Exploring acute care nurses’ decision‐making in psychotropic PRN use in hospitalised people with dementia

2020 ◽  
Author(s):  
Brittany Walsh ◽  
Sherry Dahlke ◽  
Hannah O’Rourke ◽  
Kathleen F. Hunter
Keyword(s):  
Decision Making ◽  
Acute Care ◽  
Acute Care Nurses ◽  
People With Dementia

scholarly journals 171 Programme Theory to Guide the Adoption of Assisted Decision Making with Older People in Acute Healthcare: Realist Evaluation

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Carmel Davies ◽  
Deirdre O'Donnell ◽  
Éidín Ní Shé ◽  
Sarah Donnelly ◽  
Francesco Fattori ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Acute Care ◽  
Professional Training ◽  
Legal Framework ◽  
Realist Evaluation ◽  
Shared Responsibility ◽  
Programme Theory ◽  
Key Informants ◽  
People With Dementia

Abstract Background In Ireland, the Assisted Decision-Making (ADM) (Capacity) Act and emerging Codes of Practice provide a legal framework for Healthcare Professionals (HCPs) to enable ADM for patients with impaired capacity. ADM ensures that a person’s will and preference is at the centre of all decisions related to their care. This study conducted a realist evaluation and developed a Programme Theory (PT) to highlight how ADM for older people can be operationalised within an Acute Care (AC) context. Methods Key informants with interest in ADM informed this evaluation. Interviews were conducted in two Acute Care (AC) sites with multidisciplinary HCPs working within older person services (n=20). Interviews with informants that recently received care within an AC setting involved older people (n=3) people with dementia (n=4) and family carers (n=5). Ethnographic observations from AC multidisciplinary team meetings also informed the review. The framework that guided the qualitative analysis was from a PT informed by literature on ADM implementation in healthcare (O'Donnell, Ní Shé, Davies et al.2018). Results The refined PT is supported by credible evidence that is informed by authentic experiences of decision making support in the AC setting. Validation groups (n=4) with the key informants verified the PT. Three mechanisms were identified as a positive climate and receptive environment for the adoption of formal ADM. These are: AC settings that adopt inter-professional accountability and shared responsibility for patient care that is guided by a clear policy process. Acute care and practice that is informed by a shared commitment to person-centred care and shared decision making. HCPs that operate within an AC setting where organisational learning informs practice through inter-professional training, mentorship and peer support. Conclusion Involving stakeholders in PT development enhances the utility, feasibility and applicability of the results. This PT provides a framework for those planning ADM implementation within the AC settings.

scholarly journals Acute care nurses' perceptions of barriers to using research information in clinical decision-making

2002 ◽  
Vol 39 (1) ◽  
pp. 46-60 ◽  
Author(s):  
Dorothy McCaughan ◽  
Carl Thompson ◽  
Nicky Cullum ◽  
Trevor A. Sheldon ◽  
David R. Thompson
Keyword(s):  
Decision Making ◽  
Acute Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Research Information ◽  
Acute Care Nurses ◽  
Nurses Perceptions

scholarly journals Person-centered dementia care in home care services – highly recommended but still challenging to obtain: a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kari-Anne Hoel ◽  
Anne Marie Mork Rokstad ◽  
Ingvild Hjorth Feiring ◽  
Bjørn Lichtwarck ◽  
Geir Selbæk ◽  
...  
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Shared Decision Making ◽  
Care Service ◽  
Home Care Services ◽  
Shared Decision ◽  
Care Services ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care

Abstract Background Dementia is one of the main causes of disability and dependence in older people, and people with dementia need comprehensive healthcare services, preferably in their own homes. A well-organized home care service designed for people with dementia is necessary to meet their needs for health- and social care. Therefore, it is important to gain knowledge about how people with dementia experience the home care service and if the service responds to their wishes and needs. The aim of this study was to explore the experience of home care services among people with dementia, to understand the continuity in services, how the service was adapted to people with dementia, and how the patient experienced person-centered care and shared decision-making. Methods We used a qualitative, exploratory design based on a phenomenological-hermeneutic approach and performed individual in-depth interviews with persons with dementia. A convenience sample of 12 persons with moderate to severe degrees of dementia from four Norwegian municipalities participated in the study. The interviews were conducted in February 2019. Results The findings identified that the participants appreciated the possibility to stay safely in their own homes and mostly experienced good support from staff. They expressed various views and understanding of the service and experienced limited opportunities for user involvement and individualized, tailored service. The overall theme summarizing the findings was: “It is difficult for people with dementia to understand and influence home care services, but the services facilitate the possibility to stay at home and feel safe with support from staff.” Conclusion The participants did not fully understand the organization of the care and support they received from the home care services, but they adapted to the service without asking for changes based on their needs or desires. Although person-centered care is recommended both nationally and internationally, the participants experienced little inclusion in defining the service they received, and it was perceived as unclear how they could participate in shared decision-making.

What factors affect nursing retention in the acute care setting?

2011 ◽  
Vol 16 (6) ◽  
pp. 489-500 ◽  
Author(s):  
Cynthia L. Cummings
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Moral Distress ◽  
Intent To Stay ◽  
Institutional Setting ◽  
Acute Care Setting ◽  
Nursing Retention ◽  
Acute Care Nurses ◽  
Professional Stress ◽  
The Impact

Moral distress and professional stress affect the lives of acute care nurses everyday. The impact of these stressors may be causing nurses to leave the acute care setting. This paper will outline the findings from a descriptive study of acute care nurses in Northeast Florida. The research was conducted in an effort to highlight some of the critical factors that impact nurses in the acute care setting and affect their intent to stay at an institution. The concepts of moral distress and professional stress in relation to nursing retention are highlighted and some strategies for lessening of these stressors are proposed. The study was correlational and conducted among 234 nurses in an institutional setting. The study included an online survey based on established Moral Distress and Professional Stress tools. In addition, a qualitative section was included to explore the nurses’ experiences of stressful inpatient situations. The results of this study demonstrated that when combined, both professional stress and moral distress items were predictive of the nurses’ intent to stay at the institution ( p <.001).

scholarly journals Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018337 ◽  
Author(s):  
Leontine Groen-van de Ven ◽  
Carolien Smits ◽  
Fuusje de Graaff ◽  
Marijke Span ◽  
Jan Eefsting ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Critical Points ◽  
Informal Caregivers ◽  
Case Managers ◽  
Shared Decision ◽  
People With Dementia ◽  
Informed Preferences ◽  
Adapted Process

ObjectiveTo explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories.DesignA qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction.SettingCommunity settings and nursing homes in the Netherlands.Participants19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers).ResultsThe participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare.ConclusionShared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.

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