title: Nursing staff stress from challenging behaviour of residents with dementia: a concept analysis.
abstract: OBJECTIVE
  Provide insight into the concept of stress in the context of challenging behaviour of nursing home residents with dementia and its causes and consequences.
  
  
  BACKGROUND
  Challenging behaviour is frequent in residents with dementia, but consequences for nursing staff are unclear.
  
  
  BACKGROUND
  Challenging behaviour of residents can be enervating for nurses and may lead to stress. Although stress in general is associated with negative outcomes, an overview of stress in this context would be a welcome addition to the field.
  
  
  METHODS
  Concept analysis according to Walker and Avant.
  
  
  RESULTS
  Identified antecedents of stress: physical and verbal aggression, conflicts, excessive demands and being unresponsive (residents), age, experience, tenure, nursing level and training (nursing staff). Defining attributes: disturbed homoeostasis and the personal appraisal of the situation. Identified consequences regard health, psychological aspects and behaviour.
  
  
  CONCLUSIONS
  Intervening in the identified factors may contribute to prevention of stress in nursing staff.
  
  
  CONCLUSIONS
  Given a lack of strong empirical studies, our analysis is not based on a high level of evidence and needs to be tested. Papers from before 1990 might have been missed.
  
  
  CONCLUSIONS
  The concept analysis revealed that nursing staff stress in the context of challenging behaviour may result from resident and nursing staff factors. Besides health and psychological consequences, behavioural consequences can enormously impact the well-being of residents.
  
  
  CONCLUSIONS
  Application in daily care to support teams in influencing resident and nursing staff factors could prevent stress, for instance using behavioural management training or recruiting higher educated nursing staff. Given the increasing complexity of care, creating specialized units with specifically trained staff for different groups of people with dementia may be desirable.
authors.affiliation: Vitalis WoonZorggroep Eindhoven, Eindhoven, the Netherlands.|Department of Primary and Community Care, Radboud University Medical Center, Radboud Alzheimer Centre, Nijmegen, the Netherlands.
authors.forename: T J G M
authors.initials: TJ
authors.lastname: Hazelhof
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands.|Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: L
authors.initials: L
authors.lastname: Schoonhoven
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands.
authors.forename: B G I
authors.initials: BG
authors.lastname: van Gaal
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Radboud Alzheimer Centre, Nijmegen, the Netherlands.|Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands.
authors.forename: R T C M
authors.initials: RT
authors.lastname: Koopmans
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Radboud Alzheimer Centre, Nijmegen, the Netherlands.
authors.forename: D L
authors.initials: DL
authors.lastname: Gerritsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000451:nursing*; D006801:Humans; D009735:Nursing Homes; D009740:Nursing Staff; D010820:Physicians
keywords: Challenging behaviour; Concept analysis; Dementia; Nursing Staff; Prevention; Residents; Stress