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Liu M, Wang Y, Zeng Q, Li J, Yang L, Zeng Y. Prevalence of involuntary treatment among community-living older persons with dementia: A systematic review. Arch Gerontol Geriatr 2024; 127:105574. [PMID: 39059035 DOI: 10.1016/j.archger.2024.105574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/25/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to ascertain the prevalence of involuntary treatment among community-living older persons with dementia and explore associated factors. METHODS We comprehensively searched seven electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, and Scopus) from their inception to October 17, 2023, with an update conducted on April 1, 2024. Meta-analysis synthesized prevalence estimates of involuntary treatment and its three subcategories, with 95% confidence intervals. RESULTS This study included 11 research papers involving 12,136 community-dwelling individuals with cognitive impairment and dementia from 19 countries. The pooled prevalence of involuntary treatment among community-dwelling older persons with dementia was 45.2% (95% CI: 33.7-60.5%). Subcategories included physical restraints (9.8%, 95% CI: 5.1-18.8%), psychotropic medication (19.1%, 95% CI: 13.6-26.9%), and non-consensual care (34.3%, 27.6-42.7%). Factors influencing involuntary treatment were categorized as caregiver-related and care recipient-related. CONCLUSION This study underscores the prevalent use of involuntary treatment among community-dwelling older persons with dementia, emphasizing its association with specific caregiver and care recipient factors. Addressing these findings underscores the importance of proactive measures and targeted interventions to improve the quality of care for this vulnerable population.
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Affiliation(s)
- Minyan Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuqiang Wang
- Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Qinglin Zeng
- Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Jia Li
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Liping Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yanli Zeng
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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Zhang S, Tao XJ, Ding S, Feng XW, Wu FQ, Wu Y. Associations between postoperative cognitive dysfunction, serum interleukin-6 and postoperative delirium among patients after coronary artery bypass grafting: A mediation analysis. Nurs Crit Care 2024. [PMID: 38700037 DOI: 10.1111/nicc.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND POCD is a common complication among patients who underwent coronary artery bypass graft (CABG), it is linked to loss of independence and reduced quality of life. AIMS AND OBJECTIVES To examine the association between postoperative cognitive dysfunction (POCD), postoperative delirium (POD) and interleukin-6 (IL-6). DESIGN A prospective cohort study. METHODS Patients who underwent elective isolated CABG were enrolled. POCD was assessed by a set of cognitive function tools. Delirium was assessed using the CAM-ICU. The logistic regression analyses were used to identify the predictive value of POD or IL-6 on POCD. The path analysis was used to analyse the relationship among POD, IL-6 and POCD. RESULTS A total of 212 patients were enrolled, with 25.0% of patients developing POD and 32.5% developing POCD. The multiple logistic regression analysis revealed that patients with POD had a four-fold increased hazard of POCD (OR = 3.655), and patients with IL-6 ≥ 830.50 pg/mL at the 6th hours after surgery had a 5-fold increased risk of experiencing POCD (OR = 5.042). However, the mediation effect of POD between IL-6 and POCD was not statistically significant (β = 0.059, p = .392). CONCLUSIONS POD and IL-6 at the 6th hour after surgery (≥830.50 pg/mL) are two potent predictors for POCD, while POD did not play a mediation effect between IL-6 and POCD. RELEVANCE TO CLINICAL PRACTICE Early identification of risk factors (e.g., delirium assessment and testing for serum IL-6 levels) by clinical nurses for POCD may contribute to the clinical practice for the targeted prevention nursing strategies.
