Life In The Slower Lane

Here is the standardised PICO analysis for the thirty-fifth uploaded article:

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Full Title

Strategies used by care home staff to manage behaviour that challenges in dementia: A systematic review of qualitative studies

Authors: Elizabeth O’Donnell, Carol Holland, Caroline Swarbrick

Journal: International Journal of Nursing Studies, 2022; 133:104260

DOI: 10.1016/j.ijnurstu.2022.104260

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Type of Study

Systematic review of qualitative studies using thematic synthesis

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PICO Summary

Population (P)

• Care home staff (nurses, care assistants, managers) in nursing homes
• Working with residents with dementia who exhibit behaviour that challenges (BPSD)

Intervention (I)

• Strategies to manage behaviour that challenges, grouped into:
  • Non-pharmacological approaches (e.g. distraction, person-focused support, meaningful activities)
  • Pharmacological approaches (e.g. psychotropic medications)
  • Physical restraint
  • Person-centred care practices
  • Environmental modifications
  • Multidisciplinary collaboration and training initiatives

Comparison (C)

• Not applicable (qualitative synthesis without a formal control group)

Outcomes (O)

System-level and process outcomes:

• Non-pharmacological strategies were often used reactively (“putting out fires”)
• Person-focused support and knowing the resident reduced behavioural distress
• Pharmacological interventions (especially antipsychotics) used when non-drug approaches failed or staff lacked training
• Physical restraint and covert medication were still in use in some settings, raising human rights concerns

Barriers identified:

• Inadequate training in person-centred care
• Staff attitudes and care home culture influencing decisions
• Limited staff involvement in shared decision-making, especially for care assistants
• Poor collaboration with GPs; prescribing often based on task-completion pressures
• Limited awareness of adverse effects of psychotropics, e.g. sedation, falls, but not stroke or death 

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Findings Summary

This systematic review synthesised data from 34 qualitative studies across 10 countries. The findings were grouped into three major themes:

1. “Putting out the fires” – reactive use of pharmacological or basic distraction strategies
2. “Personhood, human rights and respect” – valuing individual identity, understanding behaviours as communication, and using meaningful activities
3. “Person-focused approach – a paradigm shift” – cultural and organisational change is needed, requiring:
   • Improved training on dementia and behavioural strategies
   • Empowerment and inclusion of all staff in decision-making
   • Environmental design changes (e.g. smaller lounges, familiar rooms)
   • Staff attitude change toward a non-pharmacological first-line approach

The review highlights an urgent need to integrate non-pharmacological strategies into policy, training, and practice guidelines (e.g. NICE NG97), ensuring care is individualised, respectful, and sustainable.

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