A survey of staff attitudes and responses to people with dementia who are aggressive in residential care settings

Abstract

Aggression is reportedly common among older people with dementia in residential care. The attitudes of staff in care homes and strategies they use are under researched. Theoretical models that may be used to both understand and respond to such behaviour exist. They are the standard and person-centred paradigms. The aim of this study was to explore the views of nursing staff about aggressive behaviour in people with dementia and strategies used in practice. A survey of the attitudes of staff in six dementia care units using the Management of Aggression in People with Dementia Attitude Questionnaire was conducted including an audit of aggressive incidents using the Staff Observation Aggression Scale-Revised over a 3-month period. Staff expressed views reflective of a person-centred as opposed to standard paradigm. They viewed aggressive behaviour by people with dementia as deriving from the environment, situation or interactions with others. Participants strongly supported interpersonal means of responding to aggression, the moderate use of medication, and were largely opposed to physical restraint. Aggressive incidents were managed using less intrusive strategies such as distraction and de-escalation. Responses to aggressive behaviour, while pragmatic, were largely underpinned by a person-centred ethic as reflected in the attitudes expressed by staff.

Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

“…Aggression may be attributable to psychosocial-environmental factors or the complex interaction of patients, staff and inpatient unit culture influences [8]. It may be due to the inability of elderly patients with dementia to communicate their needs effectively [9], poor staff-to-patient interactions or the environment of care [9,10], overcrowding, lack of privacy, lack of activities, weak clinical leadership [11], being denied something [7], and restricting patients’ freedom [12]. …”

“…Research into the use of restraint in elderly people has been conducted in general hospitals [28] and nursing home settings [9,10,29]. However, there has been little investigation of the use of these containment practices with elderly persons in old age psychiatry inpatient settings, and the rate and type of restraint use can vary, even within neighbouring units [30].…”

Factors Influencing Clinicians’ Attitudes about Aggression in Australian Acute Old Age Psychiatry Inpatient Units: A Cross Sectional Survey Design

“…Pulsford et al (2011), in a United Kingdom survey of staff attitudes toward older aggressive people with dementia in residential care settings, reported that aggressive behaviour was viewed more so as an interpersonal phenomenon attributable to situational events (e.g., unfavourable interactions with others or the environment of care), and staff responses to this behaviour were predominantly informed by a person-centred approach (e.g., deescalation) than containment methods (e.g., medication, restraint, and seclusion). However, a survey of aggression in a high secure hospital in the United Kingdom, by Pulsford et al (2013) reported that staff held mixed attitudes about the causes and management of patient aggression.…”

“…Aggression may be due to psychosocial-environmental influences; the interaction of patients, relatives, and staff; the culture of the inpatient setting; or some combination of these (Hamrin, Iennaco, & Olsen, 2009 The first system is the microsystem, which incorporates the patient's interactions in the immediate setting (e.g., restricting patients' freedom in the inpatient unit (Papadopoulos et al, 2012) with other people (e.g., incapacity of elderly patients with dementia to communicate effectively (Duxbury, Pulsford, Hadi, & Sykes, 2013) and inadequate staff-topatient communication Pulsford et al, 2011), and with symbols and language (the semiotic system). Influences at this level include, for instance, service user characteristics (e.g., sociodemographic, psychological, personality and biological factors, symptomatology, and cognitive functioning) and his or her interactions with other patients, clinicians, and relatives.…”

Inhaltsvalidierung des Fragebogens «The Management of Aggression in People with Dementia Attitude Questionnaire German Version» (MAPDAQ-G)

“…Trotzdem ist es für Pflegepersonen unüblich, Aggressionen zu thematisieren. Zudem zeigt die Literatur, dass noch wenig über aggressives Verhalten von Menschen mit Demenz bekannt ist und für Pflegepersonen eher wenig Präventions-und Interventionsprogramme im Umgang mit aggressivem Verhalten angeboten werden (Hahn & Metzenthin, 2010;Pulsford & Duxbury, 2006;Skovdahl, Kihlgren & Kihlgren, 2003;Zeller, Hahn, Needham, Kok, Dussen & Halfens, 2009 (Becker & Hahn, 2011;Duxbury, 2002;Franz, Zeh, Schablon, Kuhnert & Nienhaus, 2010;Pulsford, Duxbury & Hadi, 2010).…”