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Abstract

With all the evidence pointing at the global challenge of dementia, this review looks into the factors that the nurses encounter in their duties of creating a care plan, which is empathetic and comprehensive for the patients affected by dementia. This being that their workplaces put them on the first line, they required must be very diverse to correctly text the multifaceted dimensions of this issue, especially the nursing staff. Besides compliance with the relevant directives from medical authorities including NICE or NMC by demonstrating more client-focused approach while also preserving each colleague’s dignity through effective communication techniques that targets dementia patients’ needs.

Search using the most important databases of PubMed and CINAH resulted in a systematic search process which exceeded more than 500 articles. In an effort to make sure a theme is applicable and includes individuals, studies take place within the United Kingdom and span between the years 2014 to 2024. In accordance with PRISMA framework and CASP tool we conducted writing of the selection process very carefully. The analysis of data was conducted using thematic synthesis, which uncovered three major themes: organising both the patient-centric caregiving as well as the inadequate training programs for the healthcare providers, there are other issues, such as the communication problem. Research outcomes stated that there are identical issues for healthcare professionals of any country have despite they are separated by geographic boundaries. Differences in study research methods that individual studies utilise makes there is a need to have wider participation during the upcoming researches to be objective. Besides the problem of size and research methodology, the base of evidence that individual research's results are standing on is also being questionable.

Research recommendations that are given after that unequivocally say that the inclusion of a varieties of viewpoints particularly those from the patients and their families is equally important: This would also mean it's important to start investigating alternative practices from all over and looking at how long-term training programs are held. The proposed action plan promotes reforming training programs, initiating ongoing education schemes, utilising visual aids in communication efforts, prioritising diversity and inclusivity when conducting research studies as well as emphasising person-centered care principles for individuals with dementia. Adherence to ethical standards is vital; therefore it has been advised to develop tailored ethical directives along with ethics committees aimed at tackling complicated issues associated with dementia care. Ultimately this strategy seeks to enhance comprehension resulting in delivering quality global scale comfort for sufferers dealing with Dementia-related illness or medical conditions.

Introduction

Caring for people with dementia creates intricate, demanding situations for healthcare specialists, especially nurses, who play a pivotal function in delivering complete and compassionate care (Yaghmour et al. 2021). This evaluation seeks to delve into the multifaceted challenges encountered by nurses in the care of dementia patients, analysing the current panorama, identifying the underlying factors, and offering capability techniques for development. Dementia, characterised by revolutionary and irreversible cognitive decline, influences hundreds of thousands of people globally, making it a considerable public health problem (World Health Organisation 2023). As the worldwide population ages, the prevalence of dementia keeps pushing upward, necessitating deeper expertise of the challenges faced with the aid of healthcare companies, mainly nurses, in turning in effective and man or woman-targeted care.

The decision to explore the demanding situations confronted by nurses in being concerned for dementia patients stems from the escalating occurrence of dementia and its profound effect on people, families, and healthcare structures. Dementia care necessitates specialised understanding, skills, and a nuanced understanding of the particular needs of affected individuals. Nurses, who are regularly on the frontline, are instrumental in presenting continuous guidance, managing symptoms, and improving the satisfaction of lifestyles for each sufferer and their loved ones (Yang et al. 2022). In the United Kingdom, an estimated 850,000 individuals are living with dementia, various projected to exceed 1,000,000 by way of 2025 and 2,000,000 by 2050 (UK Biobank 2024). Globally, dementia influences about fifty million humans, with nearly 10 million new instances stated yearly (WHO 2023). These data underscore the urgency of addressing the demanding situations confronted by using nurses in dementia care to ensure the shipping of exceptional, individual-focused services on a global scale.

This evaluation adheres to the directives outlined with the aid of the National Institute for Health and Care Excellence (NICE) and the Nursing and Midwifery Council (NMC), accentuating the significance of character-focused care, renovation of dignity, and effective communication within dementia care (Goossensen 2020). Emphasising those factors aligns our exploration with set-up suggestions, ensuring a foundation firmly rooted in proof-primarily based principles. Examining current policies and tips, particularly those involving NICE and NMC guidelines, will allow the identification of existing frameworks that manual nursing practices in dementia care. This alignment with acknowledged standards ensures that the analysis is the most effective and applicable and contributes to the continued enhancement of patient care through a scientific and guiding principle-supported technique.

Furthermore, this assessment is strengthened through insights from recent literature from official instructional journals. This integration of diverse perspectives and proof from scholarly courses aims to present a nuanced and up-to-date evaluation of the challenges encountered by nurses in dementia care. By synthesising records from those official assets, it aspires to provide a comprehensive review that now effectively informs nursing practice and shapes policy issues for the stepped forward care of people with dementia.

Firstly, dementia is an umbrella definition for signs that consist of reminiscence loss, impaired cognitive characteristics, and problems in everyday activities. It is a result of various diseases and conditions affecting the mind, together with Alzheimer's disease and vascular dementia (Duong et al. 2017). Secondly, person-centred care is a method that prioritises the patient’s preferences, values and wishes in decision-making, planning, and transporting healthcare. In dementia care, this technique emphasizes knowledge of the particular records, possibilities, and talents of the character living with dementia (Byrne et al. 2020). Lastly, nursing interventions in the context of dementia care encompass a range of movements taken by nurses to deal with the bodily, emotional, and social wishes of people with dementia. These interventions can also include medicinal drug management, behavioural cures, and creating a supportive surrounding (Livingston et al. 2014).

Methodology

The search for pertinent papers to tell this evaluation worried a systematic and complete method to ensure the inclusion of various views and the latest insights into the demanding situations confronted by nurses in dementia care. Key search engines and databases utilised in this approach involved PubMed and CINAHL databases. Employing a considerate combination of key phrases and Boolean operators, consisting of "nursing dementia care," "challenges faced via nurses in dementia care," "individual-focused care in dementia," "NICE dementia care," and "NMC guidelines dementia," preliminary searches produced a large pool of over 500 articles.

