A Systems Approach to Falls and Discharge Planning

The aim of this study is to generate knowledge on how to improve care for people living with dementia who are in acute hospital. The framework for data collection will be the SHEL \[Software (policy) , Hardware (equipment), Environment and Liveware (people)\] guidelines. This tool has been chosen for this research because Adams (2008) as well as George, Long, and Vincent (2013) argue that in order to improve care for people with dementia it is important to focus on both wider distal elements like the structural components of an organisation in addition to proximal features like the people factor.

This framework will allow for interview data to be collected on the following:

1. Interactions between patient, carers and staff.
2. Hardware (equipment) used on the ward.
3. Software (paperwork/policy).
4. The hospital environment.

Background: The Care Quality Commission (2016) notes that the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust (RBCH) has implemented a number of initiatives aimed at improving care given to people with dementia. However, feedback from patients with dementia indicate that improvements are still required (Care Quality Commission, 2016). Therefore, the main aim of this study is to explore how a systems based approach can be used to help with the discharge planning process and the reduction of falls amongst people with dementia by conducting interviews with hospital staff and carers of people with dementia.

Research question: How can a systems perspective contribute to reducing length of stay for people with dementia in an acute hospital through improvements in discharge planning and falls prevention?

Setting: This study will be conducted at the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust.

Duration:This study is not expected to last longer than three months.

Methods: The researcher will interview hospital staff and carers of people with dementia for a period of approximately thirty minutes. This study will use a hospital systems approach to identify the following: 1) communication and interpersonal strategies used by professionals in the discharge planning process and the reduction of falls, 2) the effectiveness of equipment such as manual handling aides in helping with the discharge planning process and the reduction of falls amongst people with dementia, 3) the impact of policies in the discharge planning process and the reduction of falls, and 4) the influence of the ward environment in helping with the discharge planning process and the reduction of falls. These questions are embedded in Edwards's (1972), Hawkins's (1987) and Zecevic et al.'s (2007) theoretical framework (interactions, environment, policies and equipment).

The findings from this study will be used to inform practice.

Eligibility Criteria:
Inclusion Criteria:

1. Staff (nursing, medical, allied healthcare professionals, support staff) - those who have worked with people who have dementia and are able and willing to provide informed consent.
2. Carers of people with dementia (paid or unpaid) - those who visit the ward regularly and who are able and willing to give informed consent

Exclusion Criteria:

1. Staff (nursing, medical, allied healthcare professionals, support staff)

   * Staff who have not worked with people who have dementia
   * Staff who are unable or unwilling to provide informed consent.
2. Carers of people with dementia

   * People who do not visit patient's on the ward, regularly.
   * People who are unable or unwilling to provide informed consent.