Organizational characteristics of highly specialized units for people with dementia and severe challenging behavior.

Autor: van Voorden G; Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands. gerrie.vanvoorden@radboudumc.nl.; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands. gerrie.vanvoorden@radboudumc.nl.; University Knowledge Network for Older Adult Care Nijmegen (UKON), Radboud University Medical Center, Nijmegen, Netherlands. gerrie.vanvoorden@radboudumc.nl.; Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands. gerrie.vanvoorden@radboudumc.nl., Koopmans RTCM; Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.; University Knowledge Network for Older Adult Care Nijmegen (UKON), Radboud University Medical Center, Nijmegen, Netherlands.; Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands.; Joachim en Anna, Center for Specialized Geriatric Care, De Waalboog, Nijmegen, Netherlands., Strik-Lips MM; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands., Smalbrugge M; Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.; Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, Netherlands., Zuidema SU; Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.; Alzheimer Center Groningen, Groningen, Netherlands., van den Brink AMA; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands., Persoon A; Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.; University Knowledge Network for Older Adult Care Nijmegen (UKON), Radboud University Medical Center, Nijmegen, Netherlands.; Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands., Oude Voshaar RC; Alzheimer Center Groningen, Groningen, Netherlands.; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Gerritsen DL; Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.; University Knowledge Network for Older Adult Care Nijmegen (UKON), Radboud University Medical Center, Nijmegen, Netherlands.; Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2024 Aug 14; Vol. 24 (1), pp. 681. Date of Electronic Publication: 2024 Aug 14.
DOI: 10.1186/s12877-024-05257-x
Abstrakt: Background: People with dementia and severe challenging behavior in the Netherlands can be temporarily admitted to highly specialized units when their behavior is not manageable in regular dementia special care units (DSCUs). With scarce evidence available for the treatment of these patients, treatment in these units is in a pioneering phase. To gain more insight into these units, this study investigated organizational characteristics, i.e. admission and discharge characteristics, staffing, the physical environment, and the management of severe challenging behavior.
Methods: Three data collection methods were used: 1) a digital questionnaire to be completed by the unit manager, 2) an interview with the physician responsible for medical care and often another practitioner, and 3) an observation of the physical environment for which the OAZIS-dementia questionnaire was used. Descriptive analysis was used for quantitative data and thematic analysis for qualitative data, after which data was interpreted together. Thirteen units participated, with their sizes ranging from 10 to 28 places.
Results: Patients were mainly admitted from regular DSCUs, home or mental health care, and discharged to regular DSCUs. A multidisciplinary team comprising at least an elderly care physician or geriatrician, psychologist, and nursing staff member and other therapists as needed provided the treatment. Nursing staff hours per patient considerably differed among units. Nursing staff played a central role in the treatment. Competences such as reflectiveness on one's own behavior, and being able to cope with stressful situations were described as relevant for nursing staff. Investing in a stable nursing staff team was described as important. The units varied in whether their work-up was more intuitive or methodological. In the diagnostic phase, observation together with an extensive analysis of the patient's biography was essential. The units used a broad variety of interventions, and all paid attention to sensory stimuli. In the observation of the physical environment, the safety scored well and domesticity relatively low.
Conclusion: Highly specialized units show strong heterogeneity in organizational characteristics and management, which can be understood in the light of the pioneering phase. Despite this, similarities were found in nursing staff roles, frequent multidisciplinary evaluation, and attention to sensory stimuli.
(© 2024. The Author(s).)
Databáze: MEDLINE
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