title: "We Have to Work Within the System!": Staff Perceptions of Organizational Barriers to Decision Making for Older Adults With Dementia in Australian Aged Care Facilities.
abstract: The current study explored the perceptions of direct care staff working in Australian residential aged care facilities (RACFs) regarding the organizational barriers that they believe prevent them from facilitating decision making for individuals with dementia. Normalization process theory (NPT) was used to interpret the findings to understand these barriers in a broader context. The qualitative study involved semi-structured interviews (N = 41) and focus groups (N = 8) with 80 direct care staff members of all levels working in Australian RACFs. Data collection and analysis were conducted in parallel and followed a systematic, inductive approach in line with grounded theory. The perceptions of participants regarding the organizational barriers to facilitating decision making for individuals with dementia can be described by the core category, Working Within the System, and three sub-themes: (a) finding time, (b) competing rights, and (c) not knowing. Examining the views of direct care staff through the lens of NPT allows possible areas for improvement to be identified at an organizational level and the perceived barriers to be understood in the context of promoting normalization of decision making for individuals with dementia.
authors.forename: Laura
authors.initials: L
authors.lastname: Tarzia
authors.forename: Deirdre
authors.initials: D
authors.lastname: Fetherstonhaugh
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Beattie
authors.forename: Rhonda
authors.initials: R
authors.lastname: Nay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001315:Australia; D003657:Decision Making; D003704:Dementia / Q000451:nursing*; D005260:Female; D017144:Focus Groups; D005851:Geriatric Nursing / Q000379:methods*; D006282:Health Personnel / Q000523:psychology*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D015279:Organizational Culture; D036301:Qualitative Research