Dementia Care Strategies in Barking and Dagenham

Introduction

The healthcare practitioner has the role to work on the basis of the medical model of health where they use their knowledge, skills and attitude to deliver holistic care intervention and treatment in general medical practice under supervision to the service users or patients (Owens, 2019). The adult dementia patients are those who are on and above the age of 65 years. In this study, the research on the strategies to be used for safeguarding adults with dementia in Barking and Dagenham is focussed. This is because the diagnosis rate of the disease is high in the area and implementing appropriate strategies available to safeguard the diagnosed adult with dementia in the area is going to create better care environment and well-being for them (lbbd.gov.uk, 2018). Thus, providing information regarding the way strategies to be implemented for safeguarding of the adults with dementia in the area would enhance the knowledge of the healthcare professionals and local authorities regarding the way quality care for dementia patients can be established in the area. For this purpose, the role of the research in health and well-being improvement strategies is to be discussed. A methodological approach is to be undertaken for action research to inform the way quality safeguarding strategies for adult with dementia in Barking and Dagenham is to be identified. An action research is to be executed to inform the safeguarding strategies to be implemented for dementia adults in the Barking and Dagenham. Moreover, the impact of the research findings of the identified safeguarding strategies on dementia adults in Barking and Dagenham is also to be discussed.

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P1 Discuss the role of research in defining research questions for a piece of action research in health and social care

The key research questions are:

What are the safeguarding strategies available for adults with dementia in the Barking and Dagenham?

What is the impact of safeguarding strategies available for adults with dementia in the Barking and Dagenham?

What are the challenges in implementing the safeguarding strategies available for adults with dementia in the Barking and Dagenham?

What are the recommended actions to be taken for resolving challenges related to implementation of safeguarding strategies available for adults with dementia in the Barking and Dagenham?

Background

Dementia is referred to collective diseases that promote neurodegenerative condition leading individuals to experience cognitive decline like forgetfulness, difficulty in solving everyday problems, performing everyday tasks, problem with speaking and others (Thorogood et al. 2018). In the UK, the Alzheimer’s Society mentions that people diagnosed with dementia are often subjected to harm and abuse in hospital and care homes. The mistreatment and abuse include financial, psychological, sexual or physical harm towards the individuals which leads to deteriorate their health condition (Lindenbach et al. 2019). Thus, in this study, the strategies to safeguard adults with dementia are to be identified in Barking and Dagenham so that effective steps can be taken to prevent abuse and neglect towards such individuals in the borough.

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Research Rationale

Dementia is considered as one of the key health issues in different London boroughs which is responsible for death among the adults who are equal to or above 65 years. In 2014-16, dementia is considered as the second leading cause of death among the adults which is evident as 117 adult males and 260 adult females died as a result of the disease (lbbd.gov.uk, 2018a). In 2019, it is mentioned that more than 1,530 people in Barking and Dagenham is affected by dementia and it is projected to rise to nearly 1,842 by 2030 (lbbd.gov.uk, 2018). This indicates that the presence of dementia is highly prevalent in the area of Barking and Dagenham and effective safeguarding of the adults are required to ensure their better well-being and quality of living. The adult people with dementia are prone to get abused and neglected in society (Mileski et al. 2019). This is because the mental condition leads the adult incapable to take their own care and develop dependence on family members and carer to support their care actions. In this condition, the family members and carers often consider the adult people with dementia as burden of care making them show abusive actions and neglect for the patients to get rid of them (Cooke et al. 2019). The increased prevalence of dementia among adult in the Barking and Dagenham could make them face similar consequences out of burden of care for their condition making safeguarding a key issue to be considered. In 2018, dementia diagnosis rate in Barking and Dagenham is mentioned to be 67.1% which is more than the average rate in England that is 61% (lbbd.gov.uk, 2018b). This indicates that there is higher diagnosis rate of dementia in Barking and Dagenham leading to expose increased number of individuals who are suffering from the disease. Thus, the way to safeguard people suffering from dementia in Barking and Dagenham is required to be focussed in the study to ensure improve well-being and quality of life of the diagnosed individuals.

