Background: People living with dementia in nursing homes are most likely to be restrained. The primary aim of\nthis mixed-method education intervention study was to investigate which factors hindered or facilitated staff\nawareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in\nresidents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and\nmonthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The\npresent article reports on staff-related data from the study.\nMethods: We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT\n(Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and\nsocial factors at work) instruments were used to measure staff effects in terms of person-centred care and\nperception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews\nand analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The\nPARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the\nstudy design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention.\nResults: Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of\nperson-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation\nwas explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative\nmeasures to restraint were applied was a function of dynamic interplay between facilitation and contextual\nelements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or\nhindering person-centered care. However, leadership-staff relations varied substantially across individual institutions,\nas did staff awareness related to restraint and person-centeredness.\nConclusions: Leadership, in interplay with staff culture, turned out to be the most important factor hindering or\npromoting staff awareness related to confidence building initiatives, based on person-centered care. While\nquantitative data indicated variations across institutions and the extent of this variation, qualitative data offered\ninsight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual\nrelationships.
Loading....