Agitation near the end of life with dementia: An ethnographic study of care

Autor: Anne Laybourne, Aisling Stringer, Shanlee Higgins, Mary-Jo Doyle, Elizabeth L Sampson, Gill Livingston, Gerard Leavey, Francesca La Frenais
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Research design
Male
Health Care Providers
Judgement
Emotions
Nurses
Social Sciences
0302 clinical medicine
Elderly
Medicine and Health Sciences
Homes for the Aged
Psychology
030212 general & internal medicine
Medical Personnel
Disengagement theory
Psychomotor Agitation
Aged
80 and over
Allied Health Care Professionals
Terminal Care
Multidisciplinary
Middle Aged
Aggression
Professions
England
Neurology
Medicine
Care work
Female
Research Article
Adult
Music therapy
Science
Moral Philosophy
Context (language use)
03 medical and health sciences
Quality of life (healthcare)
Nursing
Mental Health and Psychiatry
medicine
Dementia
Humans
Anthropology
Cultural
Aged
Behavior
Biology and Life Sciences
medicine.disease
Nursing Homes
Health Care
Philosophy
Age Groups
People and Places
Quality of Life
Population Groupings
030217 neurology & neurosurgery
Zdroj: PLoS ONE, Vol 14, Iss 10, p e0224043 (2019)
PLoS ONE
ISSN: 1932-6203
Popis: Background and objectivesAgitation is common in people living with dementia especially at the end of life. We examined how staff interpreted agitation behavior in people with dementia nearing end of life, how this may influence their responses and its impact on the quality of care.Research designEthnographic study. Structured and semi-structured non-participant observations (referred to subsequently in this paper as "structured observations") of people living with dementia nearing the end of life in hospital and care homes (south-east England) and in-depth interviews with staff, conducted August 2015-March 2017.MethodsThree data sources: 1) detailed field notes, 2) observations using a structured tool and checklist for behaviors classed as agitation and staff and institutional responses, 3) staff semi-structured qualitative interviews. We calculated the time participants were agitated and described staff responses. Data sources were analyzed separately, developed continuously and relationally during the study and synthesized where appropriate.ResultsWe identified two main 'ideal types' of staff explanatory models for agitation: In the first, staff attribute agitated behaviors to the person's "moral judgement", making them prone to rejecting or punitive responses. In the second staff adopt a more "needs-based" approach in which agitation behaviors are regarded as meaningful and managed with proactive and investigative approaches. These different approaches appear to have significant consequences for the timing, frequency and quality of staff response. While these models may overlap they tend to reflect distinct organizational resources and values.ConclusionsCare worker knowledge about agitation is not enough, and staff need organizational support to care better for people living with dementia towards end of life. Positional theory may help to explain much of the cultural-structural context that produces staff disengagement from people with dementia, offering insights on how agitation behavior is reframed by some staff as dangerous. Such behavior may be associated with low-resource institutions with minimal staff training where the personhood of staff may be neglected.
Databáze: OpenAIRE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje