Faculty of Health Studies, VID Specialized University, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
BMC Health Serv Res. 2022 Jun 4;22(1):749. doi: 10.1186/s12913-022-08123-x.
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.
To get insight into how nurses experience resistance to care from home-dwelling persons with dementia.
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.
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.
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.
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.
需要家庭保健护士提供足够的护理支持，以满足越来越多的居家痴呆症患者和拒绝护理的人的需求。护士在家庭保健中遇到痴呆症患者的抵触时所做的决定，对护理质量和获得护理的机会有广泛的影响。关于影响护士遇到居家痴呆症患者抵触护理的因素的研究甚少。
深入了解护士如何应对居家痴呆症患者的抵触护理。
采用主题分析的定性研究设计，按照 Braun 和 Clarke 的六个步骤进行。数据来自三个焦点小组和三个个人访谈，共有 18 名来自家庭保健的护士参与。访谈于 2020 年 12 月至 2021 年 4 月期间进行，为期 5 个月。
获得了挪威研究中心的批准，参考号为 515138，并获得了每个市辖区的研究顾问和家庭保健经理的批准。
确定了两个主要主题：1）受到复杂和不足的护理结构的挑战；2）根据情况调整护理。第一个主要主题下有三个子主题：缺乏系统的协作和理解、照顾的灵活性不足以及隐私的挑战。在第二个主要主题下，有三个子主题：避免强制治疗和护理以保护自主权、强制性护理的灰色地带和减少护理。这两个主要主题似乎相互依存，因为组织结构的挑战和变化影响了护士如何开展护理实践。
我们的研究结果表明，当面临抵触时，护士决定如何进行护理的责任被淡化。此外，他们的专业判断受到情境因素的影响，其特点是强烈承诺避免强制治疗和护理。一个持续的挑战是在保障共同决策的同时，平衡居家痴呆症患者严重健康损害的风险。一个需要提出的基本问题是，即使在严重健康损害的情况下，自主权是否可以战胜一切。
