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


Autoři: Elizabeth L. Sampson aff001;  Aisling Stringer aff002;  Francesca La Frenais aff002;  Shanlee Higgins aff003;  Mary-Jo Doyle aff003;  Anne Laybourne aff002;  Gill Livingston aff002;  Gerard Leavey aff004
Působiště autorů: Marie Curie Palliative Care Research Unit, Division of Psychiatry, University College London, England, London, United Kingdom aff001;  Department of Old Age Psychiatry, Division of Psychiatry, University College London, England, London, United Kingdom aff002;  Camden and Islington NHS Foundation Trust, London, England, United Kingdom aff003;  Bamford Centre for Mental Health and Wellbeing, School of Psychology, Ulster University, Coleraine, Northern Ireland, United Kingdom aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224043

Souhrn

Background and objectives

Agitation 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 design

Ethnographic 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.

Methods

Three 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.

Results

We 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.

Conclusions

Care 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.

Klíčová slova:

Aggression – Allied health care professionals – Behavior – Dementia – Elderly – Emotions – Moral philosophy – Nurses


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