implementación de políticas públicas

“to understand about the disease and where this person‟s come from and making sure that everything‟s available to them that can be” (Participant 12)

Secondly participants (6,7) wanted to know about the relevant legislation such as benchmarking, government acts and the legal policy documents that relate to dementia care. Participant 7 says,

“we should look at a patient‟s capacity... where we stand legally... we need to know the channels that we go down to, for the best interests of the patient as well”

4.5.3a How to communicate

The participants emphasised how it is important to know how to communicate with patients with dementia. The main issue, raised by four participants (1,5,9,10) relates to whether you should correct patients who are confused or whether you should just go along with what they are saying. Another concern was that there is no consensus among staff as to which approach is correct and this is currently still a problem in practice. Another issue was how to communicate with patients with sever dementia because it is difficult to,

“find something that they can sort of react to and you can have some sort of communication with” (Participant 3)

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4.5.3b How to manage behaviour

Most participants wanted to know how best to manage patients with dementia. The main concern was,

“what do we do? It‟s knowing what‟s right and wrong...” (Participant 7)

Participant 4 suggested that nurses need specific training on how to best manage patients with dementia day-to–day. Others (2,5,6,12) also wanted to be taught how to cope with difficult behaviour including techniques that would,

“keep them occupied... if they‟ve got nothing to do then the problems start” (Participant 2)

“distract people and get them involved in other kinds of tasks rather than just focussing on the behaviour that is not good” (Participant 12).

Participant 7 also mentioned,

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4.5.3c How to reduce anxiety

Related to how to manage behaviour was the theme of how to reduce anxiety. Participants (3,7,10) wanted to know how to reduce patients‟ anxiety and know what frightens them.

The main question was whether there could be,

“any changes, small changes, or even big changes that can be made to sort of make the patient‟s stay much more comfortable” (Participant 5)

Participant 6 also mentioned that it would be useful to know which professionals they should get involved and what support is available around in the trust.

4.5.3d Antipsychotics

Finally, participants (2,4,8) believed that a better understanding about antipsychotics would be useful because,

“Antipsychotics aren‟t always the way forward. We should always try to aim for less intervention; start off very basic” (Participant 8).

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4.6 MANAGEMENT IDEAS

Participants were asked about what other forms of management they use in their clinical area to reduce the use of antipsychotic medications. A number of participants made useful suggestions for alternative management strategies, for patients with dementia, which often refect a person-centred approach to dementia care. The themes that emerged include; how to communicate, how to manage behaviour, how to reduce anxiety and who should be involved.

Two participants (3,7) thought the results of this study would be interesting and hoped that the findings would help to find out if there is anything, and what nurses can do, to improve the care for patients with dementia.

4.6.1 How to communicate

Participants recommended “reassurance” (Participant 5); “trying to calm and reassure people” (Participant 12) or “just talking to them” (Participant 8). The main rationale for this was to inform patients about what you are doing because their poor memory means they are forgetful and do not understand. Participants suggested that even these little interventions can often calm an agitated patient with dementia. Participant 3 also suggested that it might be helpful to,

“try and sit and talk with them and try and relax them „cause a lot of our patients are in side rooms for isolation reasons and they get very agitated”.

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A final suggestion was re-orientation. Participant 7 says,

“use the orientation boards, write things down for people, have notebooks and diaries and that sort of thing just to kind of jog people‟s memories as to what‟s been happening with them and what we‟ve been doing with them and we write it in the diary”

4.6.2 How to reduce anxiety

All the above suggestions also relate to reducing anxiety. Another suggestion specifically relating to reducing anxiety included the use of “distraction” (Participant 7, Participant 2). Participant 3 says maybe there is,

“...something they [nurses] can do to help the patient psychologically to try and stimulate them or try, you know, get them more involved”

Participant 12 suggests using photographs and knowledge about the patients to try and redirect patient‟s thoughts and initiate conversations can reduce their anxiety and recommends trying to “get them involved in some sort of activity”. Participant 12 says this works in her experience. However, it is important to note that she was referring to patients with head injuries and general confusion on a neuro- rehabilitation ward rather than dementia patients specifically.

Participant 11 suggests that one of the main reasons we get so many behavioural problems in hospital today is because there is nothing for the patients with dementia to do and they get bored.

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