Evidence-Based Treatment of Young Adults With Substance Use Disorders.

In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among adolescents and young adults, in this special article, we review principles of care related to SUD treatment of young adults. SUDs are most commonly diagnosed during young adulthood, but most of the evidence guiding the treatment of this population has been obtained from older adult study participants. Extrapolating evidence from older populations, the expert group asserted the following principles for SUD treatment: It is important that clinicians who work with young adults effectively identify and address SUD to avert long-term addiction and its associated adverse health outcomes. Young adults receiving addiction treatment should have access to a broad range of evidence-based assessment, psychosocial and pharmacologic treatments, harm reduction interventions, and recovery services. These evidence-based approaches should be tailored to young adults' needs and provided in the least restrictive environment possible. Young adults should enter care voluntarily; civil commitment to treatment should be a last resort. In many settings, compulsory treatment does not use evidence-based approaches; thus, when treatment is involuntary, it should reflect recognized standards of care. Continuous engagement with young adults, particularly during periods of relapse, should be considered a goal of treatment and can be supported by care that is patient-centered and focused on the young adult's goals. Lastly, substance use treatments for young adults should be held to the same evidence and quality standards as those for other chronic health conditions.

Experiences of parents with an adolescent abusing substances admitted to a mental health institution in Giyani, South Africa.

BACKGROUND: Substance abuse by adolescents may be a problem that contributes to their mental illness. Substance abuse does affect not only the individual who is abusing it but also friends, family and the whole community. The adolescent abusing substances may be mentally unstable and have unpredictable behaviour. There is no research on the experiences of parents with adolescents abusing substances in Giyani, South Africa. OBJECTIVE: The purpose of the study was to explore and describe the experiences of parents with adolescents abusing substances admitted to a mental health institution in Giyani. METHOD: A qualitative, exploratory, descriptive and contextual research design was used. Data were collected by means of conducting individual, in-depth, phenomenological interviews, observations and field notes. The following central question was asked to the participants: 'How is it for you to have an adolescent who is abusing substances'. Data were analysed by using a thematic method of coding. An independent coder analysed data together with the researcher, and consensus was reached. RESULTS: Four themes emerged from the data: parents experienced uncontrolled thoughts regarding their adolescent abusing substances, not being able to control their adolescent abusing substances through discipline, negative feelings regarding their adolescent abusing substances and negative consequences regarding their adolescents abusing substances. CONCLUSION: From the study result, it is clear that parents with adolescent abusing substances need professional assistance and support as evidenced by the challenges faced in terms of promoting, maintaining and restoring their mental health. Psychiatric nurses should take responsibility to educate the community about substance abuse, for example offering school health programmes. Further research studies can also be conducted in other villages to gain a greater understanding of those parents' experiences with an adolescent abusing substances.

Restraints and seclusion in psychiatry: striking a balance between protection and coercion. Critical overview of international regulations and rulings.

Restraint and seclusion (R&S) measures in psychiatric settings are applied worldwide, despite poor scientific evidence to back up their effectiveness. The medical, ethical and medico-legal implications of coercive interventions are broad-ranging and multifaceted. The review aims to shed a light on the most relevant and meaningful standards that have been laid out by international treaties, supranational institutions (United Nations, Council of Europe, World Health Organization), scientific institutions (American Medical Association, Australian Department of Health), legislative bodies and courts of law. Several court cases are herein expounded upon, with a close focus on meaningful analysis, decisions and conclusions that have laid the groundwork for a different, more restrictive and more clearly defined approach towards R&S imposed upon psychiatric patients. It is reasonable to assume that changing norms, civil rights enforcement, court rulings and new therapeutic options have influenced the use of R&S to such an extent that such measures are among the most strictly regulated in psychiatric practice; health care providers should abide by a strict set of cautionary rules when making the decision to resort to R&S, which must never be put in place as a substitute for patient-centered therapeutic planning. Case law shows that R&S should only be weighed in terms of their effectiveness towards therapeutic goals. Being able to prove that R&S was employed as part of a therapeutic path rather than used to maintain order or to exact punishment may go a long way towards shielding operators against negligence lawsuits and litigation.

The indistinguishables: determining appropriate environments for justice involved individuals.

