a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK.
b Later Life and Memory Services , Warrington , UK.
Aging Ment Health. 2018 Feb;22(2):261-269. doi: 10.1080/13607863.2016.1244803. Epub 2016 Oct 21.
To determine how care home managers negotiate the conflict between maintaining a safe environment while enabling the autonomy of residents with dementia. This is important because there is limited research with care home managers; yet, they are key agents in the implementation of national policies.
Semi-structured interviews were conducted with 18 managers from care homes offering dementia care in the Northwest of England. Data were analysed using a thematic analysis approach.
There were three areas in which care home staff reported balancing safety and risk against the individual needs of residents. First, the physical environment created a tension between safety and accessibility to the outside world, which meant that care homes provided highly structured or limited access to outdoor space. Second, care home managers reflected a balancing act between an individual's autonomy and the need to protect their residents' dignity. Finally, care home managers highlighted the ways in which an individual's needs were framed by the needs of other residents to the extent that on some occasions an individual's needs were subjugated to the needs of the general population of a home.
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.
确定养老院经理如何在维护安全环境与保障痴呆症居民自主权之间进行协商。这一点很重要，因为目前针对养老院经理的研究有限；然而，他们是国家政策实施的关键推动者。
对英格兰西北部提供痴呆症护理的 18 名养老院经理进行了半结构化访谈。使用主题分析方法对数据进行了分析。
养老院工作人员报告了在安全和风险与居民个人需求之间进行平衡的三个方面。首先，物理环境在安全和与外界的可及性之间造成了紧张，这意味着养老院提供了高度结构化或有限的户外空间。其次，养老院经理在个人的自主权和保护居民尊严的需求之间反映出一种平衡行为。最后，养老院经理强调了个人需求被其他居民需求框定的方式，以至于在某些情况下，个人需求被置于养老院居民整体需求之下。
有一种强烈的，甚至是主导的，风险管理和保障人们安全的精神。在维护安全的养老院环境的同时管理个人需求，显然是养老院经理进行协商和平衡相互竞争利益的持续动态人际过程。
