Caring connections with older persons with dementia in an acute hospital setting - a hermeneutic interpretation of the staff nurse's experience

Background: The literature highlights the challenges inherent in caring for older persons with dementia in the acute care context. However despite concerns relating to the quality of care available to persons with dementia in this setting, there is a paucity of research with which to guide practice. Specifically the existing literature lacks in-depth knowledge on nurses' experiences. Aim: The aim of this paper is to report the findings of a study exploring nurses' experiences of caring for older persons with dementia in an acute hospital setting. Methods: Using a hermeneutic approach, a purposive sample of seven nurses was interviewed regarding the research phenomenon. Interview texts were subjected to thematic content analysis. Multiple data sources were employed to expand the horizon of understanding including: the textual data, personal and professional understandings, reflective journal data and conceptual frameworks derived from theoretical and research literature. The data were collected in 2002. Results: The findings reported here relate to the theme 'Meeting the patient as a person'. Meaningful care for the older person with dementia in the acute context required a respectful connection with the patient as person, which required establishing a bond with the person. The meaning of the caring experience was found to relate to the personhood of both the nurse and the patient, experienced within the context of relationship. To make this connection it was necessary to work with those who knew the patient best i.e. relatives/carers. Conclusions: Despite the contextual limitations of the acute setting, the importance of knowing and respecting the person with dementia and the centrality of relationship as the medium within which caring is experienced is demonstrated. However, nurses lack specific knowledge on which to base care. Further research is therefore recommended to identify how care which promotes the integrity of the person with dementia may be effectively operationalized across the acute care setting.