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A Quantitative and qualitative inquiry into dementia and physically aggressive behaviour in residential aged care

thesis
posted on 2023-05-26, 02:19 authored by Cubit, KA
Australia has an ageing population with a proportionate increase in the number of people with dementia. Subsequently, there are an increasing number of people living in residential aged care with dementia. Indirect evidence suggests behavioural symptoms associated with dementia are of concern to nursing and care staff but there is little research that explores how and why this is the case. The behavioural symptoms of dementia are referred to as Behaviours of Concern (BoC) in this thesis. This study examines the extent to which BoC are of concern to nursing and care staff in the Tasmanian residential aged care sector. A mixed methods approach comprising two distinct phases was undertaken. The first phase was a general survey to determine the incidence and impact of BoC to provide a contextual perspective. The focus was on physically aggressive behaviour in Tasmanian Residential Aged Care Facilities (RACFs). This was important because of two identified gaps in the literature: a lack of clarity found in the reporting of incidence of physically aggressive behaviours; and an ambiguity surrounding the impact of physically aggressive behaviour on nursing and care staff. The second phase focussed on the incidence, impact, understanding and management of physically aggressive behaviour in one RACF from multiple perspectives to determine how and why it was of concern to nursing and care staff. Data were collected using multiple methods including a survey, a clinical audit, structured observation, participant observation, group discussions and interviews with nursing and care staff. The literature highlighted that physically aggressive behaviour among residents with dementia is a significant issue for nursing and care staff in RACFs. This study found a low incidence of physically aggressive behaviour among people with dementia, but that when it occurred it had a high impact on nursing and care staff. The high impact is attributed to a lack of capacity within the aged care sector to manage such behaviour effectively. This lack of capacity was due to a number of key factors. These included: the absence of a formal dementia diagnosis; a shortage of skilled nursing staff able to understand and assess individual residents' needs; a nursing and care staff shortage restricting the possibility of delivering one-to-one nursing care; a culture of tolerance to physically aggressive behaviours; a culture of resistance to the implementation of behaviour management strategies; problems with the educational preparation of staff; and ineffective communication between nursing and care staff regarding behaviour management.

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