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Kim D, Hong Y, Chang SO. Ways of interdisciplinary approaches to advocating for nursing home residents with dementia. J Adv Nurs 2024. [PMID: 38771071 DOI: 10.1111/jan.16251] [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: 01/04/2024] [Revised: 04/04/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
AIM To explore how nursing home staff advocate for residents with dementia. DESIGN Phenomenographic qualitative research. METHODS Twenty nursing home staff from four disciplines (six nurses, four physical therapists, five social workers and five care workers) were purposively recruited from three different nursing homes. Data were collected through semi-structured interviews conducted from February 2023 to March 2023, and the analysis followed the sequential steps of phenomenographic analysis. RESULTS The analysis identified five categories of description: focusing on what happened, finding the gaps in perspectives, how to bridge for finding a common perspective, how to tailor care such that each resident receives equitable care and how to establish interdisciplinary sharing for a consistent advocative pattern. Their structural relationship was also identified as an outcome space. CONCLUSION The cyclical advocacy structure illustrated that nursing home staff engage in an ongoing process of advocacy during conflict situations as part of interdisciplinary care, emphasizing continuity of care rather than separate occurrences of care. IMPLICATIONS FOR THE PROFESSION This study revealed that, in advocating for residents with dementia, nursing home staff adopted an approach that fosters consistent care and proactive prevention, achieved through the formation of shared knowledge applicable uniformly across similar situations. IMPACT This study contributes significantly to the continuing education or training of interdisciplinary staff in nursing homes. The revelations of the study hold significance not only for the practical application but also for the theoretical advancement of concepts related to safeguarding the dignity, human rights and personhood of residents with dementia, with the ultimate goal of enhancing their quality of life within nursing homes. REPORTING METHOD Reporting complied with the COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTION Nursing home directors have contributed to the validation of data analysis and interpretation.
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Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Youjung Hong
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
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Hoe J, Profyri E, Kemp C, Manela M, Webster L, Anthony J, Costafreda S, Arrojo F, Souris H, Livingston G. Risk assessment for people living with dementia: a systematic review. Int Psychogeriatr 2024; 36:263-288. [PMID: 38053362 DOI: 10.1017/s1041610223004398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This systematic review identified key components of risk assessment for people with dementia, examined attitudes toward risk identification and risk assessment, and appraised existing risk assessment tools. METHODS Systematic searches of five databases on two platforms (EBSCO, OVID) and gray literature databases (Open Grey, Base) were conducted. Studies were screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. RESULTS Our review found people with dementia, their family carers, and healthcare professionals differed in how risk is conceptualized, with views being shaped by media perceptions, personal experiences, socio-cultural influences, dementia knowledge, and dementia severity. We found that mobilization (causing falls inside and getting lost outside) is the most frequently identified risk factor. Our findings show people with dementia are generally risk-tolerant, while healthcare professionals may adopt risk-averse approaches because of organizational requirements. We found factors that disrupt daily routines, living and caring arrangements, medication management, and unclear care pathways contribute toward adverse risk events. We discovered that most studies about risk and risk assessment scales did not consider insight of the person with dementia into risks although this is important for the impact of a risk. No risk instrument identified had sufficient evidence that it was useful. CONCLUSION Accurate risk assessment and effective communication strategies that include the perspectives of people with dementia are needed to enable risk-tolerant practice. No risk instrument to date was shown to be widely acceptable and useful in practice.
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Affiliation(s)
- Juanita Hoe
- Geller Institute of Ageing and Memory, University of West London, London, UK
- School of Health Sciences, University of London, London, UK
| | - Elena Profyri
- School of Health Sciences, University of London, London, UK
| | - Charlotte Kemp
- School of Health Sciences, University of London, London, UK
| | - Monica Manela
- UCL Division of Psychiatry, University College London, Maple House, London, UK
| | - Lucy Webster
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Justine Anthony
- School of Health Sciences, University of London, London, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Sergi Costafreda
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Frank Arrojo
- Alzheimer's Society Research Network, Alzheimer's Society, London, UK
| | - Helen Souris
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Dementia Clinical Network, NHS England and NHS Improvement (London Region, London, UK
| | - Gill Livingston
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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Ndjepel J, Vonarx N, Éthier S. [Improving the experience of racialized immigrant seniors in Quebec]. SOINS. GERONTOLOGIE 2024; 29:42-45. [PMID: 38331524 DOI: 10.1016/j.sger.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
In Quebec, racialized immigrant seniors (AIRs) are a significant presence in long-term care facilities (CHSLDs) in the Greater Montreal area. To identify interventions that best meet their needs, this study interviewed 12 RIAs, including their families, about their experience in CHSLDs. The results show that RIAs face three challenges: food, clothing and play. Addressing these issues could improve their LTRCC experience.