Criminalizing those with mental illness is a controversial topic with a long and complex history in the United States. The problem has traditionally been dichotomized between criminals (i.e., "bad") in need of placement in jails and prisons and the mentally ill (i.e., "mad") who are need of treatment in psychiatric facilities. Recent trends demonstrate significant increases in the rates of mental illness in jails and prisons, as well as increased rates of violence within psychiatric hospitals. This would suggest that there are a group of justice involved individuals who are "indistinguishable" within the traditional dichotomous categories of dangerousness and mental illness. The authors argue for a more nuanced model that dimensionally conceptualizes dangerousness and mental illness; increased attention to situational factors that create facilities appropriate for those who are dangerous and mentally ill and more diversion programs for those inappropriate for incarceration or hospitalization.

A Narrative Care approach for persons living with dementia in institutional care settings.

AIMS AND OBJECTIVES: We will provide insights in the theoretical background and key concepts of a Narrative Care approach, such as narrative cultures, narrative curiosity, narrative co-composition and narrative reflective practice. BACKGROUND: Care understood as narrative practice underscores the importance of experiences and how these shape identities. Important to the quality of care in institutional care settings is the ability of care providers to cope with complexities and uncertainties in older adults' stories, which can be realised by attending to ways that foster and co-compose evolving and forward-looking narratives. Recognising these ongoing co-compositions means that persons living in institutional care settings and care providers live, tell, retell and relive their experiences. A change in the current institutional culture is necessary to implement care as narrative practice. To support such a change, approaches are needed that foster a focus on experiences and relationships and make relational ethics central to care. METHODS: The proposed Narrative Care approach is the result of an iterative development process involving a literature review, interviews with, and observations of, care providers, dialogues with an advisory committee, and consultation with experts. MAIN CONTRIBUTIONS: The proposed Narrative Care approach aims to help care providers (a) to recognise the importance of curiosity in a person's verbal and embodied narratives-especially for those living with dementia; (b) to take note of individual experiences in all of their complexity and uncertainty; (c) to respect these narratives; (d) to open up spaces to co-compose new narratives; and (e) to allow care providers to engage in narrative reflective practices that shape who they are and are becoming. CONCLUSION: The introduced approach responds to the need of implementing strategies to think and work narratively in institutional care settings. IMPLICATIONS FOR PRACTICE: Narrative Care has the potential to reshape task-oriented, technical notions of care. Concepts such as embodied narratives, relational ethics, narrative co-composition and narrative reflective practice must be integrated in the education of all care providers.

Concept formation of ambience for labor and normal institutionalized delivery.

OBJECTIVE: to develop the concept ambience for labor and normal institutionalized delivery, identifying in the literature its antecedent, defining attributes and the consequent. METHOD: the method used was the analysis of literature, corresponding to the first stage of the qualitative method of concept analysis. The theoretical operation was performed in the databases CINAHL COCHRANE, LILACS, PsycINFO, and PubMed. RESULTS: aspects of the parturient woman and the qualification of the physical and social space are presented as the antecedent. The defining attributes outline the assistance interaction process with Non-Invasive Technologies. As the consequent, we highlight the outcome for normal delivery, pain relief and comfort, woman satisfaction and well-being. FINAL CONSIDERATIONS: the analysis of the antecedent, defining attributes and the consequent allowed the elaboration of an unprecedent theoretical proposition of this concept.

Quality of life of institutionalized aged with and without symptoms of depression.

OBJECTIVE: compare the quality of life (QOL) of aged residents in homes for aged people with or without symptoms of depression, and identify social, physical activity; leisure; health and basic activities of daily living (ADL) variables that correlate with QOL scores. METHOD: cross-sectional study conducted with 101 institutionalized aged. Multiple linear regression was used for data analysis. RESULTS: symptoms of depression changed negatively the QOL in the domains: autonomy; present, past and future activities; social participation; intimacy and total score. Dependent aged presented lower QOL for the performance of ADL in the domains: autonomy; social participation and total score; dancing without limitation of movement; liking the residential and not presenting symptoms of depression were the variables that positively influenced the QOL of the aged. CONCLUSION: social and psychological support, good living conditions and stimulating assistance can improve the QOL of institutionalized elderlies.

Early family adversity, stability and consistency of institutional care and infant cognitive, language and motor development across the first six months of institutionalization.

