Working With Patients Living With Dementia, Delirium and Behaviours of Concern: An Exploration into the Impact on Allied Health Staff Wellbeing

Purpose: People living with delirium, dementia and exhibiting behaviours of concern (DDBoC) are becoming increasingly common in hospitals. Allied Health (AH) are a group of professionals who frequently work with people with DDBoC in the inpatient setting to support their rehabilitation goals. Little is known about the effect working with DDBoC has on the mental health and wellbeing of AH staff. The aim of this study was to examine the impact of working with patients living with DDBoC on AH staff on inpatient wards. Materials and methods: This study used a mixed methods concurrent triangulation design with three data collection methods: (i) retrospective audit (Jan 2021 to Dec 2022) of clinical incident data to establish prevalence of incidents related to patients with DDBoC and involving AH; (ii) cross-sectional online survey of AH staff wellbeing, and exposure to and experience with patients living with DDBoC; and (iii) semi-structured one-on-one interviews with AH staff exploring experiences working with DDBoC. The study period was between April and June 2023. Results: Thirty-nine incidents related to DDBoC involving AH staff were reported during the study period. Survey participants reported frequent exposure to DDBoC (44% reported >5 encounters in the past month) and high levels of support seeking (n = 35/50; 70%). Twenty-six percent (n = 13/50) of participants reported low levels of resilience and 28% (n = 14/50) reported high levels of burnout. Analysis of interview transcripts yielded four key themes: ‘What we experience’, ‘How we are impacted’, ‘How we manage’ and ‘How we work together’. Despite most participants reporting normal levels of stress (n = 35; 70%), interview data suggested senior staff may experience and respond to stress differently. Work in this area impacted on team communication, confidence, and response to external factors outside team control. Conclusions: Working with DDBoC has a complex effect on AH staff wellbeing, eliciting feelings of reward, empathy, stress, fatigue and moral distress where person-centred care cannot be provided. AH staff appear to under-report incidents and require strategies to support their wellbeing when working with this patient population.