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Duan Y, Ng W, Bowblis JR, Akosionu O, Shippee TP. Nursing Home Resident Preferences for Daily Care and Activities: A Latent Class Analysis of National Data. THE GERONTOLOGIST 2024; 64:gnad089. [PMID: 37432373 PMCID: PMC10825845 DOI: 10.1093/geront/gnad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Uncovering subgroups of nursing home residents sharing similar preference patterns is useful for developing systematic approaches to person-centered care. This study aimed to (i) identify preference patterns among long-stay residents, and (ii) examine the associations of preference patterns with resident and facility characteristics. RESEARCH DESIGN AND METHODS This study was a national cross-sectional analysis of Minimum Data Set assessments in 2016. Using resident-rated importance for 16 preference items in the Preference Assessment Tool as indicators, we conducted latent class analysis to identify preference patterns and examined their associations with resident and facility characteristics. RESULTS We identified 4 preference patterns. The high salience group (43.5% of the sample) was the most likely to rate all preferences as important, whereas the low salience group (8.7%) was the least likely. The socially engaged (27.2%) and the socially independent groups (20.6%) featured high importance ratings on social/recreational activities and maintaining privacy/autonomy, respectively. The high salience group reported more favorable physical and sensory function than the other 3 groups and lived in facilities with higher staffing of activity staff. The low salience and socially independent groups reported a higher prevalence of depressive symptoms, whereas the low salience or socially engaged groups reported a higher prevalence of cognitive impairment. Preference patterns also varied by race/ethnicity and gender. DISCUSSION AND IMPLICATIONS Our study advanced the understanding of within-individual variations in preferences, and the role of individual and environmental factors in shaping preferences. The findings provided implications for providing person-centered care in NHs.
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Affiliation(s)
- Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Weiwen Ng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - John R Bowblis
- Department of Economics and Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Odichinma Akosionu
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tetyana P Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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McPherson R, Galik E, Gruber-Baldini AL, Holmes S, Kusmaul N, Resnick B. Model Testing of the Factors that are Associated with Care Interactions among Nursing Home Residents with Dementia. J Am Med Dir Assoc 2023; 24:1389-1395. [PMID: 37507101 DOI: 10.1016/j.jamda.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The purpose of this study was to test a model of the resident and community factors that are associated with quality of care interactions among nursing home (NH) residents living with dementia and test for invariance between model fit when tested with the Black versus White residents and female versus male residents. It was hypothesized that resident age, gender, race, pain, comorbidities, quality of life, resistiveness to care, function, cognition, community profit status, overall community star rating, community size, and staffing star rating would be directly and/or indirectly associated with quality of care interactions. It was also hypothesized that the model fit would be invariant by resident race and gender. DESIGN This was a secondary data analysis using baseline, cross-sectional data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) intervention study. SETTING AND PARTICIPANTS The study included 528 residents from 55 NH facilities. METHODS Descriptive statistics and structural equation modeling was used to test the proposed model. RESULTS The results showed that the final model with significant paths only had a poor fit to the data (χ2/df = 10.79, comparative fit index = 0.57, Tucker-Lewis index = 0.15, normed fit index = 0.57, root mean square error of approximation = 0.13). However, the findings indicated that comorbidities, pain, profit status, and overall community star rating were significantly associated with quality of care interactions. There was no difference in model fit between Black residents versus White residents, and between male versus female residents. CONCLUSIONS AND IMPLICATIONS This study suggests factors that may influence quality of care interactions. Managing comorbidities, managing pain, and supporting higher quality of care in NH communities will likely help increase the frequency of positive care interactions. These findings can inform future interventions and training curricula for NH care staff to promote positive care interactions.
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Affiliation(s)
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ann L Gruber-Baldini
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Holmes
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Nancy Kusmaul
- University of Maryland Baltimore County, School of Social Work, Baltimore, MD, USA
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
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Irwin P, Taylor D, Keefe JM. Provincial policies affecting resident quality of life in Canadian residential long-term care. BMC Geriatr 2023; 23:362. [PMID: 37296381 PMCID: PMC10252178 DOI: 10.1186/s12877-023-04074-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents' quality of life. In deference to the risk mitigation measures in Canadian long-term care settings during Covid-19, some person-centred, quality of life policies were paused, unused, or under-utilised. This study aimed to interrogate these existing but latent policies, to capture their potentiality in terms of positively influencing the quality of life of residents in long-term care in Canada. METHODS The study analysed policies related to quality of life of long-term care residents in four Canadian provinces (British Columbia, Alberta, Ontario, and Nova Scotia). Three policy orientations were framed utilising a comparative approach: situational (environmental conditions), structural (organisational content), and temporal (developmental trajectories). 84 long term care policies were reviewed, relating to different policy jurisdictions, policy types, and quality of life domains. RESULTS Overall, the intersection of jurisdiction, policy types, and quality of life domains confirms that some policies, particularly safety, security and order, may be prioritised in different types of policy documents, and over other quality of life domains. Alternatively, the presence of a resident focused quality of life in many policies affirms the cultural shift towards greater person-centredness. These findings are both explicit and implicit, and mediated through the expression of individual policy excerpts. CONCLUSION The analysis provides substantive evidence of three key policy levers: situations-providing specific examples of resident focused quality of life policy overshadowing in each jurisdiction; structures-identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories-confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. It also demonstrates and contextualises examples of policy slippage, differential policy weights, and cultural shifts across existing policies. When applied within a resident focused, quality of life lens, these policies can be leveraged to improve extant resource utilisation. Consequently, the study provides a timely, positive, forward-facing roadmap upon which to enhance and build policies that capitalise and enable person-centredness in the provision of long-term care in Canada.
