Aggressive behaviour by people with dementia in residential care settings: a review

This paper considers the phenomenon of aggressive behaviour perpetrated by people with dementia in residential care settings. Aggressive behaviour is defined in the context of people with dementia, and the problem of ascertaining the incidence of aggression among people with dementia is discussed. The emotional impact of assaults on nurses and other professionals is highlighted, and differing perspectives on the causation of aggressive behaviour are considered. Management strategies derived from the physical/pharmacological; environment management; behaviour modification and person-centred approaches are reviewed. Our conclusion is that while certain strategies appear to reflect good and common sense practice, in particular those deriving from the person-centred approach, there is no clear research evidence for the general effectiveness of any one management approach, and each has drawbacks of a practical or ethical nature. There is also little empirical information about how professional carers actually manage aggressive behaviour in practice.     

A survey of staff attitudes and responses to people with dementia who are aggressive in residential care settings

Aggression is reportedly common among older people with dementia in residential care. The attitudes of staff in care homes and strategies they use are under researched. Theoretical models that may be used to both understand and respond to such behaviour exist. They are the standard and person-centred paradigms. The aim of this study was to explore the views of nursing staff about aggressive behaviour in people with dementia and strategies used in practice. A survey of the attitudes of staff in six dementia care units using the Management of Aggression in People with Dementia Attitude Questionnaire was conducted including an audit of aggressive incidents using the Staff Observation Aggression Scale-Revised over a 3-month period. Staff expressed views reflective of a person-centred as opposed to standard paradigm. They viewed aggressive behaviour by people with dementia as deriving from the environment, situation or interactions with others. Participants strongly supported interpersonal means of responding to aggression, the moderate use of medication, and were largely opposed to physical restraint. Aggressive incidents were managed using less intrusive strategies such as distraction and de-escalation. Responses to aggressive behaviour, while pragmatic, were largely underpinned by a person-centred ethic as reflected in the attitudes expressed by staff.     

Evaluating the effectiveness of the abilities-focused approach to morning care of people with dementia

sidani s., streiner d. & leclerc c. (2012) Evaluating the effectiveness of the abilities‐focused approach to morning care of people with dementia. International Journal of Older People Nursing 7 , 37–45 doi: 10.1111/j.1748‐3743.2011.00273.x Background and purpose. The abilities‐focused approach demonstrated efficacy in promoting engagement of residents with dementia in care. The extent to which these resident outcomes can be replicated when the abilities‐focused approach is implemented by nursing staff under the conditions of day‐to‐day practice was investigated in this study. The aim was to examine changes in resident outcomes before and after nursing staff’ implementation of the abilities‐focused approach and the contribution of this approach to resident outcomes. Methods. A one‐group pretest–post‐test design was used. Observational data were obtained from 65 residents with dementia. The data pertained to the implementation of abilities‐focused strategies during episodes of morning care and residents’ level of agitation, participation in morning care and physical and psychosocial functioning. Results. The number of abilities‐focused strategies used during morning care increased at post‐test. No clinically important changes in resident outcomes were observed over time. However, the implementation of some strategies was associated with residents’ participation in care and functioning at post‐test. The results provided preliminary evidence of the effectiveness of the abilities‐focused approach in maintaining functioning in people with dementia. Additional research is needed to understand the mechanism underlying the effects of this person‐centred approach to care on resident outcomes. Implications for practice. Implementation of the abilities‐focused approach assists people with dementia to participate in morning care.     

A model for using the VIPS framework for person-centred care for persons with dementia in nursing homes: a qualitative evaluative study

røsvik j., kirkevold m., engedal k., brooker d. & kirkevold ø . (2011) A model for using the VIPS framework for person‐centred care for persons with dementia in nursing homes: a qualitative evaluative study. International Journal of Older People Nursing 6 , 227–236 doi: 10.1111/j.1748‐3743.2011.00290.x Background. The ‘VIPS’ framework sums up the elements in Kitwood’s philosophy of person‐centred care (PCC) for persons with dementia as values, individualised approach, the perspective of the person living with dementia and social environment. There are six indicators for each element. Aim. To conduct an initial evaluation of a model aimed at facilitating the application of the VIPS framework. Design. Qualitative evaluative study. Methods. A model was trialled in a 9‐week pilot study in two nursing homes and evaluated in four focus groups using qualitative content analysis. Results. Five themes emerged: (1) Legitimacy of the model was secured when central roles were held by nurses representing the majority of the staff; (2) The model facilitated the staff’s use of their knowledge of PCC; (3) Support to the persons holding the internal facilitating roles in the model was needed; (4) The authority of the leading registered nurse in the ward was crucial to support the legitimacy of the model and (5) Form of organisation seemed to be of importance in how the model was experienced. Conclusion. The model worked best in wards organised with a leading registered nurse who could support an auxiliary nurse holding the facilitating function.     