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Affiliation(s)
- Shan Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiang-Jun Tao
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shu Ding
- School of Nursing, Capital Medical University, Beijing, China
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin-Wei Feng
- School of Nursing, Capital Medical University, Beijing, China
| | - Fang-Qin Wu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Ma D, Wang H, Zhao Y, Li Y, Zhang X, Nu E, Sun J. Physical restraints applied to people diagnosed with dementia in home care from the perceptions of family caregivers: A qualitative study in China. J Psychiatr Ment Health Nurs 2023; 30:1082-1093. [PMID: 37208843 DOI: 10.1111/jpm.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Physical restraint is widely used in the elderly at home, and cognitive impairment is an important risk factor. Family caregivers of people with dementia are the main decision makers and implementers of physical restraint at home. Most people with dementia in China receive home care, and family caregivers face enormous care and moral pressures influenced by Confucian culture. Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. There is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Many family caregivers face approach - avoidance conflict and moral dilemmas when making decisions to restrain, and they make difficult choices in these dilemmas. In China, family caregivers are influenced by many unique factors, including traditional Confucian culture, family affection, and rural home environment. Inadequate laws and policies provide the ground for abuse of physical restraints, and family caregivers rarely consider legal and policy restrictions when using physical restraints. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: With limited medical resources, nurse-led dementia management is the hope to reduce physical restraints in home. Mental health nurses need to assess for the appropriateness of physical restraints associated with psychiatric symptoms in people with dementia. At both organizational and community levels, improving effective communication and relationships between professionals and family caregivers are important to address. Improvements in this context require education and time for staff to develop skills and experience which is necessary to provide family caregivers with ongoing information and psychological support within their communities. Considering Confucian culture will be of value for mental health nurses working in other countries where there are Chinese communities to better understand perceptions of family caregivers. ABSTRACT INTRODUCTION: The use of physical restraints is a common practice in home care. Family caregivers face care-related and moral pressures due to the influence of Confucian culture in China. The use of physical restraints in the Chinese cultural environment may differ from the use of such restraints in other cultures. SCIENTIFIC RATIONALE Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. However, there is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. AIM To explore the perceptions of family caregivers on physical restraints in people diagnosed with dementia receiving home care. METHOD A descriptive, qualitative study of Chinese family caregivers of people diagnosed with dementia in home care. Framework method analysis was adopted using the multilevel socio-ecological model. RESULTS Beliefs about benefit lead to a dilemma for family caregivers. Cherishing family's affection encourages caregivers to reduce physical restraints, but lack of help from family members, professionals and the community forces them to restrain their loved ones. DISCUSSION Future research should explore the complex issue of culturally specific physical restraints decisions. IMPLICATIONS FOR PRACTICE Mental health nurses must receive education regarding the negative outcomes of the use of physical restraints for family members of people diagnosed with dementia. A more liberal approach to mental health and relevant legislation, which is an emerging global phenomenon that is currently in an early phase of development in China, grants human rights to people diagnosed with dementia. Effective communication and relationships between professionals and family caregivers can contribute to the establishment of a dementia-friendly community in China.
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Affiliation(s)
- Dongfei Ma
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, Jilin, China
| | - Hong Wang
- Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Yingnan Zhao
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yijing Li
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xu Zhang
- Nursing Department, Peking Union Medical College Hospital, Beijing, Dongcheng, China
| | - Eradili Nu
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, Jilin, China
| | - Jiao Sun
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, Jilin, China
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Gjellestad Å, Oksholm T, Alvsvåg H, Bruvik F. Trust-building interventions to home-dwelling persons with dementia who resist care. Nurs Ethics 2023; 30:975-989. [PMID: 35189756 PMCID: PMC10710005 DOI: 10.1177/09697330211041745] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Providing care for a home-dwelling person with dementia who resists care is an ethical and practical complex and challenging task. Faced with a growing number of persons with dementia, the healthcare professional's understanding of how to best care for and prevent unnecessary use of coercion with persons with dementia is of key importance. RESEARCH AIM The aim of this study was to explore the use of trust-building interventions in home-dwelling persons with dementia resisting care, as described by health professionals in documents of decisions of forced treatment and care. RESEARCH DESIGN A qualitative thematic document analysis inspired by critical realism was conducted. PARTICIPANTS AND RESEARCH CONTEXT Descriptions of trust-building interventions were extracted from 88 documents of forced treatment and care for home-dwelling persons with dementia, receiving home healthcare, in 2015 and 2016. ETHICAL CONSIDERATIONS Approved by the Regional Committee for Medical and Health Research Ethics, reference number 2017/788, and controlled by the Norwegian Centre for Research Data, reference number 54897. The study adhered to the guidelines of the Declaration of Helsinki. FINDINGS We found that "balancing safe care with the person's integrity" was an overarching theme that permeated the descriptions of trust-building interventions in the study. Three main themes were identified when the data were analyzed: safeguarding care, protecting integrity, and optimizing the environment. DISCUSSION AND CONCLUSION Health professionals balanced on a thin line between care and integrity when met with resistance from person with dementia. However, the trust-building interventions used in the most challenging situations did not differ from the interventions used in general in dementia care. Two knowledge gaps were identified: how to perform appropriate assessments of situations of home-dwelling persons with dementia when met with resistance to care, and whether environmental initiatives may also benefit home-dwelling persons with dementia who are not easily cared for.
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Affiliation(s)
- Åshild Gjellestad
- Åshild Gjellestad, Faculty of Health Studies, VID Specialized University, Ulriksdal 10, 5009 Bergen, Norway.