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Affiliation(s)
- Pamela Irwin
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, NS Canada
| | - Deanne Taylor
- Interior Health Authority, Kelowna, BC Canada
- Rural Coordination Centre of British Columbia, Vancouver, BC Canada
| | - Janice M. Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, NS Canada
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS Canada
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Hoben M, Dymchuk E, Corbett K, Devkota R, Shrestha S, Lam J, Banerjee S, Chamberlain SA, Cummings GG, Doupe MB, Duan Y, Keefe J, O'Rourke HM, Saeidzadeh S, Song Y, Estabrooks CA. Factors Associated With the Quality of Life of Nursing Home Residents During the COVID-19 Pandemic: A Cross-Sectional Study. J Am Med Dir Assoc 2023:S1525-8610(23)00325-0. [PMID: 37150208 PMCID: PMC10076504 DOI: 10.1016/j.jamda.2023.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL. DESIGN Cross-sectional study (July to December 2021). SETTING AND PARTICIPANTS We purposefully selected 9 NHs in Alberta, Canada, based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). We included data for 689 residents from 18 care units. METHODS We used the DEMQOL-CH to assess resident QoL through video-based care aide interviews. Independent variables included a COVID-19 outbreak in the NH in the past 2 weeks (health authority records), care unit-levels of care aide burnout (9-item short-form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit (validated surveys), and resident covariates (Resident Assessment Instrument-Minimum Data Set 2.0). RESULTS Recent COVID-19 outbreaks (β = 0.189; 95% CI: 0.058-0.320), higher proportions of emotionally exhausted care aides on a care unit (β = 0.681; 95% CI: 0.246-1.115), and lack of access to geriatric professionals (β = 0.216; 95% CI: 0.003-0.428) were significantly associated with poorer resident QoL. CONCLUSIONS AND IMPLICATIONS Policies aimed at reducing infection outbreaks, better supporting staff, and increasing access to specialist providers may help to mitigate how COVID-19 has negatively affected NH resident QoL.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada; College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
| | - Emily Dymchuk
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Kyle Corbett
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Shovana Shrestha
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jenny Lam
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, England, UK
| | | | - Greta G Cummings
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Malcolm B Doupe
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yinfei Duan
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Faculty of Arts, Mount Saint Vincent University, Halifax, NS, Canada
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Yuting Song
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada; School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Carole A Estabrooks
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Lindmark T, Engström M, Trygged S. Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review. J Appl Gerontol 2023; 42:347-359. [PMID: 36214292 PMCID: PMC9841825 DOI: 10.1177/07334648221131468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This systematic review investigated the psychosocial work environment and well-being of direct-care staff under different nursing home ownership types. Databases searched: Scopus, Web of Science, Cinahl, and PubMed, 1990-2020. Inclusion criteria: quantitative or mixed-method studies; population: direct-care staff in nursing homes; exposure: for-profit and non-profit ownership; and outcomes: psychosocial work environment and well-being. In total, 3896 articles were screened and 17(n = 12,843 participants) were assessed using the Joanna Briggs Institute Critical Appraisal tools and included in the narrative synthesis. The results were inconsistent, but findings favored non-profit over for-profit settings, for example, regarding leaving intentions, organizational commitment, and stress-related outcomes. There were no clear differences concerning job satisfaction. Job demands were higher in non-profit nursing homes but alleviated by better job resources in one study. The result highlights work environment issues, with regulations concerning for-profit incentives being discussed in terms of staff benefits.
