Autonomy, privacy and informed consent 3: elderly care perspective

Despite the growing interest in clinical healthcare ethics, there is a dearth of empirical studies investigating the ethical elements of day-to-day clinical practice from the perspective of either patients or staff. This article, the third in a four-part series, reports the results of a Scottish Study that formed part of a multi-site comparative study funded by the European Commission. It explores patient autonomy, privacy and informed consent in the care of elderly people in long-stay care facilities (i.e. nursing homes and continuing care units). A convenience sample of 101 elderly residents and their nurses (n = 160) participated in the study. Data were collected by means of a self-completion questionnaire for staff and a structured interview schedule for elderly residents. Results indicate marked differences between staff's and residents' responses on three of the four dimensions explored: information-giving, and opportunity to participate in decision-making about care and consent. There was much closer agreement between staff's and residents' responses regarding protection of patient privacy. From the results of this study there is indication of a clear need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day nursing care of older people. Findings to date suggest there is still a significant need to educate staff concerning ethical awareness and sensitivity to the dignity and rights of patients.

The living conditions of elderly Americans

PURPOSE

This article profiles the housing settings of frail elderly individuals, whether their homes are facilitating or impeding their ability to live in the community, and the change in disability and housing status before and after passage of the 1990 Americans with Disabilities Act.

DESIGN AND METHODS

The analysis relies primarily on statistical analysis of the 1995 national American Housing Survey (AHS), with supplementary analysis of the 1978 AHS.

RESULTS

In 1995, roughly 14% of elderly individuals had a "housing-related disability," 49% had at least one dwelling modification, and 23% had an unmet need for modifications. Because half those with dwelling modification also reported unmet need, the match between disabling condition and modification, not the presence of modifications, is key. Multivariate results indicate that although unmet need is greater among the poor, lack of modifications is not. Prevalence of modifications nearly doubled between 1978 and 1995. Overall unmet need declined, but some needs were less likely to be met in 1995 than 1978.

IMPLICATIONS

The analysis highlights the importance of information about housing for understanding the care and service needs of elderly individuals and provides a compelling argument for a minimum dataset on their housing and neighborhood environments.

Bright ideas. Some rules of thumb for interior lighting design and selection

Interior lighting design and selection can be a demanding assignment for a health facilities manager or department head. It requires a balance between conflicting needs, such as providing good task lighting for a nursing station while also shielding luminaires that are visible from patients' rooms to avoid glare.

Assisted living facilities as a site for NP practice

PURPOSE

To describe what an assisted living facility (ALF) is who resides in ALFs, and the benefits of nurse practitioner (NP) practice in an ALF for the client, facility, NP, and practice.

DATA SOURCES

Selected scientific literature, legal and regulatory guidelines, consumer information and guidelines, Internet sites, and the authors' experiences.

CONCLUSIONS

Assisted living facilities are nonmedical residential settings grounded in a philosophy of providing residents with choice, autonomy, privacy, independence, dignity, and respect in a housing environment as homelike as possible. Nationally, ALFs vary considerably by size, services provided, and regulations imposed by states.

IMPLICATIONS FOR PRACTICE

Assisted living facilities are now a popular choice for individuals who desire assistance with selected activities of daily living (ADL) while maintaining maximum independence. They are becoming an excellent site for the provision of in-home primary care in order to facilitate aging in place.

The potential of smart homes for injury prevention among the elderly

Smart homes promise to make the lives of elderly people more comfortable and safe. Today, there is a significant interest from industry and policy makers in developing these technologies. In theory, the emerging technologies make it possible to provide a new range of services. So far, however, the goal has often been to develop new services for young people rather than assisting old people to improve their quality of life. Especially important is the potential for using these technologies to promote safety and prevent injury among old people because this group is at home more than the other age groups. Networked devices can collect data from sensors and aid decision-making on intervention and other measures. Furthermore, these devices can instruct and remind individuals about safety-related issues.

Staff satisfaction and its components in residential aged care

OBJECTIVE

The purpose of this study was to assess the direction and magnitude of the effects among the components of staff satisfaction in residential aged care and to examine whether the relationships among satisfaction components vary according to facility type (i.e. nursing homes and hostels). A hostel is a low care facility in which residents are more independent, have a lower level of care needs, and receive personal but not nursing care.

DESIGN

A cross-sectional survey design was adopted to collect the required information, and a stratified random sampling approach was utilized to select facilities. Structural equation modeling was used to examine relationships among satisfaction components.

SETTING

Seventy residential aged care facilities in Western Australia.

STUDY PARTICIPANTS

The sample includes 610 nursing home and 373 hostel care staff.

