03  What factors affect paramedics’ involvement of people with dementia in decisions affecting their care? A qualitative study

2020 ◽  
Vol 37 (10) ◽  
pp. e3.1-e3
Author(s):  
Esme Choonara
Keyword(s):  
Decision Making ◽  
Social Constructivism ◽  
Best Practice ◽  
Dementia Care ◽  
Research Approach ◽  
Best Interest ◽  
Complex Needs ◽  
Ethical Frameworks ◽  
People With Dementia ◽  
The Impact

BackgroundParamedics are frequently called to people with dementia due to high rates of co-morbidities and complex needs, but decision making can be challenging due to lack of information or difficulties in assessment. Best-practice dementia care should be holistic and involve people with dementia in decisions as far as possible. A small number of qualitative studies have looked at paramedics’ decision-making in relation to dementia, but these studies have not specifically investigated the involvement of people with dementia in decisions. This study aimed to explore how paramedics make decisions when attending people with dementia, with a particular focus on understanding the factors that impact on whether, how, and to what degree paramedics involve people with dementia in decisions about their care.MethodsA generic qualitative research approach was used, informed by social constructivism and by the researcher’s commitment to the concept of ‘personhood’ in dementia care. Data were collected through semi-structured individual interviews with seven paramedics, each lasting between 40 and 80 minutes. The interviews were recorded and transcribed verbatim and subsequently analysed using thematic analysis.ResultsFour themes were identified that all touched on challenges to delivering person-centred care for people with dementia. Themes identified were: 1. Paramedics’ differing approaches to assessing capacity and making best interest decisions. 2. Communication and developing a rapport. 3. Interconnections with others important to the person with dementia. 4. The impact of paramedics’ values and attitudes.ConclusionThe involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This study highlights how paramedics’ values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics with the skills and ethical frameworks needed to deliver high quality dementia care.

scholarly journals What factors affect paramedics’ involvement of people with dementia in decisions about their care? A qualitative study

2021 ◽  
Vol 5 (4) ◽  
pp. 1-8
Author(s):  
Esme Choonara ◽  
Julia Williams
Keyword(s):  
Best Practice ◽  
Dementia Care ◽  
Research Approach ◽  
Best Interest ◽  
Individual Interviews ◽  
Ethical Frameworks ◽  
Lack Of Information ◽  
People With Dementia ◽  
Generic Qualitative ◽  
The Impact

<sec id="s1">Background: Paramedics are frequently called to people with dementia, but decision making can be challenging due to lack of information or difficulties in assessment. Best-practice dementia care should be holistic and involve people with dementia in decisions as far as possible. </sec> <sec id="s2">Aims: To explore how paramedics make decisions when attending people with dementia, with a particular focus on factors that impact on how, and to what degree, paramedics involve people with dementia in these decisions. </sec> <sec id="s3">Methods: A generic qualitative research approach was used. Data were collected through semi-structured individual interviews with seven paramedics. The interviews were recorded and transcribed verbatim and subsequently analysed using thematic analysis. </sec> <sec id="s4">Results: Four themes were identified that all touched on challenges to delivering person-centred care. Themes identified were: 1) paramedics’ differing approaches to assessing capacity and making best interest decisions; 2) communication and developing a rapport; 3) interconnections with others important to the person with dementia; and 4) the impact of paramedics’ values and attitudes. </sec> <sec id="s5">Conclusion: The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This study highlights how paramedics’ values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics with the skills and ethical frameworks needed to deliver high quality dementia care. </sec>

How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care: a qualitative study

2021 ◽  
pp. medethics-2020-106690
Author(s):  
Sarah Rosenwohl-Mack ◽  
Daniel Dohan ◽  
Thea Matthews ◽  
Jason Neil Batten ◽  
Elizabeth Dzeng
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
The United States ◽  
Ethical Framework ◽  
Shared Decision ◽  
Life Care ◽  
Best Interest ◽  
Ethical Frameworks

ObjectivesThe end of life is an ethically challenging time requiring complex decision-making. This study describes ethical frameworks among physician trainees, explores how these frameworks manifest and relates these frameworks to experiences delivering end-of-life care.DesignWe conducted semistructured in-depth exploratory qualitative interviews with physician trainees about experiences of end-of-life care and moral distress. We analysed the interviews using thematic analysis.SettingAcademic teaching hospitals in the United States and United Kingdom.ParticipantsWe interviewed 30 physician trainees. We purposefully sampled across three domains we expected to be associated with individual ethics (stage of training, gender and national healthcare context) in order to elicit a diversity of ethical and experiential perspectives.ResultsSome trainees subscribed to a best interest ethical framework, characterised by offering recommendations consistent with the patient’s goals and values, presenting only medically appropriate choices and supporting shared decision-making between the patient/family and medical team. Others endorsed an autonomy framework, characterised by presenting all technologically feasible choices, refraining from offering recommendations and prioritising the voice of patient/family as the decision-maker.ConclusionsThis study describes how physician trainees conceptualise their roles as being rooted in an autonomy or best interest framework. Physician trainees have limited clinical experience and decision-making autonomy and may have ethical frameworks that are dynamic and potentially highly influenced by experiences providing end-of-life care. A better understanding of how individual physicians’ ethical frameworks influences the care they give provides opportunities to improve patient communication and advance the role of shared decision-making to ensure goal-aligned end-of-life care.

