Initial Development of the DIGNITY Program: Balancing Autonomy and Safety in Dementia Care

TL;DR

This paper introduces the DIGNITY program, designed to help nursing home staff balance resident autonomy with safety in dementia care.

Contribution

The novel contribution is the development of a multilevel intervention promoting shared decision-making in dementia care through community engagement techniques.

Findings

The DIGNITY program was developed using intervention mapping techniques to support shared decision-making in nursing homes.

A logic model and literature review identified beliefs and training goals for staff to honor residents' preferences.

The program includes a care planning protocol and staff training to address risk factors in preference situations.

Abstract

In the name of safety, nursing Home (NH) residents living with dementia often have their preferences for care and daily activities disregarded by NH staff. This impinges on residents’ rights to exercise autonomy in clinical decision-making and leads to dissatisfaction with care comprising quality of life and well-being. No comprehensive evidence-based risk management strategies exist to assist NH staff to identify and support care choices of residents while attempting to balance autonomy with safety. Thus, the purpose of this project was to use community engagement intervention mapping techniques to develop a multilevel intervention designed to support shared decision-making with NH residents living with dementia thus promoting resident health and autonomy. This presentation will describe the early planning phase of intervention mapping including the construction of a logic model of the problem, a review of literature identifying behavioral, normative, and control beliefs associated with NH staff intentions to honor residents’ preferences, and a set of training goals and objectives. This project resulted in a multi-component intervention that guides shared decision-making in NHs to support person-centered dementia care called DIGNITY (Decision-making in aging and dementia for autonomy). It includes an adapted care planning protocol and staff training to help direct-care NH staff negotiate intrinsic and cultural factors in preference situations that carry a risk to residents’ health and safety. Initial development of this intervention sets the stage for initial program manual and tool development necessary for pilot testing the intervention in the future.