To refine the choice and ensure the inclusion of new and applicable literature, a chronological limiter was applied. This involved specialising in publications from 2014-2024, acknowledging the dynamic nature of healthcare practices and guidelines. To sum up, in focusing on the particular feature of close-to-hand instruction and strategies that the scrutiny centred on UK-based researches. In order to disseminate results transparently we adhered to the requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), thus demonstrating a structured and transparent manner of reporting meta-analyses. By applying PRISMA framework we have scientific method that gives a way to have a better clarity and reproducibility of the whole review process (Nagendrababu et al. 2019). The CASP tool was used to create an inclusion criteria for study selection since rigorous scientific evidence is among the main goals of our review. Aiming at a focused pick based on set traits, this machine applies targeted parameters which keep the selected studies in line with the objectives of the review (Nadelson and Nadelson 2014).

The articles used in this evaluation of the effectiveness of dry farming practice within the context of climate resilience had to undergo a very selective process to ensure its relevance and applicability to the topic of relentless rainfall. Under titles and abstracts, in order to determine whether they were in line with the targets and topics of assessment, had been a thorough approval. The intention of this primary identification phase was to learn about seemingly helpful studies, which were most likely to deliver unique perspectives on the difficulties of dementia care and the role of nurses in it. This meticulous exam of the complete texts aimed to refine the choice in addition to ensuring that the selected research has been not simplest applicable but also met the precise parameters set for inclusion.

The very last selection represents a curated set of five articles that provide nuanced insights into the challenges confronted by the aid of nurses within the realm of dementia care. These chosen studies align carefully with the scope and desires of the evaluation, enriching the evaluation and contributing substantively to the comprehensive understanding of the multifaceted demanding situations encountered with the aid of nurses within the provision of dementia care.

Data analysis was carried out through a thematic synthesis method. Identified papers were systematically reviewed, and key subject matters related to the demanding situations encountered by nurses in dementia care might be extracted. These issues will be labelled and analysed for patterns, variations, and emerging traits. The synthesis manner allowed the mixing of findings from various resources, which include empirical research, evaluations, and coverage files. By adopting a thematic synthesis method, the evaluation pursues to present a complete and nuanced knowledge of the demanding situations confronted by means of nurses in dementia care, grounded in each study's evidence and current recommendations.

Results Table

Title, Author and Date of Publication

Research Methods used

Limitations of the study

Summary of the findings

Country of Origin

Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews, Fukuda et al. 2015

The KJ method, a qualitative synthesis technique that has been applied for more than 50 years in various areas, including nursing, was employed in this study.

Three steps are involved in the KJ method: grouping, charting, and coding. Focus group interview data were combined, coded, and categorised according to commonalities. Each group's core was briefly summarised, and these summaries served as labels for the subsequent grouping stage. This process was repeated until about six labels were generated, and then the labels were placed into a chart.

The labels' content was expressed as descriptive themes, and the logical linkages between them were determined.

The research notes that participation in study was restricted to bigger hospitals with more than 600 beds, which could limit the generalisability of the findings.

Nurses may have been persuaded to participate in the study by head nurses and nursing department directors, who oversaw the recruitment procedure.

 

Recall bias may impact the study's data because it relied on nurses' memories. However, group dynamics and the application of FGIs were used to reduce this bias as much as possible.

The study's unequal gender distribution of nurses may have made it difficult for male nurses to voice their concerns.

 

The study found two significant problems that nurses encountered when caring for patients with dementia in acute care hospitals: (a) the different challenges and issues that nurses faced interacted and created a heavy cycle, and (b) nurses tried their hardest to adjust to these conditions even though they felt conflicted about it.

Japan

Preparation to care for confused older patients in general hospitals: A study of UK health professionals, Griffiths et al. 2014

Consensual Qualitative Research (CQR) was used in the study, which collected data semi-structurally using open-ended questions. An auditor validated the work of the judges who participated in the data analysis process and came to a consensus on the interpretation of the data. Summaries were given for each category into which the data were clustered. Variations in replies from different participant groups were examined.

 

Conducted in a sizable general teaching hospital in the UK that admit 20,000 patients older than 75 annually and serve a 650,000-person catchment area (both urban and rural). Eleven wards representing five subspecialties that admitted unselected patients for acute treatment were chosen. Occupational therapists, physiotherapists, nurses, doctors, and healthcare assistants were among the participants, representing a range of specialties and levels of experience.

Consultants and ward managers were randomly sampled, while other groups were purposively sampled. Most participants were White British.

Because only one general teaching hospital in the UK was used for the study, the results cannot be applied to other healthcare environments.

 

Although the participants were drawn from various fields and seniority levels, the survey may not have included as many diverse viewpoints as possible because most participants were White British.

 

The study's CQR methodology may have introduced bias because it relied on subjective interpretations of the data by numerous judges.

 

The study excluded the viewpoints of patients or their families, which may have offered more information. Instead, it concentrated on the opinions of medical professionals regarding their readiness to care for patients with cognitive impairments.

 

 

Within a UK general hospital, healthcare professionals of all specialties and ranks agreed that they needed to prepare to give patients with cognitive impairments the best care possible. This feeling was shared by physicians, nurses, physiotherapists, occupational therapists, and healthcare assistants.

All junior physicians acknowledged unhappiness with their education, especially in managing severe co-morbidities in older patients.

During training, middle-grade physicians suggested that trainees should have more exposure to geriatric medicine.

 

Consultants expressed dissatisfaction with out-of-date training programs and highlighted a need for more trust in the readiness of junior employees.

Interestingly, experts with personal or professional experiences in caring for older adults with dementia showed higher confidence in their ability to connect with patients, grasp routines, and communicate effectively.

 

 

United Kingdom

Perspectives of healthcare professionals in England on falls interventions for people with dementia: A qualitative interview study, Burgon et al. 2019

The study focused on evaluations and interventions for falls risk reduction in dementia patients, delving into healthcare workers' experiences with falls prevention and memory assessment services.

 

 Nineteen semi-structured interviews with nurses, physiotherapists, occupational therapists, and psychiatrists were done using a qualitative research approach.

 

Using Braun and Clarke's six-phase methodology, thematic analysis was used to find and investigate themes and patterns in the interview data.

 

After completing qualitative research training, the interviews were led by an experienced qualitative researcher and were carried out by a female research occupational therapist with expertise in providing fall services.

 

Verbatim transcriptions of audio-recorded interviews were the foundation for the thorough analysis, enhanced by field notes made after the session.

