Table 3 Codes Related to Care Coordination and Management, Mapped to the TDF and the COM-B Model

Capability

Psychological

Knowledge

Constantly changing directives in LTC facilities for agitation and/or aggression

Barrier

Lack of directives in LTC facilities for agitation or aggression

Barrier

Lack of Communication (Between staff and between staff/caregivers)

Barrier

Lack of competency of staff to deliver care

Barrier

Lack of Coordination of Care among team members in LTC

Barrier

Lack of Education among friend and/or family caregivers for caring for agitation among people with dementia

Barrier

Lack of attention to hypoactive behaviours

Barrier

Lack of training for healthcare providers caring for agitation or aggression among people with dementia

Barrier

Inconsistent training for health care providers caring for people with dementia with agitation

Barrier

Changing language around agitated and aggressive behaviours to be more patient-centred

Facilitator

Healthcare providers need to be able to self-regulate when providing care to aggressive residents

Facilitator

Adequate training is provided to increase competency and expertise among LTC staff

Facilitator

Education of friend and family caregivers enables better agitation and/or aggression care among people with dementia in LTC

Facilitator

Education among healthcare providers for management approaches for agitation and/or aggression enables better care

Facilitator

Staff from different cultural

backgrounds respond differently to agitation

Barrier

Different healthcare providers perceive planning of care to be specific to their professional roles

Barrier

Ensuring that the follow-up of agitated symptoms is integrated into care practices

Facilitator

Cognitive and Interpersonal skills

Lack of competency among staff to deliver care

Barrier

Lack of Coordination of Care among team members in LTC

Barrier

Lack of Education among friend and/or family caregivers for caring for agitation among people with dementia

Barrier

Staff only have personal background knowledge as their training, with no extra education from long-term care

Barrier

Lack of attention to hypoactive behaviours

Barrier

Lack of training for healthcare providers caring for agitation or aggression among people with dementia

Barrier

Inconsistent training for health care providers caring for people with dementia with agitation

Barrier

Too many staff members handling a patient resulting in agitation

Barrier

Healthcare providers need to be able to self-regulate when providing care to aggressive residents

Facilitator

Adequate training is provided to increase competency and expertise among LTC staff

Facilitator

Education of friend and family caregivers enables better agitation and/or aggression care among people with dementia in LTC

Facilitator

Education among healthcare providers for management approaches for agitation and/or aggression enables better care

Facilitator

Confidence in Care Plan

Facilitator

Checklist of precipitants to consider (e.g. basic needs: food, drink, pain, medication, etc.)

Facilitator

Different healthcare providers perceive planning of care to be specific to their professional roles

Barrier

Staff from different cultural backgrounds respond differently to agitation

Barrier

Memory, Attention and Decision Making Processes

Decline in mental status or increased dementia impeding care for agitation

Barrier

Resident personal qualities as barrier to care

Barrier

Residents having difficulty communicating needs

Barrier

It is important to look for triggers, contributing causes, and unmet needs that lead to agitation and/or aggression

Barrier

Residents respond better to some staff members and disciplines than others (e.g. rec therapy)

Facilitator

Behavioural Regulation

Lack of attention to hypoactive behaviours

Barrier

Difficulties among LTC staff to understand the residents’ needs (e.g. likes, dislikes)

Barrier

Resident personal qualities as barrier to care

Barrier

Healthcare providers are not communicating care practices with residents

Barrier

Appropriate Use of Antipsychotics as helpful for pharmacological use guidelines

Facilitator

Having a checklist of precipitants to consider (e.g. basic needs: food, drink, pain, medication, etc.) aids in management plans

Facilitator

Care plans for all interventions need to be tailored and patient-centred

Facilitatorgivi

Residents respond better to some staff members and disciplines than others (e.g. rec therapy)

Facilitator

Physical

Physical Skills

-

-

Opportunity

Social

Social influences

Healthcare practitioners are not raising awareness of issues for fear of job (e.g. termination, etc.)