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Affiliation(s)
- Tomas Lindmark
- Faculty of Health and Occupational Studies, Department of Social Work, University of Gävle, Gävle, Sweden,Tomas Lindmark, Faculty of Health and Occupational Studies, Department of Social work, University of Gävle, Kungsbäcksvägen 47, Gävle 801 76, Sweden.
| | - Maria Engström
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
| | - Sven Trygged
- Faculty of Health and Occupational Studies, Department of Social Work, University of Gävle, Gävle, Sweden
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Clemens S, Aelick K, Babineau J, Bretzlaff M, Edwards C, Gibson J, Hewitt Colborne D, Iaboni A, Lender D, Schon D, Snowball E, McGilton KS, Bethell J. Home‐ and community‐level predictors of social connection in nursing home residents: A scoping review. Health Sci Rep 2022; 5:e743. [PMID: 35873395 PMCID: PMC9297378 DOI: 10.1002/hsr2.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Aims Methods Results Conclusion
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Affiliation(s)
- Sara Clemens
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
| | - Katelynn Aelick
- Behavioural Supports Ontario Provincial Coordinating Office North Bay Regional Health Centre North Bay Ontario Canada
| | - Jessica Babineau
- Library and Information Services University Health Network Toronto Ontario Canada
- The Institute for Education Research University Health Network Toronto Ontario Canada
| | - Monica Bretzlaff
- Behavioural Supports Ontario Provincial Coordinating Office North Bay Regional Health Centre North Bay Ontario Canada
| | | | - Josie‐Lee Gibson
- Ontario Association of Residents' Councils Newmarket Ontario Canada
| | - Debbie Hewitt Colborne
- Behavioural Supports Ontario Provincial Coordinating Office North Bay Regional Health Centre North Bay Ontario Canada
| | - Andrea Iaboni
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
| | - Dee Lender
- Ontario Association of Residents' Councils Newmarket Ontario Canada
| | - Denise Schon
- Lakeside Long‐Term Care Centre Family Council Toronto Ontario Canada
| | - Ellen Snowball
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
| | - Katherine S. McGilton
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Ontario Canada
| | - Jennifer Bethell
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada
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Choroschun K, Kennedy M, Hoben M. More than just staffing? Assessing evidence on the complex interplay among nurse staffing, other features of organisational context and resident outcomes in long-term care: a systematic review protocol. BMJ Open 2022; 12:e061073. [PMID: 35732394 PMCID: PMC9226885 DOI: 10.1136/bmjopen-2022-061073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Especially in acute care, evidence points to an association between care staffing and resident outcomes. However, this evidence is more limited in residential long-term care (LTC). Due to fundamental differences in the population of care recipients, organisational processes and staffing models, studies in acute care may not be applicable to LTC settings. We especially lack evidence on the complex interplay among nurse staffing and organisational context factors such as leadership, work culture or communication, and how these complex interactions influence resident outcomes. Our systematic review will identify and synthesise the available evidence on how nurse staffing and organisational context in residential LTC interact and how this impacts resident outcomes. METHODS AND ANALYSIS We will systematically search the databases MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO from inception for quantitative research studies and systematically conducted reviews that statistically modelled interactions among nurse staffing and organisational context variables. We will include original studies that included nurse staffing and organisational context in LTC as independent variables, modelled interactions between these variables and described associations of these interactions with resident outcomes. Two reviewers will independently screen titles/abstracts and full texts for inclusion. They will also screen contents of key journals, publications of key authors and reference lists of all included studies. Discrepancies at any stage of the process will be resolved by consensus. Data extraction will be performed by one research team member and checked by a second team member. Two reviewers will independently assess the methodological quality of included studies using four validated checklists appropriate for different research designs. We will conduct a meta-analysis if pooling is possible. Otherwise, we will synthesise results using thematic analysis and vote counting. ETHICS AND DISSEMINATION Ethical approval is not required as this project does not involve primary data collection. The results of this study will be disseminated via peer-reviewed publications and conference presentation. PROSPERO REGISTRATION NUMBER CRD42021272671.
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Affiliation(s)
| | - Megan Kennedy
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Paudel A, Galik E, Resnick B, Doran K, Boltz M, Zhu S. Factors Associated With the Quality of Staff-Resident Interactions in Assisted Living. J Nurs Care Qual 2022; 37:168-175. [PMID: 34446666 PMCID: PMC8866198 DOI: 10.1097/ncq.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Care interactions are verbal or nonverbal interactions between staff and residents during social or physical care activities. The quality of care interactions could be positive, negative, or neutral. PURPOSE The purpose of this study was to examine the resident- and facility-level factors associated with the care interactions in assisted living (AL). METHODS Regression analysis was performed using a stepwise method utilizing baseline data of 379 residents from 59 AL facilities recruited in a randomized trial. RESULTS Accounting for 8.2% of variance, increased resident agitation was associated with negative or neutral quality interactions while for-profit ownership was associated with positive quality interactions. CONCLUSIONS To promote positive care interactions, findings suggest the need to educate staff about strategies to minimize resident agitation (eg, calm posture and respectful listening) and work toward optimizing care interactions in nonprofit settings. Future research could further explore the influence of staff-level factors on care interactions.
