De Zorggroep, Center for Specialized Geriatric Care, Venlo, Netherlands.
Center for Specialized Psychiatric Care, Vincent van Gogh Institute, Venray, Netherlands.
Aging Ment Health. 2024 May;28(5):838-848. doi: 10.1080/13607863.2023.2280673. Epub 2023 Nov 22.
One of the main reasons for people with dementia to move to a dementia special care unit of a nursing home is challenging behavior. This behavior is often difficult to manage, and in the Netherlands, residents are sometimes relocated to a severe challenging behavior specialized unit. However, relocation often comes with trauma and should be prevented if possible. This study aimed to investigate the patient- and context-related reasons for these relocations.
Qualitative multiple case study using individual ( = 15) and focus group interviews ( = 4 with = 20 participants) were held with elderly care physicians, physician assistants, psychologists, nursing staff members, and relatives involved with people with dementia and severe challenging behavior who had been transferred to a severe challenging behavior specialized unit. Audio recordings were transcribed and analyzed with thematic analysis, including directed content analysis.
After five cases, data-saturation occurred. The thematic analysis identified three main processes: increasing severity of challenging behavior, increasing realization that the clients' needs cannot be met, and an increasing burden of nursing staff. The interaction between these processes, triggered mainly by a life-threatening situation, led to nursing staff reaching their limits, resulting in relocation of the client.
Our study resulted in a conceptual framework providing insight into reasons for relocation in cases of severe challenging behavior. To prevent relocation, the increasing severity of challenging behavior, increasing burden on nursing staff, and increasing realization that the clients' needs cannot be met need attention.
痴呆患者入住疗养院痴呆特殊护理单元的主要原因之一是行为挑战。这种行为通常难以管理，在荷兰，有时会将居民转移到专门的严重行为挑战单元。然而，搬迁通常会带来创伤，如果可能的话，应该避免搬迁。本研究旨在调查与患者和环境相关的这些搬迁原因。
采用个体（ = 15）和焦点小组访谈（ = 4 组，每组 20 名参与者）的定性多案例研究，访谈对象包括老年护理医生、医师助理、心理学家、护理人员和与患有痴呆症和严重行为挑战的患者有关的亲属，这些患者已被转移到严重行为挑战专科单元。对音频记录进行转录，并使用主题分析进行分析，包括定向内容分析。
经过五个案例，数据达到饱和。主题分析确定了三个主要过程：行为挑战的严重程度增加、越来越意识到客户的需求无法满足以及护理人员的负担增加。这些过程之间的相互作用，主要由危及生命的情况引发，导致护理人员达到极限，从而导致客户搬迁。
我们的研究得出了一个概念框架，深入了解了严重行为挑战情况下搬迁的原因。为了防止搬迁，需要关注行为挑战的严重程度增加、护理人员的负担增加以及越来越意识到客户的需求无法满足的情况。
