This in-depth ethnographic study aims to establish an empirically based conceptual and theoretical foundation to inform the development of innovative interventions in service organisation, delivery and training that will improve clinical care for PLWD, a large and growing, but often overlooked, population in acute hospital wards. This study focuses on an important, but poorly understood, feature of everyday care for PLWD, that is continence care.
Specific objectives are as follows:
- To provide a detailed understanding and directly observed examples of the organisational and interactional processes that influence how acute hospital staff respond to continence management and the toileting needs of PLWD –
- What are staff doing and why?
- What caring practices are observable when interacting with this patient group?
- How do staff respond to and manage continence needs?
- What informs these approaches?
- To provide a detailed understanding and concrete examples of the ward routines that have an impact on continence care for this group, specifically to examine the assessment, classification and management of patient toileting needs and their place in ward handovers, routines and schedules.
- To examine and describe the experiences of incontinence, toileting and catheterisation care in the ward from the perspectives of PLWD and their carers.
- To explore the relationship between continence needs and patient dignity to add to understandings of how continence care has an impact on person-centred care, patient dignity, the potential for dehumanisation, family experiences and staff morale.
- To identify factors associated with the improved care of this patient population that are actionable, specifically what clinical care needs to look like to improve the quality and humanity of continence care for PLWD and their carers in acute hospital settings. This may include enhanced awareness of the risk of incontinence interventions and clinical management options.
- To identify low-cost factors at the organisation level (e.g. staff training, ward practices and routines) that can lead to actionable change, and to explore barriers to and facilitators of implementing changes.
- To provide a detailed foundation of knowledge to inform a longer-term programme to develop and evaluate interventions providing new or enhanced approaches to delivery of continence care to PLWD.
- To transfer new knowledge to front-line providers of acute hospital care, including managers, service commissioners and the research community.
To the best of our knowledge, little empirical research has examined continence care for PLWD to inform practice in the acute setting. A systematic review85 has found a lack of evidence-based nursing interventions to manage continence care for PLWD. In addition, it cannot be assumed that interventions from long-term care can be transferred unproblematically to the acute setting. Therefore, we conducted a mixed-methods systematic review and thematic synthesis of the literature, alongside ethnographic fieldwork, to establish an empirical foundation from which interventions in acute care settings can be established.