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Affiliation(s)
- Anju Paudel
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Kelly Doran
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Marie Boltz
- Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802
| | - Shijun Zhu
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
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Aem L, Morath LP, Burström B, Schön P, Agerholm J. The impact of organisational characteristics of staff and facility on infectious disease outbreaks in care homes: a systematic review. BMC Health Serv Res 2022; 22:339. [PMID: 35291990 PMCID: PMC8921437 DOI: 10.1186/s12913-022-07481-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/04/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Infectious disease outbreaks are common in care homes, often with substantial impact on the rates of infection and mortality of the residents, who primarily are older people vulnerable to infections. There is growing evidence that organisational characteristics of staff and facility might play a role in infectious disease outbreaks however such evidence have not previously been systematically reviewed. Therefore, this systematic review aims to examine the impact of facility and staff characteristics on the risk of infectious disease outbreaks in care homes. METHODS Five databases (MEDLINE, EMBASE, ProQuest, Web of Science, CINAHL) were searched. Studies considered for inclusion were of any design reporting on an outbreak of any infectious disease in one or more care homes providing care for primarily older people with original data on: facility size, facility location (urban/rural), facility design, use of temporary hired staff, staff compartmentalizing, residence of staff, and/or nursing aides hours per resident. Retrieved studies were screened, assessed for quality using CASP, and analysed employing a narrative synthesis. RESULTS Sixteen studies (8 cohort studies, 6 cross-sectional studies, 2 case-control) were included from the search which generated 10,424 unique records. COVID-19 was the most commonly reported cause of outbreak (n = 11). The other studies focused on influenza, respiratory and gastrointestinal outbreaks. Most studies reported on the impact of facility size (n = 11) followed by facility design (n = 4), use of temporary hired staff (n = 3), facility location (n = 2), staff compartmentalizing (n = 2), nurse aides hours (n = 2) and residence of staff (n = 1). Findings suggest that urban location and larger facility size may be associated with greater risks of an infectious disease outbreak. Additionally, the risk of a larger outbreak seems lower in larger facilities. Whilst staff compartmentalizing may be associated with lower risk of an outbreak, staff residing in highly infected areas may be associated with greater risk of outbreak. The influence of facility design, use of temporary staff, and nurse aides hours remains unclear. CONCLUSIONS This systematic review suggests that larger facilities have greater risks of infectious disease outbreaks, yet the risk of a larger outbreak seems lower in larger facilities. Due to lack of robust findings the impact of facility and staff characteristics on infectious disease outbreaks remain largely unknown. PROSPERO CRD42020213585 .
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Affiliation(s)
- Liljas Aem
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
| | - L P Morath
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - B Burström
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - P Schön
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - J Agerholm
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
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Milte RK, Mpundu-Kaambwa C, Chen G, Crotty M, Ratcliffe J. What Constitutes Preferred Long-Term Care Provided in Residential Aged Care Facilities? An Empirical Comparison of the Preferences of the General Population, Residents, and Family Members. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:257-267. [PMID: 35094799 DOI: 10.1016/j.jval.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/28/2021] [Accepted: 09/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Relatively few studies to date have examined the preferences of members of the general population as potential future consumers of long-term aged care services. This study aimed to use discrete choice experiment methodology to compare the preferences of 3 groups: the general population, residents, and family members of people living in long-term aged care. METHODS A total of 6 salient attributes describing the physical and psychosocial care in long-term residential aged care were drawn from qualitative research with people with a lived experience of aged care and were used to develop the discrete choice experiment questionnaire. The 6 attributes included: the level of time care staff spent with residents, homeliness of shared spaces, the homeliness of their own rooms, access to outside and gardens, frequency of meaningful activities, and flexibility with care routines. The questionnaire was administered to 1243 respondents including consumers (residents [n = 126], family member carers [n = 416]), and members of the general population (n = 701). RESULTS For both the general population and resident samples, having their own room feeling "home-like" exhibited the largest impact upon overall preferences. For the family member sample, care staff being able to spend enough time exhibited the largest impact. Tests of poolability indicated that the resident and general population samples estimates could be pooled. The null hypothesis of equal parameters between the groups was rejected for the family members, indicating significant differences in preferences relative to the resident and the general population samples. CONCLUSIONS This study illustrates that preferences for residential aged care delivery may vary depending upon perspective and experience.
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Affiliation(s)
- Rachel K Milte
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia; Cognitive Decline Partnership Centre, Department of Rehabilitation and Aged Care, University of Sydney, Sydney, Australia; Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia.
| | | | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Maria Crotty
- Cognitive Decline Partnership Centre, Department of Rehabilitation and Aged Care, University of Sydney, Sydney, Australia; Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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Resident and Institutional-Level Factors, Frailty, and Nursing Homes Residents. Nurs Res 2021; 71:E1-E9. [PMID: 34620773 DOI: 10.1097/nnr.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frailty is a major cause of adverse health outcomes such as hospitalization, falls, disability, and morbidity among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions. OBJECTIVES This study aimed to examine the trend of frailty over time (at baseline, with 6-month and 12-month follow-ups) among Chinese nursing home residents and identify associated resident- and institutional-level factors. METHODS This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, staff turnover rate). These data were subjected to a multilevel linear analysis. RESULTS Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities. DISCUSSION Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.
