Reporting challenging behaviour in nursing home residents with dementia: a qualitative study

Challenging behaviour (CB) occurs frequently in nursing home residents with dementia. Up to now, little attention has been given to how to document CB in nurses' daily progress reports in a standardised way. The aim of the study was to gain deeper insight into the factors influencing nursing staff members in their reporting CB.

We conducted fourteen semi-structured interviews in Dutch nursing homes with nursing staff members (EQF level 2-6) working in (highly specialised) geriatric units. Participant used a standardised method for reporting in the Electronic Patient Record. Thematic data analysis was conducted, based on the framework by Braun and Clarke. Quality criteria for conducting and reporting qualitative research were applied.

Four themes influencing nurses reporting emerged from the data:¹ Sense of Ownership, with varying perceptions of responsibilities, and resistance towards CB;² Involvement of psychologists, with concerns about quality of plan of approach and, uncertainties in reading progress reports;³ Complexity of defining CB, including differences in interpretation and the normalisation of CB; and⁴ Complexity of reporting CB, affected by reporting skills, present-day challenges, and digital access to reports by relatives.

This study highlights that reporting CB in dementia is complex, and its complexity appears underestimated. The results display several issues including the integration of CB as part of the nursing process, the ambiguous nature of the CB concept, the occurrence of ethical dilemmas, the perceived ownership of CB, and the need for interprofessional collaboration. Recommendations for each issue have been derived from this.