Exercising Choice in Long-Term Residential Care
Braedley, S., & Szebehely, M. (2017). Opportunities to problem-solve: Conditions for dementia care. Exercising Choice in Long-term Residential Care, 77-84.
This chapter makes the case for the importance of empowering staff to problem solve. It compares a North American nursing home where staff don’t have the time to come together to address problems with a Swedish nursing home were time for reflection is supported.
It continues the analysis of the reflection process discussed in Banerjee and Braedley’s 2016 article above and makes a very important point: That these reflection meeting require structural (organizational and policy) supports.
The authors draw attention to four structural conditions that support opportunities for reflection and problem-solving. These are:
1) Small unit size and consistent staff arrangements that enable staff to get to know one another and also get to know the residents’ needs, habits, preferences as well as those of their family members.
2) Good staff to resident ratios that enable workers to have adequate time to pause, reflect and discuss problems with colleagues.
3) Appropriate training in dementia care. In the nursing home they studied, the reflection meeting was run by a nurse who had specialized training in dementia care. The meetings offered an opportunity to share this knowledge with other staff members and ensure that the solutions developed were informed by knowledge of ‘best’ practices.
4) Worker autonomy to try out new ideas. Staff had sufficient autonomy to change routines, involve different workers or use different tools or supplies. By comparison, in the North American homes the authors studied, only supervisors and managers hold this authority.