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Atee M, Burley CV, Ojo VA, Adigun AJ, Lee H, Hoyle DJ, Elugbadebo O, Leon T. Physical restraint in older people: a statement from the Early Career Network of the International Psychogeriatric Association. Int Psychogeriatr 2023:1-12. [PMID: 37782041 DOI: 10.1017/s1041610223000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The International Psychogeriatric Association (IPA) has expressed significant concerns over the use of physical restraints in older people across diverse aged care settings. Following an extensive analysis of the available literature, the IPA's Early Career Network (ECN) has formulated a collection of evidence-based recommendations aimed at guiding the use of physical restraints within various care contexts and demographic groups. Physical restraints not only infringe upon human rights but also raise significant safety concerns that adversely impact the physical, psychological, social, and functional well-being of older adults. Furthermore, their effectiveness in geriatric settings remains inadequate. Given these considerations, the IPA and its ECN firmly assert that the use of physical restraints should only be considered as a final recourse in the care of older people.
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Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Osborne Park, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Claire V Burley
- UNSW Medicine and Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - Victor Adekola Ojo
- Royal Perth and Bentley Group, Bentley, WA, Australia
- Nissi Healthcare Telehealth, Clyde, VIC, Australia
- Vita Healthcare, Mount Eliza, VIC, Australia
| | | | - Hayoung Lee
- Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Daniel Jake Hoyle
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Olufisayo Elugbadebo
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tomas Leon
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Global Brain Health Institute, Trinity College, Dublin, Ireland
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Willems J, Passos VL, Hamers JPH, Bleijlevens MHC. Professional caregivers' perceived barriers hindering the prevention and reduction of involuntary treatment among older persons receiving long-term care: A mixed methods study. J Clin Nurs 2023; 32:7175-7192. [PMID: 37458214 DOI: 10.1111/jocn.16796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 07/27/2023]
Abstract
AIMS To gain insights into the barriers towards the prevention and/or reduction of involuntary treatment in long-term geriatric care. DESIGN Mixed methods. BACKGROUND Measures to which a person resists and/or does not provide consent for are defined as involuntary treatment. The use of involuntary treatment violates the autonomy of (older) persons and causes more harm than benefit. Moreover, it contradicts the values of person-centred care. Nevertheless, its use among people living with dementia (PLWD) is still common practice. METHODS We conducted a cross-sectional, mixed methods study, including an online survey for professional caregivers and a semistructured focus group interview with professional caregivers. RESULTS A total of 218 participants completed the questionnaire. The percentage of participants who perceived barriers in one of the 22 survey items ranged from 15% to 42%. Lack of time, the experienced need to use involuntary treatment, uncertainty about responsibilities of stakeholders and a lack of knowledge on methods to prevent and/or reduce the use of involuntary treatment were most seen as barriers. Nursing staff perceived a lack of time hindering them in the prevention or reduction of involuntary treatment more often than other professional caregivers. Working in home care and having no former experience with involuntary treatment usage increased perceived barriers. Participants of the focus group interview confirmed these findings and added that professional caregivers in general lack awareness on the concept of involuntary treatment. CONCLUSIONS One out of four professional caregivers experiences barriers hindering prevention and/or reduction of involuntary treatment. More research is needed to gain a better understanding of how professional caregivers can be supported to remove barriers and, consequently, prevent and/or reduce the use of involuntary treatment. RELEVANCE TO CLINICAL PRACTICE Professional caregivers experience many barriers towards the prevention and reduction of involuntary treatment. Future initiatives should aim to remove the perceived barriers.