This study extends research on the effects of institutionalization-by examining the trajectories of cognitive, language and motor development of 64 Portuguese infants and toddlers across the first six months of institutionalization, while determining whether pre-institutional adversities and the stability and consistency of institutional care predict children's development. At time of enrollment, 23.4%, 32.8% and 31.3% of the children were moderately to severely delayed, respectively, in their cognitive, linguistic and motor functioning. Developmental problems persisted after six months of institutionalization. The accumulation of early pre-institutional adversities predicted cognitive and motor limitations at admission to the institutions, but not variation in subsequent development. The stability and consistency of institutional care also failed to predict developmental growth and change. Children who had never lived with their families of origin showed a better language development at enrollment than their counterparts who had lived with their families of origin before institutionalization. Such advantage was followed by a deceleration in language growth after six months of institutional placement. Results are discussed in terms of short- vs. longer-term effects of institutionalization.

Quality of life of institutionalized aged with and without symptoms of depression / Calidad de vida de los ancianos institucionalizados con y sin síntomas de depresión / Qualidade de vida de idosos institucionalizados com e sem sinais de depressão

ABSTRACT Objective: compare the quality of life (QOL) of aged residents in homes for aged people with or without symptoms of depression, and identify social, physical activity; leisure; health and basic activities of daily living (ADL) variables that correlate with QOL scores. Method: cross-sectional study conducted with 101 institutionalized aged. Multiple linear regression was used for data analysis. Results: symptoms of depression changed negatively the QOL in the domains: autonomy; present, past and future activities; social participation; intimacy and total score. Dependent aged presented lower QOL for the performance of ADL in the domains: autonomy; social participation and total score; dancing without limitation of movement; liking the residential and not presenting symptoms of depression were the variables that positively influenced the QOL of the aged. Conclusion: social and psychological support, good living conditions and stimulating assistance can improve the QOL of institutionalized elderlies.

RESUMEN Objetivo: comparar la calidad de vida (CV) de los ancianos residentes en instituciones de larga permanencia con o sin síntomas de depresión, e identificar variables sociales, de actividad física, de ocio, de salud y de actividades básicas de la vida diaria (ABVD) que se correlacionan con las puntuaciones de CV. Método: estudio transversal realizado con 101 ancianos institucionalizados. Para el análisis de los datos se utilizó la regresión lineal múltiple. Resultados: los síntomas de depresión cambiaron negativamente la CV en los dominios: autonomía; actividades presentes, pasadas y futuras; participación social; intimidad y puntuación total. Los ancianos dependientes para la realización de la ABVD tuvieron menor CV en los dominios: autonomía, participación social y puntuación total; bailar sin limitación de movimiento, gustar de lo hogar, y no mostrar síntomas de depresión, fueron las variables que influenciaron de forma positiva en la CV de los ancianos. Conclusión: el apoyo social y psicológico, unas buenas condiciones de vida y una asistencia estimulante pueden mejorar la calidad de vida de los ancianos institucionalizados.

RESUMO Objetivo: comparar a qualidade de vida (QV) de idosos residentes em instituições de longa permanência com ou sem sinais de depressão, e identificar variáveis sociais, de atividade física, lazer, saúde e atividades básicas da vida diária (ABVD) que se correlacionam aos escores de QV. Método: estudo transversal realizado com 101 idosos institucionalizados. A regressão linear múltipla foi usada para a análise dos dados. Resultados: sinais de depressão alteraram negativamente a QV nos domínios: autonomia, atividades presentes, passadas e futuras, participação social, intimidade e escore total; idosos dependentes para a realização das ABVD apresentaram QV inferior nos domínios: autonomia, participação social e escore total; dançar sem limitação de movimento, gostar do residencial e não apresentar sinais de depressão foram as variáveis que influenciaram positivamente a QV dos idosos. Conclusão: suporte social e psicológico, boas condições de moradia e assistência estimuladora podem melhorar a QV de idosos institucionalizados.