Research Aim

The aim of the study is to identify the way of safeguarding adults with dementia in Barking and Dagenham.

Research Objectives

To identify the safeguarding strategies available for adults with dementia in the Barking and Dagenham

To analyse the impact of safeguarding strategies available for adults with dementia in the Barking and Dagenham

To evaluate the challenges in implementing the safeguarding strategies available for adults with dementia in the Barking and Dagenham

To recommend the actions to be taken for resolving challenges related to implementation of safeguarding strategies available for adults with dementia in the Barking and Dagenham

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P3 Illustrate in detail appropriate research methods for investigating research questions/hypothesis

The following research methods are to be used in executing the study:

Research Philosophy

The two types of research philosophy commonly used are Interpretivism and Positivism. As mentioned by Treadaway (2020), interpretivism philosophy is the approach in which researchers tries to interpret study elements for a certain amount of time by inquiring the perception of people regarding the topic. This indicates that the philosophy is based on qualitative analysis of information. As criticised by Allard et al. (2020), positivism opposes interpretivism as it is the approach in which researchers based on the existing information and theories executes the study for gathering information. In this study, the positivism philosophy is to be used as it allows collection of data based on true scientific facts that are available in existing studies (Allard et al. 2020). However, interpretivism is not be used as it raises biases in the study by creating influence of personal beliefs of the researcher during data interpretation (Treadaway, 2020).

Research Approach

The research approaches are mainly of two types which are inductive research approach and deductive research approach. As asserted by Noone and Jenkins (2018), inductive research approach uses a bottom-up approach in which the hypothesis of the study is made on the basis of gathered results to present new theories. In this study, no new theories regarding the study topic can be framed and thus inductive approach is not to be used. As commented by Hung et al. (2018), deductive approach involves the process of developing hypothesis on the basis of existing theories and information. In this study, the deductive approach is to be used as the research hypothesis and questions are developed by reasoning and analysing the gaps in existing evidence and theories regarding safeguarding of adult dementia patients.

Sampling Technique

The sampling techniques are of two types which are probability sampling and non-probability sampling. As mentioned by Adams et al. (2018), probability sampling is the technique in which samples are selected from a large population and the sample represents the entire population. Thus, it is to be used in framing the study as it would help to make effective inferences about the holistic safeguarding strategies to enhance health of all adult dementia patients in the Barking and Dagenham population. According to the technique, 50 care workers working in the borough of Barking and Dagenham who provides care to adult dementia patients are to be included out of 100 individuals in the population. As argued by Rahman et al. (2019), non-probability sampling is the technique in which the selection of the sample is made on the basis of subjective judgement of researcher. This technique is to be used as it less time-consuming and cheaper (Rahman et al. 2019). According to non-probability technique, 3 healthcare professionals working in borough of Barking and Dagenham to care for adult dementia patient are to be selected.

Data Collection Method

The data collection method includes primary and secondary data collection and in this study, the primary data collection method is to be used. As mentioned by van Bussel et al. (2017), primary data collection method involves gathering first hand regarding the research topic. This data collection process is to be used as it provides increased accuracy in interpreting results. The quantitative and qualitative data collection processes are two types of data collection method. In this study, both the methods are to be used as it would help to overcome weakness of using one process with the help of strength of the other and vice-versa (Windle et al. 2016). In this study, the qualitative data is to be gathered through survey of 50 carer workers of Barking and Dagenham with the help of close-ended questionnaire that is to be distributed through email. The qualitative data is to be gathered by interviewing 3 health professionals of Barking and Dagenham with the help of Skype and use of open-ended questionnaire.

Data Analysis

The analysis of the data is required to present the findings in appropriate manner which provides answers to the raised question and aim in the study (Moore et al. 2017). The quantitative data analysis method is to be used for analysing data gathered from the survey. According to the method, statistical measurements of the data collected are to be analysed and presented in the form of percentage transcript and tabular format. The qualitative data analysis method is to be used for analysing results collected through interview in which the personal transcripts of the participants are to be evaluated for analysis of data and present the findings.

