NEW GRADUATE NURSES AND DEMENTIA CARE IN ACUTE CARE Benjamin Hartung A thesis ...

190 Pages·2017·1.69 MB·English

NEW GRADUATE NURSES AND DEMENTIA CARE IN ACUTE CARE

Benjamin Hartung

A thesis submitted to the
Faculty of Health Sciences
in partial fulfillment of the requirements for the
Master’s degree in Nursing

School of Nursing
Faculty of Health Sciences
University of Ottawa

© Benjamin Hartung, Ottawa, Canada, 2018
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Abstract
Background: With the increasing older adult population, new graduate nurses will be providing
care for patients with dementia more frequently and should be supported to care for this
population during their transition period.
Purpose: The purpose of this thesis was to explore the experiences of new graduate nurses
providing care for patients with dementia in acute care environments.
Methods: An interpretive descriptive qualitative study explored eleven Ontario new graduate
nurses’ experiences providing dementia care in acute care environments. A thematic analysis
was conducted.
Findings: The thematic analysis resulted in three themes and several sub-themes: building of
vision and values, clash of vision and values, and “make do with what you have”.
Discussion and Conclusion: Facilitators to providing dementia care in acute care were
supportive colleagues and early exposure to dementia care. The barriers identified were similar
to the barriers experienced by nurses in the literature.
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Acknowledgments
First, I would like to thank my participants. Without you, this research would not have
been possible. Thank you for sharing your stories and experiences to help advance the
knowledge of the nursing discipline.
I attribute much of my success in this program to the fundamental values my parents
instilled in me. I have learned growing up that with hard work, dedication and love for what you
do, anything is possible and your dreams will become your reality. As I write this, I know that
this dream may not have been a reality without your love and support.
Dr. Michelle Lalonde, thank you for seeing in me what I saw in myself. I entered this
program with several goals and ambitions and you have helped me meet all of them. You
encouraged me to dream big and were always there to support and guide me. It has been a
pleasure working with you. I would like to thank my committee members Dr. J. Craig Phillips
and Dr. Brandi Vanderspank-Wright for their guidance and commitment to me throughout this
project.
Finally, I am so grateful for my friendship in Arianne Bohnert, Sarah Baird, Heather
Hartley, and Maja Bugarski. You were always a listening ear and a shoulder to lean on. This
program, and my mental health, would not have been the same without you.
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Table of Contents
Abstract .......................................................................................................................................... ii
Acknowledgements....................................................................................................................... iii
Table of Contents .......................................................................................................................... iv
List of Tables ................................................................................................................................. x
List of Figures ............................................................................................................................... xi
Glossary of Terms ........................................................................................................................ xii
Chapter 1: Introduction................................................................................................................... 1
1.1 New Graduate Nurses............................................................................................................. 2
1.2 Dementia Care in Acute Care................................................................................................. 2
1.3 The Study Problem ................................................................................................................ 3
1.4 Study Purpose…………......................................................................................................... 4
1.5 Study Objectives..................................................................................................................... 4
Chapter 2: Literature Review…...................................................................................................... 5
2.1 Literature Review Search Strategy......................................................................................... 5
2.2 Literature Review…................................................................................................................ 6
2.2.1 New Graduate Nurse Transition Theory…...................................................................... 7
2.2.1.1 Marlene Kramer: Reality Shock................................................................................... 7
2.2.1.2 Patricia Benner: From Novice to Expert...................................................................... 9
2.2.1.3 Afaf Meleis: Transitions Theory................................................................................. 11
2.2.1.4 Judy Duchscher: Transition Stages Model……………............................................. 14
2.2.1.5 Transition theories in the context of new graduate nurse transition................................. 16
2.2.2 New Graduate Nurse Transition Literature.................................................................... 20
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2.2.2.1 New Graduate Nurse Experience................................................................................ 20
2.2.2.2 Turnover...................................................................................................................... 21
2.2.2.3 Support........................................................................................................................ 22
2.2.3 Limitations of the Literature on New Graduate Nurse Transition................................. 25
2.3 Dementia Care in Acute Care……………………………….............................................. 26
2.3.1 Person-Centred Care...................................................................................................... 28
2.3.2 The Experience of Nurses Caring for Patients with Dementia Care in Acute Care
Environments................................................................................................................................ 30
2.3.3 Nursing Students and Dementia Care............................................................................ 33
2.3.3.1 Nursing Education and Dementia Care....................................................................... 33
2.3.3.2 The Experience of Nursing Students in Dementia Care............................................. 37
2.3.4 Limitations of the Literature on Dementia Care in Acute Care..................................... 38
2.4 Summary of the Literature................................................................................................... 39
Chapter 3: Methodology............................................................................................................... 41
3.1 Philosophical Paradigm....................................................................................................... 41
3.2 Methodology: Interpretative Description............................................................................. 43
3.3 Conceptual Framework and Theory……………................................................................. 43
3.4 Methods................................................................................................................................ 46
3.4.1 Sampling........................................................................................................................ 46
3.4.2 Sample Size.................................................................................................................... 48
3.4.3 Recruitment.................................................................................................................... 48
3.4.4 Data Collection….......................................................................................................... 50
3.4.5 Data Analysis................................................................................................................. 51
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3.5 Rigour.................................................................................................................................. 55
3.6 Ethics and Human Participant Protection............................................................................ 56
3.6.1 Informed Consent.......................................................................................................... 56
3.6.2 Anonymity..................................................................................................................... 57
3.6.3 Data Storage....................................................................................................................57
