NCARE (Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-life Care)

 The CONNECT Study

Supporting person-centred care for people with dementia in hospital settings: co-designing and testing the feasibility of an intervention for use during constant observation activities.

Project duration

24 months (July 2021- June 2023)


Alzheimer's Society (grant number 516 AS-PG-19a-010)

Principal Investigator:

  • Dr Melanie Handley (PI), University of Hertfordshire


  • Professor Claire Goodman, University of Hertfordshire
  • Rosemary Phillips, University of Hertfordshire
  • Professor Rowan Harwood, University of Nottingham, Nottingham University Hospitals NHS Trust
  • Professor Clair Surr, Leeds Beckett University

Research fellows:

  • Danai Theodosopoulou, University of Nottingham
  • Dr Nicky Taylor, Leeds Beckett University


  • University of Hertfordshire
  • University of Nottingham
  • Leeds Beckett University

Stage of development

Phase 1 recruitment and data collection have been completed. The team are analysing the data and preparing papers from phase 1.

Recruitment is open for  Phase 2, the co-design of an intervention.

What is the study about?

Despite widespread initiatives to improve dementia care in hospitals, applying person-centred care during routine patient/staff encounters continues to challenge hospital staff. One priority area for hospitals is to manage a person's risk of harm, for example from falls. A common strategy to manage people with dementia's risk of harm is constant observation; a care activity which involves the allocation of a member of staff to provide constant supervision and address the care needs of one patient or a small group of patients in one bay area. The quality of care during these activities varies.


The aim of this study is to co-design and evaluate the feasibility and acceptability of an intervention that promotes person-centred care for people with dementia during constant observation activities in acute hospitals.

We will use a four-phase case study design:

1. Part 1: Systematic review of constant observation in hospital for people with dementia and delirium

Part 2: Map the practices and processes of constant observation for people with dementia in three hospitals

2. Co-design an intervention that is locally adapted for each site

3. Test the feasibility and acceptability of the intervention during a three-month implementation in two wards at each hospital

4. Hold a consensus event to agree the key characteristics of the intervention

What will the study achieve?

The main outcome will be evidence on how a priority area of care for hospitals can be used to embed person-centred care and reframe dementia care as skilled, important work. Additionally, we will:

1. Describe current practices and processes for constant observation

2. Assess co-design processes and practices that include people with dementia, their supporters and hospital staff

3. Co-design an intervention and test its feasibility and acceptability in three hospitals 

What did the study involve?

In phase 1, we conducted a systematic review and mapped the use of constant observation practices with people with dementia at three study sites. This included:

  • +100 hour of observations over 50 periods of observation 7am-10pm in nine wards (across three sites)
  • 25 interviews with staff and supporters of people with dementia
  • Ward surveys of the use of constant of observations

In phase 2 we will co-design the intervention through a series of site-specific and cross-site meetings over a period of ten months (March 2022 to December 2022). Meetings will be up-to two hours.

  • At each site we will recruit up to eight hospital staff and eight people with lived experience of dementia (people living with dementia and/or supporters of people living with a dementia) as co-designers.

In Phase 3 we will test the intervention in the three study sites:

Data collection will occur at three time points (baseline, week 6/7, week 11/12) using the following tools:

  • The NOMAD tool
  • The Maslach Burnout Inventory (MBI)
  • Sense of competence in dementia care staff (SCIDS)
  • Cohen-Mansfield Agitation Inventory Observational (CMAI-O)
  • Person-centred Care Climate Questionnaire – Staff Version (PCQ-S)
  • The Quality of Interactions Schedule (QUIS)

Semi-structured interviews with staff, people with dementia and their supporters will assess perceptions and the acceptability of the intervention. We will also conduct general observations spanning 8am - 10pm.

Further information

If you would like to find out more about the study, please contact Dr Melanie Handley (

Additional contacts

Professor Rowan Harwood (

NCARE (Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-life Care)

University of Nottingham
School of Health Sciences
Queen's Medical Centre
Nottingham, NG7 2HA