Iatrogenesis in the Context of Residential Dementia Care: A Concept Analysis

Abstract

Background and Objectives This concept analysis aims to explore iatrogenesis within the context of residential dementia care and to distinguish this phenomenon from similar phenomena, such as abuse and inadvertent harm. Research Design and Methods Walker & Avant’s method for concept analysis was used to define critical attributes of iatrogenesis within residential dementia care, and to explore antecedents and consequences of its occurrence. A review of the literature about iatrogenesis in the context of residential dementia was conducted across four electronic databases. Texts about iatrogenesis in surgery, medicine, social work, psychology, and other relevant disciplines were also reviewed to provide additional context for the concept. Results Iatrogenesis takes a unique form in residential dementia care. The final definition of the concept proposed in this paper is habituated, forceful, hands-on care provided to residents who exhibit responsive behaviors that results in emotional, physical, spiritual, social harm, and/or gradual functional decline, that is provided with the intention of supporting the resident’s safety and dignity. Discussion and Implications The definition of iatrogenesis proposed in this paper is an initial step toward developing evidence-based practice for the provision of non-consensual assistance in residential dementia care. A theoretical definition like the one proposed in this paper may serve as a starting point for the operationalization of the concept, which would promote future empirical research into staff and residents' experiences of healthcare-inflicted harms in this context. Theoretically, it contributes to critical conversations about the narratives, myths, and misperceptions that facilitate the provision of non-consensual care.

Supporting Persons With Dementia: Perspectives From Certified Nurse’s Assistants

“…It is worth noting that persons with dementia receiving care may be exposed to poorer care or poorer responses during the CNA’s experimentation or learning process, suggesting that while experiential learning is necessary, training could potentially reduce negative consequences for care recipients. Additionally, training may improve the delivery of nonconsensual care, thus reducing BPSD ( Morris et al, 2022 ). Training are available for free from State Health departments and/or the Alzheimer’s Association and via further certifications, such as the Certified Dementia Practitioner training program through the National Council of Certified Dementia Practitioners.…”

“…This can feel awkward and increase ambiguity, leading CNAs to limit initiating interactions. This can be problematic because it can lead to an increase in nonconsensual care and subsequent increases in BPSD ( Morris et al, 2022 ).…”

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“… Morris et al (2022) jolt our thinking by labeling some aspects of current dementia care practices as iatrogenic. Their analysis exposes the violence to personhood inherent in the physical and psychological staff tactics meant to protect and contain reactive residents with cognitive impairments.…”

“…Another group ( Carnahan et al, 2022 ; Cross & Adler-Milstein, 2022 ; Davitt & Brown, 2022 ; Hass et al, 2022 ; Ninteau & Bishop, 2022 ) discuss aspects of clinical care that should be targets for improvement and regulation. And a third group ( Grabowski, 2022 ; Morris et al, 2022 ; Shippee et al, 2022 ) take us beyond what is currently measured and regulated to investigate factors affecting meaning and quality of life for nursing home residents.…”