Background As our society is ageing, nursing homes are finding it increasingly difficult to deal with an expanding population of patients with dementia and a decreasing workforce. A potential answer to this problem might lie in the use of technology. However, the use and application of surveillance technology in dementia care has led to considerable ethical debate among healthcare professionals and ethicists, with no clear consensus to date. Aim To explore how surveillance technology is viewed by care professionals and ethicists working in the field, by investigating the ideal application of surveillance technology in the residential care of people with dementia. Methods Use was made of the concept mapping method, a computer-assisted procedure consisting of five steps: brainstorming, prioritising, clustering, processing by the computer and analysis. Various participants (ranging from ethicists to physicians and nurses) were invited on the basis of their professional background. Results The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult.
Wetsvoorstel Zorg en dwang: impact van de recente wijzigingen voor het veld en de cliënt Het wetsvoorstel Zorg en dwang psychogeriatrische en verstandelijk gehandicapte cliënten, dat in de zomer van 2009 aan de Tweede Kamer werd aangeboden, heeft in 2012 belangrijke wijzigingen ondergaan. De auteurs wijzen behalve op de voordelen hiervan voor de rechtsbescherming van kwetsbare cliënten ook op een aantal nadelen. Zo worden het voorgestelde stappenplan, de omschrijving van onvrijwillige zorg en de regeling inzake vertegenwoordiging van wilsonbekwaamheid kritisch tegen het licht gehouden. Een vergelijking met het wetsvoorstel Verplichte GGz valt niet zonder meer positief uit voor het wetsvoorstel Zorg en dwang.
In nursing homes, nursing staff have a key role in the use of restrictive measures. However, their active role in reducing restrictive measures has so far been limited. The aim of this study is to explore how and when the application of restrictive measures in nursing homes occurs including underlying factors, together with nursing staff.Participatory action research was chosen for a bottom-up understanding of the use of restrictive measures.Two Dutch nursing homes participated in 2016/2017 with 18 nursing staff members in the action research team. Nursing staff carried out 33 observations followed by a reflective interview.Nursing staff observed a wide range of restrictions, including restrictions in freedom of choice, not being able to go outside, not being in charge of medication, and a directive/unresponsive care attitude. Factors influencing restrictions included habits and institutionalization, cognitive ability of the resident, availability of personnel, and responsibility for safety. A responsive care attitude and raising awareness were seen as good practices to enhance freedom.By taking a distant view on their work, nursing staff discovered a broad range of restrictions, including 'less obvious' restrictions. Active forms of learning may position nursing staff to discuss and reduce restrictive measures.What problem did the study address?: Restrictive measures are still common in nursing homes. Despite their key role in using restrictive measures, nursing staff's active role in research has been limited. What were the main findings?: By participating as researchers, nursing staff gained a broader perspective on restrictive measures. Many 'less obvious' restrictions were related to routines and institutionalization and were considered as eye opening by nursing staff. Where and on whom will the research have impact?: Active forms of learning such as observing and reflecting has the potential to position nursing staff as 'agents of change'.
ABSTRACT Background: Technology has emerged as a potential solution to alleviate some of the pressures on an already overburdened care system, thereby meeting the growing needs of an expanding population of seriously cognitively impaired people. However, questions arise as to what extent technologies are already being used in residential care and how ethically and practically acceptable this use would be. Methods: A systematic literature review was conducted to explore what is known on the moral and practical acceptability of surveillance technologies in residential care for people with dementia or intellectual disabilities, and to set forth the state of the debate. Results: A total of 79 papers met the inclusion criteria. The findings show that application and use of surveillance technologies in residential care for vulnerable people generates considerable ethical debate. This ethical debate centers not so much around the effects of technology, but rather around the moral acceptability of those effects, especially when a conflict arises between the interests of the institution and the interests of the resident. However, the majority of articles lack in depth analysis. Furthermore, there are notable cultural differences between the European literature and American literature whereby in Britain there seems to be more ethical debate than in America. Overall however, there is little attention for the resident perspective. Conclusion: No ethical consensus has yet been reached, underlining the need for clear(er) policies. More research is thus recommended to determine ethical and practical viability of surveillance technologies whereby research should be specifically focused on the resident perspective.
In het kader van de onlangs voltooide derde evaluatie van de Wet bijzondere opnemingen in psychiatrische ziekenhuizen (Wet Bopz) is onder meer onderzoek gedaan naar internationale ontwikkelingen met betrekking tot de rechtspositie van psychiatrische patiënten. In de twee tot dusverre verrichte evaluaties van de Wet Bopz (1996, 2002) werd aan internationale documenten en buitenlandse ontwikkelingen geen aandacht besteed. Dat dit onderwerp in de derde evaluatie wel aan de orde komt, heeft te maken met ontwikkelingen die zich na 2002 hebben voorgedaan.
In the Netherlands, as in other countries, there are several ways of handling patients' complaints. These procedures have three main objectives: protecting individual rights of patients, improving the quality of health care, and protecting the public interest. In the Dutch system of handling complaints, informal and formal procedures are distinguished. The purpose of this article is to describe the formal complaints procedures: the complaints committee, the medical disciplinary board and the civil law procedure. In addition, the article describes the criminal procedure, which cannot be initiated by the patient but is also used to examine practices of health care professionals. Table 1 provides an overview of all procedures. Finally, the article discusses whether the existing procedures are appropriate to achieve the intended goals of the system for handling complaints in health care. Further research is needed to reveal whether these goals are actually realized in practice.
Abstract Research suggests that restrictive measures are widely used on adolescents with mild intellectual disabilities. In the Netherlands, restrictive measures are defined as all measures that limit the freedom of a person. In most countries, legislation and policies that seek to reduce the use of restrictive measures focus on seclusion and mechanical and physical restraints. The study aimed to investigate the extent to which restrictive practices are used in the care of adolescents with mild intellectual disabilities while also exploring the attitudes of support staff toward these interventions. A survey study was done among a nationally representative Dutch research sample consisting of support staff. A structured questionnaire was completed by 195 staff members (response of 68.7%) working in settings providing care for people with intellectual disabilities. The measures generally used by staff members who work with adolescents with mild intellectual disabilities involved restricting the freedom of movement and so‐called social restrictions (such as limiting the use of mobile phones). Nearly all respondents considered restrictive measures to be justified in the case of danger, physical aggression, or sexually abusive behavior (87.8–96.8%). Frequently mentioned reasons for using restrictive measures were averting or avoiding danger (90.4 and 83.0%, respectively) and calming the adolescent (63.8%). Although seclusion and mechanical and physical restraints were generally considered most intrusive, staff members were aware that social restrictions could also be instrusive. The fact that current policies do not address these measures makes support staff question the lawfulness of their actions. As well as staff training to reduce the use of restrictive measures, rules, and legislation are also needed to clarify the options and limits to using such measures in the professional care of adolescents with mild intellectual disabilities.