The interviewer's occupational therapy background may influence participant responses.

 

The results were not necessarily transferable to other populations or

services.

 

 

Adaptations to make falls prevention appropriate for people with dementia, such as using more visual aids in exercise interventions.

Organisational barriers, including limited resources and ineffective communication between mental and physical health teams.

 

 

United Kingdom

In a qualitative study investigating the training requirements of nurses working with people with dementia in nursing homes, Smythe et al. 2017)

Focused group interviews, which were the primary methodology used to investigate the training requirements for nurses who care for residents with dementia in assisted living facilities.

 

Focus group interviews were selected because they promote thoughtful discussion and offer insight into various perspectives and collective ideas.

 

The six-step method developed by Braun and Clarke was applied to the analysis of the focus group interview data.

 

The study's conclusions were drawn from a limited sample from four assisted living facilities in the same region.

The study's conclusions, which were derived from a limited sample of four assisted living facilities in the same region.

 

Small focus groups were used for data gathering, influencing the debate's dynamics and calibre.

 

The study recognises that additional research is necessary to validate the findings, preferably with  more extensive samples from various nations with distinct organisational and cultural contexts.

 

 

Four main themes were derived from the analysis of the transcripts: Responsibilities and frustrations, It’s not like the NHS, Barriers to learning, and Future training.

United Kingdom

Nurses’ experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital: A qualitative descriptive study, Dookhy and Daly 2021

A qualitative descriptive design was used. Nine nurses who worked on wards for patients with medical and surgical conditions participated in semi-structured interviews.

 

The data was analysed using a theme analysis technique.

 

The authors' university granted ethical approval for the study to be conducted.

The leading cause of these limitations was the small sample size—just nine people were included.

 

This narrow focus might not adequately represent the wide range of viewpoints and difficulties nurses encounter in acute hospital environments.

Moreover, there is an exclusive concentration on nurses' experiences. overlooks perspectives from other medical specialists and dementia patients, reducing the results' overall comprehensiveness.

 

Furthermore, the research overlooked a chance to investigate specific nursing interventions and tactics utilised to tackle the difficulties presented by responsive behaviours in patients with dementia, resulting in a deficiency of knowledge regarding efficient clinical methods for handling such intricate instances.

The study found that among nurses providing care for patients with dementia in acute hospital settings, three key themes emerged: obstacles faced, person-centred responses, and dementia readiness.

 

 The hospital atmosphere presented problems for nurses, as did a greater need for education and emotional support. They used person-centred strategies like teamwork and reflection to solve issues.

 

 The study focuses on specific interventions that improved nurses' readiness to handle patients with dementia who exhibit responsive behaviours.

 

The results highlight the need to educate nurses on dementia specifically and support its inclusion in induction and continuing education programs in acute care settings.

 

 To help nurses overcome obstacles, advance person-centred care, and eventually raise the standard of care for patients with dementia in acute hospital settings, this focused instruction is essential.

United Kingdom

Research Methods

The study undertaken by Fukuda et al. back in 2015 focuses on the issues related to rendering aid to a dementia patient who is being cared for by a hospital in Japan. The researchers used the KJ methodology (which looks for convergence of quality information) to analyse outcomes that emerged from; focus group discussions with participants. The study work was divided into three segments i.e. the first consisted of data charting and the other segment was data coding and the third was to discover descriptive themes by inspecting and mapping of the research data. In the UK, for instance, Griffith et al. (2014) carried out a specialised study of a middle-sized healthcare institution to figure out how are the healthcare staff being shortlisted and prepared to care for the old people with dementia. Valid instruments of Consensual Qualitative Research were created on data coming from the semi-structured interviews, which identified educational insufficiency in junior physicians and consultant dissatisfaction with nascent training programs.

The main purpose of the research conducted by Burgon et al. (2019) was to study staff members' attitudes towards falls interventions available in England to those living with dementia. Qualitative interviews are used and the research concentrates on analysing not only fall risk reduction interventions, but the workers' "voices" too within their industry. Thematic analysis was an approach utilised in order to identify those common themes and patterns that were observed during the dialogue performed with the data collected from these conversations. One suggested amendment showed implanting of visual aids into treatment plans. Even so, the fact the participants were of small amount as well as the bias introduced by interviewers whose background was occupational therapy cannot be ignored.

As can be seen in the research presented by Smythe et al. (2017) on the core training requirements of nurses who care for individuals diagnosed with dementia who are residents in nursing homes in the UK. The research employed Braun and Clarke’s six-step approach to the data analysis. It was mostly conducted during group discussions. However, the conclusion was based on a sample, which in its turn was coming from the four supported living facilities, thus showing the necessity of other investigations on a larger scale, and using samples from different parts of the usa within different regions. As a study on a single dilemma area of public sector, if only small focus groups are evaluated, the external validity may be affected. An observational study is powerful in terms of reliability as it either confirms or refutes a phenomenon. However, many drawbacks are possible due to low representation size also when it comes to diversity which might compromise accuracy and verity (Jeffery et al., 2022).

The authors Dookhy and Daly in their study were reviewing the exceptional situations with which nurses usually encounter when they care for people who have dementia in acute hospitals across the UK. The researchers used a thematic analysis technique to extract the key issues from their interview with nine participants, which they addressed in nursing. However, the small sample size and focused perspective on nurses sometimes created challenges which manifested themselves in potentially disadvantageous ways, primarily in such high-pressure hospital settings. Policy makers need to consider interventions and training programs aiming at uplifting the standards of care as the findings have depicted.

Sampling

Moreover, in the study conducted by Fukuda et al. (2015) smooth participation has been granted only to large hospitals of over six hundred beds, because of this several conclusions made in this study may not fit the situation outside this group. Moreover, there rise the cases of biased recruitment considering that the persons who were directly supervised by the chief nurses and the nursing department directors took part in the round selection process, whereby some individuals might have been persuaded selectively to participate. Similarly, Griffiths et al. (2014) call for extrapolation of the research in the light of the fact that it was conducted at only one UK-based general teaching hospital which is a quite limited, in terms of universal application across the other health care settings. Such data in the form of the over-representation of White British respondents is disconcerting as it diminishes the diversity of perspectives incorporated in it therefore. Burgon et al. (2019) pointed to the fact that the investigation only focused on a limited number of experts in health firms, which would limit the overall transferability of effective strategies to other populations or services. Smythe et al.'s (2017) study has urged for gain- broader sample size in varied countries, to back its implications and to prove that they are coming up to global level. Such a possibility may be postulated while referring to the findings of Dookhy and Daly (2021), as they only touched upon the 9 nurses, so this hinders the extrapolation of applications to a large extent of the personnel's groups connected with the nursing profession.