RESULTS

The relationships among satisfaction components are different for nursing home and hostel staff. Professional support is found to have a strong and positive effect on all other aspects of staff satisfaction.

CONCLUSION

The findings lead to an improved understanding of the interrelationship among staff satisfaction components, which has important implications through enhancing professional support. This needs to be recognized and emphasized by managers, care providers, and policy makers so as to maintain stable personnel and continuity of care.

Measuring job satisfaction in residential aged care

BACKGROUND

Staff satisfaction has received increasing recognition as an important factor influencing service quality and in particular the quality of residents' lives in residential aged care facilities, where staff typically have a long-term and close relationship with residents. Consequently, a valid and reliable instrument is required to assess staff satisfaction in this particular context.

OBJECTIVE

This paper aims to assess the factor structure, reliability, and validity of the Measure of Job Satisfaction (MJS) instrument when used in residential aged care facilities.

DESIGN

A cross-sectional survey design was used to collect the required information, and a stratified random sampling method was utilized to select facilities. Exploratory and confirmatory factor analyses were conducted to assess the factor structure of staff satisfaction via the MJS.

SETTING

Both high and low care residential aged care facilities in Western Australia.

STUDY PARTICIPANTS

Nine hundred and eighty-three staff (including the Director of Nursing, manager, registered nurses, enrolled nurses, nursing assistants, and therapists) in 70 residential aged care facilities.

RESULTS

An acceptable five-factor (22-item) measurement model was derived. The Cronbach's alpha reliability levels range from 0.86 to 0.95. Convergent and discriminant validity are also satisfactory.

CONCLUSION

This investigation has confirmed that a modified MJS is a reliable and valid instrument for assessing staff satisfaction in residential aged care settings.

Urinary health in eldercare environments: an update from the NAFC

The National Association For Continence elected to cancel its 2001 conference scheduled for October 2001 in Washington, DC in light of national events. Executive Director Nancy Muller has provided Ostomy/Wound Management with a synopsis of key issues, important considerations, and the syllabus. We are grateful for the opportunity to serve as a forum for this worthy organization.

Integration of lucid individuals and agitated individuals with dementia in different care units

The purpose of this study was to illuminate how the integration of lucid individuals and agitated cognitively impaired individuals affects aspects of perceived quality of care. A questionnaire was mailed to hospital wards, nursing home wards and residential homes in Sweden. Nursing staff replied to the questionnaire on behalf of each care unit. Integration of cognitively impaired and lucid patients/residents was identified as a problem, regardless of whether the care unit was a hospital ward, nursing home or residential home. Agitated behaviours in people who were cognitively impaired could result in lucid residents becoming anxious, afraid and irritated. This in turn could lead to an exacerbation of behaviour in residents who were already agitated. Sometimes a lucid patient/resident was required to share a room with an agitated individual. There is a need for staff training specific to the needs of people with dementia. Findings suggest that there is a shortage of units designed specifically for the care of agitated cognitively impaired patients/residents. The findings of this study support the need for healthcare providers in long-term care settings to maintain the rights and well being of all patients/residents.

Needs of frail elderly people in informal settlements

The frail elderly in informal settlements find themselves in an extremely vulnerable position due to a number of factors, namely, their increasing dependency status, limited resources and adverse physical environment. Various aspects that influence the aged in their present environment will be highlighted. A survey method was used to explore and to describe the world in which they live in informal areas. The attitude, expectation and needs of the elderly in respect of their care was also determined. A random cluster sample was taken. Data was collected by means of interviews in terms of a semi-structured questionnaire. It appears that the frail elderly were happy in the environment in which they received care in spite of their unfavourable physical environment and limited resources. The communities where the frail elderly lived were largely unaware of the valuable inputs they can make regarding the care of the aged. This necessitates the development of programs in the heart of communities, owned by communities, where all role players in the care of the aged participate.

Differing perceptions in defining safe independent living for elders

This exploratory study was conducted to determine whether fundamental differences in perceptions exist among elders, young and middle-aged adults, and nurses in their view of what factors constitute a safe independent living arrangement for elders. A convenience sample of 335 was surveyed on perceptions of the importance of situation factors (ie, ADL [activities of daily living] skills, instrumental activities, functional abilities, environmental factors) to independent living and the degree of interference of diseases and symptoms with elder independent living arrangements. The results reveal that there are fundamental differences in perceptions about factors related to safe independent living for elders among the groups. Nurses perceived that certain diseases and symptoms caused more interference with independent living, whereas nonnurses tended to be more concerned about bathing, climbing steps, and home and property maintenance. Age, level of education, gender, and race also were found to be significant predictors of the perceptions of situation factors related to independent living. More specific research is needed to determine whether these fundamental differences hold true when an actual elder living situation is at issue.