Decisions and Dilemmas: The Context of Prioritization Dilemmas and Influences on Staff Members’ Prioritization Decisions in Residential Aged Care

2021 ◽  
pp. 104973232199829
Author(s):  
Kristiana Ludlow ◽  
Kate Churruca ◽  
Louise A. Ellis ◽  
Virginia Mumford ◽  
Jeffrey Braithwaite
Keyword(s):  
Decision Making ◽  
Structured Interview ◽  
Aged Care ◽  
Residential Aged Care ◽  
Staff Members ◽  
Lower Priority ◽  
Conflicting Demands ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Missed Care

Staff members in residential aged care facilities (RACFs) make prioritization decisions to determine which aspects of care are most important and thus should be attended to first. Prioritization can potentially result in substandard care if lower priority tasks are delayed or left undone, known as “missed care.” This study investigated the contexts in which prioritization dilemmas arise in RACFs and the influences on prioritization decision-making. Thirty-two staff members participated in a think-aloud task during a prioritization activity, a demographic questionnaire, a post-sorting interview, and a semi-structured interview. Data were analyzed using inductive content analysis. Prioritization dilemmas occurred in response to high workloads, inadequate staffing, unexpected events, and conflicting demands. Seven influences on prioritization decision-making were identified. In some instances, these influences were seen to be in conflict, making prioritization decision-making challenging. Efforts to prevent missed care should consider the influences on staff members’ decision-making and aim to reduce prioritization dilemmas.

How do care staff in residential aged care facilities conceptualise their non-verbal interactions with residents with dementia and what relevance has this for how residents’ preferences and capacity for decision-making are understood?

Dementia ◽  
2018 ◽  
Vol 19 (5) ◽  
pp. 1364-1380 ◽  
Author(s):  
Nadine Cameron ◽  
Deirdre Fetherstonhaugh ◽  
Michael Bauer ◽  
Laura Tarzia
Keyword(s):  
Decision Making ◽  
Aged Care ◽  
Verbal Communication ◽  
Care Staff ◽  
Residential Aged Care ◽  
Verbal Interactions ◽  
Staff Members ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

This paper considers the significance of how staff in residential aged care facilities interpret the non-verbal communication and behaviour of residents vis-a-vis their assessments of residents’ preferences and ability to participate in decision-making. It highlights the risks associated with staff members’ failure to interpret residents’ non-verbal communication and behaviour with reference to residents’ backgrounds and prior experiences. It also considers how non-verbal communication implemented by staff may impact residents’ emotional state and, as a consequence, decision-making abilities. Drawing on interview data with aged care staff from Queensland and Victoria, it demonstrates that care staff in residential facilities appear to rely heavily on non-verbal signals in assessing the decision-making capacity and preferences of residents with dementia. It also indicates that many staff fail to consider residents’ non-verbal communication and behaviour with due consideration of residents’ individual histories.

Challenges faced by residential aged care staff in decision-making for residents with dementia

Dementia ◽  
2020 ◽  
pp. 147130122092915
Author(s):  
Nadine Cameron ◽  
Deirdre Fetherstonhaugh ◽  
Michael Bauer
Keyword(s):  
Decision Making ◽  
Aged Care ◽  
Self Determination ◽  
Care Staff ◽  
Residential Aged Care ◽  
Organisational Support ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
National Framework

Care staff in residential aged care facilities (nursing homes) in Australia are obligated, under the Australian National Framework for Action on Dementia 2015–2019, to support residents to exercise choice and make decisions. Research indicates, however, that care staff are often given little guidance regarding which residents’ decisions should be supported or how to make decisions on their behalf. This lack of guidance can result in a denial of residents’ rights and inconsistent treatment by staff, placing residents’ wellbeing at risk. Through providing an analysis of the responses of staff at RACFs in Victoria and Queensland to two case scenarios, this study seeks to provide some understanding of the difficulties staff face in supporting residents’ self-determination and their own need for greater organisational support.

scholarly journals Staff members’ prioritisation of care in residential aged care facilities: a Q methodology study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kristiana Ludlow ◽  
Kate Churruca ◽  
Virginia Mumford ◽  
Louise A. Ellis ◽  
Jeffrey Braithwaite
Keyword(s):  
Q Methodology ◽  
Aged Care ◽  
Residential Aged Care ◽  
Staff Members ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

Staff attitudes towards sexual relationships among institutionalized people with dementia: does an extreme cautionary stance predominate?

2013 ◽  
Vol 26 (3) ◽  
pp. 403-412 ◽  
Author(s):  
Feliciano Villar ◽  
Montserrat Celdrán ◽  
Josep Fabà ◽  
Rodrigo Serrat
Keyword(s):  
Aged Care ◽  
Sexual Relationships ◽  
Residential Aged Care ◽  
Model Of Care ◽  
Staff Perceptions ◽  
Staff Members ◽  
People With Dementia ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Cognitively Intact

ABSTRACTBackground:This study explores whether staff perceptions and reactions to sexual situations involving one or two persons with dementia (PWD) reflect an extreme cautionary stance (an overprotective and paternalist style) or a person-centered model of care (focusing on understanding the residents’ perspective and their rights).Method:Fifty-three staff members currently working in residential aged care facilities (RACFs) were purposively selected to participate in the study. Two vignettes describing sexual situations involving PWD were presented to participants. They were asked about their interpretation of the situation and how they would react. Data were analyzed using content analysis, aimed at identifying common themes in the responses.Results:When the sexual relationship involved a PWD and a cognitively intact resident, participants tended to define the situation as real (54.7%) or possible (35.8%) abuse, whereas when both parties had dementia it was more frequently conceptualized as a possibly abusive (39.6%) or non-abusive (37.7%) situation. The most frequent reaction to both situations was seeking the advice of other professionals.Conclusion:The interpretation of the first situation is compatible with an extreme cautionary stance, whereas the second scenario is less clearly perceived as an example of abuse.

How Residential Care Staff Conceptualize the Identities of Residents With Dementia and Its Relevance for Decision Making

2020 ◽  
pp. 073346482095173
Author(s):  
Nadine Cameron ◽  
Deirdre Fetherstonhaugh ◽  
Michael Bauer ◽  
Laura Tarzia
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Aged Care ◽  
Care Staff ◽  
Residential Aged Care ◽  
Sources Of Knowledge ◽  
People With Dementia ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

The ways in which residential aged care staff conceptualize the identities of residents with dementia has significance for how they support them to make decisions and make decisions on their behalf. This article aims to further understand how staff in residential aged care facilities comprehend who residents “are.” Methods: This qualitative study draws on individual and group interview data with aged care staff from two Australian states concerning decision making for individuals with dementia. It identifies themes relevant to how staff refer to identity in relation to such residents. Results: Staff possess disparate ideas about what things comprise residents’ identities and, accordingly, which sources of knowledge are most relevant to learning about residents. Discussion: This article argues for the application of a multidimensional and temporally inclusive understanding of identity by those who provide care to people with dementia.

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