Data Collection

Although there are many ways to process a series of focus group interviews (Fukuda et al., 2015), they used a KJ Method that has 3 steps : grouping, charting, and coding. But the formalization of the technique also carries 'the risk' that with the use of subjective source of coding methods are involved. This dependence on memory of nurses evokes doubts about the recollection biases even through steps were made to obviate/minimize this during the interview phases where nurse groups talk in a collective dynamic to come up with the comprehensive and authentic account. While they have adopted the Consensual Qualitative Research (CQR), this technique is prone to personal interpretation considering it is subjectively centered on participants' experiences and expressions rather than being based on quantifiable data. Nevertheless, in spite of, inclusivity is limited by not involving enough patient and family suggestion which caused a setback in findings that addressed all problems.

The research underlined by Burgon et al. (2019) is thematic analysis applied to find patterns and themes which were discovered in the interview data from the partecipants. Having an organized procedure enabled us to maintain accuracy, while it is known that the possible bias might have come during the time of interviewing from our supervisor who was a occupational therapy therapist. In contrast, Smythe et al. (2017) turned to combined use of the six steps for analysing focus group interviews according to Braun and Clarke's method for wider credibility concluding; however, some limitations like sampled areas' restriction and a limited number of samples could dent data validity. As for their qualitative descriptive design, Dookhy and Daly (2021) did a semi-structured interviews theme analysis. This can also lead to questions about the accuracy of the results given the sample of only the nine nurses who had their shifts covered. Another point is that researching only nurses can potentially left out invaluable opinions of other health care professionals and patients which, in turn, would make the research less generalized (Dookhy and Daly, 2021)

Reliability

That is, Fukuda et al. (2015) made use of KJ method for the sake of enhancing the reliability of their information derived through the systematic processes. Although coding biases and subjectivity might cause weakening reliability, the choice of manual or automatic coding is influenced by the researcher's background (Joffe, 2020). As Gibson alt (2014) put it the CQR had that kind of subjective component that made data analysis depend on several crtic opinions as for the interpretation so apparently inconsistent judgments could bias by detracting dependability. Thematic analysis technique was implemented by Burgon et al. (2019) which involved systematic approach and therefore, the credibility of their findings was enhanced.

However, the quasi-experimental design method used by Smythe et al. (2017) could increase the result reliability; this was contributed by the inclusion of Braun and Clarke's six-step method, notwithstanding the concern over the sample's small size which affected the reliability of the overall study. Furthermore, Dhooky and Daly (2021) had adopted thematic analysis to further consolidate the credibility of their findings with regards to reliability. However, frictions still exist regarding the unclear level of importance one can place on these because the analysis is only focused on the nurses’ reports while small sampling amounts are used, which may eventually dilute or alter the outcome of the study.

Validity

The research of Fukuda doubting the KJ method's validity stems from the possibility of the subjectivity in coding and the fact that nurses have to rely on their memories to provide information. This allowed for group discussions and interviews while attempting to make fair comparisons which is minimal, and thus there could be even high level of uncertainty when it comes to validity of the research (Rising et al., 2019). Consequently, just as in the case of the CQR employed by Griffith et al (2014) collateral risks of subjectivity may be brought into play and become a factor adversely influencing the research validity. Besides, the participation in collecting information by the patients and families or relatives makes the findings of the study more generalizable or increases their credibility (Pyo et al., 2022).

In the work of Burgon et al. (2019), a thematic analysis was used to strengthen the trustworthiness of their conclusions. Yet, this may lend itself to slanting the results due to the interviewer's occupational therapy background, which could make the study less of a credible one. On the contrary, Smythe et al. (2017), employed Braun and Clarke’s conditional method that hampered the results' reliability. To begin with the study drew heavily on theme analysis method which helped in achieving positive results, but it was limited by small samples of exclusively nurses among the respondents which could have weakened its practicality as it could not have universal application in various sectors and professions alike.

Generalisability/ Transferability

The study of Fukuda et al. (2015) was also limited in its applicability, as it included only the medium and large hospitals in Japan, and thus other healthcare facilities in smaller size or the ones outside of Japan could not be affiliated with the study findings. For instance, the work of Griffiths et al. (2014) was conducted in just one UK general teaching hospital which means that it could be unwise to generalize it and use it in the operational structures of different health care systems. This too should be taken into consideration because the observed data related mostly to the White British and thus there are limits to the extent which these outcomes can be applied across the population. The doubt was confirmed by Burgon et al. (2019) when they admitted that their findings could be subjective to other methodologies and could fail to apply to other circumstances due to the small size of their sample and specific environment.

Another imperative area of improvement is the magnification of the cross-country research from Smythe et al. paper (2017) with wider ranges of samples alternatively, the study by Dookhy and Daly (2021) had narrowed its range of participants to the nurses with low levels of participation, which reduced its broad applicability to other areas other than health and personnel.

Ethical Considerations

All the above publications mentioned that the first step to make scientific work ethical is gaining ethical approval and being ethical in your behaviour all the time. Nevertheless, it is acute to discern the ethical aspects that might be involved in such encounters (Masic et al., 2014). Such as in the article of Fukuda et al. (2015), the act of some service departments or head nurses might whatever could have made people feel like they don't have a free choice in their work. The importance of considering the insights from patients and their families who were not mentioned by Griffiths et al. (2014) is an ethical question that was left out as such suggestions may affect coverage comprehensively of their research findings.