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Affiliation(s)
- Jules Willems
- Faculty of Health, Medicine and Lifesciences, CAPHRI Care and Public Health Research Institute, Living Lab in Ageing and Long-term Care, Maastricht University, Maastricht, The Netherlands
| | - Valéria Lima Passos
- Faculty of Health, Medicine and Lifesciences, Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Jan P H Hamers
- Faculty of Health, Medicine and Lifesciences, CAPHRI Care and Public Health Research Institute, Living Lab in Ageing and Long-term Care, Maastricht University, Maastricht, The Netherlands
| | - Michel H C Bleijlevens
- Faculty of Health, Medicine and Lifesciences, CAPHRI Care and Public Health Research Institute, Living Lab in Ageing and Long-term Care, Maastricht University, Maastricht, The Netherlands
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7
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Östlund L, Ernsth Bravell M, Johansson L. Working in a gray area—Healthcare staff experiences of receiving consent when caring for persons with dementia. DEMENTIA 2022; 22:144-160. [DOI: 10.1177/14713012221137472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Every person has the right to autonomy, and to be involved in decisions about their care. When persons with dementia have difficulties in expressing what they want, their autonomy is challenged. Staff should strive to involve the person in care decisions, to obtain consent and to avoid the use of coercion and restraints. However, care without consent exists and coercion and restraints are being used. In order to improve care, further knowledge is warranted. Aims The purpose of this study was to explore staff’s experiences of obtaining consent when caring for persons with dementia. Methods In total 14 focus group interviews were conducted with staff with experience of dementia care who work in either home care or residential care in Sweden. An inductive qualitative content analysis was used to analyze the collected data. Results Three categories were generated describing staff experiences of consent in dementia care: the person as the decision-maker, the staff as the decision-makers, and the viability of the consent. Overall, staff found it difficult to know if they really had consent from the individual. Even if the person verbally gave consent, it was challenging to know if the person really understood what they had consented to. Common to all three categories was the significance of the relationship between the person with dementia and staff: getting to know the person, recognizing the person’s response in terms of their facial expressions and body language as well as being able to explain and justify specific actions to the person. Conclusion Staff need better conditions in dementia care, including training and time to reflect on how to obtain consent. A person-centered approach can be one way to develop care and ensure that persons with dementia are allowed autonomy and to share in making decisions.
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Affiliation(s)
- Lena Östlund
- School of Health and Welfare, Ageing Research Network, Institute of Gerontology, Jönköping University,Jönköping,Sweden
| | - Marie Ernsth Bravell
- School of Health and Welfare, Ageing Research Network, Institute of Gerontology, Jönköping University,Jönköping,Sweden
| | - Linda Johansson
- School of Health and Welfare, Ageing Research Network, Institute of Gerontology, Jönköping University,Jönköping,Sweden
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Backhouse T, Ruston A, Killett A, Ward R, Rose-Hunt J, Mioshi E. Risks and risk mitigation in homecare for people with dementia-A two-sided matter: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2037-2056. [PMID: 35703588 DOI: 10.1111/hsc.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first-order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second-order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person-centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Annmarie Ruston
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Renée Ward
- Older Persons' Services, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Julia Rose-Hunt
- Dementia Intensive Support Team East, Norfolk and Suffolk Foundation Trust, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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Mengelers AMHJ, Bleijlevens MHC, Verbeek H, Capezuti E, Hamers JPH. A Quasi-experimental study on prevention and reduction of involuntary treatment at home (PRITAH) in people with dementia. J Clin Nurs 2022; 31:3250-3262. [PMID: 34878198 PMCID: PMC9788076 DOI: 10.1111/jocn.16163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/08/2021] [Accepted: 11/10/2021] [Indexed: 12/30/2022]
Abstract
AIM AND OBJECTIVES To examine the implementation (reach, dose, fidelity, adaptations, satisfaction), mechanisms of impact (attitude, subjective norm, perceived behavioural control and intention) and context of the PRITAH intervention. BACKGROUND Involuntary treatment, defined as care provided against one's will, is highly prevalent in home care. The PRITAH intervention comprises policy, workshops, coaching and alternative measures for professional caregivers to prevent and reduce involuntary treatment in home care. DESIGN Quasi-experimental study. METHODS Eight home care teams from two care organisations participated in this study. Guided by the Theory of Planned Behavior, the mechanisms of impact were evaluated with questionnaires. Implementation and context were assessed using attendance lists, evaluation questionnaires, focus groups and logbooks. The study adhered to the TREND checklist. RESULTS 124 of 133 eligible professional caregivers participated (93%). All four components were delivered with minor deviations from protocol. Participants' subjective norms and perceived behavioural control changed over time in favour of the intervention group. No effects were seen for attitude and intention. Barriers included an unclear policy and lack of communication between stakeholders. The multidisciplinary approach and possibility to discuss involuntary treatment with the specialised nurse were described as facilitators. CONCLUSIONS Prevention and reduction of involuntary treatment at home is feasible in home care practice and contributes to changing professional caregivers' subjective norms and perceived behavioural control, prerequisites for behavioural change in order to prevent and reduce involuntary treatment. A follow-up study on the effectiveness of PRITAH on actual use, prevention and reduction of involuntary treatment in home care is needed. Future studies should emphasise the role of family caregivers and GPs and actively involve them in the prevention and reduction of involuntary treatment. RELEVANCE TO CLINICAL PRACTICE Involuntary treatment is commonly used in dementia home care and professional and family caregivers need to be supported in prevention and reduction of involuntary treatment in people with dementia.