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Affiliation(s)
- Jacky Ndjepel
- Faculté des sciences infirmières, Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec G1V 0A6, Canada.
| | - Nicolas Vonarx
- Faculté des sciences infirmières, Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec G1V 0A6, Canada
| | - Sophie Éthier
- École de travail social et de criminologie, Faculté des sciences sociales, Université Laval, 1030 avenue des Sciences-Humaines, Pavillon Charles-De-Koninck, Québec (Québec) G1V 0A6, Canada
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Supporting autonomy for people with dementia living in nursing homes: A rapid realist review. Int J Nurs Stud 2023; 137:104382. [PMID: 36402057 DOI: 10.1016/j.ijnurstu.2022.104382] [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: 05/25/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND For people with dementia living in nursing homes, autonomy is important. However, they experience difficulty with being heard as an autonomous person, as well as with expressing their preferences and choices. The question is how to support their autonomy. OBJECTIVE Despite extensive efforts to support autonomy in daily care for people with dementia living in nursing homes, we do not know exactly what works for whom, in which context, how and why. The objective of this realist review is to explore what is known in literature on autonomy support interventions for people with dementia in nursing homes. DESIGN A rapid realist review of literature. REVIEW METHODS To understand how autonomy is supported, a realist approach was applied that entailed identifying the research question, searching for information, performing a quality appraisal, extracting data, synthesizing the evidence and validating the findings with a panel of experts. Causal assumptions were derived from articles found in four bibliographic databases (PubMed, PsychInfo, Cochrane and CINAHL) leading to context (C)-mechanism (M)-outcome (O) configurations. RESULTS Data extraction from the included articles ultimately resulted in sixteen CMO configurations on four themes: a. preferences and choice: interventions for supporting autonomy in nursing homes and their results, b. personal characteristics of residents and family: people with dementia and their family being individuals who have their own character, habits and behaviors, c. competent nursing staff each having their own level of knowledge, competence and need for support, and d. interaction and relationships in care situations: the persons involved are interrelated, continuously interacting in different triangles composed of residents, family members and nursing staff. CONCLUSION The findings showed that results from interventions on autonomy in daily-care situations are likely to be just as related not only with the characteristics and competences of the people involved, but also to how they interact. Autonomy support interventions appear to be successful when the right context factors are considered.
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Lynch B, Ryan AA, O’Neill M, Penney S. The factors that influence care home residents’ and families’ engagement with decision-making about their care and support: an integrative review of the literature. BMC Geriatr 2022; 22:873. [PMID: 36396991 PMCID: PMC9672635 DOI: 10.1186/s12877-022-03503-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background: As care homes play an important role in the lives of an increasing number of older people, it is pivotal to understand how residents’ and their families engage in decision-making about their care and support. Internationally, there is an increasing emphasis in long-term care settings on the right of residents to be actively involved in all aspects of decision-making about their care and support. However, the steps necessary to achieving a culture of shared decision-making in long-term care settings remain unclear. The aim of this literature review is to summarise what is known in the literature about the factors that influence care home residents’ and families’ engagement with decision-making about their care and support. Methods: An integrative literature reviews was carried out, guided by the methodological framework proposed by Whittemore and Knafl (2005). CINAHL, Medline Ovid and ProQuest Health and Medical databases were searched for relevant articles from 2011 to 2021. A three-step method was used, including the use of reference and citation management software to manage search results and identify duplicate citations. Abstracts and full texts were reviewed by two reviewers. Details of the selected articles were then extracted using the Data Extraction Form. Results: In total, 913 articles were located and 22 studies were included in the final analysis. The thematic analysis identified three main themes that illustrate the complexities of shared decision-making in care homes: (a) a positive culture of collaborative and reciprocal relationships; (b) a willingness to engage and a willingness to become engaged; and (c) communicating with intent to share and support rather than inform and direct. Conclusion: The implementation of shared decision-making in care homes is highly dependent on the support and nurturing of collaborative and reciprocal relationships between residents, families, and staff. Part of this process includes ascertaining the willingness of residents and families to become engaged in shared decision-making. Communication skills training for staff and guided approaches that view decision-making as a supportive process rather than a once off event are essential prerequisites for implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03503-8.
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Jayes M, Austin L, Brown LJE. Supported decision-making and mental capacity assessment in care homes: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1061-e1069. [PMID: 34250675 DOI: 10.1111/hsc.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/25/2021] [Accepted: 06/22/2021] [Indexed: 05/12/2023]
Abstract
Up to 75% of UK care home residents may lack the mental capacity to make certain decisions (Wade, Clinical Rehabilitation, 2019, 33, 1561-1570). Care home staff need evidence-based tools to help them assess residents' mental capacity and provide decision-making support (NICE, Decision-making and mental capacity NICE guideline NG108, 2018). The Mental Capacity Assessment Support Toolkit (MCAST) was designed to support multidisciplinary healthcare staff to prepare, complete and document legally compliant mental capacity assessments. MCAST has not yet been trialled in care homes. This study used a descriptive qualitative design to: (a) understand the current challenges faced by care home staff when supporting residents to make decisions and participate in mental capacity assessments; (b) explore staff members' support needs in this context and (c) to identify if and how the toolkit could be adapted for use in care homes. A purposive sample of 29 staff working as managers (n = 18), nurses (n = 7) and care assistants (n = 4) across five care homes in North West England participated in five semi-structured focus groups between May and July 2019. Data from the focus group transcripts were analysed thematically (Braun & Clarke, Qualitative Research in Psychology, 2006, 3, 77-101). Five main themes were identified: (a) involvement of residents in decision-making; (b) approaches to mental capacity assessment; (c) working with residents with communication difficulties; (d) feelings about practice and (e) responses to MCAST. Participants appeared competent and confident about supporting decision-making and assessing capacity, but recognised the complexity of this area of practice, and identified a need for further support. They reported a range of challenges, including accessing support from speech and language therapists for residents with communication needs. They responded positively to the toolkit and were keen to use it in practice. This study suggests that care home staff would benefit from, and welcome, support to develop their practice. Furthermore, MCAST appears usable in this context and formal feasibility testing is justified.