Concept formation of ambience for labor and normal institutionalized delivery / Elaboración del concepto de ambiencia para el trabajo de parto y el parto normal institucionalizado / Formação do conceito ambiência para trabalho de parto e parto normal institucionalizado

ABSTRACT Objective: to develop the concept ambience for labor and normal institutionalized delivery, identifying in the literature its antecedent, defining attributes and the consequent. Method: the method used was the analysis of literature, corresponding to the first stage of the qualitative method of concept analysis. The theoretical operation was performed in the databases CINAHL COCHRANE, LILACS, PsycINFO, and PubMed. Results: aspects of the parturient woman and the qualification of the physical and social space are presented as the antecedent. The defining attributes outline the assistance interaction process with Non-Invasive Technologies. As the consequent, we highlight the outcome for normal delivery, pain relief and comfort, woman satisfaction and well-being. Final considerations: the analysis of the antecedent, defining attributes and the consequent allowed the elaboration of an unprecedent theoretical proposition of this concept.

RESUMEN Objetivo: elaborar el concepto ambiencia para el trabajo de parto y el parto normal institucionalizado, identificando en la literatura sus antecedentes, sus atributos definidores y consecuentes. Método: se utilizó el método de análisis crítico de la literatura, que corresponde al primer paso de la metodología cualitativa del análisis de concepto. Se hizo una búsqueda teórica en las bases de datos CINAHL, COCHRANE, LILACS, PsycINFO y PubMed. Resultados: los elementos relativos a la parturienta y a la calificación del espacio físico y social se presentan como antecedentes. Los atributos definidores delimitan el proceso de interacción de la atención con el uso de las tecnologías no invasivas. Ya de los consecuentes, se destacan el resultado del parto normal, el alivio del dolor y comodidad, la satisfacción y el bienestar de la parturienta. Consideraciones finales: el análisis de los antecedentes, atributos definidores y consecuentes permitieron elaborar una propuesta teórica inédita de este concepto.

RESUMO Objetivo: elaborar o conceito ambiência para trabalho de parto e parto normal institucionalizado, identificando na literatura seus antecedentes, atributos definidores e consequentes. Método: empregou-se o método da análise crítica da literatura, correspondendo à primeira etapa da metodologia qualitativa de análise de conceito. A exploração teórica foi realizada nas bases de dados CINAHL, COCHRANE, LILACS, PsycINFO e PubMed. Resultados: elementos referentes à parturiente e à qualificação do espaço físico e social são apresentados como antecedentes. Os atributos definidores delineiam o processo de interação assistencial com o uso das Tecnologias Não Invasivas. Como consequentes, destacam-se desfecho para o parto normal, alívio e conforto da dor, satisfação e bem-estar da parturiente. Considerações finais: a análise dos antecedentes, atributos definidores e consequentes permitiu elaborar uma proposição teórica inédita desse conceito.

The adolescent and the institutionalization: understanding the phenomenon and meanings attributed to it.

OBJECTIVE: To understand the meaning of being institutionalized and in conflict with the law for the institutionalized adolescent. METHOD: A qualitative, phenomenological-comprehensive study carried out in a Socio-educational Service Foundation in the northern region of Brazil, with 05 institutionalized adolescents. The analysis was carried out under the understanding of the content suggested by Heidgger, thus allowing the construction of analytical categories for a hermeneutical interpretation. RESULTS: Conflicting with the law means something negative and bad for the institutionalized adolescents, in which they understand that although there is deprivation of liberty, the period of hospitalization is an important moment for the reflection on the need to start over. CONCLUSION: The meaning of conflicting with the law goes far beyond a simple word, act or behaviour, it is something that only those who experience the phenomenon are able to unveil, arouse deep feelings and provide reflection to the adolescent about the damages caused by the infraction.

The adolescent and the institutionalization: understanding the phenomenon and meanings attributed to it / El adolescente y la institucionalización: comprensión del fenómeno y significados atribuidos / O adolescente e a institucionalização: compreensão do fenômeno e significados atribuídos

ABSTRACT Objective: To understand the meaning of being institutionalized and in conflict with the law for the institutionalized adolescent. Method: A qualitative, phenomenological-comprehensive study carried out in a Socio-educational Service Foundation in the northern region of Brazil, with 05 institutionalized adolescents. The analysis was carried out under the understanding of the content suggested by Heidgger, thus allowing the construction of analytical categories for a hermeneutical interpretation. Results: Conflicting with the law means something negative and bad for the institutionalized adolescents, in which they understand that although there is deprivation of liberty, the period of hospitalization is an important moment for the reflection on the need to start over. Conclusion: The meaning of conflicting with the law goes far beyond a simple word, act or behaviour, it is something that only those who experience the phenomenon are able to unveil, arouse deep feelings and provide reflection to the adolescent about the damages caused by the infraction.

