Table 3 Overview of (groups of) stakeholders with general, main and sub-factors

RESIDENT

CHARACTERISTICS

PERSON

Unlike other residents

BEHAVIOR

Nature of the behavior

Course of the behavior

Severity of the behavior

Unpredictability of the behavior

Unclear triggers of the behavior

Behavior considered as (partly) on purpose

Behavior differs from personality before diagnosis of dementia

INTERACTION ISSUES WITH OTHER (GROUPS OF) STAKEHOLDERS

WITH OTHER RESIDENTS

The resident’s behavior causes inconveniences and danger for the other residents

Reactions of other residents negatively affect the resident’s behavior

WITH NURSING HOME STAFF

The resident not understanding verbal requests

The resident giving short answers/minimal reaction

The resident not wishing to/not making any contact

Inability of nursing home staff to read the resident’s emotions

Nursing home staff not understanding the resident’s behavior and having no control over the behavior

WITH CARE STAFF SPECIFICALLY

Not noticing signs of escalation of the resident’s behavior in a timely manner

Positive moments with the resident are scarce

Paying attention to the resident takes a lot of time

Undertaking pleasant activities with the resident is problematic

Applying compulsory treatment is difficult

RELATIVE

CHARACTERISTICS

PERCEPTIONS

Having a different perception of the behavior, treatment and care

Finding it hard to accept that usual care could not always be provided

INTERACTION ISSUES WITH OTHER (GROUPS OF) STAKEHOLDERS

WITH NURSING HOME STAFF

Nursing home staff insufficiently informs/involves relatives

Relative has limited trust in (certain) care staff members

Relative criticizes actions of care staff

Relative crosses personal boundaries of care staff members

Relative is ambivalent/uncommunicative about emotions and wishes for treatment

CARE STAFF

CHARACTERISTICS

PERSONALITY ISSUES

Different approaches and interactions with the resident due to different personalities of care team members

SKILLS ISSUES

Having insufficient knowledge and experience

Reports are of an insufficient quality

Reflects insufficiently on own actions and feelings

ATTITUDE ISSUES

Having a wait-and-see attitude/refraining from taking the initiative

Not asking for help/asking for help too late

Refraining from complying with the behavioral management approach that was agreed on

Having a fatalistic attitude

Differences in views on the behavior, approaches in dealing with the resident’s extreme challenging behavior and experiences of the behavior due to a difference in working shifts (day/night) and number of working hours

Difference in opinions about appropriate care

Difference in the extent to which the resident’s behavior is accepted

INTERACTION ISSUES WITHIN STAKEHOLDER GROUP

WITHIN CARE STAFF

Little opportunity for formal and informal exchange of information

Giving each other feedback is difficult

New ideas from care staff members often receive a negative response from other care staff members

Communication takes place indirectly

TREATMENT STAFF

CHARACTERISTICS

BEING AT BAY

Missing the whole picture of the situation and the resident’s behavior

Only present during office hours

TREATMENT ISSUES

Difficult to develop and implement a treatment plan

Treatment plans have no effect/temporary effect

The situation often needed to end as soon as possible

Difficulties with prescribing medication

SKILLS ISSUES

Having insufficient knowledge and experience

Making treatment plans which are outdated/ impractical/unachievable/not feasible

Unable to detect the needs of the care staff, meet their expectations or support them properly

Involving external expertise too late

ATTITUDE ISSUES

Being indecisive/taking little responsibility

Undertaking too few actions

Not informing themselves properly about the (severity of) the behavior

Unaware of the expertise of care staff

INTERACTION ISSUES WITHIN STAKEHOLDER GROUP

WITHIN TREATMENT STAFF

Different perceptions as to everyone’s responsibilities pertaining to the situation

Not enough formal and informal exchange of information between the psychologist and elderly care physician

NURSING HOME STAFF

INTERACTION ISSUES WITHIN STAKEHOLDER GROUP

QUALITY OF INTERDISCIPLINARY COMMUNICATION

Limited exchange of information due to few meetings

No room for reflection

No room for giving each other feedback

No room for an extensive analysis of the behavior

Care staff members not communicating their needs, wishes and actions taken with the treatment staff

Care staff members share incomplete and unclear information

Treatment staff members insufficiently involving care staff in their plans

Care and treatment staff not taking each other seriously or not listening to each other’s ideas/rationalizations for approaching the problem

INEFFICIENT WORK PROCESSES

Indirect communication between care and treatment staff

Inefficient communication due to a missing working agreement

ORGANIZATION

CHARACTERISTICS

STAFFING ISSUES

Short staffing and staff-turnover

Excessive workload

UNIT

Size of the unit

ORGANIZATIONAL NORMS

Acceptance of the behavior by considering it as part of the dementia or the resident’s personality

ROLE OF MANAGEMENT

Management staff insufficiently investing in solutions to improve the situation for the resident

Management staff making decisions interfering with the clinical situation