Effectiveness of a Multidisciplinary Expertise Team in the reduction of restrictive measures in sheltered care homes for people with an intellectual disability.

Minimizing restrictive measures is an important lever to promote self-determination for people with intellectual disabilities. This study assesses the efficacy of the Multidisciplinary Expertise Team (MDET) program in reducing such measures within Dutch sheltered care homes for people with intellectual disabilities. A clustered randomized trial encompassed 30 residential units, reporting 428 measures on 107 residents through an organization-wide registration system.

[A prescription for yourself or acquaintances, a good idea?].

Many doctors regularly write a prescription for themselves or for family members or friends. In this article, we discuss the legal and ethical considerations surrounding these prescriptions. We also discuss the role of the pharmacist who receives the prescription.

The value of experts by experience in social domain supervision in the Netherlands: results from a 'mystery guests' project.

Background: User involvement and participation in the supervision of the quality of care is an important topic for many healthcare inspectorates. It offers regulators an additional view on quality, increases the legitimacy and accountability of the inspectorate, empowers users and enhancing the public's trust in the inspectorate. To assess the accessibility of the local governmental social domain services the Joint Inspectorate Social Domain in the Netherlands worked together with people with intellectual disabilities performing as 'mystery guests' in an innovative project.

The Moral and Gender Implications of Measures Used to Modulate the Mobility of People With Dementia Living in Residential Care Environments: A Scoping Review.

Background And Objectives: Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can violate human rights and affect the quality of life. This review aims to summarize the literature on what is known about measures used to modulate the life-space mobility of residents with dementia living in a residential care environment.

[Doctors and lawyers in the disciplinary board: cooperation with added value].

Doctors and lawyers in the disciplinary board work together intensively, each from their own professional perspective, whereby the mutual dynamics greatly benefit the quality of the judgments: 1+1=3. How this cooperation takes place is not always visible to outsiders. After all, the session of the disciplinary board is public, but what is discussed before and after the session in the council chamber is decided and only comes out in the form of the ruling.

Exploring restrictive measures using action research: A participative observational study by nursing staff in nursing homes.

Aim: 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.

[The Psychiatric Hospitals (Compulsory Admissions) Act ceases to exist; what does this mean for treating physicians and patients?].

The Psychiatric Hospitals (Compulsory Admissions) Act, Wet BOPZ in Dutch, will be replaced by two new laws as of 1 January 2020. This has many implications for patients as well as the physicians treating them. The new laws are emphasising treatment rather than admission.

Restraint interventions in people with moderate to profound intellectual disabilities: Perspectives of support staff and family members.

Background: Due to incompatibilities in communication, it is key that family members and support staff can take the perspective of people with moderate to profound intellectual disabilities (ID) whilst putting aside their own perspectives.

Method: Ten vignettes describing types of restraint interventions (RIs) were presented to 20 unique pairs of support staff and family members related to individuals with moderate to profound ID.

Results: In taking their own perspective, more than half of the support staff and family members perceived all RIs as involuntary and severe.

Involuntary care - capturing the experience of people with dementia in nursing homes. A concept mapping study.

Objective: To avoid restraints and involuntary care caregivers should be aware if and how a patient resists care. This article focuses on behavioural expressions of people with severe dementia in nursing homes that are interpreted by their formal and informal caregivers as possible expressions of their experience of involuntary care.

Method: Concept mapping was used, following five steps: (1) brainstorming, (2) rating, (3) sorting, (4) statistical analysis & visual representation and (5) interpretation.

CE: Original research: the use of surveillance technology in residential facilities for people with dementia or intellectual disabilities: a study among nurses and support staff.

Background: The use of surveillance technology in residential care facilities for people with dementia or intellectual disabilities is often promoted both as a solution to understaffing and as a means to increasing clients' autonomy. But there are fears that such use might attenuate the care relationship.

Objective: To investigate how surveillance technology is actually being used by nurses and support staff in residential care facilities for people with dementia or intellectual disabilities, in order to explore the possible benefits and drawbacks of this technology in practice.

[Involuntary admission to psychiatric care of people with mild intellectual disability: missed chances in the Dutch Care and Coercion Act].

The aim of the Dutch Care and Coercion Act (Wet Zorg en Dwang) is to improve the legal position of people with an intellectual disability in cases of involuntary admission to psychiatric care. The present law, the Dutch Psychiatric Act (Wet BOPZ), only offers legal protection to clients who are admitted involuntarily to specific institutions. The Care and Coercion Act will lead to significant changes in the care of people with an intellectual disability and a much larger group of clients with an intellectual disability will fall under the range of this Act.

The experiences of people with dementia and intellectual disabilities with surveillance technologies in residential care.

Background: Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.

Objective: To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.

Setting: Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual disabilities.

The legal position of vulnerable people in the future: improving or going backwards?

Two vulnerable groups in our society are children with psychiatric problems and people with intellectual disabilities. The demand for care is growing every year in both groups. The current (Dutch) legal status of people with intellectual disabilities and children with psychiatric problems is one in which too much attention is devoted to the right to self-determination.

The ideal application of surveillance technology in residential care for people with dementia.

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.

Ethical and practical concerns of surveillance technologies in residential care for people with dementia or intellectual disabilities: an overview of the literature.

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.

Dialogical nursing ethics: the quality of freedom restrictions.

This article deals with the question of how ethicists respond to practical moral problems emerging in health care practices. Do they remain distanced, taking on the role of an expert, or do they become engaged with nurses and other participants in practice and jointly develop contextualized insights about good care? A basic assumption of dialogical ethics entails that the definition of good care and what it means to be a good nurse is a collaborative product of ongoing dialogues among various stakeholders engaged in the practice. This article discusses the value of a dialogical approach to ethics by drawing on the work of various nursing scholars.