Centre for Ageing Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YG, United Kingdom.
Int J Nurs Stud. 2022 Sep;133:104260. doi: 10.1016/j.ijnurstu.2022.104260. Epub 2022 Apr 22.
Psychotropic drugs are often prescribed to manage behaviour that challenges in care home residents with dementia but contravene guidelines as evidence shows their use increases the risk of strokes and death. Therefore, a review is needed that conceptualises understanding of the pharmacological and non-pharmacological strategies implemented by care home staff to manage behaviour that challenges in dementia and the factors that influence decision-making. This knowledge is important to develop dementia guidelines to implement a sustainable non-pharmacological approach to support residents with behaviour that challenges.
To review qualitative studies to synthesise understanding of strategies implemented by care home staff to manage behaviour that challenges in dementia.
This systematic review involved a synthesis of qualitative data (PROSPERO protocol registration CRD42020165948). Searches of three electronic databases, PubMed, PsycINFO and CINAHL were conducted from inception until July 2021, supplemented by grey literature searches. Studies were included if they used qualitative methods and explored how care home staff respond to behaviour that challenges; data exploring other aspects of dementia care were excluded. Study quality was assessed using the Critical Appraisal Skills Programme checklist. Thematic synthesis was used to conceptualise understanding of the strategies implemented by care home staff to manage behaviour that challenges in dementia.
In total 1151 records were identified of which 34 studies were included in the review. Three themes emerged, 'Putting out the fires', refers to reactive strategies, implemented by staff to quell behaviour that challenges. However, if these strategies fail, staff may resort to pharmacological approaches for convenience to suppress these behaviours. The theme 'Personhood, human rights and respect' highlights the need for people with dementia to feel valued and useful by engaging residents in meaningful activities. Furthermore, the theme "Person focused approach - A paradigm shift" reflects changes in culture, required to implement non-pharmacological strategies to behaviour management these include staff training, collaboration and equitable decision-making.
This review has identified strategies used by care home staff to manage behaviour that challenges. Non-pharmacological approaches to support residents with behaviour that challenges require staff training in behaviour management and psychotropic medicine management as part of their formal education program, and enhanced opportunities for collaboration and decision-making. In addition, residents should receive person focused support to facilitate participation in meaningful activities. These findings will be beneficial in developing guidelines to implement sustainable non-pharmacological approaches to manage behaviour that challenges in dementia.
精神药物常用于管理患有痴呆症的养老院居民的行为问题，但这些药物的使用与指南相违背，因为有证据表明它们会增加中风和死亡的风险。因此，需要进行一次综述，该综述将从概念上理解养老院工作人员为管理痴呆症患者的行为问题而实施的药理学和非药理学策略，以及影响决策的因素。这些知识对于制定痴呆症指南以实施支持具有挑战性行为的居民的可持续非药物方法非常重要。
综述定性研究，综合了解养老院工作人员为管理痴呆症患者的行为问题而实施的策略。
本系统综述涉及对定性数据的综合（PROSPERO 方案注册 CRD42020165948）。从一开始到 2021 年 7 月，对三个电子数据库（PubMed、PsycINFO 和 CINAHL）进行了搜索，并补充了灰色文献搜索。如果研究使用定性方法并探讨了养老院工作人员如何应对行为挑战，则将其纳入研究；排除了数据探索痴呆症护理其他方面的研究。使用批判性评估技能计划检查表评估研究质量。主题综合用于从概念上理解养老院工作人员为管理痴呆症患者的行为问题而实施的策略。
共确定了 1151 条记录，其中 34 项研究纳入了综述。出现了三个主题，“扑灭火灾”，指的是工作人员为平息行为挑战而采取的被动策略。然而，如果这些策略失败，工作人员可能会为了方便而诉诸药物手段来抑制这些行为。主题“人格、人权和尊重”强调了痴呆症患者通过参与有意义的活动感到有价值和有用的需要。此外，主题“以人为主导的方法——范式转变”反映了实施非药物策略来管理这些行为所需的文化变革，包括工作人员培训、协作和公平决策。
本综述确定了养老院工作人员为管理行为挑战而采用的策略。支持具有挑战性行为的居民的非药物方法需要工作人员在行为管理和精神药物管理方面接受培训，作为其正规教育计划的一部分，并增强协作和决策的机会。此外，居民应该得到以人为主导的支持，以促进参与有意义的活动。这些发现将有助于制定实施可持续非药物方法来管理痴呆症患者行为挑战的指南。