P4 Discuss ethical considerations when researching human participants

The ethical consideration to be managed when researching the human participants in the study includes maintaining confidentiality and anonymity of the individual. This is to be executed by avoiding sharing any personal information of the sample participants and avoiding use of name in mentioning the data delivered by them. The informed consent from the participants is to be taken by providing them detailed information regarding the way their responses are to be used in the study. In the study, to maintain ethical consideration no forced participation is to be made and the participants are allowed to leave the study if they feel their safety is been compromised and confidentiality is violated (Bennett et al. 2017).

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P5 Implement a piece of action research in health and wellbeing improvement

In this study, the mixed research study is implemented according to which systematic integration of qualitative and qualitative data is made within the investigation and gathering of information (Kaur et al. 2019). In gathering quantitative data, the survey method is implemented in which responses from 50 nurses caring for the adult dementia patient in the borough of Barking and Dagenham are collected. The findings mentioned that executing risk assessment of the patients so that any vulnerable issues to be faced can be detected prior to their occurrence. The findings also informs that proactive and personalised care support, strict implementation and following of legislation and polices during care, community support and regular monitoring of patients are essential strategies for safeguarding adult dementia people in the borough of Barking and Dagenham. In qualitative data collection, the health professionals informs early and timely care support, patient empowerment and immediate availability of care services are essential to safeguard adult dementia patients in borough of Barking and Dagenham.

P6 Interpret data using appropriate data analysis techniques

Quantitative Data Interpretation:

1. What are the safeguarding strategies do you think are to be implemented for adults with dementia in the Barking and Dagenham?

2. What is the impact of safeguarding strategies available for adults with dementia in the Barking and Dagenham?

3. What are the challenges faced by you in implementing the safeguarding strategies available for adults with dementia in the Barking and Dagenham?

4. What are the recommended actions to be taken for resolving challenges related to implementation of safeguarding strategies available for adults with dementia in the Barking and Dagenham?

Qualitative Data Interpretation:

1. What are the safeguarding strategies do you think are to be implemented for adults with dementia in the Barking and Dagenham?

1st Respondent: The patients are to be provided opportunity and space along with avoided to be ignored during communication of their detailed needs and demands to the care workers. This is because it would lead the patients with dementia feel valued and express their concerns or vulnerable condition to be identified by the service providers in protecting them from further risk and ensures safeguarding. 2nd Respondent: The risk assessment of the adults with dementia is to be performed to determine the vulnerable safety risk to be faced by them in turn helping care providers develop actions to control the risk from occurring and ensure safeguarding. 3rd Respondent: The adults with dementia are to be provided supportive care services for their everyday needs to avoid the patients from being burden of care on the family that may raise abuse or neglect in turn acting to safeguard their health and well-being.

Critically analysing research data and findings from action research using appropriate data analysis techniques (M3, D2)

