Structure of difficulties novice nurses encounter in providing care for older patients with dementia in acute care settings

Abstract

Background and objective: Hospitalized older patients with dementia frequently face unmet needs and adverse outcomes, creating major challenges for nurses. For novice nurses, dementia care has become an unavoidable responsibility, yet they remain especially vulnerable during their transition to practice. Previous studies have described individual difficulties, but little is known about how these difficulties interact. This study aimed to clarify the structure of difficulties experienced by novice nurses during their first year of dementia care in acute care settings, to inform supportive interventions.

Methods A qualitative descriptive study was conducted using semi-structured interviews and a demographic survey with 11 novice nurses from five acute care hospitals in the Kanto region of Japan. Data collected between July and August 2022 were analyzed using the KJ method (affinity diagramming) to visualize the interaction structure of the challenges.

Results Seven final labels and an affinity diagram depicting their relationships were identified. Persistent difficulties stemmed from the interplay of inexperience, the acute care environment, and dementia-related complexities. These were underpinned by ethical dilemmas and resulted in feelings of inadequacy and guilt, contributing to sustained distress throughout the year.

Conclusions This study presents the first visual model of interrelated challenges faced by novice nurses in dementia care, offering new insights into their early clinical experience. The findings underscore the need for structured, multidimensional, and transition-sensitive educational strategies, with practical implications for nursing education and policy internationally.

Keywords

Acute care / Care difficulties / Novice nurses / Older patients with dementia

AUTHORS CONTRIBUTION

Tingting Chen: Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Validation, Visualization, Writing - original draft. Toshihiro Ono: Methodology, Formal analysis, Validation, Writing - review & editing. Harue Masaki: Conceptualization, Methodology, Formal analysis, Supervision, Writing - review & editing. All authors approved the final version of the manuscript and agreed with its content. No authors contributed equally to this work.

FUNDING

This work was supported by JST SPRING [grant number JPMJSP2109]. The sponsor had no role in the study design, data collection, data analysis, interpretation of the data, writing of the manuscript, or the decision to submit the article for publication. The funding was used for English language editing and publication fees.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

INFORMED CONSENT

Obtained.

ETHICS APPROVAL

The Publication Ethics Committee of the Association for Health Sciences and Education. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

PROVENANCE AND PEER REVIEW

Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

DATA SHARING STATEMENT

No additional data are available.

ACKNOWLEDGEMENTS

The authors express their gratitude to all the participants, as well as the nursing directors and head nurses at the study locations, for their support in conducting this study. The authors also thank colleagues who provided helpful comments on the study design and manuscript.

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