While Burgon et al. (2019) did not utilize the ethical implications as its subject matter, the researcher can still doubt every interviewer's involvement which may result to biased results due to the interviewer's occupational therapist background (Haley and Huber, 2022). However, the research by Smythe and colleagues (2017) consisted in working with a larger and international sample. This enables researchers to seek for other improvements for the comprehensive solidity of their study (Andrade, 2020). In their study conducted in a particular university, Dookhy and Daly (2021) gained ethical approval. The common accepted moral principles for studies involving humans apply here; even though, that is not to say there are no other considerations (David, 2015). For example, only nurses were permitted to participate in the study not including other healthcare professionals or patients from different backgrounds thus, may not represent all the medical staffs in a broad spectrum.

Discussion

Theme 1: Challenges in Dementia Care in Acute Settings

To draw attention, studies by groups Fukuda et al. (2015) and Dookhy and Daly (2021) reported on the hurdles that healthcare professionals meet when tending to dementia pateints who are being cared for in acute care settings. These challenges are multidimensional: from skill matching issues to burnout which can be caused by despair and exhaustion on a personal level in nurses. Fukuda et al. (2015) identified these challenges using focus group interview and KJ method. Based on the results, it emerged that these obstacles form an endless loop that causes more fearful concerns as to the quality of care that is given to such patients within a fast-paced hospital environment where there is a burden simply because the care provided may require a longer period of time in catering for the needs of the elderly patients with dementia because such complexities cannot be quickly addressed once there is an issue that has to be resolved

Moreover, since communication obstruction is one of the most typical challenges of dementia care, this cycle is also influenced. Information exchange between healthcare practitioners and patients and their loved ones is severely hindered by their condition. Effective communication is of paramount importance for quality healthcare delivery, and this communication is especially important when dealing with a patient who may have compromised ability to communicate, like someone who is suffering from dementia. This work done by Fukuda et al. (2015) specifies training on strategic ways of talking to those patients for the physicians who practice in the emergency conditions also they need the methods of providing care for people suffering from Dementia due to the features that are characteristic of such condition.

According to a descriptive qualitative study performed by Dookhy and Daly (2021) eligible UK hospitals demonstrated more hindrances in care services towards dementia patients. In line with this, the researchers analysed semi-structured interviews with nine nurses working in general and surgical positions with the aim of identifying the issues that hinder patient care effectiveness. From the dialogue, they found that hospice was suffering domestically because the health practitioners lacked the necessary skills to help and direct them to go through these barriers.

Taken together, the cognitive stressors coupled with a deficiency in psychological support services during daily work related tasks made an immeasurable impact on hospital staff who were frequently placed in the delicate and close situations surrounding both hospitalized and non-hospitalized patients - thereby identifying the systemic inefficiencies generally faced by emergency departments all over the world.

The findings combine a set of primary studies on crucial issues challenged acute care providers staff, irrespective of their location. The topic addresses the fact that it is a complex and multidimensional task involving many factors that are out of easy reach, but it is their combination that makes the job of preventing or slowing down the dementia so difficult. Whilst treatment is a crucial task with immediate needs and demand for rationales, extraordinary emotional and communicative aspects also equally make attention to this or that issue urgent.

As for the measurable outcomes of the nursing job, health professionals also have to be aware of the emotional burden that follows all contexts of the day-to-day duties (Kilbourne et al. 2018). It is also found in the studies by Fukuda, et al. (2015) in Japan and Dookhy and Daly (2021) in the UK, which show that the caregivers experience a tough time, when trying to sift through the confusing emotions while providing care to the patients with the condition of dementia. The obstacles are of linguistic and cultural types. However, this is not absolute. We must give focused intervention to overcome the barriers.

Given that these issues exist under one common theme, it is normal to say that caregivers also experience the same issues associated with nurse care. Through comparing situations on a global scale, a person can identify what stands as the base of the complexity which allows him to cooperate with others in search of practical solutions that aim at addressing sameness rather than individuality. Rightfully so, the attendant effects on the welfare or the health care workers cannot be underplayed, and hence any negligible practices should be highly discouraged to prevent burnout among staff thus giving rise to inadequate number of staff, or even worse, prompting crippled systems altogether.

The study by Livingston et al. (2017) draws hereby the common conclusions by conducting the systematic examination of global challenges in dementia care. The assessment used to combine diverse perspectives and the result showed certain everyday things that everyone- from one continent to another. The report spotlighted the issues like insufficient training courses, impossible communication between healthcare providers, and fast burnout due to emotional strain they face. This is in frame with the results of Fukuda et al. (2015) and Dookhy and Daly (2021), that sensitive the burden of diseases in dementia care.

In the "now what" phase, nursing profession is a necessity for the options that is well-organized and planned. After all, offering customized education programs is now one of the most important aspects if the solution is to work well. Besides ensuring adequate treatment procedures, providers must also receive training to address the emotional and psychological needs of patients taking care of them (Gkioka et al. 2020). The review systemically undertaken Surr et al. (2017) existing confirms this hypothesis. As per they personalized education leads to substantial increase in the quality of care further emphasizing the necessity of capacity building. The detailed research was conducted with many areas of emphasis being centered on teaching for longer periods and not just the usual short-term training as a strategy to enable the healthcare professionals get more knowledge about dementia which will improve their expertise and render quality services to patients. Further, this initiative not only fosters continuous professional improvement by integrating postgraduate level studies on all academic levels that are of an advantage but also accentuate knowledge via acquired research skills which are essential in any medical society gaining the quality of high-end technologies (Surr et al. 2017).

It is crucial for the establishment of vice that builds and honours work culture that caters for the emotional demands of providing for the dementia-stricken individuals (Sturge et al., 2020). The impact of these discomforts, including the ones which are not really considered but important, falls under the findings of Daksi and Daly (2021). Van der Lee et al in 2017 went further to unveil that caregiving resembles emotions in health providers while it calls for organisational support. As a result, the discussion suggests the introduction of bodies of psychological counselling and debriefing on a regular basis to ensure that medical workers have support. Creating ample space for emotional difficulties during the "now what" comes to the fore as a pivotal point. Identifying such gap makes sure that we give high quality and sustainable care at the end.

The specific case studies of problems in dementia care services within acute units are revealed in Fukuda, et al (2015) and Dookhy and Daly (2021) along with a myriad of challenges faced by service staff globally. Surr et al. (2017) as well as Livingston et al. (2017) synthesis this research problem as the pervasive obstacle, and therefore, imminent measures for mitigating the problem are required immediately. These research findings should be considered during the recommendation of systemic changes otherwise the pain and the emotional upheavals of patients with dementia in acute settings would be neglected. Fostering supportive working environments, and good healthcare alongside the emotional links should be some of the priorities for nursing interventions.