The quantitative data analysis of the information collected through survey informs that 28% of nurses taking care of adult dementia patients mention risk assessment as effective strategy for safeguarding of the patients. As mentioned by Risvoll et al. (2019), risk assessment during care helps the service providers to develop awareness of the risks of abuse or harm towards the patients. However, it is argued by Clarke and Mantle (2016) is that without risk assessment in care the nurses and health professionals remain unaware of the concerns to be talked for the patients and the factors which are vulnerable for their health. Thus, its implementation to safeguarding adult dementia patients is appropriate because it is going to assist the healthcare works take proactive actions to protect the patient’s well-being which could otherwise be compromised making them face health safety issues. Moreover, 24% mentions strict implication and following of legislation and policies during care delivery to safeguard adult dementia patients in the borough of Barking and Dagenham apart from 18% mentioned supportive community care practices and personalised care and 20% supporting regular monitoring of patients to safeguard them from abuse and risk. The following of effective care legislations helps to safeguard adult dementia patients as the healthcare practitioners are able to avoid making any error in care that could expose the patients to face vulnerable condition, in turn, acting to safeguard their health (Manthorpe and Martineau, 2019). As argued by Fenge (2017), lack of following strict care policies leads nurses deliver unsafe care. This is because without following the care policies the nurses show lack of commitment in care as well as lack guidance in delivering safe care to the patient which acts to the disrupt patient's safeguarding of health. Moreover, the regular monitoring of adults dementia patients leads healthcare practitioner identify any probable abuse or harm prior to their occurrence, in turn, acting to take steps in protection of the patients to ensure their safeguarding (Chen et al. 2020). As mentioned by Fang and Yan (2018), burden of care leads dementia patients to be abused or harmed. This is to overcome the responsibility in caring for them. However, it is argued by Holle et al. (2019), supportive community care practices for dementia patients avoid to make them become burden of care on the family members or society as well as provide them support for meeting their health needs. This is because in supportive community care various professionals are involved who collaborative arrange and delivery care for the service users. Thus, the actions help to avoid rise of negligence of care out of burden towards the dementia patients, in turn, ensuring their safeguarding and wellbeing through continuous support. Thus, the mentioned strategies are appropriate to be used for safeguarding adult dementia patients in the borough of Barking and Dagenham. The quantitative data analysis mentions that 30% of nurses considered the safeguarding strategies to be implemented for adult dementia patients in Barking and Dagenham is going to create enhanced patient health condition. Moreover, 26% mentions lower vulnerability in care, 16% mentions that increased trust in care and 20% mentions enhanced patient dignity and care satisfaction to be provided to the patient. As commented by Kupeli et al. (2018), safeguarding of patients includes protecting well-being and rights of the people and allowing them live a life free of harm and abuse. The implementation of the current safeguarding strategies ensure adults dementia patients in Barking and Dagenham to have less risk of abuse in turn allowing to live a carefree life without fear of harm, develop dignity and support that are their human rights along with it have enhanced health which ensures the strategies are effective in safeguarding and promoting well-being of the patients in the area. As argued by MacIntyre and Stewart (2017), lack of safeguarding to adults with dementia makes them to face worst mental health condition and care make become prone to death. Thus, effectiveness of the strategies to safeguard adult dementia patients in Barking and Dagenham is important to ensure their improved health and well-being.

In the qualitative data analysis, few challenges to implement the determined strategies of safeguarding of adult dementia patients in the Barking and Dagenham are highlighted. It is seen that 32% nurses report lack of training, 28% reported hindered communication establishment, 20% reports maladministration and 16% report lack of availability of adequate resources as the challenged to be experienced with implementation of strategies for dementia patients in the area. As argued by Testad et al. (2016), without effective training the nurses fail to successfully implement care strategies in appropriate manner. This is because they lack knowledge and skills regarding the way to implement the care strategies. Thus, extensive safeguarding training is important to be established to overcome the challenge and it is also supported by 30% of nurses in care for dementia patients in Barking and Dagenham. The communication is key towards promoting safeguarding of dementia patients. This is because it leads the nurses to identify risk to be experienced by patients and empower them in taking appropriate action towards resolving them (Manthorpe and Martineau, 2019). As argued by Windle et al. (2019), lack of effective communication establishment with the adult dementia patients makes the nurses face hindrance in safeguarding and protecting them from harm. This is because hindered communication leads nurses remain unaware of the abuse and concerns of the patients along with fails to motivate them in taking appropriate actions available to support their safeguarding of health. Thus, 26% of the nurses supported the establishment of better knowledge delivery of using non-verbal communication towards them in ensuring safeguarding of dementia patients in the Barking and Dagenham. This is because dementia patients due to deteriorated brain condition losses ability to verbally communicate in later stages and depend on non-verbal communication way to share information (Stevenson et al. 2019). The maladministration leads to create challenge in implementation of safeguarding strategies in care as no systematic process and principles are followed to ensure safety and protection of health of people from harm by the care workers (Phillips, 2016). Thus, 22% nurses supported that strict implication of rules for service delivery in case of adult dementia patients in Barking and Dagenham is to be established so that effective safeguarding strategies implementation for them can be ensured to protect them any further harm or abuse. The qualitative data analysis made by analysing the transcripts of health professionals in Barking and Dagenham informs that establishment of effective communication with dementia patients in the area is key towards safeguarding them from harm or abuse. This is evident as study by Martin et al. (2019) informs that communication with vulnerable dementia patients helps care workers identify the people responsible for abusing them along with identify the factors responsible towards making them face vulnerability. Thus, successful communication is essential in ensuring safeguarding of the adult dementia patients in borough of Barking and Dagenham. The qualitative data analysis also revealed that risk assessment is to be implemented for safeguarding of dementia patients in the Barking and Dagenham. However it is criticised that lack of risks assessment in care environment for dementia patients makes the healthcare practitioner remain unable to be recognise and control probable risks and harm towards the patients (alzheimers.org.uk, 2019). Thus, this signifies the value of risk assessment in safeguarding of the dementia patients in the area. It is also revealed with analysis of data that supportive care practices are to be available for dementia patients in the Barking and Dagenham to ensure their safeguarding. As argued by Cerajewska and West (2019), supportive care to the dementia patients helps to overcome their risk of facing abuse. This is because supportive care includes involvement of various care advisors who work together to effective analyse the vulnerable condition of the dementia patients and accordingly take appropriate steps to overcome the issues to ensure safeguarding of the patients.