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Nwakasi C, Mehri N, Parajuli J. Psychometric Analysis of the 2016 Ohio Long-Term Care Facilities Family Satisfaction Scale. Res Aging 2021; 44:426-435. [PMID: 34553618 DOI: 10.1177/01640275211046304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the Ohio Family Satisfaction Survey (OFSS) has been around since 2002 as an important indicator of long-term care facilities' performance, the validity of this scale has not been evaluated. Using the Robust Maximum Likelihood Estimator Method in Mplus, psychometric analysis involving second-order construct validity or hierarchical construct validity was conducted using responses from 1636 facilities including nursing homes and residential care facilities (N = 32,424). The results showed that OFSS retained the 7-factor structure for the 7 domains and the factor loadings for each domain were above 0.5. It is crucial to include families' input regarding quality of long-term care facilities as some older residents, especially those with moderate to severe cognitive impairments may be unable to provide consistent and comprehensive inputs about the quality of care and services they receive. Therefore, validation of the OFSS has an important implication for quality improvement practice.
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Affiliation(s)
- Candidus Nwakasi
- Department of Health Policy and Management, 6753Providence College, Providence, RI, USA
| | - Nader Mehri
- Aging Studies Institute, 2029Syracuse University, Syracuse, NY, USA
| | - Jyotsana Parajuli
- School of Nursing, 14727University of North Carolina, Charlotte, NC, USA
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13
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Clemens S, Wodchis W, McGilton K, McGrail K, McMahon M. The relationship between quality and staffing in long-term care: A systematic review of the literature 2008-2020. Int J Nurs Stud 2021; 122:104036. [PMID: 34419730 DOI: 10.1016/j.ijnurstu.2021.104036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Higher staffing levels in long-term care have been associated with better outcomes for residents in several landmark studies. However previous systematic reviews found mixed results, calling into question the effectiveness of higher levels of staff. With persistent concerns about quality, rising resident acuity, and a growing demographic of seniors requiring more services, understanding the relationship between quality and long-term care staffing is a growing concern. OBJECTIVES This review considered the following question: What is the influence of nursing and personal care staffing levels (registered nurse, licensed practical nurse, and nursing assistant) and / or skill mix on long-term care residents, measured by quality of care indicators? DESIGN Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guided the report of this systematic review. DATA SOURCES Published articles focused on quality and nursing and personal care staffing in long-term care in peer-reviewed databases (MEDLINE, CINAHL, and AGELINE) and several Cochrane databases to retrieve studies published between January 2008 and June 2020. REVIEW METHODS A systematic review was conducted. 11,096 studies were identified, of which 34 were included in this review. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to evaluate study quality and risk of bias, and five quality measures were selected for in-depth analyses: pressure ulcers, hospitalizations, physical restraints, deficiencies and catherization. RESULTS This review confirms previous review findings that evidence on the relationships between quality and long-term care staffing level and skill mix, remain mixed. Higher staffing levels and skill mix generally supported better rather than worse outcomes. Significant and consistent findings were more evident when staffing levels were further analyzed by indicator and staffing category. For example, registered nurses were consistently associated with significantly fewer pressure ulcers, hospitalizations, and urinary tract infections. Few studies examined the impact of total nursing and personal care hours compared to the impact of specific categories or classes of nursing staff on outcomes. CONCLUSIONS Evidence on the relationship between quality and long-term care staffing remains mixed, however some categories of nursing staff may be more effective at improving the quality of certain indicators. Study quality has improved minimally over the last decade. Although research continues to standardize units of measurement, and longitudinal and instrumental variable analyses are increasingly being used, very few studies controlled for endogeneity, conducted adequate risk-adjustment, and used resident-level data. Additional strides must still be made to improve the rigor of long-term care staffing research.
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Affiliation(s)
- Sara Clemens
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
| | | | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Canada.
| | - Meghan McMahon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
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14
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Zirves M, Pfaff H. Nursing Home Residents Aged over 80-A Cross-Sectional Analysis on Which Activity Traits Correlate to Positive Affect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249583. [PMID: 33371397 PMCID: PMC7767436 DOI: 10.3390/ijerph17249583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023]
Abstract
Admission to a care facility is assumed to enhance depressive symptoms and dependent behavior in old age. In this context, the relevance of participation in activities that make everyday life in a care facility more pleasant has been pointed out. This study examines if there is a relationship between participation in different activities as well as the frequency of this participation and the positive affect of nursing home residents aged over 80. Data from the unique cross-sectional representative study ‘Quality of life and subjective well-being of the very old in North Rhine-Westphalia’ in Germany (n = 150, aged 90.15 years in average) were used. The data were collected between 08/2017 and 02/2018 using computer-assisted personal interviewing. The variability in and frequency of activity participation functioned as independent, and positive affect as dependent variable. Multiple regression analysis was performed. Residents’ predicted positive affect significantly increased with a higher variability in activity participation. There was no independent effect of frequency in participation. Our findings indicate that there is a significant and positive relationship between participating in a high number of different activities and the overall positive affect of residents aged over 80 years. This does not hold true for the frequency of participation.
