Factors Associated With Residents' Responsive Behaviors Toward Staff in Long-Term Care Homes: A Systematic Review.
Yuting Song, Abubakar M Nassur, Viraji Rupasinghe, Fajr Haq, Anne-Marie Boström, R Colin Reid, Elizabeth Andersen, Adrian Wagg, Matthias Hoben, Zahra Goodarzi, Janet E Squires, Carole A Estabrooks, Lori E Weeks
Author Information
Yuting Song: School of Nursing, Qingdao University, Qingdao, Shandong, China. ORCID
Abubakar M Nassur: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. ORCID
Viraji Rupasinghe: School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
Fajr Haq: Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Anne-Marie Boström: Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
R Colin Reid: School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada.
Elizabeth Andersen: School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada.
Adrian Wagg: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. ORCID
Matthias Hoben: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Zahra Goodarzi: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Janet E Squires: Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
Carole A Estabrooks: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Lori E Weeks: School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
BACKGROUND AND OBJECTIVES: When staff experience responsive behaviors from residents, this can lead to decreased quality of work life and lower quality of care in long-term care homes. We synthesized research on factors associated with resident responsive behaviors directed toward care staff and characteristics of interventions to reduce the behaviors. RESEARCH DESIGN AND METHODS: We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and "gray" literature, using 2 keywords (long-term care, responsive behaviors) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organizing structure and prepared narrative summaries for each factor. RESULTS: From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level), staff approaches to care (interpersonal level), leadership and staffing resources (institutional level), and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviors, and quantitative findings on the impact of staff approaches to care on behaviors. Effects of interventions (n = 14) to reduce the behaviors were inconclusive. DISCUSSION AND IMPLICATIONS: We identified the need for an enhanced understanding of the interrelationships among factors associated with resident responsive behaviors toward staff and processes leading to the behaviors. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviors, we suggest intervention studies with systematic process evaluations.