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Affiliation(s)
- Mark Jayes
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Lynn Austin
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Laura J E Brown
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Kiss V, Maléth A, Tőkey B, Hoffman I. An empirical study of actions on custodianship in Hungary. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 78:101719. [PMID: 34333264 DOI: 10.1016/j.ijlp.2021.101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
Our research on the operation of legal institutions related to the restriction of the legal capacity of adults (custodianship and supported decision-making) started in December 2019. Our present analysis of case law on custodianship and supported decision-making is based on cases published in the Collection of Court Decisions. The adoption of the new Hungarian Civil Code has clearly had a significant effect on the court decisions, as it made it compulsory to designate the categories of decisions to which a partial restriction on legal capacity applies. However, the change in regulation also implies a change of attitude that is considerably less apparent in the cases. In the context of international human rights expectations, any limitation of legal capacity should be applied as circumspectly as possible, and only in the most necessary cases. In the examined cases, the efforts of the Curia (the Hungarian Supreme Court) to reinforce this change of attitude in court practice may be detected but they are not extensive. At the same time, the spirit of the UN Convention on the Rights of Persons with Disabilities (CRPD) is not clearly reflected in court practice, and supported decision-making is not seen by courts as a real alternative to custodianship. Regarding the processes of the analyzed disputes, we found that the procedures in the published cases are relatively short, the higher courts in most cases upholding the decision of the lower courts, and that there is no legal or critical evaluation of any expert opinion. In a number of cases, the dominant function of custodianship is not the protection but the restriction of the rights of the given person and - against its declared goal - it serves to protect the interest of others. For example, property issues and the protection of the financial interests of family members are given priority in the published cases. In addition, there were several cases in which the authorities themselves sought to be 'protected' by limiting the capacity of the person to initiate official and judicial proceedings.
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Affiliation(s)
- Valéria Kiss
- Eötvös Loránd University Faculty of Law, Center for Theory of Law and Society, Hungary.
| | - Anett Maléth
- Pázmány Péter Catholic University Faculty of Law, Eötvös Loránd University Bárczi Gusztáv Faculty of Special Needs Education, Institute for Postgraduate Studies in Special Needs Education, Hungary.
| | - Balázs Tőkey
- Eötvös Loránd University Faculty of Law, Department of Civil Law, Hungary.
| | - István Hoffman
- Eötvös Loránd University Faculty of Law, Department of Administrative Law, Hungary.
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Lee K, Bartlett R. Material Citizenship: An ethnographic study exploring object-person relations in the context of people with dementia in care homes. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1471-1485. [PMID: 34170522 DOI: 10.1111/1467-9566.13321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Materiality has become an increasingly important topic in sociological studies of health care. How objects support the identity of people with dementia in care homes is an emerging area. While early research has tended to focus on sentimental or cherished items (such as photographs or keepsakes), the present study focused on functional objects (such as curling tongs or a hairdryer) as a mechanism to actualise citizenship. This article presents findings from an ethnographic study into the everyday experiences of people with dementia living in a residential care home in southern England. Drawing on a framework analysis of observations of daily life, object-elicitation interviews with residents, in-depth interviews with staff and relatives and documentary research, the findings demonstrate that object relations are a critical but overlooked site for citizenship. Residents are rarely involved in decision-making relating to their personal possessions, lack control over objects and are often discouraged from material interactions important to the maintenance and cultivation of identity. We introduce a new concept 'material citizenship' to advance thinking and practice in this area and argue that it is valuable for care practices to combine a material citizenship approach with existing care practices; thus, elevating the importance of object-person relations in dementia care.
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Affiliation(s)
- Kellyn Lee
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Ruth Bartlett
- School of Health Sciences, University of Southampton, Southampton, UK
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9
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Garratt SM, Kosowicz L, Gilbert AS, Dow B, Ostaszkiewicz J. What is and what ought to be: A meta-synthesis of residential aged care staffs' perspectives on quality care. J Clin Nurs 2021; 30:3124-3138. [PMID: 34060164 DOI: 10.1111/jocn.15842] [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: 11/30/2020] [Revised: 02/22/2021] [Accepted: 04/14/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND As places of both residence and work, what constitutes "good quality care" in residential aged care requires consideration of staffs' perspectives. OBJECTIVE A meta-synthesis of the qualitative literature was conducted exploring residential aged care staff perspectives on "quality of care." METHODS Six electronic databases were searched for articles that met the screening inclusion criteria. This meta-synthesis was informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and included studies were critically appraised using JBI SUMARI. Two independent reviewers conducted thematic network mapping and analysis of included articles, with oversight from three additional reviewers. RESULTS Forty-seven articles were included, with findings summarised into four organising themes and nine basic themes. The four organising themes about quality care from staff perspectives include direct care, professional values and competence, the care environment and organisational/regulatory factors. CONCLUSION Staff describe a wide range of factors that they perceived to influence the quality of care. Some may feel motivated to leave employment in aged care, due to organisational pressures that make staff unable to uphold what they perceive as an acceptable standard of care. There is tension between professional values and organisation/regulatory factors-regulation should be enacted at a level that supports good practice and staff's moral integrity. RELEVANCE TO CLINICAL PRACTICE This review found that while person-centred care is now well established as the benchmark of quality care in residential aged care homes, achieving it in reality remains challenged by limitations on staff members' time, resources and sometimes their competencies and the regularity of their employment.
