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Title: The impact of contextual factors on the prescribing of psychoactive drugs with older people : an analysis of treatment culture in nursing homes
Author: Shaw, Catherine Lorna
ISNI:       0000 0004 6495 0435
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2017
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Prescribing of psychoactive medications for older residents in nursing homes has been a cause for concern and such medications have been described as ‘chemical restraints’. One factor which may influence the prescribing of these medicines is treatment culture, defined as the way in which prescribing of psychoactive medication is undertaken. Nursing homes have been defined as resident-centred (least likely to use psychoactive medication), traditional (most likely to use psychoactive medication) or ambiguous (a combination of the two) in terms of treatment culture. The overall aim of the research presented in this thesis was to explore and understand treatment culture in nursing homes for older people with dementia in respect of the prescribing of psychoactive medication, and to produce a resource package to assist in decision-making regarding the prescribing of these medications. Qualitative methods were used in Studies 1&2 (Chapters 2&3) to explore and analyse treatment culture in nursing homes. These studies led to the work detailed in Chapter 4 which involved a literature search on culture change in nursing homes, alongside a mapping exercise linking the results from the literature with the findings from Studies 1&2. The outcome of this exercise was to inform the content of an educational resource which was developed during the fourth study (Chapter 5) to promote person-centred care and assist with decision-making on psychoactive medication in nursing homes. The examination of treatment culture in the first and second studies revealed traits that were indicative of the treatment culture category to which each home was assigned. Four contextual themes arose simultaneously throughout the first and second studies; Characteristics of the Setting, Characteristics of the Individual, Relationships, and Decision-making. These themes were linked and each one depicted the differences between the three treatment cultures examined. Traditional homes showed strict routine, little interaction between staff and residents and the administration of psychoactive drugs without a non-pharmacological treatment being tried first. However, in the ambiguous and resident-centred homes, there was a greater focus on resident choice, individualised care and interaction between staff and residents, with more emphasis on non-pharmacological treatments such as distraction and one-on-one attention. The third study confirmed that these contextual elements relating to treatment culture were consistent throughout the existing international literature on culture change. Thus, the content of the educational resource to promote person-centred care and assist with decision-making on psychoactive medication in nursing homes was based upon these four elements. An initial evaluation of the educational resource by nurses working within the nursing home setting, a pharmacist and two Patient and Public Involvement participants revealed that the resource was viewed positively and may be of use to the nursing home sector. Further refinement and pilot-testing of the resource is required. The work of this thesis has confirmed the existence of different treatment cultures among nursing homes in respect of psychoactive prescribing. The traits displayed by each home, were, on the whole, in accordance with the treatment culture category previously assigned to them, and demonstrated how these differences affect the prescribing and administration of psychoactive medications in nursing homes. Assessing and exploring the treatment culture of nursing homes and promoting resident-centred culture in line with current policy should form the focus of future work in this area.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available