Many nurses feel that they are stressed and their attitudes towards the care of older people with cognitive impairment and disturbed behavior in the acute hospital care sector has sometimes been shown to be negative.

The aim of this study was to determine the effectiveness of a person-centred approach to care for older patients with cognitive impairment and disturbed behavior in terms of decreased nursing stress, enhanced patient care practices and improved patient outcomes.

This was an exploratory before and after-intervention study, which employed mixed methods, in one Portuguese 25-bed acute aged care hospital ward over a 12-month period.

During the study there were few apparent adverse patient outcomes with significant improvements in patient analgesic administration, relatives´ satisfaction with care, nursing care practices involving the completion of a communication and care cues form and nurses´ interactions with the patients. Conversely, there was a significant increase in the nurses´ stress levels when caring delirious patients, a trend towards more emotional exhaustion, high nursing turnover and increased sick leave rates.

The quest for the study goals has shown that some progress occurred in changing the culture of care. Given the ‘chaos’ occurring in the ward and throughout the hospital during the study period, ongoing nursing support and patient care enhancement can still be achieved in some degree at such times. It is the ingrained barriers to systems change in the way nursing care is organized and practiced at a structural level, which presents the main impediments to practice improvement.