Dementia-related crisis admissions destabilize regular care: a qualitative study among Dutch nursing-home staff

This study explores nursing-home staff experiences with crisis admissions of persons with dementia and their impact.

A grounded theory approach based on semi-structured interviews with healthcare professionals from three Dutch nursing homes. The data were analyzed using Strauss and Corbin's coding paradigm.

Seven doctors and eight nurses participated. They reported that crisis admissions destabilize regular care by disrupting unit structure, workflows, and team dynamics. Causal conditions include the unpredictability and complexity of these admissions, often involving clients with severe behavioral symptoms, limited background information, and urgent care needs. Contextual and intervening conditions, such as client characteristics, prior interventions, unit setup, and collaboration, further influence the extent of destabilization. These disruptions increase workload and challenge routines. To restore stability, staff employee strategies including adjusting schedules and procedures and enhancing collaboration. Despite these efforts, professionals report physical and emotional strain, ethical dilemmas, and feelings of inadequacy. However, crisis admissions also offer opportunities for learning, motivation, and team cohesion.

Crisis admissions can destabilize care, but targeted organizational strategies, such as improved information transfer, acute care protocols, and staff education, can mitigate impact. Tailored approaches are essential to safeguard staff well-being and ensure continuity in long-term dementia care.