Barrier

High staff turnover in LTC

Barrier

There is a lack of personalized care plans and thus low confidence in care

Barrier

Lack of attention to hypoactive behaviours

Barrier

Inconsistent training for health care providers caring for people with dementia with agitation

Barrier

Not enough time for health care providers to provide care

Barrier

Certain staff members unable to carry out care due to personal characteristics

Barrier

Hiring someone to carry out interventions or day to day affairs with resident

Facilitator

Communication with staff is effective among persons involved with the care or planning of care in LTC

Facilitator

Hiring recreational therapist privately for residents with agitation

Facilitator

Having a checklist of precipitants to consider (e.g. basic needs: food, drink, pain, medication, etc.) aids in management plans

Facilitator

Residents respond better to some staff members and disciplines than others (e.g. rec therapy)

Facilitator

Staff from different cultural

backgrounds respond differently to agitation

Barrier

Physical

Environmental Context and Resources

Constantly changing directives in LTC facilities for agitation and/or aggression

Barrier

Lack of directives in LTC facilities for agitation or aggression

Barrier

Cost of care barriers

Barrier

Cultural Barriers to Care for Agitation among POC residents

Barrier

Environmental Challenges (e.g. loud noises, unideal room configurations)

Barrier

Lack of Communication (Between staff and between staff/caregivers)

Barrier

Lack of communication between health facilities

Barrier

Lack of Education among friend and/or family caregivers for caring for agitation among people with dementia

Barrier

Healthcare practitioners are not raising awareness of issues for fear of job (e.g. termination, etc.)

Barrier

High staff turnover in LTC

Barrier

There is a lack of personalized care plans and thus low confidence in care

Barrier

Inconsistent training for health care providers caring for people with dementia with agitation

Barrier

Not enough time for health care providers to provide care

Barrier

Reliance on caregiver as management strategy for agitation

Barrier

Lack of available resources

Barrier

Too many staff members handling a patient resulting in agitation

Barrier

We can identify an unmet need, but there can be difficulty with solving it

Barrier

Hiring someone to carry out interventions or day to day affairs with resident

Facilitator

Environmental Benefits of the facility (e.g. supportive environment, personalized environment)

Facilitator

Hiring recreational therapist privately for residents with agitation

Facilitator

Having a checklist of precipitants to consider (e.g. basic needs: food, drink, pain, medication, etc.) aids in management plans

Facilitator

Lack of Communication between LTC centres

Barrier

Motivation

Reflective

Social/Professional Role and Identity

Lack of action among care workers

Barrier

Caregivers may not always understand how agitation and/or aggression impacts patient care

Barrier

Caregivers may under-report symptoms

Barrier

Lack of Communication (Between staff and between staff/caregivers)

Barrier

Lack of communication between health facilities

Barrier

Lack of competency of staff to deliver care

Barrier

Lack of Coordination of Care among team members in LTC

Barrier

Too many staff members handling a patient resulting in agitation

Barrier

Lack of Education among friend and/or family caregivers for caring for agitation among people with dementia

Barrier

Staff only have personal background knowledge as their training, with no extra education from long-term care

Barrier

Healthcare practitioners are not raising awareness of issues for fear of job (e.g. termination, etc.)

Barrier

Lack of Inclusion of Needs and Values of family and residents

Barrier

Reliance on caregiver as management strategy for agitation

Barrier

Certain staff members unable to carry out care due to personal characteristics

Barrier

Staffing issues

Barrier

Using family members to help provide care

Facilitator

Communication with staff is effective among persons involved with the care or planning of care in LTC

Facilitator

Team members coordinate care between each other

Facilitator

Interdisciplinary or entire team used to develop care plans

Facilitator

LTC have committees or groups that help to provide the best evidence to inform care

Facilitator

Education of friend and family caregivers enables better agitation and/or aggression care among people with dementia in LTC

Facilitator

Personalized and interdisciplinary approaches to care improve confidence in care plans

Facilitator

Not all LTC sites have access to necessary interdisciplinary team members

Barrier

Staff from different cultural backgrounds respond differently to agitation

Barrier

Different healthcare providers perceive planning of care to be specific to their professional roles

Barrier

Lack of Communication between LTC centres

Barrier

Beliefs about capabilities

Lack of action among care workers

Barrier

Lack of competency of staff to deliver care

Barrier

Lack of Coordination of Care among team members in LTC

Barrier

Staff only have personal background knowledge as their training, with no extra education from long-term care

Barrier

Lack of Inclusion of Needs and Values of family and residents

Barrier

Inconsistent training for health care providers caring for people with dementia with agitation

Barrier

Lack of training for healthcare providers caring for agitation or aggression among people with dementia