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P7 Discuss the potential impact of findings from action research study on health and wellbeing improvement

The findings from the actions research such as continuous monitoring of dementia patients implement of risk assessment, delivery of supportive community care practices and others in Barking and Dagenham are going to impact in effectively promoting their safeguarding from abusive care, financial exploitation, physical harm and others. This is because risks assessment, along with supportive care and continuous monitoring of health of dementia patients led the health practitioner become proactive in detecting any potential harm and take steps to avoid it with immediate actions (Parkinson et al. 2017). This, in turn leads to health and well-being improvement of the adult dementia patients as their fear of harm is resolved along with actions to promote their health condition is appropriately taken in timely manner. The findings of the challenges or barriers towards implementation of safeguarding strategies for dementia patients in Barking and Dagenham along with the way to resolve them helped in this study to direct health practitioners or workers, nurses and others in assure error-free health improvement for the patients in the area. As argued by Dugstad et al. (2019), inability to resolve barriers in implementation of care strategies leads to delay in care support towards the patients. This is because the care providers remain confused regarding the way successful establishment of the care is to be made. Thus, the findings led to smooth implementation of safeguarding for dementia patients in the Barking and Dagenham in turn protecting them from abuse or harm to ensure improved health and well-being.

P8 Discuss own learning in research journey identifying strategies for future developmental needs in conducting ethical research into health and wellbeing improvement

The execution of the research led me the opportunity to learn regarding the skills and strategies to be used for ensure ethical practice in the study. It led me to learn the key ethical principles of confidentiality and privacy is to be followed in research. The action research made me aware of the importance of primary data collection process along with need of supportive literature review. The research led me to identify that including qualitative and qualitative data in study led to development of enriched study as it provides accurate results to be presented with in-depth information. Thus, in future, while conducting ethical research I am going to use mixed research method where qualitative and qualitative data both can be collected and analysed. Further, to ensure ethical aspect of the research, informed consent from participants are to be taken and their personal information are to be appropriately protected. In future, I am going to use primary data collection method as it is cheaper and allows first-hand data to be gathered allowing to present updated information.

M4 Evaluate how findings relate to research questions in supporting improvement in health and wellbeing and own professional development