Chapter 4: Results......................................................................................................................... 58
4.1 Sample Demographic and Employment Characteristics..................................................... 58
4.2 Overview of Themes........................................................................................................... 60
4.3 Theme One: The Building of Vision and Values................................................................ 60
4.3.1 Nursing Education......................................................................................................... 61
4.3.2 Personal Sense of Connectedness with People with Dementia..................................... 65
4.3.3 Early Exposure to Dementia Care….............................................................................. 66
4.3.3.1 Long-Term Care Experience……............................................................................... 66
4.3.3.2 Gentle Persuasive Approach……............................................................................... 69
4.4 Theme Two: Clash of Vision and Values............................................................................ 72
4.4.1 Being a New Graduate Nurse........................................................................................ 72
4.4.2 The Acute Care Environment........................................................................................ 74
4.4.2.1 Lack of Time and Resources………........................................................................... 75
4.4.2.2 Dementia Care as a Lesser Priority............................................................................. 78
4.4.3 Patients with Dementia.................................................................................................. 81
4.4.3.1 Unpredictability and Patient Safety…........................................................................ 81
4.4.3.2 Working with Family Members of Patients with Dementia…................................... 85
4.4.3.3 The Basics: Communication and Personal Care......................................................... 87
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4.5 Theme Three: Make Do With What You Have................................................................... 89
4.5.1 Lying and Dementia Care……...................................................................................... 90
4.5.2 Learning On-the-Go………...………............................................................................ 92
4.5.2.1 Learning from Others.................................................................................................. 92
4.5.2.2 Learning Through Trial-and-Error.............................................................................. 95
4.5.3 Seeing Past the Dementia…........................................................................................... 95
4.5.4 Patients with Dementia as Teachers.…......................................................................... 97
4.6 Summary.............................................................................................................................. 98
Chapter 5: Discussion ................................................................................................................ 100
5.1 Participants..........................................................................................................................100
5.2 Sample Size........................................................................................................................ 101
5.3 Sampling and Recruitment................................................................................................. 102
5.4 Overview of Themes.......................................................................................................... 104
5.5 New Graduate Nurse Transition ....................................................................................... 105
5.6 New Graduate Nurses and Stress....................................................................................... 106
5.7 Support of New Graduate Nurses...................................................................................... 109
5.8 Registered Practical Nurses and New Graduate Nurse Transition.................................... 111
5.9 Personal Sense of Connectedness with Dementia Care..................................................... 113
5.10 Early Exposure to Dementia Care.................................................................................... 116
5.10.1 The Gentle Persuasive Approach Course.................................................................. 116
5.10.2 Paid Employment in Long-Term Care as Students ................................................... 119
5.10.3 Theoretical Discussion of Early Exposure to Dementia Care................................... 121
5.11 Registered Practical Nurses and Dementia Care............................................................. 123
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5.12 Challenges Caring for Patients with Dementia in Acute Care......................................... 124
5.13 Nursing Ethics.................................................................................................................. 126
5.13.1 Lying and Dementia Care.......................................................................................... 126
5.13.2 Humour and Dementia Care...................................................................................... 129
5.13.3 Dementia Care as a Lesser Priority............................................................................ 131
5.13.4 Clash of Values.......................................................................................................... 133
5.14 Implications for Research, Education, and Advanced Practice Nursing......................... 134
5.14.1 Recommendations for Research................................................................................ 134
5.14.2 Recommendations for Education............................................................................... 137
5.14.3 Recommendations for Advanced Practice Nursing................................................... 139
5.14.3.1 Clinical.................................................................................................................... 139
5.14.3.2 Leadership............................................................................................................... 140
5.14.3.3 Consultation and Collaboration.............................................................................. 140
5.14.3.4 Research.................................................................................................................. 141
5.15 Limitations....................................................................................................................... 141
5.16 Conclusion…................................................................................................................... 142
References…............................................................................................................................... 144
Appendix A: Literature Search Inclusion and Exclusion Criteria and Search Terms................ 160
Appendix B: Literature Search Outline...................................................................................... 161
Appendix C: Registered Practical Nurse Search Terms and Rationale...................................... 162
Appendix D: Registered Practical Nurse Literature Search Overview....................................... 163
Appendix E: Recruitment Strageity Timeline and Outcomes .................................................... 164
Appendix F: Recruitment Poster................................................................................................. 167
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Appendix G: Nursing Jounral Recruitment Advertisement........................................................ 168
Appendix H: Interview Guide..................................................................................................... 169
Appendix I: Original Data Codes............................................................................................... 170
Appendix J: Consent Form......................................................................................................... 171
Appendix K: Verbal Consent Script........................................................................................... 174
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List of Tables
Table 1: The Stages of Novice to Expert ..................................................................................... 11
Table 2: New Graduate Nurse Transition Themes Across Theories............................................ 17
Table 3: College of Nurses of Ontario Gerontological Related Competencies............................ 35
Table 4: Participant Inclusion Criteria and Rationale .................................................................. 47
Table 5: Data Analysis Steps ....................................................................................................... 52
Table 6: Sample Demographics and Employment Characteristics .............................................. 59