Gaining access to unspoken narratives of people living with dementia on a hospital ward-A new methodology.

BACKGROUND: This is a methodological paper that aims to advance the conceptualisation of participatory research by focusing on the value of capturing and understanding movement as a vital means of communication for older people with dementia in a general hospital ward. Qualitative research involving people with dementia tends to be word-based and reliant upon verbal fluency. This article considers a method for capturing and understanding movement as a vital means of communication. METHOD: This narrative enquiry is underpinned by the model of social citizenship that recognises people with dementia as citizens with narratives to share. The study focused on spontaneously produced conversations that were video recorded and analysed through a lens of mobility. This enabled each participant to share what was important to them in that moment of time without always using words. FINDINGS: The study findings showed that people with dementia have narratives to share, but these narratives do not fit the bio-medically constructed model that is generally expected from patients. Utilising a mobilities lens enabled the narratives to be understood as containing layers of language. The first layer is the words; the second layer is gestures and movements that support the words; and the third layer is micro movements. These movements do not only support the words but in some cases tell a different story altogether. CONCLUSION: This methodology brings attention to layers of communication that reveal narratives as a mobile process that require work from both the teller and the listener to share and receive. Movements are shown to be the physical manifestations of embodied language which when viewed through a lens of mobility enable a deeper understanding of the experience of living with dementia when an inpatient. Viewing narratives through a mobilities lens is important to the advancement of dementia and citizenship practices.

The changing role of Advanced Clinical Practitioners working with older people during the COVID- 19 pandemic: A qualitative research study.

BACKGROUND: COVID-19 was identified as a pandemic by the World Health Organisation (WHO) in December 2020. Advanced Clinical Practitioners (ACPs) in England working with older people with frailty, experienced their clinical role changing in response to the emergency health needs of this complex population group. In contrast to other countries, in England Advanced Clinical Practitioners are drawn from both nursing and allied health professions. Whilst much of the literature emphasises the importance of ensuring the sustainability of the Advanced Clinical Practitioners' role, the pandemic threw further light on its potential and challenges. However, an initial review of the literature highlighted a lack of research of Advanced Clinical Practitioners' capabilities working with uncertainty in disaster response situations. AIM: To capture the lived experience of how English Advanced Clinical Practitioners working with older people adapted their roles in response to the COVID-19 pandemic (October 2020-January 2021). DESIGN, SETTING AND PARTICIPANTS: A qualitative research design was used. Following ethical approval, 23 Advanced Clinical Practitioner volunteer participants from across England with varied health professional backgrounds were recruited from Advanced Clinical Practitioners' professional and social media networks on Twitter using a snowballing technique. METHODS: Depending on preference or availability, 23 participants (nurses (18), physiotherapists (2), paramedics (2) and a pharmacist (1)) were interviewed singularly (n = 9) or as part of 3 focus groups (n = 14) using Zoom video communication. Audio recordings were transcribed and using qualitative data analysis software, NVivo 12 pro, coded for an essentialist thematic analysis of Advanced Clinical Practitioners' responses using an inductive approach. 27 codes were identified and collated into five themes. For the purposes of this paper, four themes are discussed: experiencing different work, developing attributes, negotiating barriers and changing future provision. FINDINGS: Advanced Clinical Practitioners successfully transferred their advanced practice skills into areas of clinical need during the pandemic. Their autonomous and generic, high level of expertise equipped them for management and leadership positions where speed of change, and the dissolution of traditional professional boundaries, were prioritised. Barriers to progress included a lack of knowledge of the Advanced Clinical Practitioner role and friction between Advanced Clinical Practitioners and physicians. DISCUSSION AND CONCLUSION: The study demonstrated the successful adaption of the Advanced Clinical Practitioner role to enable more creative, personalised and sustainable solutions in the care of older people living with frailty during the pandemic. The potential of Advanced Clinical Practitioner development is in a juxtaposition to the threat of pandemic services being dismantled once the emergency nature of care has passed. Healthcare organisations have a vital part to play in considering the enablers and barriers of Advanced Clinical Practitioner capability-based practice when responding to uncertainty.

Older people's experiences in acute care settings: Systematic review and synthesis of qualitative studies.

BACKGROUND: There is no recent synthesis of primary research studies into older people's experiences of hospital care. OBJECTIVE: To synthesise qualitative research findings into older people's experiences of acute health care. DESIGN: Systematic procedures for study selection and data extraction and analysis. Comparative thematic approach with meta-ethnographic features for synthesis. DATA SOURCES: Worldwide grey and published literature written in English between January 1999 and December 2018 identified from databases: CINAHL, Medline, British Nursing Index, EMBASE Psychiatry, International Bibliography of the Social Sciences, PsychINFO, and AgeInfo. REVIEW METHODS: Systematic review and synthesis of 61 qualitative studies and two systematic reviews describing older patients' experiences of care in acute hospital settings. RESULTS: The physical and social environment of the hospital positioned many older patients as insignificant and powerless to influence the care they received. Patients subjugated their needs to those of staff and other patients, holding back information and requests for help. Patient knowledge of the time-based schedules for care, and experiences of waiting for care and of staff limiting their time with them served to reinforce patients' feelings of insignificance and powerlessness, reflecting the perceived primacy of bureaucratic organisation of care over individual needs and preferences. Highly negative experiences would result if these aspects of context were not mediated by individualised relational work by staff, nursing staff in particular. Some groups of patients were at particular risk of negative experiences: people with dementia and/or delirium; people with difficulty communicating, hearing or understanding; people from ethnic minority groups, especially where there was a language difference; people with low functional/physical ability; people with low literacy; and people without regular visitors and/or family support. Three key features of care consistently mediated negative feelings and were linked to more positive experiences were: "maintaining identity: see who I am", "building relationships: connect with me", and "partnering in care: involve me". CONCLUSION: Older people's care experiences in hospital may be negative in the absence of relational work by nurses to maintain people's identity, establish caring connections and ensure that individual patient needs, preferences and values are honoured in the care that is delivered. Relational care by nurses can mediate powerful institutional drivers that may otherwise result in negative experiences and poor care. Organisational and service-wide commitment are needed to create the culture and context in which relational care can flourish. Tweetable abstract: Synthesis of qualitative research on older ppl's hospital experiences: hospital's physical and social environment positions older ppl as insignificant and powerless. Highly negative experiences result if impact of context not mediated by individualised relational work by nurses.