Project Description
2024 Winner Best Early Career Researcher Award - Dr Frederick Graham
Biography
Frederick Graham (BNurs, PhD) is a Clinical Nurse Consultant and a Senior Research Fellow with the Centre for Health Services Research at the University of Queensland. As an academic-nurse, Fred is clinical lead of a hospital-wide Dementia and Delirium Nursing Service at Princess Alexandra Hospital where he has worked as clinical expert in the care of people with dementia and delirium for more than 15 years. As a senior research fellow under the mentorship of Professor Ruth Hubbard, his research focuses on reorganising care environments and building workforce capacity to provide therapeutic care to this vulnerable cohort with a specific focus on accelerating knowledge translation in managing symptoms of agitation through innovative experiential learning, models of care, environmental design, leisure activity, and recognition of pain-related symptomology.
Fred qualified as registered nurse from The Queensland University of Technology and has worked in acute-care wards at Princess Alexandra Hospital. He has clinically led multiple quality initiatives focussed on improving acute-care for patients with cognitive impairment including education and change champion initiatives, models of specialised care, resource development to facilitate person-centred care and development of a chart for evaluating analgesic trials through monitoring pain-related behaviour. These initiatives led Fred to undertake his PhD with Professor Elizabeth Beattie at QUT, titled “Do hospital nurses recognise pain in older agitated patients with cognitive impairment. A descriptive correlational study using virtual simulation.”, which was awarded QUT Outstanding Doctoral Thesis Award 2021. He has subsequently published his PhD results in the top gerontological and nursing journals in the world. Fred currently holds a Queensland Health Early Career Nursing Fellowship under the mentorship Professor Amanda Henderson, Nursing practice Development Unit PAH. He also has three Metro South Research Support Grant schemes including the Metro South Health Future Research Leader Fellowship under the mentorship of Professor Ruth Hubbard which will investigate pain-related phenotypes through a longitudinal response to treatment study.
As an emerging research leader and early career researcher, Fred is passionate teacher and encourages nurses to consider higher degree by research pathways in the clinical careers. He is currently supervising two higher research nursing students and a mentoring nurse practitioner student at UQ.
The Paper
Frederick A Graham, Lisa Kelly, Elizabeth A Burmeister, Amanda Henderson, Annette Broome, Ruth E Hubbard, Emily H Gordon
The impact of a hospital-based special care unit on behavioural and psychological symptoms in older people living with dementia. Age and Ageing, Volume 53, Issue 4, April 2024, afae081, https://doi.org/10.1093/ageing/afae081
Abstract
Background
Hospital patients with behavioural and psychological symptoms of dementia (BPSD) are vulnerable to a range of adverse outcomes. Hospital-based Special Care Units (SCUs) are secure dementia-enabling environments providing specialised gerontological care. Due to a scarcity of research, their value remains unconfirmed.
Objective
To compare hospital based SCU management of BPSD with standard care.
Design
Single-case multiple baseline design.
Setting and participants
One-hundred admissions to an 8-bed SCU over 2 years in a large Australian public hospital.
Methods
Repeated measures of BPSD severity were undertaken prospectively by specialist dementia nurses for patients admitted to a general ward (standard care) and transferred to the SCU. Demographic and other clinical data, including diagnoses, medication use, and care-related outcomes were obtained from medical records retrospectively. Analysis used multilevel models to regress BPSD scores onto care-setting outcomes, adjusting for time and other factors.
Results
When receiving standard care, patients’ BPSD severity was 6.8 (95% CI 6.04–7.64) points higher for aggression, 15.6 (95% CI 13.90–17.42) points higher for the neuropsychiatric inventory, and 5.8 (95% CI 5.14–6.50) points higher for non-aggressive agitation compared to SCU. Patients receiving standard care also experienced increased odds for patient-to-nurse violence (OR 2.61, 95% CI 1.67–4.09), security callouts (OR 5.39 95% CI 3.40–8.52), physical restraint (OR 17.20, 95% CI 7.94–37.25) and antipsychotic administration (OR 3.41, 95% CI 1.60–7.24).
Conclusion
Clinically significant reductions in BPSD and psychotropic administration were associated with SCU care relative to standard ward care. These results suggest more robust investigation of hospital SCUs, and dementia-enabling design are warranted.