Older patients with cognitive impairment are known to experience fear, anxiety and increased confusion when admitted to the hospital environment. They are more susceptible to falls, functional decline, prolonged length of stay, premature nursing home placement and death. Staff stress and care burden can be greatly increased in the care of confused hospitalised older patients with lack of time to support the necessary emotional care and safety needs highlighted. In rural areas with high ageing populations and limited or no access to geriatrician support these issues are more pronounced. Evidence for sustainable person centred models of care for people with cognitive impairment in hospitals is lacking. Increasingly the use of volunteers has been promoted as a supportive adjunct to care for patients with dementia or delirium but empirical support in the use of volunteer interventions for this patient group is lacking. The primary aim of the study was to establish and train a group of volunteers in a person centred care approach to supporting patients with cognitive impairment in a rural hospital and evaluate outcomes for patients, staff and volunteers. Sub aims were to describe the structure and reach of the volunteer intervention, the acceptability of the intervention by nursing staff and volunteers, as well as to determine resources for replication. The volunteer intervention provided one to one emotional support aimed at enhancing the psychological wellbeing for patients with cognitive impairment as well as practical assistance aimed at reducing delirium risk and adverse outcomes. The intervention was conducted over two shifts five days/week. The morning shift was from 8am – 12.30pm and the afternoon shift was from 3pm – 7pm. The intervention study used a quasi-experimental control group design. The volunteer intervention was implemented over a six month period at a rural hospital (intervention) with comparison of outcomes at a different but similar sized rural hospital (control). Measures included patient outcome data, staff and volunteer dementia/delirium knowledge and attitudes to dementia questionnaires and post program acceptability by staff and volunteers. The volunteer program was highly accepted with 96% of staff and 100% of volunteers perceiving the program as having a beneficial effect on patient outcomes and should continue. Staff felt supported and assisted in their care of patients, and volunteers perceived what they were doing was worthwhile and beneficial to patient outcomes. No significant difference was found in the patient outcomes analysed. There were limitations in these results as the patient groups were not matched on all variables. The volunteer program is now continuing 30 months post implementation, has won two health excellence awards and has been included as an example of existing good hospital practice in the New South Wales Health (Australia) Dementia Services Planning Framework 2010-2015. Replication of the program is occurring in other areas. This research addresses gaps in the literature related to both the need for intervention studies in care of patients with dementia in acute care and the use of structured volunteer programs in supporting patients with cognitive impairment. In doing so, it adds to the existing body of literature by providing a detailed description of an innovative intervention for improving acute care of patients with dementia. Additionally, it provides an intervention which has proved to be sustainable with minimal resources. Further research is needed in evaluating patient outcomes based on this model.
|Date of Award
|Diane Gibson (Supervisor), Catherine Hungerford (Supervisor) & Mike Bird (Supervisor)