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Affiliation(s)
- Angela M. H. J. Mengelers
- Department of Health Services ResearchFaculty of Health, Medicine and Life SciencesCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands,Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
| | - Michel H. C. Bleijlevens
- Department of Health Services ResearchFaculty of Health, Medicine and Life SciencesCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands,Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
| | - Hilde Verbeek
- Department of Health Services ResearchFaculty of Health, Medicine and Life SciencesCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands,Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
| | - Elizabeth Capezuti
- Hunter College and the Graduate Center of City University of New YorkNew YorkNew YorkUSA
| | - Jan P. H. Hamers
- Department of Health Services ResearchFaculty of Health, Medicine and Life SciencesCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands,Living Lab in Ageing and Long‐Term CareMaastrichtThe Netherlands
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10
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Moermans VRA, Bleijlevens MHC, Verbeek H, Passos VL, Milisen K, Hamers JPH. District nurses' attitudes towards involuntary treatment in dementia care at home: A cross-sectional study. Geriatr Nurs 2022; 47:107-115. [PMID: 35905633 DOI: 10.1016/j.gerinurse.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
One in two persons living with dementia (PLWD) at home receive care which they resist to and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in the use of involuntary treatment. However, little is known how their attitudes and opinions influence the use of involuntary treatment. This cross-sectional study aims to investigate the attitudes of district nurses towards the use of involuntary treatment in dementia care at home, determinants and their opinion about its restrictiveness and discomfort. Results show that district nurses perceive involuntary treatment as regular part of nursing care, having neither positive nor negative attitude towards its appropriateness. They consider involuntary treatment usage as moderately restrictive to PLWD and feel moderately uncomfortable when using it. These findings underscore the need to increase the awareness of district nurses regarding the negative consequences of involuntary treatment use to PLWD at home.
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Affiliation(s)
- Vincent R A Moermans
- PhD - Student, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht 6229 GT, The Netherlands; Regional Manager and Nurse Specialist, Department of Nursing, White and Yellow Cross Limburg, Genk, Belgium; Voluntary Scientific Assistant, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
| | - Michel H C Bleijlevens
- Assistant Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Hilde Verbeek
- Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Valéria Lima Passos
- Associate Professor, Department Methodology and Statistics, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Koen Milisen
- Professor, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Jan P H Hamers
- Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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11
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Autonomy conquers all: a thematic analysis of nurses’ professional judgement encountering resistance to care from home-dwelling persons with dementia. BMC Health Serv Res 2022; 22:749. [PMID: 35659660 PMCID: PMC9167050 DOI: 10.1186/s12913-022-08123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adequate care support from home health care nurses is needed to meet the needs of an increasing number of home-dwelling persons with dementia and those who resist care. The decisions nurses make in home health care when encountering resistance from persons with dementia have an extensive impact on the quality of care and access to care. There is little research on what influences nurse’s encounters with resistance to care from home-dwelling persons with dementia. Research aim To get insight into how nurses experience resistance to care from home-dwelling persons with dementia. Methods A qualitative research design using a thematic analysis was conducted following the six steps by Braun and Clarke. Data was gathered from three focus group and three individual interviews, and a total of 18 nurses from home health care participated. The interviews took place over a period of 5 months, from December 2020 to April 2021. Ethical considerations Approved by the Norwegian Centre for Research, reference number 515138 and by the research advisers and home care managers in each section of the municipality. Results Two main themes were identified: 1) Challenged by complex and inadequate care structures and 2) Adapting care according to circumstances. There were three subthemes within the first main theme: lack of systematic collaboration and understanding, insufficient flexibility to care, and the challenge of privacy. In the second main theme, there were three subthemes: avoid forced treatment and care to protect autonomy, gray-areas of coercive care and reduced care. The two main themes seemed to be interdependent, as challenges and changes in organizational structures influenced how nurses could conduct their care practices. Conclusion Our findings indicate that nurses’ responsibility to decide how to conduct care is downplayed when facing resistance. Further, their professional judgement is influenced by contextual factors and characterized by a strong commitment to avoid forced treatment and care. A continuous challenge is to safeguard shared decision-making at the same time as it is balanced against risks of severe health damage in home-dwelling persons with dementia. A fundamental question to ask is whether autonomy does conquer all, even when severe health damage is at stake.