E-Governance and Natural Hazards in Mozambique

2015 ◽  
pp. 253-268 ◽  
Author(s):  
Avelino Mondlane ◽  
Karin Hasson ◽  
Oliver Popov
Keyword(s):  
Decision Making ◽  
Strategic Planning ◽  
Information And Communication Technologies ◽  
Local Governments ◽  
Best Practice ◽  
Good Governance ◽  
Communication Technologies ◽  
Information And Communication ◽  
Decision Making Processes ◽  
The Impact

Strategic planning is a decisive process toward sustainable development for any organization. Mozambique has developed many tools toward good governance, among which Poverty Alleviation Strategy Paper (PARPA) is an umbrella. PARPA includes different key decisive segments of society, particularly the Information and Communication Technologies (ICTs) as the pool for development. This chapter investigates to what extent e-Governance, particularly the development of strategies based on ICTs, can contribute to minimize the impact of floods at local governments by addressing best practice and decision-making process. The authors address backcasting methodology as an approach to consider in a participatory strategic planning for long-term decision-making processes. They use Chókwe District as a showcase where e-governance has an impact in mitigating and preventing the impact of floods.

scholarly journals Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039463
Author(s):  
Ramin Asgary ◽  
Katharine Lawrence
Keyword(s):  
Decision Making ◽  
Social Constructivism ◽  
Moral Distress ◽  
Unintended Consequences ◽  
Aid Effectiveness ◽  
International Agency ◽  
Negative Consequences ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Humanitarian Operations

IntroductionData regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.MethodsWe conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.Results61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks.ConclusionsEthical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.

The Impact of a Shared Decision-Making Training Program on Dementia Care Planning in Long-Term Care

2018 ◽  
Vol 64 (4) ◽  
pp. 1123-1135 ◽  
Author(s):  
Elena Mariani ◽  
Rabih Chattat ◽  
Giovanni Ottoboni ◽  
Raymond Koopmans ◽  
Myrra Vernooij-Dassen ◽  
...  
Keyword(s):  
Decision Making ◽  
Training Program ◽  
Shared Decision Making ◽  
Long Term Care ◽  
Dementia Care ◽  
Care Planning ◽  
Shared Decision ◽  
Term Care ◽  
The Impact

Caring for people with dementia in hospital: findings from a survey to identify barriers and facilitators to implementing best practice dementia care

2016 ◽  
Vol 29 (3) ◽  
pp. 467-474 ◽  
Author(s):  
Joanne Tropea ◽  
Dina LoGiudice ◽  
Danny Liew ◽  
Carol Roberts ◽  
Caroline Brand
Keyword(s):  
Best Practice ◽  
Quality Care ◽  
Hospital Setting ◽  
Hospital Staff ◽  
Dementia Care ◽  
Perceived Barriers ◽  
Barriers And Enablers ◽  
People With Dementia ◽  
Multidisciplinary Staff ◽  
Survey Responses

ABSTRACTBackground:Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care.Methods:A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey. The survey collected data about the respondents’ current role, work area, and years of experience, their perceived level of confidence and knowledge in dementia care and common symptoms of dementia, barriers and enablers to implementing best practice dementia care, job satisfaction in caring for people with dementia, and to rate the hospital's capacity and available resources to support best practice dementia care.Results:A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low.Conclusion:The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.

scholarly journals Resource allocation decision-making in dementia care with and without budget constraints: a qualitative analysis

2020 ◽  
Vol 3 ◽  
pp. 69
Author(s):  
Fiona Keogh ◽  
Tom Pierse ◽  
Eamon O'Shea ◽  
Christine Fitzgerald ◽  
David Challis
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Budget Constraint ◽  
Dementia Care ◽  
Assessment Process ◽  
Nominal Group ◽  
Dementia Case ◽  
People With Dementia ◽  
Health And Social Care ◽  
Services And Supports

Introduction: Health systems in many different countries have increasingly been reorienting the delivery of dementia care to home and community care settings. This paper provides information on how health and social care professionals (HSCPs) in Ireland make decisions on resource allocation for people with dementia living at home and how resource constraints affect their decisions and choices. Methods: The study employed a balance of care approach to assess resource allocation across six dementia case types, ranging from low to high needs. Decision-making workshops were held with 24 HSCPs from a range of backgrounds. Participants were asked to allocate services and supports across dementia case types in two scenarios: allocation with and without a budget constraint. Nominal group technique was used to structure discussions around resource allocation in both scenarios. Thematic analysis was applied to analyse the qualitative data using a general inductive approach. Results: The following themes influenced allocative deliberations: whose needs are being met; what needs are identified; decision making context; decision making process; and allocation outcomes. Participants used ‘decision rules’ or heuristics to help them make decisions under fixed budget rules. Conclusions: Freedom from a budget constraint allowed HSCPs to consider a broader range of services and to take a more expansive view on what needs should be considered, with a particular emphasis on adopting a proactive, preventative approach to the allocation of resources. The effect of the budget constraint overall was to narrow all considerations, using heuristics to limit the type of needs addressed and the range of services and supports provided. The consequences were a largely reactive, less personalised system of care. The findings emphasise the need for an integrated and comprehensive assessment process that is more concerned with individualised responses rather than relying on existing models of care alone.