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Affiliation(s)
- Stephanie M Garratt
- National Ageing Research Institute, Parkville, Vic., Australia.,University of Auckland, Auckland, New Zealand
| | - Leona Kosowicz
- National Ageing Research Institute, Parkville, Vic., Australia
| | - Andrew S Gilbert
- National Ageing Research Institute, Parkville, Vic., Australia.,La Trobe University, Bundoora, Vic., Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, Vic., Australia.,Deakin University, Burwood, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | - Joan Ostaszkiewicz
- National Ageing Research Institute, Parkville, Vic., Australia.,Deakin University, Burwood, Vic., Australia
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Wied TS, Haberstroh J, Gather J, Karakaya T, Oswald F, Qubad M, Scholten M, Vollmann J, Pantel J. Supported Decision-Making in Persons With Dementia: Development of an Enhanced Consent Procedure for Lumbar Puncture. Front Psychiatry 2021; 12:780276. [PMID: 34867561 PMCID: PMC8635234 DOI: 10.3389/fpsyt.2021.780276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
The right to make autonomous decisions is enshrined in law. However, the question how persons with cognitive deficits can be enabled to make autonomous decisions has not been satisfactorily addressed. In particular, the concept of supported decision-making and its implementation into practice has been poorly explored for persons with dementia (PwD).This article describes the empirical development and implementation of support tools to enhance informed consent processes (so called enhanced consent procedures/ECP) for PwD on whether to undergo lumbar puncture. In the end of the process of pilot testing and further development of the tools, the following tools were defined: (1) Standardized Interview Structure, (2) Elaborated Plain Language, (3) Ambience and Room Design, (4) Keyword Lists, (5) Priority Cards, (6) Visualization, and (7) Simplified Written Informed Consent (Patient Information), as well as the general attitude (8) Person-Centered Attitude of the facilitator. As the development, implementation and evaluation of ECP tools is one objective of the transnational ENSURE project, we also include an overview of future empirical procedures. So far, our findings can serve as a selection of possibilities to support PwD in decision-making and help practitioners achieve an appropriate balance between the autonomy and protection of PwD in complex decision-making situation. Future studies should address the question if the proposed set of tools is effective to enhance informed consent processes in PwD.
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Affiliation(s)
- Theresa S Wied
- Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Julia Haberstroh
- Psychological Aging Research, Institute of Psychology, University of Siegen, Siegen, Germany
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany.,Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tarik Karakaya
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Frank Oswald
- Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Mishal Qubad
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Johannes Pantel
- Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
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De Sabbata K. Dementia, Treatment Decisions, and the UN Convention on the Rights of Persons With Disabilities. A New Framework for Old Problems. Front Psychiatry 2020; 11:571722. [PMID: 33240127 PMCID: PMC7680726 DOI: 10.3389/fpsyt.2020.571722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
The UN Convention on the Rights of Persons with Disabilities has been at the center of considerable debate in the field of mental health. The discussion has caught up in particular after the publication of General Comment No. 1 in which the Committee on the Rights of Persons with Disabilities proposes a particularly radical interpretation of Article 12 of the Convention. Such a document has triggered skeptic and at times hostile reactions especially by psychiatrists, together with some positive comments. In this context, there is sometimes the tendency to focus only on the problematic aspects of the rights and support based model proposed by the CRPD and its Committee, forgetting that also "pre-CRPD" legislations on legal capacity present significant shortcomings. In this contribution I focus on the paradigmatic case of treatment decisions of people living with dementia with the aim to show how a number of provisions emerging from the CRPD and General Comment No. 1 can contribute to overcome the issues characterizing the traditional model of legal capacity and consent to treatment. First, I provide a brief overview of the provisions contained in the CRPD and General Comment No.1, summarizing the debate in this area. Then, I move to the case of treatment decisions of people living with dementia, analysing the main issues posed by the traditional model of capacity still characterizing European legislations. I will show how such problems and the solutions previously advanced by academics and practitioners resound in many ways with those identified by the CRPD and its Committee. In the second part, I analyse one by one the main provisions proposed by the CRPD and the Committee, studying how they can be applied in the area of treatment decisions of people living with dementia. In this context I point out the possible interpretations of the various provisions and their pros and cons, also referring to ongoing initiatives providing an insight on how such norms might work in practice.
