“But what should we do?” : A critical study about pursuing autonomy in dementia care settings.

The legislation governing the care of people with dementia is based on consent and therefore reflects the western society’s idealization of autonomy. However, common symptoms of dementia include decreased ability to make adequate decisions and an impaired judgement. The purpose of this study was to understand the rationality in organizing the care of people with dementia without the presence of coercion, based on experience of nursing staff working in dementia care. How does the nursing staff reason about the use of coercion in the care of people with dementia? How do they relate to current legislation? To answer these questions three focus group interviews were made, consisting of nursing staff working at special units for people with dementia. The study was based on a critical hermeneutic perspective where ruling norms, values and beliefs were questioned. The result showed that the nursing staff considered use of coercion as an inevitable part of their work to ensure safety for people with dementia. Additionally, the result showed that the nursing staff used various strategies to work in a way that was compatible with the current legislation, although these strategies often failed to be sufficient enough to ensure the protection of people with dementia. Based on the result, this study discusses the conflict occurring between the discourses on autonomy in the society in relation to organizing a safe dementia car