scholarly journals Tourism, ageing and the demographic time bomb – the implications of dementia for the visitor economy: a perspective paper

2019 ◽  
Vol 75 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Joanne Connell ◽  
Stephen Page
Keyword(s):  
Behavioural Change ◽  
Leisure Activities ◽  
Health Conditions ◽  
Ageing Population ◽  
Business Practices ◽  
Content Type ◽  
Call To Action ◽  
Complex Needs ◽  
People With Dementia ◽  
The Impact

Purpose This paper aims to examine the development of research on ageing and demography and the implications for the study of tourism. It examines the demographic time bomb created by an ageing population and the implications of complex health conditions, such as dementia, for the visitor economy. Practical measures are identified with an example of a “call to action” for small to medium-sized tourism businesses. Design/methodology/approach This review is based on existing knowledge of ageing and draws upon a historical timeline that stretches from the nineteenth century to 2100. Findings The impact of complex health conditions such as dementia will pose major challenges for the visitor economy and will require behavioural change within existing business practices to accommodate the needs of people with dementia and their carers. Research limitations/implications Major changes in business practices and the development of more holistic views of accessibility will be needed to accommodate an ageing population in 2100. Some of the initial changes businesses can make are outlined in a “call to action” leaflet extract. Practical implications Businesses will need to focus more on customer care practices to ensure that they can accommodate the complex needs of people with dementia and their carers as they continue to pursue the tourism and leisure activities that they have grown accustomed to. Social implications Businesses will need to become more fully engaged with new agendas on accessibility, inclusivity and good business practice that raise significant ethical, financial and legal issues for the way they do business in the future. Originality/value The paper sets out an overarching grand societal challenge around ageing that is now confronting many countries worldwide. As part of that agenda, this paper raises the issue of hidden conditions such as dementia. The paper seeks to stimulate a wider debate for researchers and policymakers going forward, framed around the following questions which arise from the paper: How is dementia understood as a hidden condition in the visitor economy? To what extent is there awareness and action in the visitor economy sector? What can the visitor economy sector do to address issues of inclusivity and dementia?

Chile

2019 ◽  
pp. 329-336
Author(s):  
Andrea Slachevsky ◽  
Jean Gajardo
Keyword(s):  
Civil Society ◽  
Social Policy ◽  
Public Funding ◽  
Health Sector ◽  
Dementia Care ◽  
Awareness Campaign ◽  
Complex Needs ◽  
People With Dementia ◽  
The Family ◽  
Day Care Centres

Currently, it is estimated there are about 180,000 people living with dementia in Chile, and this number is projected to triple by 2020. Dementia has increasingly become an important condition for society, health, and social policy. Dementia care falls mostly under the family responsibility, with limited involvement from the health sector which is usually in terms of diagnosis in secondary healthcare. Chile has no National Dementia Strategy. However, civil society and academic efforts over the last few years have helped to create a favourable setting that has paved the way for several milestones in dementia care in the country: a national awareness campaign, enhanced research, increased public funding for day care centres, and the development of a National Dementia Plan with a multisectoral approach to address the complex needs of people with dementia and their caregivers.

Everybody needs a group: A qualitative study looking at therapists’ views of the role of psychotherapy groups in working with older people with dementia and complex needs

2018 ◽  
Vol 51 (1) ◽  
pp. 3-17 ◽  
Author(s):  
Sara Perren ◽  
Tracy Richardson
Keyword(s):  
Interpretative Phenomenological Analysis ◽  
Common Humanity ◽  
Complex Needs ◽  
Staff Members ◽  
People With Dementia ◽  
Expression Of Emotion ◽  
Group A ◽  
Group Members ◽  
Psychotherapy Groups ◽  
The Impact

Our objective was to evaluate clinicians’ views of the impact of conducting inpatient psychotherapy groups for older adults with enduring mental health issues and/or cognitive impairment. We conducted a literature review. A focus group was held with four group facilitators using a semi-structured format and open questioning. The transcript was analysed by the interviewer using Interpretative Phenomenological Analysis. Using guidelines provided by Smith and Osborn, themes were identified, clustered and a final set of themes developed. On completion, the researcher reported the findings back to one participant to increase the validity and trustworthiness of the analysis. Facilitators described impacts that were intra-personal, inter-personal and extra-personal. The capacity and desire to communicate and belong demonstrated by group members challenged their own views (and ageism) and that of staff members. The facilitators’ experience was of the beneficial and normalising effects of these groups in enabling and enhancing communication, emphasising common humanity, facilitating the expression of emotion and combating isolation by promoting a sense of belonging. Research is needed into the views of the group members. Thought is given to the challenges inherent in this.

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