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Affiliation(s)
- Kevin De Sabbata
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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12
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Cameron N, Fetherstonhaugh D, Bauer M, Tarzia L. How Residential Care Staff Conceptualize the Identities of Residents With Dementia and Its Relevance for Decision Making. J Appl Gerontol 2020; 40:1551-1558. [PMID: 32869683 DOI: 10.1177/0733464820951734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The ways in which residential aged care staff conceptualize the identities of residents with dementia has significance for how they support them to make decisions and make decisions on their behalf. This article aims to further understand how staff in residential aged care facilities comprehend who residents "are." METHODS This qualitative study draws on individual and group interview data with aged care staff from two Australian states concerning decision making for individuals with dementia. It identifies themes relevant to how staff refer to identity in relation to such residents. RESULTS Staff possess disparate ideas about what things comprise residents' identities and, accordingly, which sources of knowledge are most relevant to learning about residents. DISCUSSION This article argues for the application of a multidimensional and temporally inclusive understanding of identity by those who provide care to people with dementia.
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Affiliation(s)
| | | | | | - Laura Tarzia
- The University of Melbourne, Victoria, Australia
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13
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Siewert JS, Alvarez AM, Santos SMAD, Brito FA, Hammerschmidt KSDA. Institutionalized elderly people with dementia: an integrative review on nursing care. Rev Bras Enferm 2020; 73 Suppl 3:e20180419. [PMID: 32756799 DOI: 10.1590/0034-7167-2018-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/11/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To ascertain the characteristics of the nursing care provided to institutionalized elderly people with dementia. METHODS Integrative review of studies published between 2013 and 2017, in English, Spanish, and Portuguese, from the databases BDENF, LILACS, CINAHL, PubMed, SciELO, TRIP, and National Guideline Clearing House. Thematic data analysis was used. RESULTS From the data collected in the 41 included studies, three themes emerged: Care with a focus on the needs of elderly people in LTCIEs; Care based on the work process of the nursing team; and Shared care. Final considerations: Elderly care can take place from different perspectives: that of the elderly; the nursing team; and it can be shared among the different parties involved. The importance of communication must be stressed, as do the development of skills and attitudes of the team, as well as proper training and support, good environment in the care process, and an approach centered on the institutionalized elderly.
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Boumans J, van Boekel LC, Baan CA, Luijkx KG. How Can Autonomy Be Maintained and Informal Care Improved for People With Dementia Living in Residential Care Facilities: A Systematic Literature Review. THE GERONTOLOGIST 2020; 59:e709-e730. [PMID: 30239712 PMCID: PMC6858830 DOI: 10.1093/geront/gny096] [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: 03/06/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives For people with dementia living in residential care facilities, maintaining autonomy and receiving informal care are important. The objective of this review is to understand how caregiving approaches and physical environment, including technologies contribute to the maintenance of autonomy and informal care provision for this population. Research Design and Methods A literature review of peer-reviewed articles published between January 1995 and July 2017 was performed. Realist logic of analysis was used, involving context, mechanism and outcome configurations. Results Forty-nine articles were included. The improvement of the relationship between residents and formal/informal caregivers is important. This increases the knowledge (sharing) about the resident and contributes to their autonomy. A social, flexible, and welcoming attitude of the formal caregiver improves the provision of informal care. Specially designed spaces, for instance, therapeutic gardens, create activities for residents that remind them of themselves and contribute to their autonomy. Use of technologies reduces caregiver’s time for primary tasks and therefore enables secondary tasks such as interaction with the residents. Discussion and Implications The results revealed how residential care facilities could maintain autonomy of their residents and improve informal care delivery using caregiving approaches and the physical environment including technologies. The results are supporting toward each other in maintaining autonomy and also helped in enhancing informal care provision. For residential care facilities that want to maintain the autonomy of their residents and improve informal care delivery, it is important to pay attention to all aspects of living in a residential care facility.
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Affiliation(s)
- Jogé Boumans
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - Leonieke C van Boekel
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - Caroline A Baan
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands.,Department of Quality of Care and Health Economics, Centre for Nutrition, Prevent and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Katrien G Luijkx
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
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15
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Davies C, Fattori F, O'Donnell D, Donnelly S, Ní Shé É, O Shea M, Prihodova L, Gleeson C, Flynn Á, Rock B, Grogan J, O'Brien M, O'Hanlon S, Cooney MT, Tighe M, Kroll T. What are the mechanisms that support healthcare professionals to adopt assisted decision-making practice? A rapid realist review. BMC Health Serv Res 2019; 19:960. [PMID: 31831003 PMCID: PMC6909502 DOI: 10.1186/s12913-019-4802-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) establishes a right to legal capacity for all people, including those with support needs. People with disabilities have a legal right to be given the appropriate supports to make informed decisions in all aspects of their lives, including health. In Ireland, the Assisted Decision-Making (Capacity) Act (2015) ratifies the Convention and has established a legal framework for Assisted Decision Making (ADM). The main provisions of the Act are not yet implemented. Codes of Practice to guide health and social care professionals are currently being developed. Internationally, concerns are expressed that ADM implementation is poorly understood. Using realist synthesis, this study aims to identify Programme Theory (PT) that will inform ADM implementation in healthcare. METHODS A Rapid Realist Review using collaborative methods was chosen to appraise relevant literature and engage knowledge users from Irish health and social care. The review was led by an expert panel of relevant stakeholders that developed the research question which asks, 'what mechanisms enable healthcare professionals to adopt ADM into practice?' To ensure the PT was inclusive of local contextual influences, five reference panels were conducted with healthcare professionals, family carers and people with dementia. PT was refined and tested iteratively through knowledge synthesis informed by forty-seven primary studies, reference panel discussions and expert panel refinement and consensus. RESULTS The review has developed an explanatory PT on ADM implementation in healthcare practice. The review identified four implementation domains as significant. These are Personalisation of Health & ADM Service Provision, Culture & Leadership, Environmental & Social Re-structuring and Education, Training & Enablement. Each domain is presented as an explanatory PT statement using realist convention that identifies context, mechanism and outcome configurations. CONCLUSIONS This realist review makes a unique contribution to this field. The PT can be applied by policymakers to inform intervention development and implementation strategy. It informs the imminent policy and practice developments in Ireland and has relevance for other worldwide healthcare systems dealing with similar legislative changes in line with UNCRPD.
