Exploring how care home staff manage responsive behaviours, associated with dementia, in care homes in Ireland, during the Covid-19 pandemic

O'Donnell, Elizabeth and Holland, Carol and Swarbrick, Caroline (2022) Exploring how care home staff manage responsive behaviours, associated with dementia, in care homes in Ireland, during the Covid-19 pandemic. PhD thesis, Lancaster University.

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Abstract

Introduction: Care home residents with dementia often exhibit responsive behaviours including agitation, aggression and wandering. Psychotropic drugs are often prescribed to manage responsive behaviours but contravene guidance as they increase the risk of serious adverse events and death in people with dementia. Aim: This thesis aims to understand how care home staff manage responsive behaviours to identify the barriers and facilitators to implementing a non-pharmacological approach to behaviour management. Methods: This thesis was underpinned by the transformative paradigm and critical theory. A review of qualitative studies was conducted to synthesise understanding of the facilitators or barriers to implementing non-pharmacological strategies to behaviour management (PROSPERO protocol registration CRD42020165948). The findings from the review, in addition to a qualitative survey and patient and public Involvement informed the design of the qualitative interview study to understand how responsive behaviours are managed by care home staff in the Republic of Ireland (ROI) prior to, and during the Covid-19 pandemic. In total, 25 interviews were conducted with staff from 21 care homes across Ireland. Reflexive thematic analysis of qualitative data was informed by Braun and Clarke (2019). All participants provided written informed consent. Ethical approval was obtained from Lancaster University. Findings: The findings from the systematic review and qualitative study found the barriers to taking a non-pharmacological approach to manage responsive behaviours included inadequate staff training and multidisciplinary collaboration. The qualitative study extends current knowledge by showing that a power hierarchy exists between healthcare assistants and nurses that posed a barrier to taking a non-pharmacological approach to behaviour management. Facilitators to taking a non-pharmacological approach included effective leadership and family involvement in resident care. Conclusion: This thesis extends knowledge by conceptualising how responsive behaviours are managed using both pharmacological and non-pharmacological approaches to identify the facilitators and barriers to implementing non-pharmacological strategies to behaviour management.