Forced treatment and care in home-dwelling persons with dementia

Gjellestad, Åshild; Oksholm, Trine; Bruvik, Frøydis Kristine

doi:10.1177/0969733020948107

Cited by 13 publications

(11 citation statements)

References 46 publications

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“…Subsequently, the ward personnel discussed whether they should apply for a coercive decree (a formal decision of forced treatment and care, sent to the County Governor's Office, cf. Gjellestad. et al, 2021).…”

Section: Avoiding Coercionmentioning

confidence: 99%

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

2021

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Introduction Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care. Therefore, quality in daily care for older people also depends upon the nurses’ ability to make complex, ethical decisions in their practice. Objectives To explore ethical challenges experienced by nurses caring for older people in clinical practice, and to provide examples of management for the challenges. Methods The data collected were written reflection notes by Norwegian continuous education students in advanced gerontology. Forty two of 83 notes were included and a thematic analysis in six steps was utilized. Findings There are three main themes: (1) meeting vulnerability, discomfort, and suffering, (2) collaboration with relatives, and (3) struggling to perform professional care. Conclusion Nurses strive to “do what is in the patients’ best interest”, and this is fostered through collaboration, professionalism, care, and presence. Nurses’ ethical competencies may develop when reflecting upon their own care performance. Building ethical competencies should be a priority in both nursing education and clinical practice. However, to improve care quality, nurses also need professional knowledge about older people care and ethical awareness should be supported by the workplace.

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Section: Avoiding Coercionmentioning

confidence: 99%

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

2021

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“…From previous research we know that the reported use of forced treatment to care for persons with dementia in home health care is low and there is little knowledge about how health professionals face situations of resistance [ 3 ]. The prevalence of forced treatment and care found in international studies show considerable variation [ 12 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Autonomy conquers all: a thematic analysis of nurses’ professional judgement encountering resistance to care from home-dwelling persons with dementia

Gjellestad

Oksholm

Alvsvåg

et al. 2022

BMC Health Serv Res

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Background Adequate care support from home health care nurses is needed to meet the needs of an increasing number of home-dwelling persons with dementia and those who resist care. The decisions nurses make in home health care when encountering resistance from persons with dementia have an extensive impact on the quality of care and access to care. There is little research on what influences nurse’s encounters with resistance to care from home-dwelling persons with dementia. Research aim To get insight into how nurses experience resistance to care from home-dwelling persons with dementia. Methods A qualitative research design using a thematic analysis was conducted following the six steps by Braun and Clarke. Data was gathered from three focus group and three individual interviews, and a total of 18 nurses from home health care participated. The interviews took place over a period of 5 months, from December 2020 to April 2021. Ethical considerations Approved by the Norwegian Centre for Research, reference number 515138 and by the research advisers and home care managers in each section of the municipality. Results Two main themes were identified: 1) Challenged by complex and inadequate care structures and 2) Adapting care according to circumstances. There were three subthemes within the first main theme: lack of systematic collaboration and understanding, insufficient flexibility to care, and the challenge of privacy. In the second main theme, there were three subthemes: avoid forced treatment and care to protect autonomy, gray-areas of coercive care and reduced care. The two main themes seemed to be interdependent, as challenges and changes in organizational structures influenced how nurses could conduct their care practices. Conclusion Our findings indicate that nurses’ responsibility to decide how to conduct care is downplayed when facing resistance. Further, their professional judgement is influenced by contextual factors and characterized by a strong commitment to avoid forced treatment and care. A continuous challenge is to safeguard shared decision-making at the same time as it is balanced against risks of severe health damage in home-dwelling persons with dementia. A fundamental question to ask is whether autonomy does conquer all, even when severe health damage is at stake.

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“… Harmful interventions : In order to mitigate first‐order risks such as level of care needed by the client, their home environment and behaviours, homecare workers' skill levels and working conditions a range of interventional actions were described that had the potential to result in adverse care. These were the use of physical and chemical restraints and non‐consensual care (Gjellestad et al, 2020; Hamers et al, 2016; Leverton, Burton, Beresford‐Dent, Rapaport, Manthorpe, Mansour, et al, 2021b; Mengelers et al, 2018, 2020; Moermans et al, 2018); reduction of formal care provision, such as shorter visits when technology had been introduced or when homecare workers were fearful of violence (Fæø et al, 2020; Galinsky et al, 2010; Mole et al, 2019), and paternalism which was employed to manage conflict (Smebye et al, 2016). Beneficial interventions : Homecare workers adapted their approach to improve clients' wellbeing, reduce clients' anxiety, support them to feel safer and to work more effectively with family carers.…”

Section: Resultsmentioning

confidence: 99%

“…Homecare workers were also affected by second‐order risks, for example, when regulatory codes constrained person‐centred care (Lundberg, 2017) or ethical dilemmas became apparent (Gjellestad et al, 2020; Leverton, Burton, Beresford‐Dent, Rapaport, Manthorpe, Mansour, et al, 2021b; Smebye et al, 2016). Homecare workers had to cope with fear of violence (Galinsky et al, 2010), exhaustion, isolation (Yeh et al, 2018), their own emotional responses (Yeh et al, 2018), losses to professional integrity (Abrams et al, 2019), and/or loss of clients (Mole et al, 2019).…”

Section: Resultsmentioning

confidence: 99%

Risks and risk mitigation in homecare for people with dementia—A two‐sided matter: A systematic review

Backhouse

Ruston

Ward

et al. 2022

Health Social Care Comm

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Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first‐order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second‐order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person‐centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks.

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Forced treatment and care in home-dwelling persons with dementia

Cited by 13 publications

References 46 publications

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis

Autonomy conquers all: a thematic analysis of nurses’ professional judgement encountering resistance to care from home-dwelling persons with dementia

Risks and risk mitigation in homecare for people with dementia—A two‐sided matter: A systematic review

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