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Affiliation(s)
- Carmel Davies
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Francesco Fattori
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marie O Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | | | - Áine Flynn
- Decision Support Service, Mental Health Commission, Dublin, Ireland
| | | | | | - Michelle O'Brien
- Medicine for the Elderly, St. Vincent's University Hospital, Dublin, Ireland
| | - Shane O'Hanlon
- Medicine for the Elderly, St. Vincent's University Hospital, Dublin, Ireland
| | | | | | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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16
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Sinclair C, Bajic-Smith J, Gresham M, Blake M, Bucks RS, Field S, Clayton JM, Radoslovich H, Agar M, Kurrle S. Professionals' views and experiences in supporting decision-making involvement for people living with dementia. DEMENTIA 2019; 20:84-105. [PMID: 31349752 DOI: 10.1177/1471301219864849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The provision of supported decision-making for people living with disabilities is an emerging area of practice and rights-based law reform, and is required under international law. OBJECTIVES This qualitative study aimed to understand how Australian health and legal professionals conceptualised their professional roles in the practice of providing decision-making support for people living with dementia. METHODS The methods were informed by grounded theory principles. In-depth, semi-structured interviews were conducted with 28 health and legal professionals involved in providing care or services for people with dementia. Interviews explored how professionals described their practice of providing support for decision-making and how they conceptualised their roles. The analysis was underpinned by the theoretical perspective of symbolic interactionism. RESULTS Participants described providing support across a range of decision domains, some of which were specific to their professional role. Four key themes were identified: 'establishing a basis for decision-making', 'the supportive toolbox', 'managing professional boundaries' and 'individualist advocacy versus relational practice'. Participants identified a range of generic and specialised techniques they used to provide support for people with dementia. These techniques were applied subject to resource limitations and perceived professional obligations and boundaries. A continuum of professional practice, ranging from 'individualist advocacy' to 'relational practice' describes the approaches adopted by different professionals. DISCUSSION Professionals conceptualised their role in providing support for decision-making through the lens of their own profession. Differences in positioning on the continuum of 'individualist advocacy' through to 'relational practice' had practical implications for capacity assessment, engaging with persons with impaired decision-making capacity, and the inclusion of supporters and family members in decision-making processes. Further progress in implementing supported decision-making (including through law and policy reform) will require an understanding of these inter-professional differences in perceived roles relating to the practice of providing decision-making support.
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Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia, Australia; Centre of Excellence in Population Ageing Research, University of New South Wales, Australia
| | | | | | - Meredith Blake
- UWA Law School, University of Western Australia, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Australia
| | - Sue Field
- UWA Law School, University of Western Australia, Australia
| | - Josephine M Clayton
- HammondCare, Australia; Sydney Medical School, University of Sydney, Australia
| | | | - Meera Agar
- Faculty of Health, University of Technology Sydney, Australia
| | - Susan Kurrle
- Faculty of Medicine and Health, University of Sydney, Australia
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17
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The transition to technology-enriched supported accommodation (TESA) for people living with dementia: the experience of formal carers. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis paper presents the experiences of formal carers working in technology-enriched supported accommodation for people living with dementia, examining their care-giving role from a person-centred care perspective. Within a qualitative study, 21 semi-structured interviews were conducted with formal carers and data were analysed following a thematic approach. Four main themes were identified that mapped to the attributes of the person-centred practice framework (PCPF): promoting choice and autonomy, staffing model, using assistive technology and feeling that ‘you're doing a good job’. Central to person-centred practice in these settings was the promotion of choice, autonomy and independence. The dichotomy between safety and independence was evident, curtailing the opportunities within the environmental enablers and associated embedded assistive technologies. Formal carers reported considerable job satisfaction working in these settings. The small-scale, home-like facilities seemed to have a positive effect on job satisfaction. These findings are relevant to policy makers, commissioners and service providers, highlighting the facilitators of person-centred care in community dwellings for people living with dementia and the role of formal carers in promoting this approach.
