Use of constraints and their correlates in Norwegian nursing homes

Kirkevold, Øyvind; Sandvik, Leiv; Engedal, Knut

doi:10.1002/gps.1197

Cited by 47 publications

(70 citation statements)

References 39 publications

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“…Of the patients with dementia in Norwegian nursing homes, 71% have at least one clinically significant neuropsychiatric symptom as measured by the Neuropsychiatric Inventory . Neuropsychiatric symptoms cause distress for the patients, their relatives and nursing home staff (Sourial et al, 2001), and increase the incidence of physical restraints in the nursing homes (Werner et al, 1989;Kirkevold et al, 2004) and the prescription of psychotropic drugs (Bartels et al, 2003). As dementia becomes more severe, the NPS occur more frequently .…”

Section: Introductionmentioning

confidence: 99%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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ObjectiveThe Severe Impairment Battery (SIB) is developed to test cognitive function in patients with dementia of moderate to severe degree. We have conducted a study to assess the inter‐rater reliability and the validity of the Norwegian version of SIB.MethodsThe reliability study comprised 30 patients, and the validity study 59 patients in nursing homes. We assessed Cronbach's alpha coefficient of the scale and the inter‐rater reliability for the total SIB score and its nine sub scores between two testers by means of the Spearman's correlation coefficients. In the validity study we compared the SIB scores with the scores on the Clinical Dementia Rating Scale.ResultsThe mean SIB score was 72.10 (SD 25.37). The Cronbach's alpha was 0.97, and the inter‐rater reliability of total SIB score was Spearman's rho 0.85, and ranged from 0.46 to 0.76 for the nine sub‐scores. The mean SIB score for patients with a CDR score < 2 was 84.2(13.4), whereas total scores for patients with CDR 2 and 3 were 74 (18.9) and 48.4 (33.3), respectively. A cut‐off point of 80.5 points gave the highest accuracy in discriminating between patients with CDR 2 and CDR 3, while a cut‐off point of 87.5 best discriminated between CDR < 2 and CDR 3.ConclusionThe study indicates that the Norwegian version of SIB is a reliable and valid test with which to evaluate the cognition in patients with dementia of moderate to severe degree. Copyright © 2008 John Wiley & Sons, Ltd.

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Section: Introductionmentioning

confidence: 99%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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“…In such situations, their autonomy was overruled, despite the fact that there was no danger to life or health. As previous studies have shown, 4,7,12,15,16,19,28 RNs using coercive measures had convinced themselves that residents' problematic behaviour was due to lack of insight, and therefore, constraints were seen as appropriate. It seems as though legal rights were understood as actions to prevent falls or harm, and not as actions to support autonomy and non-coercive dementia care.…”

Section: Discussionmentioning

confidence: 97%

“…In one study, staff level did not reduce the use of coercive treatment, 4 and in another, understaffing was a significant factor in promoting such treatment. 16 In the theme 'nursing strategy with coercive treatment under specific circumstances', the RNs prioritized the residents' autonomy, but not non-coercive nursing care.…”

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confidence: 92%

“…In everyday dementia care, there are severe ethical dilemmas, in that legitimate demands for good and safe nursing conflict with national and international legislations. [2][3][4] In their everyday work, registered nurses (RNs) must balance between legislation and safe gerontological nursing, where preserving the dignity and integrity of older people with dementia is the aim of professional nursing. 5,6 Understanding when established constraints are to be perceived as an enforced physical violation or detention, and reflecting over existing norms and attitudes in care of older people, requires legal knowledge, competent staff, committed leadership and multi-professional teamwork.…”

Section: Introductionmentioning

confidence: 99%

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The ethics of coercive treatment of people with dementia

et al. 2013

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The aim of the present study was to describe how registered nurses in nursing homes ensure legal security, good and safe nursing care and uphold the dignity of nursing home residents with severe dementia without violating residents' integrity. Semi-structured interviews were conducted with 10 charge nurses in a county in central Sweden. The transcribed interviews were examined using manifest and latent content analyses. The manifest analysis identified actual local routines involving coercive treatment and registered nurses' descriptions of complications and alternative measures. The latent analysis resulted in three themes describing nursing strategies: one with coercive treatment, one with coercive treatment under specific circumstances and one to prevent coercive treatment. Interpretations of legal terms regarding coercive treatment and inadequate gerontological nursing training and understaffing seem to preserve the use of coercive treatment.

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“…The mean staffing ratio is 0.30 for RUs and 0.35 for SCUs. The proportion of unskilled staff is 11.9% in RUs and 12.6% in SCUs [28]. …”

Section: Methodsmentioning

confidence: 99%

Factors to Make the VIPS Practice Model More Effective in the Treatment of Neuropsychiatric Symptoms in Nursing Home Residents with Dementia

Røsvik

Engedal

Kirkevold

2014

Dement Geriatr Cogn Disord

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Background/Aims: A recent cluster-randomized controlled study showed that the VIPS practice model (VPM) for person-centred care had a significant effect on neuropsychiatric symptoms in nursing home residents with dementia. The randomized controlled trial (RCT) indicated that a substantial proportion of the total variance of the effects was related to conditions in the particular unit (ward). We have explored which factors explain the variance of the effect of the VPM. Methods: The VPM subset of data from the RCT was explored using multilevel linear regression. The dependent variables were the change in scores on the Neuropsychiatric Inventory Questionnaire (NPI-Q) and the Cornell Scale for Depression in Dementia (CSDD). Results: The unit in which the resident was living explained 22% of the VPM's total variance of the effect on the NPI-Q and 13% of that on the CSDD. The intraclass correlation coefficient at the unit level was explained mainly by unit size on both scales and was considerably higher than at the institutional level. Conclusion: The unit is the most influential level when implementing person-centred dementia care by use of the VPM. The unit size explains most of the variance of the effect of the VPM, and the effects were best in the small units.

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Use of constraints and their correlates in Norwegian nursing homes

Abstract: Constraint is frequently used in nursing homes, and most frequent toward patients with severe dementia, aggressive behaviour or low ADL function.

Cited by 47 publications

References 39 publications

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

The ethics of coercive treatment of people with dementia

Factors to Make the VIPS Practice Model More Effective in the Treatment of Neuropsychiatric Symptoms in Nursing Home Residents with Dementia

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