The findings made in the study are seen to appropriately relate with the research question to facilitate improved health and well-being of patients along with enhanced professional development. It is evident as the first research question can be effectively linked with the first qualitative and quantitative question where the nurses caring or dementia patients in Barking and Dagenham has mentioned use of risk assessment for patient, supportive community care practices, regular monitoring of patients, strict following of legislations in care delivery and others as strategies to ensure safeguarding of the patients. Moreover, the health professionals caring for dementia patients in the Barking and Dagenham also supported the facts by mentioning risk assessment and supportive care as effective strategies along with communication establishment in care to effectively safeguard adult dementia patients in the borough of Barking and Dagenham. The facts led to my own professional development by empowering to identify the exact actions to be taken while caring for adult dementia patients in the Barking and Dagenham to ensure their safeguarding. The second question can be linked with findings from the second quantitative research question. This is evident as the data from the second question revealed that the suggested strategies for adult dementia patients in the Barking and Dagenham is going to improve patient well-being, create low risk for abuse towards patients, enhance their dignity and increase their trust towards receiving care. These are able to ensure safeguarding of dementia patients in the area as it protects them by resolving their risky concerns as well as create opportunity for their improved health. It led to my own professional development by informing the effectiveness of the strategies being planned to delivery safeguarding to adults dementia patients in the Barking and Dagenham. The third question can be linked with the findings of third qualitative question where detailed explanation of the challenges to be faced towards implementation of the strategies for safeguarding of dementia patients in Barking and Dagenham is mentioned. It is mentioned that lack of training, hindered ability to establish communication with patients and maladministration in care is going to act as challenge in the process. However, the fourth qualitative question can be linked with the fourth research question of the study where the way to resolve the challenges in implementing safeguarding strategies for dementia patents in Barking and Dagenham are explained. The findings in these two question supported health and well-being of adults dementia patients in the Barking and Dagenham as they providing facts regarding the challenges faced towards implementation of safeguarding strategies are to be resolved to ensure effective protection of risk and harm towards the individuals. It also supported my own professional development by making me aware of the barrier to be faced and the way they are to be resolved to ensure successful implementation of the strategies to safeguard the adult dementia patients in the Barking and Dagenham.

D3 Critically evaluate research study in terms of influencing change and its value in improving quality of health and social care service provision nationally and globally

The information gathered from the action research will create enhanced change to promote safeguarding from abuse or harm for adult dementia patients. The findings from the study will make healthcare professionals and nurses globally and locally understand the importance of successful communication establishment with the adult dementia patients in protecting them from harm. The outlined challenges in implementation of safeguarding strategies for dementia patients and recommendations to resolve them would act as support and knowledge in understanding actions to be made for successful safeguarding in dementia care both globally and locally. However, the findings are going to create overall improvement in the care quality of adult dementia patients in the Barking and Dagenham by acting as care guidance which may even act to create lower prevalence and enhanced management of the health issue in the area.

Conclusion

In Barking and Dagenham, it is seen that dementia is reason for most number of deaths among the adult people. Moreover, it is seen that the overall prevalence of the disease is quite high and it is going to increase by 2030 to concerning numbers. Since dementia adults are vulnerable to abuse as a result of hindered mental efficiency, thus it is essential to identify strategies for them in promoting their safeguarding. Moreover, safeguarding strategies for adult dementia patients are essential to be identified in Barking and Dagenham as with increasing number of patients in the areas there is high probability of abuse towards them which is to be avoided to ensure the patient’s well-being. The mixed data collection method is used in executing the research where qualitative and qualitative data are to be collected in the study. The findings inform that safeguarding strategies to be implemented for adult dementia patients in the borough of Barking and Dagenham include Regular monitoring of patients, risk assessment of patients, delivering supportive community care practices and making strict implication and following of legislation and care policies. Moreover, communication with patients to be appropriately established to determine their concern and risk so as to take effective action in minimising them by the nurses and ensure safeguarding to the patients.

Reflection on research findings and conclusion

The framing and execution of the research project led me as health and social care practitioner understand the significance of gathering evidence and evaluating them in determining care support for patients. The study aimed to determine safeguarding strategies for adult dementia patients in the borough of Barking and Dagenham. The primary research methods are used and mixed data collection and analysis is implemented to gather evidence regarding the study. The findings from the study led to develop the conclusion that effective communication along with monitoring of patients is to be maintained along with risk assessment of patients, strict following of legal guidance in delivering care and delivering supportive communicate care to the patients is to be managed to ensure safeguarding. Moreover, it led me to understand that presence of effective training is required to be present along with effective administration, adequate resources and communication skills to successfully implement the safeguarding strategies for adult dementia patients in Barking and Dagenham without experiencing any barriers.

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