Fatania, Vidya
(2017)
How do inpatient psychiatric nurses make sense of and respond to behaviours in dementia?
DClinPsy thesis, University of Nottingham.
Abstract
PORTFOLIO ABSTRACT
Introduction: Existing literature suggests that the perceived understanding nurses have of behaviours in dementia can influence how they respond to persons with dementia (PsWD) (Todd & Watts, 2005; Eriksson & Saveman, 2002; Dupuis, 2012). Their responses can be influenced by a range of factors, such as organisational pressures (Stacey et al., 2010) and staff burnout (Edvardsson et al., 2008). However, this is likely to have an impact on PsWD’s quality of life and sense of self (Kitwood, 1997). Absent from literature is the psychological process nurses go through to make sense of and respond to behaviours that could help to provide comprehensive knowledge of the complexities involved. Furthermore, there are very few research studies looking at nurses’ experiences in inpatient dementia care, where the environment is very different to a long-term care setting.
Aim: To explore how inpatient psychiatric nurses make sense of and respond to behaviours in dementia.
Design: A qualitative methodological design was used.
Method: Eight inpatient psychiatric nurses were recruited from two National Health Service (NHS) sites across one Trust. Semi structured interviews were conducted, transcribed and then analysed using Interpretative Phenomenological Analysis (Smith et al., 2009). Quality was assessed using criteria specifically developed for IPA (Smith, 2011). A reflective diary was kept throughout the research process, which included examples of reflexivity.
Results: Four interrelated superordinate themes were identified, with no one theme taking primacy over another. These four themes were: ‘Effort to sense make’, (which consisted of three subthemes: Trial and error, Drawing on existing knowledge and “Putting myself in his shoes”), ‘Pressures of the organisation’, ‘Balancing personal and professional selves: The underlying emotional connection’ and ‘”Looking back on it…”’.
Discussion: This study adds to the current research base by identifying that sense making is a dynamic process, which occurs through a range of psychological processes. It can change moment-by-moment, dependent on the influences on the nurse, such as environmental pressures and the personal and professional negotiations that occur. When sense making was psychologically and socially informed, the corresponding response resulted in less overall distress for PsWD. The study further adds to existing research through identifying an emotional connection with the patient, which can either be conscious or unconscious. Those that demonstrated a conscious empathic emotional connection appeared to be the ones that were more likely to want to reconnect with patients, following a need to disconnect in-line with professional duties. The study findings are important from a research and clinical point of view, as nurses need to be supported to move flexibly through a range of emotional connections. Furthermore, a managerial approach that promotes reflective space and supervision is likely to increase psychologically informed sense making, which is specifically important given the positive impact this has on both staff and PsWD’s wellbeing.
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