RESUMEN Objetivo: Comprender el significado de estar institucionalizado y en conflicto con la ley para el adolescente institucionalizado. Método: Estudio cualitativo, fenomenológico-comprensivo, realizado en una Fundación de Atención Socioeducativa de la región norte de Brasil, con 05 adolescentes institucionalizados. El análisis se produjo a partir de la comprensión del contenido sugerido por Heidgger, permitiendo así la construcción de categorías analíticas para una interpretación hermenéutica. Resultados: El estar en conflicto con la ley para el adolescente institucionalizado significa algo negativo y malo, donde el adolescente comprende que aunque exista la privación de libertad, el período de internación es un momento importante para la reflexión sobre la necesidad de recomenzar. Conclusión: El significado de estar en conflicto con la ley va mucho más allá de una simple palabra, acto o comportamiento, siendo algo que solamente quien vive el fenómeno es capaz de desvelar, despertar sentimientos profundos y proporcionar reflexión al adolescente sobre los perjuicios acarreados por el acto infractor.

RESUMO Objetivo: Compreender o significado de estar institucionalizado e em conflito com a lei para o adolescente institucionalizado. Método: Estudo qualitativo, fenomenológico-compreensivo, realizado em uma Fundação de Atendimento Socioeducativa da região norte do Brasil, com 05 adolescentes institucionalizados. A análise ocorreu a partir da compreensão de conteúdo sugerida por Heidgger, permitindo, assim, a construção de categorias analíticas para uma interpretação hermenêutica. Resultados: Estar em conflito com a lei para o adolescente institucionalizado significa algo negativo e ruim, onde o adolescente compreende que embora exista a privação de liberdade, o período de internação é um momento importante para a reflexão sobre a necessidade de recomeçar. Conclusão: O significado de estar em conflito com a lei vai muito além de uma simples palavra, ato ou comportamento, sendo algo que somente quem vivencia o fenômeno é capaz de desvelar, despertar sentimentos profundos e proporcionar reflexão ao adolescente sobre os prejuízos acarretados pelo ato infracional.

A 21-winter seasons retrospective study of antibody response after influenza vaccination in elderly (60-85 years old) and very elderly (>85 years old) institutionalized subjects.

Influenza vaccination is considered the best mean for preventing the higher rates of mortality associated with influenza virus infection in the elderly as compared with younger people. Since the number of very elderly subjects, aged >85 years, is rapidly increasing, and some authors reported increments in influenza-associated mortality with age, the aim of this study was to increase the limited information available on the immunogenicity of the influenza vaccines in this age group. This was a retrospective study which analyzed the antibody response induced by commercially available trivalent inactivated influenza vaccines in 1491 elderly subjects (60-85 years old) and 1139 very elderly subjects (>85 years old) during 21 winter seasons included between 1993-1994 and 2014-2015. The antibody response of the two age groups was, in most instances, acceptable according to the Committee for Medical Products for Human Use and comparable. In accordance with previous data obtained in the elderly, the use of MF59-adjuvanted or intradermal administered vaccines (enhanced vaccines) was found to be preferable as compared with conventional formulations (split or subunit vaccines). Vaccines containing new strains induced higher antibody response as compared with vaccines with the same antigenic composition of the previous years. These results suggest that the current recommendation for use of enhanced influenza vaccines for the elderly is appropriate, but that efforts to improve the effectiveness of the present prophylactic measures against influenza are needed, especially in the years with vaccines with the same antigenic composition of the previous winter season.

Psychosocial intervention for carers of people with dementia: What components are most effective and when? A systematic review of systematic reviews.

BACKGROUND: Psychosocial interventions for carers of people with dementia are increasingly recognized as playing an important role in dementia care. We aim to systematically review the evidence from existing systematic reviews of psychosocial interventions for informal carers of people with dementia. METHODS: Thirty-one systematic reviews were identified; following quality appraisal, data from 13 reviews, rated as high or moderate quality, were extracted. RESULTS: Well-designed, clearly structured multi-component interventions can help maintain the psychological health of carers of people with dementia and delay institutionalization of the latter. To be most effective, such interventions should include both an educational and a therapeutic component; delivery through a support group format may further enhance their effectiveness. CONCLUSIONS: Successful translation of evidence into practice in this area remains a challenge. Future research should focus on determining the most cost-effective means of delivering effective multi-component interventions in real-world settings; the cost-effective potential of technology-based interventions is considerable.

Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study.

BACKGROUND: The elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. Information about Romanian prescribing practices among the elderly and potential medication associated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially inappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an observational retrospective design. METHODS: All reimbursed medications prescribed to a sample of ambulatory elderly accessing two community pharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania, same month) were analyzed. The STOPP/START criteria and the PRISCUS list were used for PIM identification and for classification as misprescribed, underprescribed or overprescribed -subtypes. RESULTS: The analysis involved 345 prescriptions recommended to ambulatory elderly and 91 medical files available for the institutionalized patients. The ambulatory elderly had a mean age of 74.8 years old and were daily exposed to a median number of 3 prescribed medications. The institutionalized elderly were older (mean age 80.77) received 8 medications daily and 69 % of them were functionally dependent. Cardiovascular and neuropsychiatric indications were the most frequent: 64.34 % and 18.55 % of the ambulatory prescriptions, 93.40 % and 41.75 % of the institutionalized patients' medical files. 159 PIM were identified on 34.49 % of the ambulatory prescriptions. 82.41 % of the institutionalized patients' medical files contained 140 PIM. The potential underprescribing of cardiovascular therapies was the most frequent PIM category on the ambulatory prescriptions (55.34 % of all PIM), while for the institutionalized patients' medical files, the misprescribed and overprescribed PIM were those predominantly represented (62.14 % and 27.14 % of all PIM). In both subgroups of data, NSAIDs (56.66 % of ambulatory prescriptions and 35.63 % of institutionalized patients' data) and benzodiazepines (26.66 % of ambulatory prescriptions and 24.13 % of institutionalized patient's data) were predominantly misprescribed. Anticholinergics were rarely used (0.62 % of total PIM from ambulatory prescriptions, 2.14 % of total PIM from institutionalized patients' data). CONCLUSIONS: The PIM identified in both elderly groups suggested potential risks for the occurrence of adverse events specific to the elderly population. Larger studies, both observational and interventional, are needed to ensure a safer therapeutic approach.

Development and usability of the MAINtAIN, an inventory assessing nursing staff behavior to optimize and maintain functional activity among nursing home residents: a mixed-methods approach.

BACKGROUND: Functional decline is common in nursing home residents. Nursing staff can help prevent this decline, by encouraging residents to be more active in functional activities. Questionnaires measuring the extent to which nursing staff encourage functional activity among residents are lacking. In addition, there are no measurement instruments to gain insight into nursing staff perceived barriers and facilitators to this behavior. The aim of this study was to develop, and study the usability, of the MAastrIcht Nurses Activities INventory (MAINtAIN), an inventory assessing a) the extent to which nursing staff perceive to perform behaviors that optimize and maintain functional activity among nursing home residents and b) the perceived barriers and facilitators related to this behavior. METHODS: Using a mixed-methods approach the MAINtAIN was developed and its usability was studied. Development was based on literature, expert opinions, focus group (N = 3) and individual interviews (N = 14) with residents and staff from nine nursing homes in the Netherlands. Usability was studied in a cross-sectional study with 37 nurses and certified nurse assistants; data were analyzed using descriptive statistics. RESULTS: Development of the MAINtAIN resulted in two distinctive parts: MAINtAIN-behaviors and MAINtAIN-barriers. MAINtAIN-behaviors, targeting nursing staff behavior to optimize and maintain functional activity, includes 19 items covering activities of daily living, household activities, and miscellaneous activities. MAINtAIN-barriers addresses the perceived barriers and facilitators related to this behavior and comprises 33 items covering barriers and facilitators related to the residents, the professionals, the social context, and the organizational and economic context. The usability study showed that the inventory was not difficult to complete, that items and response options were clear, and that the number of missing values was low. Few items showed a floor or ceiling effect. CONCLUSIONS: The newly developed inventory MAINtAIN provides a usable method for researchers and nursing homes to obtain insight into nursing staff perceived behavior in optimizing functional activity among residents and their perceived barriers and facilitators related to this behavior. Outcomes of the MAINtAIN may contribute to change in nursing staff behavior and may improve nursing care. Further research with regard to the psychometric properties of the MAINtAIN is recommended.