title: The Trajectory of Tolerance for Wandering-related Boundary Transgression: An Exploration of Care Staff and Family Perceptions.
abstract: This study aimed to explore the experience of living with and caring for a person with dementia who wanders and transgresses boundaries into out-of-bounds and potentially hazardous areas (wandering-related boundary transgression [BT]), from the perspective of family members and care staff.
  
  
  
  This descriptive qualitative study utilized four focus groups with care staff (n = 28), one with family members (n = 4), and individual interviews (n = 8) with family members. Content analysis generated key concepts that formed the basis of the development of a theoretical understanding of the experience.
  
  
  
  Care staff and families described wandering-related BT as a common dementia-related behavior in residential aged care (RAC). Drawing on the generated concepts, a complex theoretical trajectory of tolerance for BT was developed. At one end of the trajectory, BT was perceived as being beyond the control of the individual and when unwitnessed by others, having little or no impact. Tolerance for BT shifted when the BT was witnessed by others, and potentially unsafe consequences for the person who wanders or their coresidents were experienced. Under the latter circumstances, BT was perceived as a troubling behavior that needed more effective management. Underpinning the complexity of this behavior was a constantly shifting perception of how hazardous this behavior might be, a factor that appeared to contribute to the challenges faced by families and care staff.
authors.affiliation: School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: MacAndrew
authors.affiliation: School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Beattie
authors.affiliation: School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: O'Reilly
authors.affiliation: College of Nursing, The Pennsylvania State University, University Park.
authors.forename: Ann
authors.initials: A
authors.lastname: Kolanowski
authors.affiliation: School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Windsor
mesh_terms: D000368:Aged; D001315:Australia; D017028:Caregivers / Q000523:psychology*; D003617:Dangerous Behavior; D003704:Dementia / Q000451:nursing / Q000523:psychology; D005190:Family / Q000523:psychology; D005260:Female; D017144:Focus Groups; D005851:Geriatric Nursing / Q000379:methods*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D016901:Intergenerational Relations; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods; D036301:Qualitative Research; D055816:Wandering Behavior / Q000523:psychology*
keywords: Aged care; Dementia; Intrusion; Wandering