Skip to main content

Research Repository

Advanced Search

Should I stay or should I go?: how healthcare professionals close encounters with people with dementia in the acute hospital setting

Allwood, Rebecca; Pilnick, Alison; O'Brien, Rebecca; Goldberg, Sarah; Harwood, Rowan H.; Beeke, Suzanne

Authors

Rebecca Allwood

ALISON PILNICK alison.pilnick@nottingham.ac.uk
Professor of Language, medicine Andsociety

Suzanne Beeke



Abstract

Around a quarter of hospital beds in the UK are occupied by patients living with dementia (PWD), and communication impairments are common across all types of dementia, often exacerbated by the hospital environment. Unsurprisingly, healthcare professionals (HCPs) report particular challenges in caring for this patient group, whilst trying to recognise and value their personhood as per the underpinning ethos of person-centred care. However, whilst there is a growing body of research that underlines the importance of communication in dementia care, there is far less that actually examines this communication in real time interaction. Suggestions and pointers for good communication do exist, but these do not tend to be empirically derived, and sometimes conflict with empirical findings. This paper focuses on a specific area of interaction which has previously received very little attention: the way in which healthcare encounters are ended or closed. There is potentially a conflict between a pressure to manage a patient as efficiently as possible, and endeavouring to ensure person -centred care and deal with communication difficulties arising from dementia. Using conversation analysis, we examined forty-one video recordings of HCP/PWD interactions collected from an acute inpatient ward. We identify three phenomena around which there were recurring troubles in our dataset: ‘open-ended pre-closings’, ‘mixed messages’ and ‘non specifics and indeterminate terms’. We conclude that moves towards closing an encounter that appear intuitive to HCPs as competent interactants, and that may represent best practice in other healthcare settings, may in fact serve to confuse a PWD and create difficulties with closings. Our findings underline the importance of examining best practice guidance as it is actually talked into being, using approaches which can unpack the interactional detail involved. They also emphasise the importance of context in the analysis of healthcare delivery, to avoid a ‘one size fits all’ approach.

Citation

Allwood, R., Pilnick, A., O'Brien, R., Goldberg, S., Harwood, R. H., & Beeke, S. (2017). Should I stay or should I go?: how healthcare professionals close encounters with people with dementia in the acute hospital setting. Social Science and Medicine, 191, 212-225. https://doi.org/10.1016/j.socscimed.2017.09.014

Journal Article Type Article
Acceptance Date Sep 7, 2017
Online Publication Date Sep 9, 2017
Publication Date Oct 1, 2017
Deposit Date Sep 11, 2017
Publicly Available Date Sep 10, 2018
Journal Social Science & Medicine
Print ISSN 0277-9536
Electronic ISSN 0277-9536
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 191
Pages 212-225
DOI https://doi.org/10.1016/j.socscimed.2017.09.014
Keywords UK; Dementia; Conversation analysis; Person-centred care; Closings; Healthcare of older people
Public URL http://eprints.nottingham.ac.uk/id/eprint/45713
Publisher URL http://www.sciencedirect.com/science/article/pii/S0277953617305488
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0

Files


Closings paper version for publication August 2017 Pilnick.pdf (583 Kb)
PDF

Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0






You might also like



Downloadable Citations