Work system influences on nursing staff capacity for relational dementia care on Medicine for Older Persons wards: An ethnographic study

Theme 2

Ageing and Dementia

Start: 25/10/14
End: 9/7/19 (PhD awarded)

Thesis outline and abstract

The Department of Health estimates that a typical general hospital in the UK will have 100 people with dementia admitted at any given time with approximately one in four hospital beds occupied by someone with a diagnosis (Department of Health 2009). Due to this increasing prevalence of people with dementia in hospitals, providing high quality care for this patient group is now a public health priority, however, ongoing reports have identified consistent failures. Many empirical studies have explored care for people with dementia in hospitals commenting on the impact of contextual features on nursing care, however, most of these have been based on acute hospital wards (Featherstone, Northcott et al 2019) and limited research has been conducted in specialist older persons wards.


This ethnographic study has contributed to this gap in the knowledge base providing an in-depth exploration into the impact of the work system on

relational care for people with dementia on medicine for older person’s wards. Data was collected between January 2017 and March 2018 and consisted of 125 hours observations and 26 interviews with nursing staff (health care support workers and nurses).


The results highlight that nursing staff capacity for relational care for sits at an organisational level and not with the individuals themselves. Nursing staff are continuously balancing the needs of the patients with the priorities of the organisation which is detrimental to the care they provide. Rigid routines and expected task durations are causing nursing staff to become “task blind” in which they cannot see the patient behind the task. Power imbalance no longer sits within the medical-nursing hierarchy but within the nursing teams themselves. All of these factors, mixed with strong emotions of fear, guilt and a lack of autonomy are contributing to the shortfalls of care that are being seen nationally.


  • Invited Speaker, Hospice UK Conference, Liverpool, 2019 
  • Invited Speaker, East Midlands Dementia Conference, Nottingham, 2019 
  • Speaker, Royal College of Nurses International Conference, Sheffield, 2019  
  • Speaker, Royal College of Nurses International Conference, Birmingham 2018 
  • Speaker, Alzheimer’s Europe, Berlin 2017 
  • Speaker, Dementia Congress, Brighton 2016 


  • Bridges, J Griffiths, P (joint first authors), Oliver, E & Pickering, R.M, Hospital nurse staffing and staff-patient interactions: an observational study. BMJ Quality & Safety
Back to theme >Contact us