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Ma D, Zhu X, Dong Y, He M, Meng X, Zhao Y, Ye Y, Sun J. ‘It is my turn to raise her’ - decision-making regarding physical restraint in home care in China: A descriptive qualitative study. Int J Nurs Stud 2022; 134:104315. [DOI: 10.1016/j.ijnurstu.2022.104315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
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Moermans VR, Mengelers AM, Bleijlevens MH, Verbeek H, de Casterle BD, Milisen K, Capezuti E, Hamers JP. Caregiver decision-making concerning involuntary treatment in dementia care at home. Nurs Ethics 2021; 29:330-343. [PMID: 34872409 PMCID: PMC8958636 DOI: 10.1177/09697330211041742] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. OBJECTIVE To identify and describe family caregivers' experiences regarding care decisions for situations that can lead to involuntary treatment use in persons living with dementia at home. RESEARCH DESIGN A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. PARTICIPANTS AND RESEARCH CONTEXT A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. ETHICAL CONSIDERATION The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. FINDINGS Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences. DISCUSSION AND CONCLUSION To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations.
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Affiliation(s)
- Vincent Ra Moermans
- Maastricht University, The Netherlands; White Yellow Cross Limburg, Belgium; Living Lab in Ageing and Long-Term Care, the Netherlands
| | | | | | - Hilde Verbeek
- Maastricht University, The Netherlands; Living Lab in Ageing and Long-Term Care, The Netherlands
| | | | - Koen Milisen
- KU Leuven, Belgium; University Hospitals Leuven, Belgium
| | | | - Jan Ph Hamers
- Maastricht University, The Netherlands; Living Lab in Ageing and Long-Term Care, The Netherlands
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Vaismoradi M, Fredriksen Moe C, Vizcaya-Moreno F, Paal P. Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective. PHARMACY 2021; 9:174. [PMID: 34707079 PMCID: PMC8552074 DOI: 10.3390/pharmacy9040174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Prescription and administration of pro re nata (PRN) medications has remained a poorly discussed area of the international literature regarding ethical tenets influencing this type of medication practice. In this commentary, ethical tenets of PRN medicines management from the clinical perspective based on available international literature and published research have been discussed. Three categories were developed by the authors for summarising review findings as follows: 'benefiting the patient', 'making well-informed decision', and 'follow up assessment' as pre-intervention, through-intervention, and post-intervention aspects, respectively. PRN medicines management is mainly intertwined with the ethical tenets of beneficence, nonmaleficence, dignity, autonomy, justice, informed consent, and error disclosure. It is a dynamic process and needs close collaboration between healthcare professionals especially nurses and patients to prevent unethical practice.
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Affiliation(s)
- Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway;
| | | | - Flores Vizcaya-Moreno
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03080 Alicante, Spain;
| | - Piret Paal
- WHO Collaborating Centre, Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria;
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Feasibility and Effectiveness of a Biography-Based Physical Activity Intervention in Institutionalized People With Dementia: Quantitative and Qualitative Results From a Randomized Controlled Trial. J Aging Phys Act 2021; 30:237-251. [PMID: 34426552 DOI: 10.1123/japa.2020-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/19/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
The objective of this multicenter randomized controlled trial was to evaluate the feasibility and effectiveness of a physical activity intervention for institutionalized people with dementia, individualized by capacity and biography. The intervention group (n = 34; age: mean = 86.09 years; 79.40% female; mean Mini-Mental State Examination value = 18.59) participated in a multicomponent training program, which included daily activities, dancing, gardening, and sports/games, twice weekly for 3 months. The control group (n = 29; age: mean = 86.34 years; 75.90% female; mean Mini-Mental State Examination value = 19.90) received standard care. Feasibility was evaluated by means of focus groups and feedback questionnaires. Functional performance (Short Physical Performance Battery and Timed Up and Go Test), activities of daily living, and gait were outcomes for effectiveness. A high adherence rate (80.46%) and uniformly positive feedback indicate that the piloted training program is feasible. The results show preliminary effectiveness on functional performance (Short Physical Performance Battery mean t0 = 3.15; mean t1 = 4.50; p = .006) and gait (e.g., velocity mean t0 = 46.97; mean t1 = 58.04; p = .007).
