Examining Nurses' Knowledge, Attitudes, and Perceptions when Caring for People with Dementia in Hospital: A Mixed-Methods Study.

Abstract

Introduction: Nurses in Saudi Arabia lack sufficient training in dementia care, a challenge compounded by cultural beliefs that frame dementia as fate rather than a medical condition. This gap in knowledge and skills hinders nurses' ability to provide appropriate support to people living with dementia in hospital settings. This study investigated Saudi Arabian hospital nurses' knowledge (cognitive expertise), attitudes (feelings and behaviors), and perceptions (thoughts, concerns, and interpretations of behaviors) of caring for people living with dementia to inform future training programs.

Methods: The study used a sequential explanatory mixed-methods design, conducted in six hospital settings in Jeddah, Saudi Arabia. Data were collected between March and July 2018. Quantitative data were gathered using two validated tools: the Dementia Attitude Scale and the Dementia Knowledge Assessment Tool Version 2. Qualitative data consisted of diary entries for ten working days followed by semi-structured interviews. Data integration was performed using the Pillar Integration Process.

Results: A paper survey was completed by 710 nurses, with 17 keeping a diary and 18 participating in interviews. The survey identified themes of knowledge-attitude links, work environment impact, cultural and educational influences, low confidence levels, and gaps in dementia care knowledge. Diary-interviews revealed themes such as knowledge acquisition, attitude-driven behaviors, perceptions of dementia care, professional challenges, and suggestions for improving care. The Pillar Integration Process highlighted five key findings: (1) a lack of knowledge is linked to low confidence in nursing people with dementia, (2) nurses are eager to learn but face limited access to resources, (3) attitudes, emotions, and communication challenges influence care delivery, (4) stigmas and cultural norms negatively impact dementia care, and (5) organizational factors hinder care quality.

Conclusion: Saudi Arabian nurses face significant challenges in dementia care, including inadequate knowledge, resource constraints, and negative attitudes. These findings emphasize the need for targeted training and policy interventions to improve dementia care quality. This study highlights nurses' emotional strain and practical difficulties in dementia care, providing insights for global improvements in dementia care practices and support for nurses' well-being.