Care home manager attitudes to balancing risk and autonomy for residents with dementia

Evans, Elizabeth A.; Perkins, Elizabeth; Clarke, Pam; Haines, Alina; Baldwin, Ashley; Whittington, Richard

doi:10.1080/13607863.2016.1244803

Cited by 31 publications

(59 citation statements)

References 22 publications

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“…This is not surprising considering the challenging nature of care home contexts that are full of everyday ethical issues (Bollig et al, ; Preshaw, Brazil, McLaughlin, & Frolic, ). In care homes, professionals balance, for instance, between an older person's autonomy and the need to protect the residents’ safety, and individual's needs are framed by the needs of other residents (Evans et al, ). It is essential to consider the special characteristics of the care home context when aiming to promote the ethical competence of care home personnel.…”

Section: Discussionmentioning

confidence: 99%

Older people nursing in care homes: An examination of nursing professionals' self‐assessed competence and its predictors

Kiljunen

Partanen

Välimäki

et al. 2019

Int J Older People Nursing

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such as care and nursing homes) have a high prevalence of dependency, multimorbidity, polypharmacy, cognitive impairment and behavioural symptoms resulting in complex care needs (Gordon et al., 2014;Onder et al., 2012). When providing care in care and nursing Abstract Background: The need for older people nursing expertise is increasing, and every effort is required to ensure that personnel taking care of older people are capable of providing high-quality care. Aims:To explore care home nursing professionals' self-rated competence in older people nursing and to identify predictors of this competence. Design: A cross-sectional survey design.Method: Data were collected in August-September 2017 via an electronic questionnaire using the newly developed Nurse Competence in Care Home Scale (NCCHS).Participants (n = 781) were recruited via nurses' associations and social media. They were working in care homes either as licensed practical nurses (n = 680) or as registered nurse and/or in managerial position (n = 101).Findings: Approximately 65% of the respondents had "adequate competence," and 35% had "inadequate competence" in older people nursing based on self-assessed overall competence. Respondents rated their competence highest in "observation, communication, interaction" and lowest in "group guidance and activities" subscale.Age and further training were predictors of licensed practical nurses' competence, and length of work experience predicted registered nurses' competence. Conclusions:Self-assessments revealed the need for competence development especially in relation to holistic support of a person's well-being. It is recommended that care home nurses, managers, educators and curriculum developers all strive to develop care home staff's ability to support residents' well-being holistically. Implications for practice:Nursing personnel should consider all aspects of older people's well-being holistically. In care homes, it is essential to assess nursing staff competence and to provide possibilities for competence development for personnel. K E Y W O R D Scare home, competence, licensed practical nurses, nursing, older people, registered nurses, self-assessment

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Section: Discussionmentioning

confidence: 99%

Older people nursing in care homes: An examination of nursing professionals' self‐assessed competence and its predictors

Kiljunen

Partanen

Välimäki

et al. 2019

Int J Older People Nursing

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“…The article is structured as follows. Firstly, I consider conceptualizations of frailty and explore potential implications of its medicalization in shaping cultures of paternalism and risk‐aversion in nursing homes . I contrast this discourse with the current ethicolegal drive for “shared decision‐making” and “person‐centred care,” where people are supported to make informed decisions about their own care and choose when to invite others to act on their behalf .…”

Section: Aims and Objectivesmentioning

confidence: 99%

“…Structures and staffing of nursing home organizations entail pressures on time available for tasks to be completed, and efficiency requirements may be addressed through standardized protocols. Nursing home conventions may compete with a focus on individuals' personal preferences and values or may prioritize the needs of the group of residents over the needs of particular individuals . Staff may feel compelled to comply with protocol as they interpret it within a view of their professional obligations and their statutory duties to “protect” residents, in addition to a need to maintain control of their own work …”

Section: Norms Performativity and Agencymentioning

confidence: 99%

“She doesn't want to go to hospital. That's one thing she hates”: Collective performativity in avoidable nursing home to hospital transfers

Mäkelä

2018

Evaluation Clinical Practice

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Older people who live with a combination of conditions experience fluctuations over time, which others may interpret as a need for medical attention. For some nursing home residents, this results in transitions in and out of hospital. Such transfers may be arranged without expectation of improved quality of life, can be associated with significant morbidity and mortality, and may preclude end-of-life preferences. Factors affecting avoidable hospitalization for nursing home residents are not well understood. I aim to explore potential drivers, moving beyond deficit explanations relating to funding, training, and resources. I use a framework of analysis that firstly considers medicalization of frailty, as a state of vulnerability that provides focus for others' action. I then draw on Judith Butler's theory of performativity, to explore nursing homes as sites of identity work for staff, residents and families. I consider ways subjectivities can be effected through reiterative practice that is compelled by normative conventions. Trouble may arise when citational practice of health care staff, and performative acquiescence of residents and families, culminates in an inevitability of hospitalization when navigating grey areas of assumed clinical risk. Principles of coproduction could present a disruptive opening, to rework power asymmetries, and move toward aspirations for residents and their relatives to be at the centre of decisions about care.

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“…In the care of older people, there has been a tendency to prioritize physical safety and minimize risks (Gilmour et al, 2003;Morgan, 2010;Robinson et al, 2007). Care providers are often faced with ethical challenges in balancing between trying to reduce possible risks and protect persons with dementia and, at the same time, taking into account the individual's autonomy and quality of life (Clarke et al, 2009;Evans et al, 2018;Stevenson et al, 2018). It has been argued that this can lead to patronizing persons with dementia and overlooking their social and psychological well-being (Clarke & Mantle, 2016).…”

Section: Introductionmentioning

confidence: 99%

Risks as dilemmas for home care staff caring for persons with dementia

Sandberg

Borell

Rosenberg

2020

Aging & Mental Health

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Objectives: Many persons with dementia live at home with support from home care services. Despite this, research is scarce concerning how risks in daily life among persons with dementia are perceived and handled by home care staff. This study aimed to explore how home care staff identify risks in the everyday lives of persons with dementia, and to inquire into how they reasoned about their own actions related to those risks. Method: A qualitative approach was applied for the study. Both individual interviews and focus groups were conducted with home care staff (n ¼ 23). Data was analysed using a constant comparative method. Results: Identifying, reasoning and acting upon risks in the everyday lives of persons with dementia were related to several dilemmas for the home care staff. These dilemmas are described and elaborated on in three categories: 1) Strategies for tracking risks, 2) Dilemmas concerning where to draw the line and deciding when to act, and 3) Dilemmas when acting on risks. Conclusion: The study provides new knowledge about the dilemmas that staff in home care services may face and how they reason about managing risks in the homes of persons with dementia. The study shows that the staff had to weigh risk and safety against the autonomy of persons with dementia. Based on these findings, we want to highlight the importance of competence among home care staff and the organizational conditions that must exist in order to manage the challenges of risky situations.

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Care home manager attitudes to balancing risk and autonomy for residents with dementia

Abstract: There was a strong, even dominant, ethos of risk management and keeping people safe. Managing individual needs while maintaining a safe care home environment clearly is a constant dynamic interpersonal process of negotiating and balancing competing interests for care home managers.

Cited by 31 publications

References 22 publications

Older people nursing in care homes: An examination of nursing professionals' self‐assessed competence and its predictors

Older people nursing in care homes: An examination of nursing professionals' self‐assessed competence and its predictors

“She doesn't want to go to hospital. That's one thing she hates”: Collective performativity in avoidable nursing home to hospital transfers

Risks as dilemmas for home care staff caring for persons with dementia

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