Investigating the management of refusal of care: people with dementia
Research type
Research Study
Full title
Underserved and overlooked: Investigating the management of refusal of care in people with dementia admitted to hospital with an acute condition
IRAS ID
160678
Contact name
Katie Featherstone
Contact email
Sponsor organisation
Cardiff University(Research and Innovation Services)
Duration of Study in the UK
2 years, 5 months, 31 days
Research summary
Little is known about how clinical teams in acute hospitals respond when they believe a patient with dementia is refusing care. In response, this ethnography examines (1) medication and mealtimes within wards; (2) the care of patients within the wards who refuse or resist care; and (3) focus on the experiences of patients with dementia (a group known to refuse care) and their families.
Fieldwork will take place in 5 hospitals (across Wales and England) and observation in each hospital (30 days) will be carried out within two acute hospital wards (MAU and orthopaedic) known to have high admission rates of people with dementia (approximately 15 days per ward). In each ward it will involve observation, interviews, case studies and routine ward data:
• Observations of (1) the everyday work of ward staff as they are involved in medication rounds and meal times, ward routines, handover and admissions, (2) medication rounds and meal times of patients identified as refusing care.
• Short (within observation) interviews (<15 minutes each, 3-6 per shift) with a sub-sample of patients who refuse: patients with dementia who refuse. Short interviews will also be carried out with their carers and staff caring for them.
• A detailed case study of one patient with dementia (identified as refusing or resisting care) throughout their hospital admission (identified in the MAU or the orthopaedic ward) via regular periods of observation and a series of in-depth interviews (<30 minutes each) with the patient, their carer/family members and staff caring for them (n= 6-8). Interviews will be carried out with the patient and carer following discharge (n=2).
• Collect routine ward data (from ward managers: ward staffing levels, bed occupancy, turnover etc), recorded levels of resistance and refusal, and the number of patients with dementia (from patient records) admitted to the ward during fieldwork.REC name
Wales REC 3
REC reference
15/WA/0191
Date of REC Opinion
24 Jun 2015
REC opinion
Further Information Favourable Opinion