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Worldwide, there are approximately 55 million people who have a dementia diagnosis (World Health Organization [WHO], 2022). Persons living with dementia (PLWD) are hospitalized more often and stay in the hospital longer than those who do not have dementia (Chenoweth et al., 2021; Grealish et al., 2019; Zonsius et al., 2020). Hospitalized PLWD receive inconsistent pain management, decreased nutritional intake, and experience cognitive and functional decline, delirium, falls, and death more frequently than those who do not have dementia (Chenoweth et al., 2021; Grealish et al., 2019; Zonsius et al., 2020). The environmental change from home to hospital can cause distress for PLWD (Liperoti et al., 2008; McCloskey, 2004; Reilly & Houghton, 2019). Hospitalized PLWD have a 90% risk of demonstrating responsive behaviors at least once during their hospital stay (Goonan et al., 2019; Sampson et al., 2014). Responsive behaviors, also referred to as behavioral and psychological symptoms of dementia (BPSD) (Clifford & Doody, 2018), are intentional behaviors that result from unmet needs. Nurses find caring for PLWD who demonstrate responsive behaviors challenging (Handley et al., 2017; Sampson et al., 2014). However, it is not well understood how hospital nurses make decisions and manage responsive behaviors.
Background
Responsive behaviors occur in PLWD because dementia is associated with memory problems, difficulties learning new things, concentrating, making daily life decisions, and behavioral and personality changes (WHO, 2022). These challenges affect how PLWD perceive and interact with nurses and other health care professionals as well as how they try to make sense of the hospital environment (Gwernan-Jones et al., 2020). Thus, it can be expected that PLWD will have difficulty expressing their needs and finding important places, such as the toilet, amid the often chaotic hospital environment. When PLWD are unable to problem solve or express their unmet needs, they may exhibit behaviors, such as anxiety, agitation, physical aggression, disturbed perceptions, depression, apathy, repetitive questioning, inappropriate sexual behaviors, sleep disturbances, and wandering (Kales et al., 2015; Zonsius et al., 2020).
The gold standard for dementia care that includes responsive behaviors in any health care setting is person-centered care...