Communicating good care: A qualitative study of what people with urological cancer value in interactions with health care providers

PurposeCommunication with health care providers is important to help meet cancer patients' information and support needs. It can significantly affect the extent to which patients feel cared for, respected and involved, and it can influence a range of cancer care processes and outcomes. This paper presents findings from a study which explored urological cancer patients' experiences of care, focussing on insights into what they appeared to value in their interactions with health care providers and why.MethodIn-depth interviews were undertaken with 20 men and 6 women with different types of urological cancer at a range of times since diagnosis. Interviews were audio-recorded, transcribed and thematically analysed using an established interpretive approach.ResultsPatients valued being treated as someone who mattered and was worthy of care; being recognised and responded to as an individual; and experiencing support for autonomy/agency. Reasons for their valuations related to the implications of communicative interactions for the ways patients thought health professionals related to them ‘as persons’. Our findings highlight the value of relational aspects of communication for: indicating to patients what clinicians think of their worth; facilitating individualised care; and enabling patients to contribute to their own care.ConclusionsEfforts to improve health care provider-patient communication should attend not only to the transfer of information about the condition and its management but to the range of features of interactions that can signal to people how health care providers relate to them as persons.     

Caring for older people with dementia in residential care: nursing students' experiences

AIM: This paper is a report of selected findings from two projects aimed at improving nursing students' experiences of caring for older people in elder care settings. BACKGROUND: With a growing number of older people the prevalence of dementia is rapidly increasing, such that it is now a primary reason for admission to residential care. This has implications for the preparation and support of nursing students on clinical placements as people with dementia represent a key focus of their nursing activities. METHOD: Two projects were conducted in Tasmania between 2001 and 2005, involving 87 second year Bachelor of Nursing students who participated in 3-week clinical placements in eight residential elder care facilities. During the placements, students and their mentors participated in a series of weekly focus group discussions to explore their experiences of caring for residents with dementia. Thematic analysis of the data was conducted. FINDINGS: Staff in the facilities struggled to support students effectively and often failed to recognize that students found residents' behaviour disturbing. Despite having some theoretical understanding of dementia, students reported being unsure of how to respond to residents and often felt scared and intimidated. CONCLUSION: Better preparation and support are needed for students on placements involving residents with dementia. Feasible strategies for more effective support include increased curriculum content about caring for people with dementia, and improved collaboration between university schools of nursing and settings for care of older people.     

The impact of residential respite care on the behaviour of older people with dementia: literature review

Aim.  The aim of this review was to examine the impact of residential respite care on the behaviour displayed by older people with dementia.
Background.  Relocation of older people with dementia to a different care setting could have a negative impact on their behaviour. If such a response is anticipated, a short-term admission to a residential aged care facility for respite care would appear to be futile for the older person and their home caregiver. Therefore, it is important to know what the outcomes of residential respite care are in relation to behaviour for older people with dementia.
Methods.  A literature search was undertaken and papers emerged from a range of disciplines. The search terms 'respite'; 'respite care'; 'residential respite care'; 'short-stay', 'short-term', 'overnight stays/admissions', 'behav*' and various combinations of these terms were used to find relevant publications in English from Ageline, CINAHL, Medline and, Psychinfo databases dating from 1966. Other key publications were located when searching through the reference lists of retrieved publications. A limited body of literature on residential respite care for older people with dementia was revealed.
Results.  Six studies were identified, which met the criteria of residential respite care as the intervention and behaviour as an outcome.
Conclusions.  The studies had a variety of methodological limitations and produced contradictory findings. The strength of the studies was the reporting of outcomes for respite recipients who are usually overlooked in the outcomes for respite research.
Relevance to clinical practice.  Residential respite care has great anecdotal support but more empirical and evaluative research is needed on outcomes for the respite recipients.