Patterns of Difficulty Experienced by Nurses Caring for Elderly Patients with Dementia in Medical Facilities

Abstract

The purpose of this study was to describe and clarify nurses' experience of difficulties with institutionalized elderly patients with dementia in medical facilities. This study was a qualitative study using grounded theory guided data collection and analysis. Twenty-seven registered nurses (RN) who care for elderly with dementia in medical facilities were interviewed. Retrospective audio-taped narration provided the data for analysis. The semi-structured interviews were transcribed. Finally, a core category emerged following the refinement of categories and diagrams. Dimensions of Accepting patients and their situation was the core category and four categories were identified : An encounter with demented patients, necessity to watch, the tension of the routine work, and conflict between families and nurses. Antecedent conditions were an encounter with demented patients and conflict between families and nurses. These two conditions lead to several categories, necessity to watch and the tension of routine work. Between these two states nurses struggled to find ways to accept patients' situation. Dementia patient's behaviours are risky and unpredictable for nurses, but the most difficult problem was to accept their patients during their tension of routine work (becoming accustom to the situation). These patterns suggested that there was marked tendency of ethical problems to emerge resulting from watching patients and the burden of labor in medical facilities. It is necessary to support nurses in accepting patients through education, and reduce the tension in routine work. Further research is necessary to clarify watching patients ("Mimamori" in Japanese) and nurse's accepting patients and their situation.