Barrier

Using family members to help provide care

Facilitator

Adequate training is provided to increase competency and expertise among LTC staff

Facilitator

Education of friend and family caregivers enables better agitation and/or aggression care among people with dementia in LTC

Facilitator

Education among healthcare providers for management approaches for agitation and/or aggression enables better care

Facilitator

Confidence in Care Plan

Facilitator

The focus of the care plan needs to align with goals of care for the resident

Facilitator

Not all LTC sites have access to necessary interdisciplinary team members

Barrier

Optimism

Confidence in Care Plan

Facilitator

The focus of the care plan needs to align with goals of care for the resident

Facilitator

Beliefs about Consequences

Lack of Inclusion of Needs and Values of family and residents

Barrier

Too many staff members handling a patient resulting in agitation

Barrier

Confidence in Care Plan

Facilitator

Intentions

Caregivers may not always understand how agitation and/or aggression impacts patient care

Barrier

Caregivers may under-report symptoms

Barrier

Lack of attention to hypoactive behaviours

Barrier

Lack of follow-up of patient agitation symptoms

Barrier

Healthcare providers are not communicating care practices with residents

Barrier

We can identify an unmet need, but there can be difficulty with solving it

Barrier

Changing language around agitated and aggressive behaviours to be more patient-centred

Facilitator

Hiring someone to carry out interventions or day to day affairs with resident

Facilitator

Healthcare providers need to be able to self-regulate when providing care to aggressive residents

Facilitator

Using family members to help provide care

Facilitator

Team members coordinate care between each other

Facilitator

Hiring recreational therapist privately for residents with agitation

Facilitator

Personalized and interdisciplinary approaches to care improve confidence in care plans

Facilitator

The focus of the care plan needs to align with goals of care for the resident

Facilitator

Having a checklist of precipitants to consider (e.g. basic needs: food, drink, pain, medication, etc.) aids in management plans

Facilitator

Care plans for all interventions need to be tailored and patient-centred

Facilitator

Ensuring that the follow-up of agitated symptoms is integrated into care practices

Facilitator

Goals

Caregivers may not always understand how agitation and/or aggression impacts patient care

Barrier

Caregivers may under-report symptoms

Barrier

Lack of follow-up of patient agitation symptoms

Barrier

Healthcare providers are not communicating care practices with residents

Barrier

Lack of communication between health facilities

Barrier

We can identify an unmet need, but there can be difficulty with solving it

Barrier

Changing language around agitated and aggressive behaviours to be more patient-centred

Facilitator

Hiring someone to carry out interventions or day to day affairs with resident

Facilitator

Using family members to help provide care

Facilitator

Team members coordinate care between each other

Facilitator

Interdisciplinary or entire team used to develop care plans

Facilitator

Hiring recreational therapist privately for residents with agitation

Facilitator

Confidence in Care Plan

Facilitator

The focus of the care plan needs to align with goals of care for the resident

Facilitator

Ensuring that the follow-up of agitated symptoms is integrated into care practices

Facilitator

Care plans for all interventions need to be tailored and patient-centred

Facilitator

Lack of Communication between LTC centres

Barrier

Automatic

Reinforcement

Lack of Coordination of Care among team members in LTC

Barrier

Lack of follow-up of patient agitation symptoms

Barrier

Communication with staff is effective among persons involved with the care or planning of care in LTC

Facilitator

Team members coordinate care between each other

Facilitator

Interdisciplinary or entire team used to develop care plans

Facilitator

Personalized and interdisciplinary approaches to care improve confidence in care plans

Facilitator

Care plans for all interventions need to be tailored and patient-centred

Facilitator

Ensuring that the follow-up of agitated symptoms is integrated into care practices

Facilitator

Emotion

Decline in mental status or increased dementia impeding care for agitation

Barrier

Difficulties among LTC staff to understand the residents’ needs (e.g. likes, dislikes)

Barrier

Resident personal qualities as barrier to care

Barrier

Residents having difficulty communicating needs

Barrier

It is important to look for triggers, contributing causes, and unmet needs that lead to agitation and/or aggression

Barrier

Having a checklist of precipitants to consider (e.g. basic needs: food, drink, pain, medication, etc.) aids in management plans

Facilitator

Residents respond better to some staff members and disciplines than others (e.g. rec therapy)

Facilitator