Hospital and care home nurse perspectives on optimising care for people living with dementia who transfer between hospitals and care homes

Abstract

Background: Transitions out of hospital result in poor outcomes for older people. Research investigating transitions for care home residents living with dementia is limited, even though such residents often have multi-morbidities and frequently use hospital services. Nurses are key care providers. Yet their perspectives on optimising care for people living with dementia transferring back to their care home remains under explored. Aims: This qualitative descriptive study explores hospital and care home nurses’ perspectives on how they optimise care for people living with dementia who transfer from hospital back to their care home, and the alignment of this care with best practice. Methods: Thirty-three nurses participated in either semi structured interviews or focus groups. Data were analysed using qualitative content analysis. Results: Nurses described four roles: 1) exchanging information, 2) assessing and meeting needs, 3) working with families and 4) checking and organising medication. They described care home residents with dementia as having distinct needs and variation in how they provided care. Nurses described interdependent roles, but care home nurses were often excluded from involvement in planning resident’s care on return and were not fully recognised as members of wider healthcare teams. Facilitators for optimising care include: nurses understanding the principles of dementia care, nurse leadership and autonomy, having positive relationships between hospital and care home nurses and opportunities for joint working. The care practices nurses described broadly aligned with best practice. Implications: Hospital and care home nurses require joint working opportunities to understand their roles and build relationships. Care home nurses’ status needs to be addressed with action to support their integration into the wider healthcare system.