What is an identifier good for? Issues in using visual identifiers to improve care for people with dementia in hospital

Aims: To examine practical, ethical and organisational implications of use of a key technology deployed in the care of hospitalised people with dementia – visual identifiers – through a comparative analysis with parallel interventions in other spheres of healthcare and social activity. Design: Discursive paper. Methods: We contrast visual identification systems used for hospitalised patients with dementia with other, ostensibly similar, systems to understand how they differ in key characteristics: what they disclose, to whom, and with what intended consequence. Results: Certain distinctive features of the ways identifier systems are used to improve dementia care appear particularly consequential for their impact. Given how much is expected of such identifiers, they are likely to fail at least a proportion of patients. Conclusion: We argue that it is important to critically evaluate the interests served by visual identifiers, identifying the dimensions of quality they can enhance and those that may be negatively impacted. Implications for the profession and/or patient care: Visual identifiers for people with dementia can contribute to the ‘taskification’ of nursing care, implying that achieving person-centred care is a matter of following defined protocols rather than an emergent, relational, time-consuming process. Staff may end up prioritising risk avoidance and hospital routines (tasks that are measurable and auditable) rather than embracing the unpredictability of developing relationships with patients. Impact: Visual identifiers are a part of well-established strategies to improve hospital care for those with cognitive impairment. While these identifiers aim to prompt healthcare professionals to deliver individually-tailored care, research suggests that they are unable to consistently ensure the desirable quality of care. Understanding influences on how they are deployed can help reshape the expectations placed on such low-tech interventions, and inform more reflective use.