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Affiliation(s)
- Melanie Zirves
- Gerontological Research on Well-Being—Graduate School GROW, Faculty of Human Sciences, University of Cologne, 50923 Cologne, Germany
- Correspondence: ; Tel.: +49-0221-470-1177
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine, University of Cologne, 50933 Cologne, Germany;
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15
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Armijo-Olivo S, Craig R, Corabian P, Guo B, Souri S, Tjosvold L. Nursing Staff Time and Care Quality in Long-Term Care Facilities: A Systematic Review. THE GERONTOLOGIST 2020; 60:e200-e217. [PMID: 31115444 DOI: 10.1093/geront/gnz053] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. RESEARCH DESIGN AND METHODS A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. RESULTS The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. DISCUSSION AND IMPLICATIONS Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.
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Affiliation(s)
- Susan Armijo-Olivo
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada.,Faculty of Rehabilitation Medicine, Department of Physical Therapy/Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Rodger Craig
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada
| | - Paula Corabian
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada
| | - Bing Guo
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada
| | - Sepideh Souri
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada
| | - Lisa Tjosvold
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada.,John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
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16
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Mcgann S, Bulsara C, Farley H. Socio‐spatial and quality of life themes in aged care architecture: A qualitative methods protocol. J Adv Nurs 2020; 76:3171-3178. [DOI: 10.1111/jan.14497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Sarah Mcgann
- The University of Notre Dame Fremantle Australia
| | | | - Holly Farley
- The University of Notre Dame Fremantle Australia
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17
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Bergmann JM, Ströbel AM, Holle B, Palm R. Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis. BMC Health Serv Res 2020; 20:646. [PMID: 32652983 PMCID: PMC7353672 DOI: 10.1186/s12913-020-05401-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizational health care research focuses on describing structures and processes in organizations and investigating their impact on the quality of health care. In the setting of residential long-term care, this effort includes the examination and description of structural differences among the organizations (e.g., nursing homes). The objective of the analysis is to develop an empirical typology of living units in nursing homes that differ in their structural characteristics. METHODS Data from the DemenzMonitor Study were used. The DemenzMonitor is an observational study carried out in a convenience sample of 103 living units in 51 nursing homes spread over 11 German federal states. Characteristics of living units were measured by 19 variables related to staffing, work organization, building characteristics and meal preparation. Multiple correspondence analysis (MCA) and agglomerative hierarchical cluster analysis (AHC) are suitable to create a typology of living units. Both methods are multivariate and explorative. We present a comparison with a previous typology (created by a nonexplorative and nonmultivariate process) of the living units derived from the same data set. RESULTS The MCA revealed differences among the living units, which are defined in particular by the size of the living unit (number of beds), the additional qualifications of the head nurse, the living concept and the presence of additional financing through a separate benefit agreement. We identified three types of living units; these clusters occur significantly with a certain combination of characteristics. In terms of content, the three clusters can be defined as: "house community", "dementia special care units" and "usual care". CONCLUSION A typology is useful to gain a deeper understanding of the differences in the care structures of residential long-term care organizations. In addition, the study provides a practical recommendation on how to apply the results, enabling living units to be assigned to a certain type. The typology can be used as a reference for definitions.
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Affiliation(s)
- Johannes Michael Bergmann
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, North Rhine-Westphalia, 58453, Germany. .,University Witten/Herdecke, Faculty of Health, Department for Nursing Science, Witten, North Rhine-Westphalia, Germany.
| | - Armin Michael Ströbel
- Center for Clinical Studies, University Hospital Erlangen, Krankenhausstraße 12, Erlangen, Bavaria, 91054, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, North Rhine-Westphalia, 58453, Germany.,University Witten/Herdecke, Faculty of Health, Department for Nursing Science, Witten, North Rhine-Westphalia, Germany
| | - Rebecca Palm
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, North Rhine-Westphalia, 58453, Germany.,University Witten/Herdecke, Faculty of Health, Department for Nursing Science, Witten, North Rhine-Westphalia, Germany
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18
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Smith C, Newbury G. Palliative care for community patients diagnosed with dementia: a systematic review. Br J Community Nurs 2020; 24:570-575. [PMID: 31800308 DOI: 10.12968/bjcn.2019.24.12.570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite many efforts made by health organisations to deliver effective end-of-life care to patients with dementia, research indicates that palliative care is predominantly aimed at patients with terminal cancer, and that patients with dementia face challenges in accessing end-of-life care. This article explores the views of health professionals on providing palliative care to those patients diagnosed with dementia within the community setting. A systematic review of seven qualitative studies was performed to identify the best available evidence. The findings show that effective palliative care for patients with dementia continues being affected by many barriers and challenges. Good practice seems to be inconsistent and fragmented throughout the UK and European countries, and many health professionals are faced with difficulties associated with services and financial implications, training and education, staff support, communication, family support and dementia care.
