Backhouse T, Jeon YH, Killett A, Mioshi E. How do family carers and care-home staff manage refusals when assisting a person with advanced dementia with their personal care?
DEMENTIA 2022;
21:2458-2475. [PMID:
36053711 PMCID:
PMC9583289 DOI:
10.1177/14713012221123578]
[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] [Indexed: 11/22/2022]
Abstract
Background and objectives
Caregivers may encounter, or inadvertently cause, refusals of care by a care
recipient. Managing refusals of care can be challenging and have potential
negative consequences. We aimed to examine caregivers’ (care-home staff and
family carers) experiences of managing refusals of personal care in advanced
dementia.
Research design and methods
One-to-one semi-structured interviews with 12 care assistants from six care
homes and 20 family carers who were physically assisting a person with
advanced dementia with their personal care in the UK. Interviews were audio
recorded and transcribed verbatim, with data analysed using qualitative
content analysis.
Findings
Core to the caregiver experience of refusals of care was
knowing the person. This underpinned
five key themes identified as caregivers’ strategies used in preventing or
managing refusals of care: (1) finding the right moment to care; (2) using
specific communication strategies; (3) being tactful: simplifying, leaving,
or adapting care; (4) having confidence in care; and (5) seeking support
from others when safety is at risk.
Discussion and implications
Different caregiver relationships with the person with dementia influenced
how they managed refusals of care. Refusals of care can place caregivers in
tough situations with tensions between providing care when it is seemingly
not wanted and leaving care incomplete. Both caregiver groups require
support such as coaching, mentoring and/or advice from other health and
social care practitioners to manage difficult personal care interactions
before crisis points occur.
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