Clinical Judgement Process of Nurses at Dementia Treatment Wards who Notice Early Signs of Aggressive Behavior in Patients with Alzheimer’s Disease

Abstract

Purpose: To understand the clinical judgment process of nurses at dementia treatment wards when identifying early signs of aggressive behavior in patients with Alzheimer’s disease.

Method: Semi-structured interviews were conducted with 12 nurses from a dementia treatment ward, all of whom had experience in identifying early signs of aggressive behavior in patients with Alzheimer’s disease. Data were analyzed using the Modified Grounded Theory Approach (M-GTA).

Results: Two categories and seven subcategories were identified from 24 concepts. The basis of clinical judgment processes when recognizing signs of aggressive behavior in patients with dementia was to establish a foundation of safety. This process included strategies aimed at ensuring the psychological safety in patients with Alzheimer’s disease, with an emphasis on understanding each patient as unique, which was crucial for accurately interpreting signs of aggression. Repeating the processes of verifying signs of aggressive behaviors and using strategies to prevent said aggressive behaviors encouraged the nurses to develop a deeper understanding of their patients, and the accuracy of their clinical judgments improved.

Conclusion: The clinical judgment process of nurses at the dementia treatment ward regarding identification of early signs of aggressive behavior in patients with Alzheimer’s disease was based on repetition of identification of signs of aggressive behavior and utilization of measures to avoid aggressive behavior.