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Gjellestad Å, Oksholm T, Bruvik F. Forced treatment and care in home-dwelling persons with dementia. Nurs Ethics 2020; 28:372-386. [PMID: 33054528 DOI: 10.1177/0969733020948107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of forced treatment and care of home-dwelling persons with dementia is a universally important topic. These patients are completely dependent on care from others to continue living at home. AIM This study aimed to gain insights into formal decisions related to the forced treatment and care of home-dwelling persons with dementia. DESIGN AND SAMPLE This is a cross-sectional study, based on formal decisions of forced treatment and care of home-dwelling persons with dementia in Norway between 1 January 2015 and 31 December 2016. METHODS Descriptive statistical analysis. Statistically significant associations suitable for binary logistic regression were presented as odds ratios with 95% confidence intervals. ETHICAL CONSIDERATIONS Approved by The Regional Committee for Medical and Health Research Ethics, and by the Norwegian Center for Research. RESULTS We found 108 formal decisions of forced treatment and care of persons with dementia. Decisions of admission represented 57% of the data, other medical and safety decisions 27%, and assistance with activities of daily living 16%. In most cases, physicians were responsible for the decisions (77%), but nurses and family members were often involved. DISCUSSION AND CONCLUSION This study demonstrated a prevalence rate of formally documented decisions of forced treatment and care much lower than findings in previous studies. Poor documentation may constitute a risk for the safety and wellbeing of persons with dementia. Although physicians were usually responsible for the decisions, nurses and family members were often involved in the process. Family participation in forced treatment and care raises ethical dilemmas. More research on the experiences of nurses, persons with dementia and family members with forced treatment and care is needed to aid ethical, legal, and clinically challenging decision-making processes.
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Mengelers AMHJ, Moermans VRA, Bleijlevens MHC, Verbeek H, Capezuti E, Tan F, Milisen K, Hamers JPH. Involuntary treatment in dementia care at home: Results from the Netherlands and Belgium. J Clin Nurs 2020; 31:1998-2007. [PMID: 32918342 PMCID: PMC9292312 DOI: 10.1111/jocn.15457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/01/2023]
Abstract
Aims and objectives To gain insight into the request, use and associated factors of involuntary treatment in people with dementia (PwD) receiving professional home care in the Netherlands and Belgium. Background Most of the PwD remain living at home as long as possible. Due to complex care needs, this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment. Design Secondary data analyses of two cross‐sectional surveys. Methods Dementia case managers and district nurses filled in a questionnaire for each PwD in their caseload. This study included data of 627 PwD receiving professional home care in the Netherlands and 217 in Belgium. The same methodology (questionnaire and variables) was used in both samples. Descriptive statistics and multi‐level logistic regression analyses were used to analyse the data. The study adhered to the STROBE checklist. Results More than half of the PwD (50.7%) living at home received involuntary treatment (Belgium 68.2% and the Netherlands 44.7%). Nonconsensual care (82.7%) was the most common, followed by psychotropic medication (40.7%) and physical restraints (18.5%). Involuntary treatment use was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. Involuntary treatment was most often requested by family caregivers. Conclusions Involuntary treatment is often used in PwD, which is in line with previous findings indicating dementia as a risk factor for involuntary treatment use. More research is needed to gain insight into variations in prevalence across other countries, which factors influence these differences and what countries can learn from each other regarding prevention of involuntary treatment. Relevance to clinical practice To provide person‐centred care, it is important to study ways to prevent involuntary treatment in PwD and to stimulate dialogue between professional and family caregivers for alternative interventions.
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Affiliation(s)
- Angela M. H. J. Mengelers
- Faculty of Health, Medicine and Lifesciences CAPHRI Care and Public Health Research Institute Maastricht University Maastricht The Netherlands
| | - Vincent R. A. Moermans
- Faculty of Health, Medicine and Lifesciences CAPHRI Care and Public Health Research Institute Maastricht University Maastricht The Netherlands
- Department of Nursing White Yellow Cross Limburg Genk Belgium
| | - Michel H. C. Bleijlevens
- Faculty of Health, Medicine and Lifesciences CAPHRI Care and Public Health Research Institute Maastricht University Maastricht The Netherlands
| | - Hilde Verbeek
- Faculty of Health, Medicine and Lifesciences CAPHRI Care and Public Health Research Institute Maastricht University Maastricht The Netherlands
| | - Elizabeth Capezuti
- Hunter College The Graduate Center of City University of New York New York NY USA
| | - Frans Tan
- Faculty of Health, Medicine and Lifesciences CAPHRI Care and Public Health Research Institute Maastricht University Maastricht The Netherlands
| | - Koen Milisen
- Department of Public Health & primary Care Academic Centre for Nursing and Midwifery KU Leuven Leuven Belgium
- Division of Geriatric Medicine University Hospitals Leuven Leuven Belgium
| | - Jan P. H. Hamers
- Faculty of Health, Medicine and Lifesciences CAPHRI Care and Public Health Research Institute Maastricht University Maastricht The Netherlands
