objective(s) The focus of this study was to examine a common but poorly understood phenomena within the acute setting: refusal and resistance to care. Our research questions were: How do ward staff respond to refusal and resistance to food, drink and medicines by people with dementia being cared for on acute hospital wards, and what is the experiences of refusal of care from the perspective of patients and their carers? Design This ethnography was informed by the symbolic interactionist research tradition, with an emphasis on interaction, focusing on understanding how action and meaning are constructed within a setting. In-depth evidence based analysis of everyday care and enabled us to understand how ward staff responded to the care needs of people living with dementia and to follow the consequences of their actions. Setting This ethnography was carried out across 155 days (over 18 months) in ten wards within five hospitals across England and Wales purposefully selected to represent a range of hospitals types, geographies and socio-economic catchments. Participants In addition to general observations of the wards 155 participants participated directly in this study, contributing to 436 ethnographic interviews. Ten detailed case studies were also undertaken with people living with dementia. Results We identified high levels of resistance to care amongst people living with dementia within acute hospital wards. Every person living with dementia observed within an acute hospital ward resisted care at some point during their admission. Conclusions Ward staff typically interpreted resistance as a feature of a dementia diagnosis, which overshadowed the person. However, resistance to care was typically a response to ward organisation and delivery of care and typically rational to that person’s present ontology and perceptions. In response, nurses and HCAs using multiple interactional approaches that combined highly repetitive language with a focus on completing essential care on the body, with a focus on the containment and restraint of the person in their bed or at the bedside. These approaches to patient care were both a response to resistance but also frequently the trigger of resistance, creating cycles of stress for patients, families, and ward staff. Future Work The findings have informed the development of simple no-cost innovations at the interactional and organisational level. A further study is underway exploring continence for people living with dementia in acute hospital settings. Funding The National Institute for Health Research Health Services and Delivery Research programme.