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18
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Mariani E, Chattat R, Ottoboni G, Koopmans R, Vernooij-Dassen M, Engels Y. The Impact of a Shared Decision-Making Training Program on Dementia Care Planning in Long-Term Care. J Alzheimers Dis 2018; 64:1123-1135. [PMID: 30010130 DOI: 10.3233/jad-180279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Shared decision-making (SDM) can be a way for staff to adopt international recommendations advocating the involvement of nursing home residents and their family members in care planning and the development of personalized care plans. OBJECTIVE The main aim was to analyze the effects of training nursing home staff in the implementation of SDM on agreement of residents' 'life-and-care plans' with the recommendations (primary outcome) and on family caregivers' quality of life and sense of competence, and staff's job satisfaction (secondary outcomes). METHODS In the intervention condition, staff attended a training program on the use of SDM with residents and family caregivers in the care planning process. In the control condition, care planning as usual took place. For the primary outcome, in-depth qualitative and quantitative analyses of the care plans were performed. Multivariate Permutation Tests were applied to assess the impact on secondary outcomes. RESULTS Forty-nine residents and family caregivers and 34 professionals were involved. Overall, many of the care plans developed during the intervention showed a high level of agreement with the care planning recommendations. Both Italian and Dutch care plans showed improvement in the number of clear problem statements (p < 0.001). In Italy, significant improvements (p < 0.05) were also found regarding specific care objectives, documentation of objectives met, and of residents and families' involvement. No impact was found on secondary outcomes. CONCLUSION The involvement of residents and family caregivers in care planning contributed to an improvement of the residents' care plans, but it did not have an effect on family caregivers and staff outcomes.
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Affiliation(s)
- Elena Mariani
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giovanni Ottoboni
- Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Raymond Koopmans
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Joachimen Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.,Radboudumc Alzheimer Center, Nijmegen, The Netherlands.,Kalorama Foundation, Beek-Ubbergen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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19
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Davis R, Ziomkowski MK, Veltkamp A. Everyday Decision Making in Individuals with Early-Stage Alzheimer's Disease: An Integrative Review of the Literature. Res Gerontol Nurs 2017; 10:240-247. [PMID: 28926672 DOI: 10.3928/19404921-20170831-05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/24/2017] [Indexed: 11/20/2022]
Abstract
Individuals with Alzheimer's disease (AD) demonstrate fluctuation in cognitive abilities that can affect their ability to make decisions. Everyday decision making encompasses the types of decisions about typical daily activities, such as what to eat, what to do, and what to wear. Everyday decisions are encountered many times per day by individuals with AD/dementia and their caregivers. However, not much is known about the ability of individuals with AD/dementia to make these types of decisions. The purpose of the current literature review was to synthesize the evidence regarding everyday decision making in individuals with early-stage AD/dementia. Findings from the review indicate there is beginning evidence that individuals with early to moderate stages of AD/dementia desire to have input in daily decisions, have the ability to state their wishes consistently at times, and having input in decision making is important to their selfhood. The literature revealed few interventions to assist individuals with AD/dementia in everyday decision making. Findings from the review are discussed with implications for nursing practice and research. [Res Gerontol Nurs. 2017; 10(5):240-247.].
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20
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Scales K, Lepore M, Anderson RA, McConnell ES, Song Y, Kang B, Porter K, Thach T, Corazzini KN. Person-Directed Care Planning in Nursing Homes: Resident, Family, and Staff Perspectives. J Appl Gerontol 2017; 38:183-206. [PMID: 29165004 DOI: 10.1177/0733464817732519] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Empowering individuals to direct their own care is central to person-centered care and health care policy. However, there is limited knowledge of how "person-directed care planning" (PDCP) can be achieved in particular settings. This study identifies key structures and processes for operationalizing and implementing PDCP in nursing homes. Using participatory inquiry, we convened "stakeholder engagement sessions" with residents, families, nursing staff, and managers/administrators in two North Carolina nursing homes ( N = 24 sessions; N = 67 unique participants). Stakeholders discussed current care-planning processes and provided feedback on an emergent conceptual framework of PDCP. Three themes emerged through directed-content analysis: strategies included providing formal and informal opportunities to engage in care planning and ensuring effective follow-through; different roles were required among leadership, staff, residents, and families to accomplish PDCP; and limits on achieving PDCP included competing priorities and perceived regulatory and resource constraints. Results are discussed in terms of the specific competencies required for accomplishing PDCP.
