Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
Mijzo, Waalwijk, The Netherlands.
Qual Health Res. 2023 Sep;33(11):945-955. doi: 10.1177/10497323231186879. Epub 2023 Jul 10.
Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities and aim to provide person-centered care (PCC). Maintaining residents' autonomy is important to provide PCC, for example, with shared decision-making (SDM). Residents are largely dependent on multiple stakeholders, which could jeopardize their autonomy, especially regarding unhealthy behaviors, such as smoking tobacco or drinking alcohol. This case study explores the dynamics of multiple stakeholders around four RCF residents regarding their alcohol and/or tobacco use. Four RCF residents who smoke tobacco and/or drink alcohol were selected from a previous study, and their (in)formal caregivers were additionally invited to participate. A qualitative research design was chosen, and semi-structured interviews were conducted. The Ethics Review Board from the Tilburg University School of Social and Behavioral Sciences (Reference: RP39) and the executive boards of the two participating organizations granted approval. Narrative portraiture resulted in four case descriptions. Two cases focused mostly on tobacco use, and two cases focused mostly on alcohol use. Multiple stakeholders were involved on different levels: family bought alcohol or cigarettes, and team managers supported care professionals. However, little interaction was found between stakeholders. In these cases, limited interaction between the stakeholders, including the resident, jeopardizes SDM and, in this way, PCC regarding residents' alcohol and/or tobacco use. SDM on this topic could enhance interaction between all stakeholders involved, which could increase PCC. Finally, the cases indicate a constant struggle between protecting residents from adverse outcomes of alcohol and tobacco use and enhancing their autonomy.
养老院为认知和/或身体残疾的老年人提供 24/7 的护理，并旨在提供以患者为中心的护理（PCC）。维护患者的自主权对于提供 PCC 很重要，例如，通过共同决策（SDM）。患者在很大程度上依赖于多个利益相关者，这可能会危及他们的自主权，尤其是在涉及到吸烟或饮酒等不健康行为时。本案例研究探讨了围绕四名养老院居民的多个利益相关者在其烟酒使用方面的动态。从之前的一项研究中选择了四名吸烟或饮酒的养老院居民，并邀请他们的（非正式）护理人员参与。选择了定性研究设计，并进行了半结构化访谈。蒂尔堡大学社会与行为科学学院伦理审查委员会（参考号：RP39）和两个参与组织的执行委员会批准了这项研究。叙事肖像画产生了四个案例描述。两个案例主要集中在吸烟问题上，两个案例主要集中在饮酒问题上。多个利益相关者在不同层面上参与：家属购买烟酒，团队经理支持护理人员。然而，发现利益相关者之间的互动很少。在这些情况下，利益相关者之间，包括患者之间的有限互动，会危及 SDM，从而危及患者的烟酒使用方面的 PCC。关于这个主题的 SDM 可以增强所有相关利益相关者之间的互动，从而提高 PCC。最后，这些案例表明，在保护患者免受烟酒使用的不良后果和增强其自主权之间存在着持续的斗争。
