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The overall aim of the Better Mental Health study was to understand the care of older people with mental health problems in general hospitals and provide advice to the health services about how things could be improved.
The work was conducted between 2008 and 2011 in the wards of Nottingham University Hospitals NHS Trust. The research included a review of relevant literature, a patient and carer study involving ward observations and interviews of discharged patients and their carers at home, and an interview study of staff caring for confused older patients in the hospital.
The literature review set the context for the work, exploring reasons why training and organization of care seemed to have failed to ensure high quality care for confused older people in hospitals. It also noted that notions of patient-centred and relationship-centred care were believed to provide the best model for good, dignified care.
The patient and carer study concluded that an admission of a person with dementia could be best understood as a process of disruption to the patient and carer routines, and that their responses to these disruptions could be seen as attempts to restore control over the disruptions. The staff study showed that many staff were unable to use such understanding to guide their care in a patient or relationship centred way. Staff also identified organizational factors that prevented or hindered them from delivering good quality care.
The findings presented a challenge to the health care system, as it is unlikely that our observations were unique to the hospitals we studied. Given the huge number of confused people in a typical general hospital in the UK, it is perhaps astounding that workforce education, planning and hospital organization seemed to be unprepared for the task of caring for these people.
The full report of the project is: Gladman J, Porock D, Griffiths A, Clissett P, Harwood RH, Knight A, Jurgens F, Jones R, Schneider J, Kearney F. Care of Older People with Cognitive Impairment in General Hospitals. Final report NIHR Service Delivery and Organisation programme; 2012.
Publications and other outputs arising from the project are shown on the Medical Crises in Older People website: http://www.nottingham.ac.uk/mcop/index.aspx
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