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Affiliation(s)
| | - Gina Newbury
- Senior Lecturer and Director of Recruitment and Admissions, both at School of Healthcare Sciences, Cardiff University, Cardiff, Wales
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19
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Duan Y, Mueller CA, Yu F, Talley KM. The Effects of Nursing Home Culture Change on Resident Quality of Life in U.S. Nursing Homes: An Integrative Review. Res Gerontol Nurs 2020; 13:1-15. [PMID: 31968121 DOI: 10.3928/19404921-20200115-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/15/2019] [Indexed: 02/28/2024]
Abstract
Culture change is intended to transform nursing homes from impersonal institutions into person-centered homes. Despite a growing interest in studying culture change, empirical evidence for its effects on quality of life (QOL) has not been synthesized. The current integrative review examined how QOL outcomes were measured in culture change studies and analyzed the current evidence for culture change effects on QOL. Guided by a conceptual framework, this review systematically searched for literature in multiple databases and identified 11 eligible studies. QOL measures varied across studies, ranging from overall perception of life to specific measures associated with physical and psychosocial well-being. Overall, culture change demonstrated a positive trend in benefiting QOL. Although inconsistent evidence existed for most QOL measures, relatively consistent evidence was found to support positive effects on resident satisfaction and autonomy. Rigorous designs are needed for future studies to generate strong evidence. [Research in Gerontological Nursing, xx(x), xx-xx.].
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20
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Hanratty B, Craig D, Brittain K, Spilsbury K, Vines J, Wilson P. Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - John Vines
- Northumbria School of Design, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
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21
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Gräske J, Schmidt A, Wolf-Ostermann K. More staff = better quality of life for people with dementia? results of a secondary data analysis in German shared-housing arrangements. Isr J Health Policy Res 2019; 8:26. [PMID: 30786931 PMCID: PMC6381648 DOI: 10.1186/s13584-019-0295-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Shared-housing arrangements (SHAs) in Germany are an alternative care arrangement for people with dementia. They are disconnected from traditional nursing homes and are often situated in ordinary apartment buildings. Community health care providers serve persons with dementia in SHAs, and there is no official regulation regarding the staff-resident ratio. The association between the staff-resident ratio and the quality of life (QoL) of persons with dementia has not yet been investigated in SHAs. Method A cross-sectional study was performed in SHAs in Berlin, Germany, using ANCOVA models to analyse whether residents’ QoL (QUALIDEM), as assessed by staff in SHAs, can be explained by the staff-resident ratio, adjusted for residents’ sex, age, length of stay, challenging behaviour (CMAI), cognitive impairment (GDS) and level of care dependency according to the German statutory health care insurance. Results In this study, 58 SHAs with 396 residents (mean age 78.4 years, 69.4% female) participated. The staff-resident ratio was 0.2 and 0.6 for registered nurses and certified nursing assistants, respectively. Associations with QoL were found predominantly for challenging behaviour and cognitive impairment. The analysis showed that there was no significant effect of the total staff-resident ratio (p > 0.05) in explaining the variation in residents’ QoL (total and subdomains). In general, the proportion of explained variance was weak (R2 < 0.216). Conclusions The present study did not show a significant association between staffing and residents’ QoL in SHAs. However, further investigation is required regarding the direct interaction between staff and residents. A main focus should be to educate users about the benefits and disadvantages of shared-housing arrangements.
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Affiliation(s)
- Johannes Gräske
- School of Social Sciences, Department of Health and Nursing, HTW Saar, Saarbrucken, Germany.
| | - Annika Schmidt
- Health Services Research in Nursing Sciences, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Karin Wolf-Ostermann
- Health Services Research in Nursing Sciences, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
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22
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Verloo H, Salina A, Fiorentino A, Cohen C. Factors influencing the quality of life perceptions of cognitively impaired older adults in a nursing home and their informal and professional caregivers: a mixed methods study. Clin Interv Aging 2018; 13:2135-2147. [PMID: 30464423 PMCID: PMC6217874 DOI: 10.2147/cia.s184329] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Identifying the objective and subjective aspects of the quality of life (QoL) of institutionalized cognitively impaired older adults (CIOAs) is a challenge. However, it can reveal which aspects of their care require improvement. Aim The aim of this study was to identify the core aspects of the QoL of CIOAs living in a nursing home (NH) by involving informal and professional caregivers (PCs). Methods Our sequential, mixed methods study exploring the QoL of CIOAs was based on Lodgson et al’s (2002) quantitative quality of life–Alzheimer’s disease (QoL-AD) questionnaire. Subsequently, a qualitative phase study analyzed perceptions and impressions of QoL using interviews of CIOAs and their most significant informal caregivers (SICs) and PCs. Results Fifteen CIOAs, 12 SICs, and 2 PCs were recruited. Two-thirds of the older adults were females, overall average age was 86 years (SD=6.1), and all had a severe clinical dementia rating (CDR=3). A high level of comorbidity (measured using the Cumulative Illness Rating Scale for Geriatrics) was significantly associated with a lower QoL-AD score (P=0.046). Higher numbers of visits by SICs or family members had a positive effect on QoL-AD scores (P=0.036). No significant differences were found in overall QoL-AD scores as rated by CIOAs, SICs, and PCs (P=0.080). Combining quantitative and qualitative data analyses revealed four significant themes influencing the QoL of CIOAs: 1) human dignity and acceptance; 2) development and existence; 3) functionality and health; and 4) recognizability and safety. Conclusion Sequentially using mixed methods proved an appropriate way to examine the QoL of severe CIOAs living in an NH, and these results were compared with the perceptions of informal and PCs. The factors optimizing overall health were visits by SICs and family members, and the major aspect that increases the QoL was freedom of movement inside and outside the NH.
