Watkins et al, 2019IrelandAppreciative inquiry:discovery phaseTo generate insightsabout what mattersand is valued by familySingle site, large EDPhase 1: data analysisFamily members (15)EDPhase 1: data analysisFamily members (15)Older people withdementia did not take24Caring for an older personwith dementia in theemergency department(ED): An appreciativeinquiry exploring familymember and ED nurseexperiencesmembers of olderpeople with dementiain the ED and tocapture theexperiences of EDnurses looking afterolder people withdementia in anepisode of careED nurses (12)Participant observation(30 hours)Semi-structuredinterviewsThematic analysisED nurses (12)Participantobservation (30 hours)Semi-structuredinterviewsThematic analysisTwo themes:what matters to familymembers; challengesfor family membersand nurses in ED. Beingtriaged quicklyenhances experiences.Triage nurse underpressure to seeeverybody as fast aspossible. Priority hasto be given to heartattacks/strokes.Cubicle space offerssanctuary. Familymembers fear wayolder person withdementia mightbehave in a chaoticenvironment. Risk ofbecoming a publicspectacle. ‘Conveyorbelt’ nursing. EDnurses remote frompersonal contact.Some ED nursesmanaging to integratepart as in advancedstate of the diseaseModification of triagesystem required toprioritise older peoplewith dementia.Increased educationfor nurses about theneed for familymember insights. EDnurses need to find away to blend technicaland relational aspectsof care. Some EDnurses doing this.Need to find a way tomake this happenmore frequently

What activity encourages family members to be involved during the late stage of dementia?Discussing end-of-life decisionsMassaging their hands with lotionPlaying cards with themAsking them about their military service

In which Stage will a person with dementia require complete assistance?Reversible stageEarly stageMiddle stageLate stage

Caring for older people with dementia in theemergency department.

Hunter et al, 2017 CanadaBalancing safety andharm for older adults withdementia in ruralemergency departments:health professionals'perspectivesInterpretative,descriptive exploratorydesign: social ecologicalperspectivePurposive/snowballingsamplingTo understand safetyand harm in rural EDtransitional care forcommunity-dwellingolder adults withdementia fromperspectives of HPs.HPs asked to describetheir experiences ofworking with olderpeople with dementiaand their caregivers inED2 small rural EDs (95inpatient beds/76inpatient beds)12 healthprofessionals: nurses,social worker,occupational therapist,physiotherapist,medicsSemi-structuredinterviewsHP perspectives: ED ischallenging for olderpeople with dementia.Chaotic andovercrowded. Thisgroup not a prioritydue to priorities ofemergency care. HPsometimes too busy togive proper care to thisgroup. Competingpressures in triage.HPs experience moraldistress when theycannot provide carethat they should beable to give. Negativeconsequences: no safespace, no quietenvironment. HPssensitive to familymember situation.Need to look at olderpeople with dementiaand family member asa complete package—obligations to bothSmall ED can be ofbenefit: potential toget older person withdementia out of EDfaster due to goodcommunity links.Disadvantages: makingassumptions orbecoming complacentabout patients whoare well known to HPsMaking things better:more resources,valuing contribution offamily members whocould provide care inED. Changing triageapproach to olderpeople with dementia,getting to know theperson beyond thesuperficial, betterdischarge planning

Parke et al 2013 CanadaFacilitators and barriers tosafe emergencydepartment transitionsfor community-dwellingolder people withdementia and theircaregivers: a socialecological studyInterpretive,qualitative exploratorydesignPurposive samplingParticipants were: PWDplus familymember/carer (6)Carers (4) ED nurses(10) Nurse practitioners(4)To identify factors thatimpede/facilitate safetransitional care forPWD in the ED. Toidentify potentialsolutions that wouldsupport nurses toprovide sensitive careThree phases:interviews; creation ofa photographicnarrative journal;photo-elicitation focusgroups. Verbatimtranscription. NvivoConstant comparativeanalysisBeing under-triaged;time pressures; lack ofattention to basicneeds; feeling ignored,forgotten andunimportant. Triagesystem in the ED doesnot recognise atypicalpresentations—sets inmotion a cascade ofvulnerability of olderPWD. Family membersvalue the relationalaspects of care—recognition ofvulnerability,communication,interactions withnursesNurses should beadvocates forrelationship-centredcareNurses need supportto carry out bestpracticeDifficult to recruitolder people withdementia to the studybecause of effects ofdiseaseNeed for researchabout contextNeed for research thatfocuses on what workswell and wh