Skip to main content

Research Repository

Advanced Search

How do emergency department staff respond to behaviour that challenges displayed by people living with dementia? A mixed-methods study

Goodwin, Laura; Liddiard, Cathy; Manning, Sera; Benger, Jonathan Richard; Benger, Jonathan; Carlton, Edward; Carlton, Edd; Cheston, Richard; Hoskins, Rebecca; Taylor, Hazel; Voss, Sarah

How do emergency department staff respond to behaviour that challenges displayed by people living with dementia? A mixed-methods study Thumbnail


Laura Goodwin

Cathy Liddiard

Sera Manning
Senior Lecturer in Adult Nursing

Jonathan Richard Benger

Jonathan Benger

Edward Carlton

Edd Carlton

Rebecca Hoskins
Senior Lecturer in Advanced Practice

Hazel Taylor

Sarah Voss
Professor of Emergency and Critical Care


Objectives: To investigate staff experiences of, and approaches to behaviour that challenges displayed by patients with dementia in the emergency department (ED). Behaviour that challenges is defined as ‘actions that detract from the well-being of individuals due to the physical or psychological distress they cause within the settings they are performed’, and can take many forms including aggressive physical actions, shouting and verbal aggression and non-aggressive behaviour including repetitive questioning, inappropriate exposure and resistance to care. Design: Mixed-methods study consisting of an online survey and semistructured telephone interviews. Quantitative data were analysed and presented using descriptive statistics. Qualitative data were analysed thematically. Setting: The EDs of three National Health Service (NHS) Hospital Trusts in Southwest England. Participants: Multidisciplinary NHS staff working in the ED. Results: Fifty-two online survey responses and 13 telephone interviews were analysed. Most (24/36, 67%) survey respondents reported that they had received general training in relation to dementia in the last 2–5 years, however, less than a fifth (4/23, 17%) had received any ED-specific dementia training. All (48/48) felt that behaviour that challenges could potentially be prevented, though resource constraints and practice variation were identified. Four main themes emerged from the qualitative data: (1) the ‘perfect storm’ of the ED; (2) behaviour that challenges is preventable with the right resources; (3) improvisation and (4) requirement for approaches that are specific to the ED. Conclusions: The findings of this study suggest that ED staff do not feel that they are prepared to respond effectively to behaviour that challenges displayed by people living with dementia. Future work could adapt or develop an intervention to support ED staff in responding to behaviour that challenges.

Journal Article Type Article
Acceptance Date Jul 26, 2023
Online Publication Date Aug 4, 2023
Publication Date Aug 1, 2023
Deposit Date Jul 26, 2023
Publicly Available Date Aug 9, 2023
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 13
Issue 8
Article Number e075022
Keywords Aging, Hospitals, Public, Dementia, ACCIDENT & EMERGENCY MEDICINE
Public URL


You might also like

Downloadable Citations