AimsTo gain insights into the barriers towards the prevention and/or reduction of involuntary treatment in long‐term geriatric care.DesignMixed methods.BackgroundMeasures 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.MethodsWe conducted a cross‐sectional, mixed methods study, including an online survey for professional caregivers and a semistructured focus group interview with professional caregivers.ResultsA 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.ConclusionsOne 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 PracticeProfessional caregivers experience many barriers towards the prevention and reduction of involuntary treatment. Future initiatives should aim to remove the perceived barriers.
IntroductionSupporting care receivers in Activities of Daily Living (ADL), irrespective of diagnosis, setting, or cultural background, lies at the heart of fundamental nursing care. The pursuit of quality ADL care becomes increasingly challenging with the changing complexity of care needs. ADL care delivery is often undervalued and is considered a low‐status task despite its crucial importance to care receivers. This study aims to synthesize challenges in ADL care irrespective of the care setting.MethodsIn the mixed qualitative methods study, we used expert panel consultations, world café sessions, and a rapid literature review. For data analysis, we simultaneously analyzed the three data sets using inductive and deductive inquiry.ResultsWe identified four challenges and their corresponding subthemes. They are (1) Undervalued common‐sense work versus complex, high‐skilled care provision; (2) Limitations in professional reflective clinical decision‐making; (3) Missed opportunities for shared ADL decisions; and (4) Meeting ADL care needs in a high‐throughput system.ConclusionThese challenges reveal the complexity of ADL care and how its paradoxical narrative relates to the conditions in which nursing professionals struggle to create opportunities, for reflective clinical reasoning and shared ADL decisions, by facing organizational and environmental barriers.Clinical RelevanceThis study is relevant to nursing professionals, care organizations, policymakers, and researchers aiming to improve ADL care and provide insights into challenges in ADL care. This study forms the starting point for a changing narrative on ADL nursing care and subsequent quality improvements in the form of, for example, guidelines for nursing professionals.
Measures to which a person resits 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 Persons Living with Dementia (PLWD) is still common practice and remains difficult to prevent and/or reduce. The aim of this study was to gain insights into the barriers towards the prevention and/or reduction of involuntary treatment in long-term geriatric care. We conducted a cross-sectional, mixed-methods study, including an online survey for professional caregivers, and a semi-structured focus group interview with professional caregivers. A total of 218 participants completed the questionnaire. The percentage of participants that experienced barriers in one of the twenty-two 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 its use were most seen as barriers. Nursing staff experienced a lack of time 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. One out of four professional caregivers experience barriers hindering prevention and/or reduction of involuntary treatment. More research is needed to gain better understanding on how professional caregivers can be supported aiming to, remove barriers and consequently prevent and/or reduce the use of involuntary treatment.
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