Theme 2: Needs for Training and Education

There has been a lot of literature review to illustrate the healthcare professional training and education needs for dealing with dementia, and the result shows that their preparedness is inadequate to cope with dementia computer issues due to its complexity. Griffiths et al. UK-based CQR, the drawing of conclusions has been based mostly on specificity hospitals’ physicians’ perceptions and what they are thinking. The study demonstrated a wide dissatisfaction among junior physicians towards current educational programs mostly lacking the ability to guide junior physicians when they come undulating case of patients, who have multiple co-morbidities, in their training primary classes. In the qualitative study by Smythe et al. (2017), which focused on identifying the training requirements of nurses working with people who have dementia in nursing homes, four key themes were identified as follows: Duties and Utter exasperation, Inconsistencies between practices of NHS, obstacles to learning and the shortcomings demand for training. The research methodology focused on the application of the focus group interviews for discovering the underlying aspects of combining the care that residents living with dementia in senior housing communities require.

It should be also noted that these findings were obtained based on random observation among different assisted living units only on one particular area of the country, which could mean that the prior well-known knowledge might be incomplete or some divergent can exist involving conflicting perspectives or canyons in the context of this topic among the qualified health care professionals who work with such cognitive impairment patients, which are characters of the advanced age patients. It does not go deep enough on the subject to warrant any further probing on its information; here the probe seems to be just a little unlike the generalisation being expected, since the scope investigated is more than just local yet small sizes of samples as compared against the diversity that can span the whole nation if the said context were provided. This, in turn, limits information being freely discussed, even the outside literature over the subject that is being reviewed presently.

Time to consider through the " what so it" phase, these training needs should cover all the perspectives of mankind. Personal matters in the junior physicians’ survey done by Griffiths et al. (2014) exposes a more deep-rooted problem that emerged on a systems’ level. Professionals engaged in the care of dementia patients also fail to develop themselves because of the deficiency in training programs. An excellent training of healthcare workers also involves the quality of care given to patients themselves. Secondly, the article suggests that various challenges exist to accessing quality education which includes those arising from institution impediments to the one of care being given in old homes. Given that both studies made this revelation, it is crystal clear that the existent system is having a major flaw which means a complete system overhaul might be necessary to address the challenges of people learning to take proper care of individuals with dementia.

An article by Kim and Park (2017) is a systematic review and meta-analysis which on the reaffirm these outcomes having been datedently determinate on the ability to improve healthcare providers' knowledge and attitude toward dementia care. With an all-encompassing assessment which involved an assortment of measures like randomised controlled trials and observational investigations, this review proofed that properly directed educational methods are actually capable of efficiently improving the competence of health providers when it comes to dementia patient care. This is in line with other findings such as from Griffiths, et al.'s (2014) and Smythe et al.'s (2017) studies - they also underline the current status and the importance of specialised education programs that are able to provide all the necessary things to all people around the world who are facing cognitive changes.

Confronting the demands for training, education and nursing practice relating to dementia necessarily entail a move from routine mode to a transformational phase of role development. There must be more focus on designing the curricula to incorporate all the knowledge behind the whole clinical field and not just the technical part. This can include more of the social approach, for example, person-centered approach (Lorenz-Artz et al. 2023). More especially the fact of the elderly who have mental illness in intensive care units like dementia, it is necessary now to look critically into the teaching formats as already done (Livingston et al. 2014). The suggestion presented in the study by trainee physicians from Griffiths et al. (2014) urges include essential modules on geriatric medicine which is a basic and crucial training subject for the future medical professionals who will always be prepared and equipped in order to handle any possible challenge while taking care of the patient who is experiencing this condition. Additionally, the nurses emphasized the hurdles and discouragements moulded into personalized education geared towards deal with the challenging aspects of dementia integration in several environments.

The potential barriers can be attributed to structural problems as well as to the specific dynamics, arising in nursing homes that deal with patients whose dementia is progressing. Accordingly, the strategy for educating those who care for them should be customized and comprehensive. Making contextual representativeness a top priority is consequential in the planning of programs which are directed explicitly towards addressing medical professionals' specialized activities related to their specific fields with their different settings. This specific technique guarantees those lessons are meaningful, and the technique makes the training contextual enough to the nuances this field is well known to experience, including agile workers able to tackle emerging problems quickly and confidently (Rosen et al. 2018).

Having selected issues on which the focus needs to be placed, it is essential that staff learn how to deliver person-centred care. Apply specific to dementia care, where no two cases are identical and one-size-fits-all approach is out of the question, this strategy places individuals at the centre of their care. When educating health care professionals about dementia it is useful to make the training interactive and to focus on a comprehensive approach so that clinicians can truly comprehend the tasks needed for patients with dementia (Coulter and Oldham 2016).

 This approach thus does not only pay attention to the clinical matters, but also matters related to psychosocial, emotional and personal issues that drastically affect the state of healthcare. This way values could be injected into the modules for medical training which would equip healthcare professionals with a way of providing compassionate and personalized healthcare orientation beyond mere medical management (Kuipers et al. 2019).

Additionally, Smythe et al. (2017) elaborated on one of the notable aspects of future education, which is extensiveness in areas of particular importance because high-impact studies and new practices continue emerge. In the interim, professionals cannot get out into the field or deal with patients. Steady education programs that can reflect this dynamism by incorporating the recent research findings and best practices into training modules can efficiently serve this purpose (Hassmiller, et al. 2022). Creating adaptable learning programs is not only for bridging the knowledge gap but also help in the creation of a new learning culture throughout the management of health care communities via the (Zirilli et al. 2021).

Such matters impose the context of nursing practice based on the principle of viewing Dementia patients through care principles that are innovative and could be used to make decisions.

Hence the convergence is always taking place in the health care, therefore, it is prudent and pragmatic to intend to pull out educational strands from the continual bubbling of trends. It is important for health practitioners to keep abreast with the changes and thereby improve patient care and attention. The holistic approach involves mobilizing and persuading reformers in diverse levels to come up install policies that will resolve the source of the diverse issues as a way to give better services to the communities. These policies ensure easier access of the services than ever before (National Academies of Sciences, Engineering, and Medicine 2018).

