The ‘unworthy’ patient with dementia in geriatric rehabilitation hospitals

© 2017 Australian College of Nursing Ltd Background: The number of people presenting to hospital with dementia is escalating worldwide. Hospitals are inadequately prepared leading to a poor patient experience. Aim: To explore the perspectives of nurses caring for people with dementia to critically evaluate the reasons behind the widely reported poor care received by such patients. The study examined what was privileged in the care of patients with dementia in geriatric rehabilitation facilities. Method: The study used critical ethnography. Data were obtained from interviews with 29 nurses working with patients with dementia in geriatric rehabilitation hospitals. The interviews were audio-recorded and transcribed verbatim. Findings: The theme of the ‘unworthy’ patient was supported by sub-themes of people with dementia and hospital performance targets, risk, nurse workload and acute care issues. Discussion: Hospitals have increasing pressure to conform to tight budgets and must justify all expenditure, increase patient throughput and minimise risk. Patients with dementia can have a longer hospital stay complicated by frailty, complications and social problems. The focus on rapid discharge influences the mind-set of nurses and nurse habitus. Patients with multiple chronic co-morbidities are unpopular and considered low priority and less worthy of resources. Privileging care for certain patients and tasks is supported by organisational cultural beliefs. Nurses require support to maintain empathetic caring practices in the face of managerial priorities. Conclusion: The research found that patients with dementia were considered unworthy in the geriatric rehabilitation hospital setting. The difficulties caring for patients with dementia are considerable. Nurses need education and support to improve practice.