Between compassion and control: nursing ethos, professional responsibilities, limited resources, and the use of psychotropic drugs in dementia care

The widespread use of psychotropic medication in long-term care, especially antipsychotics for managing dementia-related behaviours, is controversial due to serious side effects, significant risks, and increased mortality rates. While prescribing authority lies with physicians, nurses often demand treatment and administer as-needed medications at their discretion. This study discusses the ongoing reliance on antipsychotics within the context of structural tensions between person-centred nursing values, multiple professional responsibilities, and resource constraints in long-term care facilities. Drawing on in-depth qualitative interviews with 15 nurses across seven German nursing homes, the study reveals diverse ways in which nursing staff navigate the use of psychotropic medication in dementia care. While nurses' self-descriptions and explicit ethos are framed in humanistic terms – addressing individual needs, promoting health and preserving functional capacities of those in need of care – they also feel responsible for protecting other residents and maintaining organisational stability in the care facilities. While some nurses still try to uphold their person-centred care ethos, seek to resist the rationing of care, and strongly oppose excessive sedation, others set aside their compassionate nursing values in everyday care and rationalise psychotropic medication for managing dementia-related behaviours as a matter of organisational necessity. Moving beyond individualised explanations for the overuse of psychotropic drugs, this study discusses the practices of pharmacological behaviour control as part of a pharmaceuticalisation of dementia care and as emblematic of the broader social-political governance of ageing and dementia. • Explores nurses' perspectives on psychotropic medication in dementia care. • Analyses antipsychotic use amid the economisation of long-term care systems. • Reveals tensions between nursing values, multiple role responsibilities and limited resources. • Conceptualises drug overuse as part of the pharmaceuticalisation of dementia. • Examines psychotropic behavioural control within the socio-political governance of ageing.