In the era of dementia care, a great concern was draw through studies like Griffiths et al. (2014) and Smythe et al. (2017) that the area of education and training is one of the aspects with huge gaps. The groundbreaking study by Kim and Park (2017) clearly emphasizes socioeconomic--technical education. Furthermore, assessment of this type of practice by Molina-Mula and Gallo-Estrada (2020) leads to modification which entails redesigning the curriculum, introduction of preventative geriatric measures, and implementation of 24/7 person-centred care principles to assist health practitioners ascertain quality dementia care in any type of environment with attitude and joy.

Theme 3: Altered communication in dementia care.

The case of communication disturbances in dementia care documented in the studies of Fukuda et al. (2015), Burgon et al. (2019), and Dookhy and Daly (2021), shows that the difficulty in communications between healthcare providers and those suffering from dementia has many variables that each professional must take into consideration while providing treatment to those with this condition. Fukuda et al. in their study utilising the KJ method that was done in Japan has shown that the nurses encounter a lot of obstacles that include the communication blocks they go through during their interaction with patients with dementia as well as broad issues that they face while conducting the care services.

The 'what' that is apparent from examining these studies reveals the underlying complexity of these complex communicational problems: they are not just special instances or circumstances that should be treated singularly but rather a more 'universal phenomena,' requiring serious study and appreciation of the many nuances at play.

However, communication in dementia goes beyond words by offering a notion of nonverbal cues, expressions of emotions and comportment to individuals in an attempt to understand the person-centered type of care (Ellis and Astell, 2017). 'Pushing forward', a qualitative study by Burgon et al. (2019) aimed to understand how healthcare professionals are involved with the fall risk reduction interventions for patients with dementia who are in the United Kingdom. Registered nurses, physiotherapists, occupational therapists and psychiatrists were included in the study that had been done by interviewing them to get to some of the difficulties encountered as they engaged their patients in several contextual arenas, like memory assessment or fall prevention. An analysis applying thematic approaches demonstrated significant contribution to the thorough insight of the underlying complicated issues in this regard and particularly determined the influence on an appropriate communication among the involved health workers (Burgon et al. 2019).

Dookhy and Daly made an article of qualitative descriptive research in the UK titled" Barriers in communication among nurses when dealing with responsive behaviours in patients with dementia in acute hospital setting ", which showed that nurses encounter communication barriers as a result of the exhibition of responsive behaviour by patients with dementia in a hospital environment. Their research involved open-ended interviews as a source of information about nurses’ immediate perceptions of the conditions in medical or surgical wards these nurses normally operate in. It was out that challenging communication issues were prominent and dominated most of the issues encountered by healthcare professionals which resulted in negative experience of the experience of healthcare professionals when providing care for people with dementia in acute settings.

Stages of "so what" further the piece of evaluation that is usually linked to wider meaning of communication challenges in a society. These complications are not only clinical, but also eccentric that it engulf the providers of health care and the patients and it crosses the borders of the interactions and emotional health for both the care providers and patients. From this perspective, however, quality care will be led by a reduction in the amount of rendered. The research opened up the que of how important these matters go into dementia patient overall well-being and claimed it out as a priority of the current attention in order to find an effective solution. It turns out that obstacles in communication are not just rare incidences, but cases that frequently arise in different contexts more than healthcare experts expect. This situation highlights the paramountity of well communicated practices among all the caregivers because it is not important where in the world the dementia care is taking place, in Japan or in England. The consequences of this will require nursing practice to be strategic and proactive in their approaches to addressing the barriers faced by patients at this stage.

Meta-analysis by Van Manen et al. (2020) was performed on existing studies to further the degree of understanding toward the use of effective communication strategies in dementia care by building on what was reported in other studies that came beforehand. It is argued in the review that patient-centred communication methods that acknowledge the traumatic experiences of patients is among the most important element of an effective healthcare system. Applying this technique to patient engagement means everyone receives customised attention based on their unique needs and not just as just numbers associated with diagnoses, resulting in a more compassionate and effective approach towards caregiving. This viewpoint indeed is the same as Fukuda et al., (2015) Burgon et al. (2019) and Dookhy & Daly (2021) emphasizing the significance of communication the right way for persons having dementia and meeting distinct needs of people respectively because such plays an important role.

Moreover, an empirical study of Chen et al. 2022 focused on the way visuals can alter communication problems among people with dementia. Unlike a systematic review which offers a robust underpinning, this study focuses on scoping review and progressively examines the implementation of different visual tools such as figures and images to enrich communication among those who are in this population.

The declarative involves that such visuals are of great value in that they assist the individuals having cognitive problems associated with dementia and Alzheimer’s to think and express their thoughts more quickly. It's visual aids that give an opportunity to learn how to communicate non-verbally and to express a person's desire, needs or feelings through non-verbal means for the individuals with dementia. This method gives patient a pivot tool of psychological control and wards off the sense of the frustration that being speechless makes (Hoel et al. 2021). The outcomes emphasize that a synergic combination of modern solutions, which are for example: using Visual Aids, may help in providing a higher grade of care to dementia sufferers and their caregivers.

Through the studies of Fukuda and colleagues (2015), Burgon and coworkers (2019) and Dookhy and Daly (2021), it became clear that the communication problems related to dementia care inflict the major obstacles for the healthcare professionals staff. In addition to these, reviews and randomized trials also confirm the need of comprehensive educational strategy and innovative visual aids along with the fostering of an environment where patients are allowed to check the effectiveness of the learning process in the health practice of a nurse to eventually become good communicators. These may not be the foundations of improvement of patients’ lives but also the engine for continuous growth of standards in healthcare across different contexts. As the name suggests, it is expressed especially towards individuals who have this disease or ailment that can take down the lifespan from those affected longer than any other diseases in the current era.

Conclusion

Brief Summary of Themes

Quite a lot of researches have been finding three common themes relevant to the problems relating dementia. First of all, giving the best technology by Fukuda et al. (2015) and Dookhy and Daly (2021) is a complicated process with many problems when giving care of patients in acute healthcare settings.

