1. Mixed Methods Exploration of Dementia Nursing Care Anna C Ayton, Lecturer/Practitioner, Gerontological Nursing, TCD/St James’s Hospital, Dublin Supervisors: Dr Elizabeth Curtis, TCD Dr Siobhan Corrigan, TCD Dr Conal Cunningham, TCD/St James’s Hospital, Dublin

2. Background and Context Dementia is an overarching term used to describe a number of conditions that cause damage to brain cells. There are over 100 different types of dementia. The most common are Alzheimer’s disease, vascular dementia and dementia with Lewy bodies. Symptoms of dementia include loss of memory, confusion and problems with speech and understanding (Alzheimer’s Association, 2012).

3. Ageing and Dementia Distinct correlation between ageing and dementia with the prevalence rate doubling approximately every five years after the age of 60 from 1% for those in their 60s, increasing to over 25% for those over 80 years of age. Our older population is increasing > 65 years – 2001 = 430,000 > 65 years – 2036 = 1.1 million This will impact exponentially on the numbers of the population at risk of developing dementia.

4. Health Care Services Hospitals which provide dedicated health care services for the older person are encountering an escalation in the numbers of both acutely and chronically ill older people with coincidental dementia. Hospital admission for a person who is experiencing progressive decline in cognitive function and who may be displaying psychiatric manifestations of the condition is extremely challenging both for the person and the nursing staff.

5. Purpose of this Mixed Methods Study To explore the views and opinions of nurses providing care for the older person with dementia. To explore the influences of nurses’ demographics, attitudes and their beliefs about the environment of care in relation to providing care for the older person with dementia. Setting - three Dublin hospitals which provide dedicated health care services for the older person.

6. What is Mixed Methods Research? Definition “the type of research in which a researcher or team of researchers combines elements of qualitative and quantitative research approaches (eg use of qualitative and quantitative viewpoints – data collection, analysis, inference techniques) for the broad purposes of breadth and depth of understanding and corroboration” (Burke Johnson, et al, 2007 p123).

7. Mixed Methods Typologies Data – use of multiple data sources trained on a single phenomenon. Investigator – the use of different investigators in one study. Theoretical – all possible theoretical models used in the same study.

8. Mixed Methods Typologies cont Methodological – use of different methods to investigate the same phenomenon, further broken down into (a) within methods, a combination of two or more similar data collection methods in the one study, or (b) across methods – where quantitative and qualitative methods are used in the one study. Across methods can be undertaken: Sequentially (explanatory, exploratory, transformative) or Concurrently (triangulation, nested, transformative)

9. Sequential Explanatory Strategy The strategy chosen for this study is the Across Methods – Sequential Explanatory strategy which involves two separate phases, the quantitative followed by qualitative. The study will be conducted in two distinct phases “for the broad purpose of breadth and depth of understanding” (Burke Johnson et al, 2007, p123).

10. Why Sequential Explanatory Strategy The intricacies of human experiences requires the use of multifaceted research design to adequately capture them (Sandelowski, 2000). According to the literature review, providing nursing care for the person with dementia is a multifaceted undertaking, therefore, an exploration requires the use of a multifaceted research design.

11. Why Sequential Explanatory Strategy Using a mixed methods sequential explanatory design will permit the expansion from average analysis and description of the views and opinions of the nurses using questionnaires in phase one to their unique individual subjective experiences by way of focus group interviews in phase two. This holistic tactic further assists in improving the completeness of a study by exposing data that might otherwise have remained concealed.

12. Procedures - Sequential Explanatory Strategy Planning the procedures for a mixed methods study include: Timing Purpose Weighting Mixing

13. Sequential Explanatory Strategy cont Timing Phase One involved a survey study using four self completing questionnaires. Phase Two will involve running three focus group interviews with two to include staff nurses and one with nurse managers.

14. Sequential Explanatory Strategy cont Data Purpose The purpose of mixing methods in this study is complementary, to bring about further clarity, elaboration and enhancement of the data collected. Weighting Sequential explanatory designs usually involves giving a greater priority to the quantitative phase, the purpose of the less dominant phase is to build on the data from the first quantitative phase.

15. Sequential Explanatory Strategy cont Mixing or Data Analysis and Integration. Most difficult characteristic of mixed methods research, when one considers the philosophical differences inherent in interpretivism which consists of texts and images and positivism which is concerned with numbers. Findings must be mixed or integrated at some point.

16. Sequential Explanatory Strategy cont Mixing has taken place in the introduction to the study with the outline of the quantitative and qualitative questions. Connecting will take place at the intermediate stage when the results of the quantitative data will inform the data collected in the qualitative phase.

17. Sequential Explanatory Strategy cont Data analysis will be executed by collecting and analysing the quantitative data from phase one quantitatively and independently of the data from the second qualitative phase. Data from the second phase will be analysed qualitatively and independently from the first quantitative phase.

18. Sequential Explanatory Strategy cont Integrating the data will take place in the discussion chapter when an explanation regarding how the qualitative findings assisted in bringing a richness and depth of understanding to the quantitative findings will be provided but the data sets will remain analytically separate from the other.

19. Conclusion Given the increase in numbers of people with dementia, a current picture of dementia nursing care must be established. Nurses who provide care for the person with dementia have to be able to clarify their role and state factors that enable/inhibit them in providing quality nursing care for this vulnerable cohort of people.

20. Conclusion cont Hospital admission is extremely challenging for both the person with dementia and the nurses providing care. To adequately capture the complexities involved requires the use of a mixed methods approach “for the broad purpose of breadth and depth of understanding”.

21. Contact Details Thank you for listening Contact details: Anna C Ayton anna.ayton@tcd.ie or aayton@stjames.ie anna.ayton@tcd.ie aayton@stjames.ie Phone – 01 416 2266