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Scheepmans K, Dierckx de Casterlé B, Paquay L, Van Gansbeke H, Milisen K. Reducing physical restraints by older adults in home care: development of an evidence-based guideline. BMC Geriatr 2020; 20:169. [PMID: 32380959 PMCID: PMC7204038 DOI: 10.1186/s12877-020-1499-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background Restraint use is a complex and challenging issue in home care. Due to socio-demographic trends, worldwide home healthcare providers are faced with an increasing demand for restraint use from informal caregivers, patients and healthcare providers, resulting in the use of various types of restraints in home care. Awareness and knowledge of restraint use in home care, its implications and the ethical challenges surrounding it are of crucial importance to its reduction. This research aimed to describe the development process of an evidence-based practice guideline to support caregivers to optimize home care. Method The practice guideline was developed according to the framework of the Belgian Centre for Evidence-Based Medicine and AGREE II. The guideline was developed over several stages: (1) determination of the target population and scope, (2) literature search, (3) drafting and (4) validation. A multidisciplinary working group determined the proposed purpose, target group, and six clinical questions for the guideline. A consensus procedure and consultation by experts were used to develop the guideline. Results The guideline provides an answer to six clinical questions and contains ten key recommendations based on the classification of GRADE, with the objective of increasing healthcare providers’ awareness, knowledge and competence to adequately deal with situations or questions related to restraint use. The guideline also includes a flowchart for dealing with complex situations where the use of restraints is requested, already present or considered. Conclusions The guideline was validated by the Belgian Centre for Evidence-Based Medicine. Increasing competence, awareness and knowledge related to restraint use are key objectives of the guideline for reducing restraint use in home care. A multicomponent intervention to support healthcare workers in implementing the guideline in clinical practice needs to be developed.
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Affiliation(s)
- Kristien Scheepmans
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium
| | - Louis Paquay
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium
| | - Hendrik Van Gansbeke
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium. .,Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Herestraat 49, 3000, Leuven, Belgium.
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Affiliation(s)
- Roberta Heale
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
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Mengelers AMHJ, Bleijlevens MHC, Verbeek H, Moermans VRA, Capezuti E, Hamers JPH. Prevention and reduction of involuntary treatment at home: A feasibility study of the PRITAH intervention. Geriatr Nurs 2020; 41:536-543. [PMID: 32139030 DOI: 10.1016/j.gerinurse.2020.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
Sometimes care is provided to a cognitively impaired person against the person's will, referred to as involuntary treatment. We developed the PRITAH intervention, aimed at prevention and reduction of involuntary treatment at home. PRITAH consists of a policy discouraging involuntary treatment, workshops, coaching by a specialized nurse and alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy.
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Affiliation(s)
- Angela M H J Mengelers
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Michel H C Bleijlevens
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Vincent R A Moermans
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Department of Nursing, White Yellow Cross Limburg, Genk, Belgium.
| | - Elizabeth Capezuti
- Hunter College and the Graduate Center of City University of New York, New York, United States.
| | - Jan P H Hamers
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
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Vaismoradi M, Vizcaya Moreno F, Sletvold H, Jordan S. PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review. PHARMACY 2019; 7:pharmacy7040157. [PMID: 31775262 PMCID: PMC6958522 DOI: 10.3390/pharmacy7040157] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 01/03/2023] Open
Abstract
Many medications are prescribed and administered PRN (pro re nata, as needed). However, there are few integrative reviews to inform PRN psychotropic medication use in long-term care facilities and nursing or care homes. Accordingly, this integrative systematic review aimed to improve our understanding of PRN medicines management with a focus on psychotropic medications (antipsychotics, sedatives, anxiolytics, and hypnotics) in long-term care settings. Keywords relating to PRN in English, Norwegian, and Spanish were used, and articles published between 2009 and 2019 were retrieved. Based on the inclusion criteria, eight articles were used for data analysis and synthesis. This review offers a description of PRN prescription and administration of psychotropic medications in long-term care. Variations were observed in the management of PRN psychotropic medications based on residents’ underlying health conditions and needs, duration of use, and changes between medications and doses. Neither the reasons for PRN prescription and administration nor the steps taken to identify and manage any associated adverse reactions or adverse drug events were reported. Further initiatives are needed to improve PRN medicines management to explore factors that affect PRN prescription and administration and to develop appropriate PRN guidelines to prevent harm and improve the safety of people living in long-term care facilities.
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Affiliation(s)
- Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway;
- Correspondence: ; Tel.: +47-75517813
| | | | - Hege Sletvold
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway;
| | - Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK;
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Heale R. Better support and education is imperative to bolster informal at-home carers of people with cognitive impairment and reduce incidences of involuntary treatment of older adults in their homes. Evid Based Nurs 2019; 22:51. [PMID: 30609990 DOI: 10.1136/ebnurs-2018-103028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Roberta Heale
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
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