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Balancing integrity vs. risk of falling – nurses’ experiences of caring for elderly people with dementia in nursing homes

Faculty of Nursing Science, Gjøvik University College, Gjøvik, Norway; Department of Nursing, Karlstad University, Karlstad, Sweden

Margareta Bachrach-Lindström

Division of Nursing Science, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden

Solveig Struksnes

Faculty of Nursing Science, Gjøvik University College, Gjøvik, Norway

Birgitta Hedelin

Faculty of Nursing Science, Gjøvik University College, Gjøvik, Norway; Department of Nursing, Karlstad University, Karlstad, Sweden

Abstract

Dementia is recognized as being a major risk for falls that cause suffering and increase dependency for the individual. The purpose of this study was to explore registered nurses’ and nurse assistants’ experiences of caring for elderly people with dementia who are at risk of falling, and factors that contribute or reduce falls in this group. A phenomenographic design was chosen. Ten nurses and 18 nurse assistants with experience of fall events were strategically selected for a recorded interview. The informants were chosen from 10 nursing homes in Sweden and Norway. They were asked to describe a fall situation they had been involved in when caring for elderly people with dementia. The findings shed light on an ethical dilemma in the main category ‘Balancing integrity and autonomy versus risk of falling’ which was comprehensively related to two descriptive categories. The first one was ‘Adjusting to the older person’s condition’ with the concepts of forgetfulness, anxiety and confusion, ability to express oneself and understand, bodily build and function. The second category was ‘Adjusting the care environment’, comprising these conceptions: the physical environment, the psychosocial environment, organization and human resources. Based on the staff’s perceived difficulties in preventing falls in elderly people with dementia, there is a need for additional support or professional supervision in their work to enhance possibilities for successful fall prevention.

Key Words: dementia • falls • nursing home • nursing staff • phenomenography

Journal of Research in Nursing, Vol. 14, No. 1, 61-73 (2009)
DOI: 10.1177/1744987107086423


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