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Affiliation(s)
| | | | | | - Eleanor S McConnell
- 4 Duke University, Durham, NC, USA.,5 Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Durham, NC, USA
| | - Yuting Song
- 6 University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Trini Thach
- 3 University of North Carolina at Chapel Hill, USA
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21
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Villar F, Celdrán M, Vila-Miravent J, Serrat R. Involving institutionalised people with dementia in their care-planning meetings: lessons learnt by the staff. Scand J Caring Sci 2017; 32:567-574. [PMID: 28901562 DOI: 10.1111/scs.12480] [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: 04/06/2017] [Accepted: 04/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Applying a person-centred care (PCC) approach is an aspiration for many services attending people with dementia (PwD). However, the implementation and assessment of PCC practices represent a challenge to health professionals. AIM To evaluate the impact on staff of a programme aiming to involve people with dementia (PwD) in their individualised care-planning (ICP) meetings in long-term residential settings; specifically, to explore the lessons that staff perceived they had learned from the experience. METHODS Twenty-one staff members working in residential facilities for older people were interviewed after the programme. Responses to two questions ('Do you think that your work has been affected in any way by the attendance of PwD at ICP meetings?' and 'Have you learnt something new as a result of these meetings?') were submitted to thematic analysis. RESULTS Eighteen of the 21 participants identified at least one lesson they had learned from the experience. The lessons could be grouped under three main headings: (i) an increase in their understanding of PwD, (ii) questioning of their own care practices, and (iii) an improvement in teamwork. CONCLUSION The involvement of PwD in ICP meetings had a positive impact on staff. They stated that the experience encouraged them to develop PCC-compatible attitudes and modify the way they treat PwD, thus improving the quality of care they deliver. The experience also seemed to empower staff (particularly the lesser trained members) and increase the cohesion of working teams.
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Affiliation(s)
- Feliciano Villar
- Department of Cognition, Development, and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Montserrat Celdrán
- Department of Cognition, Development, and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Josep Vila-Miravent
- Department of Cognition, Development, and Educational Psychology, University of Barcelona, Barcelona, Spain.,Alzheimer Catalonia Foundation, Barcelona, Spain
| | - Rodrigo Serrat
- Department of Cognition, Development, and Educational Psychology, University of Barcelona, Barcelona, Spain
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22
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Span M, Hettinga M, Groen-van de Ven L, Jukema J, Janssen R, Vernooij-Dassen M, Eefsting J, Smits C. Involving people with dementia in developing an interactive web tool for shared decision-making: experiences with a participatory design approach. Disabil Rehabil 2017; 40:1410-1420. [DOI: 10.1080/09638288.2017.1298162] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marijke Span
- Department of Health and Wellbeing, Research Group Innovation of Care of Older Adults, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Marike Hettinga
- Department of Technology, Research Group IT Innovation in Health Care, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Leontine Groen-van de Ven
- Department of Health and Wellbeing, Research Group Innovation of Care of Older Adults, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Jan Jukema
- Department of Health and Wellbeing, Research Group Innovation of Care of Older Adults, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Ruud Janssen
- Department of Technology, Research Group IT Innovation in Health Care, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Myrra Vernooij-Dassen
- Department of Primary Care, IQ Health Care, Radboud Alzheimer Centre Nijmegen, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Jan Eefsting
- Department of Nursing Home Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - Carolien Smits
- Department of Health and Wellbeing, Research Group Innovation of Care of Older Adults, Windesheim University of Applied Sciences, Zwolle, the Netherlands
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Scales K, Bailey S, Middleton J, Schneider J. Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:227-243. [PMID: 27891628 DOI: 10.1111/1467-9566.12524] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings.
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Affiliation(s)
- Kezia Scales
- Center for the Study of Aging and Human Development, Duke University, USA
- School of Nursing, Duke University, USA
| | - Simon Bailey
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Joanne Middleton
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Justine Schneider
- School of Sociology & Social Policy, University of Nottingham, Nottingham, UK
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Fetherstonhaugh D, Rayner JA, Tarzia L. Hanging on to Some Autonomy in Decisionmaking: How do Spouse Carers Support this? DEMENTIA 2016; 18:1219-1236. [PMID: 27852728 DOI: 10.1177/1471301216678104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Australia, the majority of people with dementia live in the community with informal care provided by family, commonly a spouse. A diagnosis of dementia is a threat to one's personhood and is often accompanied by perceptions of future dependency, which will involve the inability to carry out conventional roles and complete everyday tasks including making decisions. Being able to make decisions, however, is part of being a 'person' and it is through relationships that personhood is defined and constructed. In face-to-face interviews with seven couples (a carer and person with dementia dyad) and two spouse carers, this study explored why, and how, spouse carers support continued involvement in decision-making for people with dementia. The findings highlight the importance of loving and respectful relationships in the development of strategies to support continued decision-making for people with dementia.
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Affiliation(s)
| | - Jo-Anne Rayner
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Australia
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Parkville, Australia
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25
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Ampe S, Sevenants A, Smets T, Declercq A, Van Audenhove C. Advance care planning for nursing home residents with dementia: policy vs. practice. J Adv Nurs 2015; 72:569-81. [DOI: 10.1111/jan.12854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Sophie Ampe
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Aline Sevenants
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Tinne Smets
- Vrije Universiteit Brussel; End-of-Life Care Research Group; Belgium
| | - Anja Declercq
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
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26
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Tarzia L, Fetherstonhaugh D, Bauer M, Beattie E, Nay R. “We Have to Work Within the System!”: Staff Perceptions of Organizational Barriers to Decision Making for Older Adults With Dementia in Australian Aged Care Facilities. Res Gerontol Nurs 2015; 8:286-92. [DOI: 10.3928/19404921-20150413-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/16/2015] [Indexed: 11/20/2022]
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27
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Supported Decision-Making for People with Cognitive Impairments: An Australian Perspective? LAWS 2015. [DOI: 10.3390/laws4010037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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