PDF(Pubmed)
Abstract：
Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities and aim to provide person-centered care (PCC). Maintaining residents\' autonomy is important to provide PCC, for example, with shared decision-making (SDM). Residents are largely dependent on multiple stakeholders, which could jeopardize their autonomy, especially regarding unhealthy behaviors, such as smoking tobacco or drinking alcohol. This case study explores the dynamics of multiple stakeholders around four RCF residents regarding their alcohol and/or tobacco use. Four RCF residents who smoke tobacco and/or drink alcohol were selected from a previous study, and their (in)formal caregivers were additionally invited to participate. A qualitative research design was chosen, and semi-structured interviews were conducted. The Ethics Review Board from the Tilburg University School of Social and Behavioral Sciences (Reference: RP39) and the executive boards of the two participating organizations granted approval. Narrative portraiture resulted in four case descriptions. Two cases focused mostly on tobacco use, and two cases focused mostly on alcohol use. Multiple stakeholders were involved on different levels: family bought alcohol or cigarettes, and team managers supported care professionals. However, little interaction was found between stakeholders. In these cases, limited interaction between the stakeholders, including the resident, jeopardizes SDM and, in this way, PCC regarding residents\' alcohol and/or tobacco use. SDM on this topic could enhance interaction between all stakeholders involved, which could increase PCC. Finally, the cases indicate a constant struggle between protecting residents from adverse outcomes of alcohol and tobacco use and enhancing their autonomy.
摘要：
住宅护理设施（RCF）为认知和/或身体残疾的老年人提供24/7全天候护理，旨在提供以人为本的护理（PCC）。保持居民自治对提供PCC很重要，例如,共享决策(SDM)。居民在很大程度上依赖于多个利益相关者，这可能会危及他们的自主权，特别是关于不健康的行为，例如吸烟或饮酒。本案例研究探讨了四个RCF居民周围的多个利益相关者对酒精和/或烟草使用的动态。从先前的研究中选择了四名吸烟和/或饮酒的RCF居民，他们的正式护理人员也被邀请参加。选择了定性研究设计，进行了半结构化访谈。蒂尔堡大学社会与行为科学学院的道德审查委员会（参考：RP39）和两个参与组织的执行委员会获得了批准。叙事肖像画产生了四个案例描述。两个案例主要集中在烟草使用上，两个案例主要集中在酒精使用上。多个利益相关者参与了不同的层面：家庭购买酒精或香烟，和团队经理支持护理专业人员。然而,利益相关者之间的互动很少。在这些情况下,利益相关者之间的互动有限，包括居民,危及SDM和，这样,PCC关于居民酒精和/或烟草使用。关于这一主题的SDM可以增强所有相关利益相关者之间的互动，这可能会增加PCC。最后,这些案例表明，在保护居民免受酒精和烟草使用的不良后果与增强他们的自主权之间一直存在斗争。