Healthcare professionals rise to the challenges conveyed through the cyclic nature of difficulties, as this means that they are adapting and they are the complications which are important.

 Next the Griffiths et al. (2014) and Smythe et al. (2017) research works point towards that the training plans don't address all the delicacies about dementia care, which leaves space for the gaps and thus the ongoing education is vital support service when these voids are found. To wrap it up, (years, articles) (Burgon et al.2019), (Dookhy and Daly, 2021) and (Fukuda et al., 2015) shows how the health care professionals communicate problems connected to falls at elderly home environment is a complicated issue. This is also due to the fact that effective communication practise in fall prevention intervention is much rel

Common concern, an in-depth debate, or the lack of knowledge are the subjects of our research.

Another important issue that directly relates to these subjects is a worldwide nature of problems that sooner or later all caregivers face. In addition to the amputation violation, for doctors there are the same problems, indicating common difficulty, when it comes to providing the best attitude towards those sick with this affliction. Nevertheless, the difference in research technique uses, including qualitative synthesising and thematic analysis methods, are where the argument arises due to a notion that the outcome may be biased and thus generalisations of findings invalidated. Vacuums within our pre-existing knowledge may be evident in this dilemma, caused by absence of subject variability from certain studies rather than data presenting the opinions of patients and families. Such insufficiencies open the room for more representational inclusiveness in the discovery of these issues from different perspectives.

Strength of Evidence

The magnitude of the proof is dependent upon the studies and is driven by some of the identified factors. The qualitative methods of Fukuda et al. (2015) and Dookhy & Daly's (2021) also add to reliability of with their results but may affect supposing the severity of the issue due to potential biases. According to Griffiths et al. (2014) and Smythe et al. (2017), positive biases are good, even in their works, but the possibility of personalized adaptations and omitted perspectives might make their findings less strong. While the all-around nature of evidence evaluations is a distinct benefit in the contextual aspects of analyses, the ways in which such appraisals are conducted, though essential, have value in a heuristic approach that demands consideration.

Recommendations for Further Research

In order employ a bettering approach of understanding the stresses in caring for dementia patients, the future studies should involve both personal and professional perspectives. The patients and their relatives, need to be thought of that much. Through different health institutions and authorities, observations of the healthcare work can reveal both complexities and treatments that are unique to different settings. Further research is called upon to trace changes such programs achieve over time on medical practitioners, because it will be vital to know how successful and sustainable the initiatives are (Mlambo et al. 2021). This may be exemplified through investigatory engagement to find out about the critical interventions, for example, if visual aids were to be included when sharing such information, then the practical approaches or simple principles could be a method of translating the theories to practice by health providers/practitioners (Hafner et al. 2022). To that extent, the ethically acceptable future researchers' investigations need to be tailored to include distributed interest in the individual patients' state of the health and treatment period at the same time observing the integrity of care delivery and the enjoyment of all the stakeholders involved.

Recommendations

The resulting research outcome is therefore a solid basis that guides the mission of the action plan which is geared towards improving the failed dementia care systems. This changes to the training programs for the healthcare professionals are the most important things needed because there is a huge gap. On the one hand, in line with the Griffiths et al. (2014) finding and those of the Smythe et al. (2017), current education is not a proper preparation for professionals looking after dementia, which ends up as a big problem. Synergy with the educational sector and the medical institutions to come up with a solution to solve this problem. Training programs should cover geriatric medicine and person-centred approaches which are combined with effective techniques of caring patients living with dementia and Alzheimer’s being some of the most prevalent cognitive disorders (Zucchella et al. 2018). The adaptation of e-learning modules that include the latest information in best practices across various settings could help to ensure healthcare professionals have the latest updates needed to enhance their abilities when required in a dynamic environment such as a dementia ward (Vaona et al., 2018)

College continuing education courses, targeted to medical professionals, especially nurses, shall be geared to impart understanding of the contemporary trends in care management adversely affecting those individuals walking the mental decline path including cognitive decline (Kang et al. 2017). Chang et al. (2020) empirical study shows that visual communication techniques can be widely used to enhance our general communication strategies. Illustrations and figures have been found to facilitate successful information exchange, which is now regarded as an integral part of dementia perspective intervention. Consequently, research encourages the training programs which empower healthcare workers to devise and apply these devices to improve and restore patient’s movement (Klooster et al., 2022). Facilitating dementia support facilities to allocate resources meant for their promotion will simultaneously invent new means of health personnel communicating with dementia patients since that becomes part of their program of care (Hung et al. 2021).

For developement of dementia care practices the top approaches must be given to individuals with various backgrounds to the researching and healthcare communities (B. S. Kolanowski, L. Coster, J. Scogna, S. Martin, 2018).Considering how the Smythe et al (2017) study includes a low number of racially diverse participants as pointed out in the previous paragraph, it is necessary to have strategies that ensure research studies that recruit fairly from all groups of people. Moreover, health care institutions should implement programs that touch on diverse demands of patients from different origins by ensuring diversity and inclusion proficiency of the care givers. The concept will cultivate a caring environment that is not only respectful but also sensitive, where all patients will be treated accordingly to culture (Stanford & et al. 2020).

Planning of dementia care should be at their core the person-centred care principles, as presented in the review by Kim and Park (2017). The objective on hand has been chalked to be accomplished by means of a plan of action. It thus entails crafting of guidelines for the introduction of a person-centred approach within dementia settings. In order to ensure that these healthy practices do not get overlooked in the healthcare sector, workshops and training should be provided for the professionals. Moreover, feedback mechanisms will support the ongoing refinement and institutionalisation of the personalised methods that are already being used in the cases of neurocognitive disorders patients like in the instances of dementia cases.

As Dookhyne and Daly (2021) attempts to show ethical problems are the core issue in the dynamic of dementia care. The strategy would, therefore, be to frame policies that are ethically based on the unique features of the elderly and at the same time set up an ethics committee in medical institutions to arbitrate issues that arise in the special treatment of dementia patients. Frequent imperative moral thinking training in conjunction with regular updates of established guidelines would be very helpful for healthcare providers to make their responsibilities clear and to ensure a destructively running all clinical processes at all intervention phases (Vaismoradi et al. 2020).

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