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Affiliation(s)
- Henk Verloo
- School of Health, Department of Nursing Valais - Wallis, HES-SO University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland,
| | - Alexandre Salina
- Home Salem Nursing Home, Eben-Hézer Foundation, Saint-Légier, Switzerland
| | - Assunta Fiorentino
- La Source, School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Christine Cohen
- La Source, School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Nadash P, Hefele JG, Miller EA, Barooah A, Wang X(J. A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality. Res Aging 2018; 41:215-240. [DOI: 10.1177/0164027518805001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little research has explored the relationship between consumer satisfaction and quality in nursing homes (NHs) beyond the few states mandating satisfaction surveys. We examine this relationship through data from 1,765 NHs in the 50 states and District of Columbia using My InnerView resident or family satisfaction instruments in 2013 and 2014, merged with Certification and Survey Provider Enhanced Reporting, LTCfocus, and NH Compare (NHC) data. Family and resident satisfaction correlated modestly; both correlated weakly and negatively with any quality-of-care (QoC) and any quality-of-life deficiencies and positively with NHC five-star ratings; this latter positive association persisted after covariate adjustment; the negative relationship between QoC deficiencies and family satisfaction also remained. Overall, models explained relatively small proportions of satisfaction variance; correlates of satisfaction varied between residents and families. Findings suggest that satisfaction is a unique dimension of quality and that resident and family satisfaction represent different constructs.
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Affiliation(s)
- Pamela Nadash
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Jennifer Gaudet Hefele
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Adrita Barooah
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Xiao (Joyce) Wang
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
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24
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Björk S, Lindkvist M, Lövheim H, Bergland Å, Wimo A, Edvardsson D. Exploring resident thriving in relation to the nursing home environment: A cross-sectional study. J Adv Nurs 2018; 74:2820-2830. [PMID: 30043451 DOI: 10.1111/jan.13812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/15/2018] [Accepted: 07/11/2018] [Indexed: 11/30/2022]
Abstract
AIM To explore the extent to which environmental factors are associated with resident thriving. BACKGROUND Thriving is a concept that denotes experiences of well-being in relation to the living environment. Although there is a substantial body of research into quality of life in nursing homes, less is known about what contributes to thriving among residents. Recent research on resident thriving has focused mainly on resident characteristics and activities associated with thriving. Less attention has been given to explore associations with the physical and psychosocial environment of the nursing home. This study explores facility- and unit-level factors associated with resident thriving. DESIGN A cross-sectional national survey. METHODS Data on 4,205 residents, 3,509 staff, and environment of 147 nursing home facilities collected in 2013-2014 were analysed using descriptive statistics, multilevel simple, and multiple linear regression to explore resident thriving in relation to environmental factors. RESULTS Multilevel analysis revealed that residents' thriving varied significantly across nursing home units. Several environmental factors were associated with thriving in univariate analyses. However, a positive psychosocial climate of units, having access to newspapers, living in a special care unit, and living in an unlocked facility showed significant positive associations with resident thriving when controlling for resident characteristics. The psychosocial climate showed the strongest association of the environment variables with resident thriving. CONCLUSIONS Nursing home environments may have an impact on residents' thriving. A positive psychosocial climate of units seems to have an important role in facilitating thriving in nursing home residents.
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Affiliation(s)
- Sabine Björk
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
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Sullivan L, Willis DG. Towards Changing the Long Term Care (LTC) Paradigm: Explicating the Concept of Thriving in Older Adults Living in LTC. Issues Ment Health Nurs 2018; 39:388-397. [PMID: 29319403 DOI: 10.1080/01612840.2017.1390021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A phenomenon of interest for nursing is the facilitation of humanistic health care experiences and quality of life (Willis, Grace, & Roy, 2008 ). Inquiry into the concept of thriving as it manifests in the older adult residing in long-term care aligns with this interest. Thriving has been described by scholars in various disciplines but no context-specific definition for the LTC resident currently exists. Contrary to the generally held negative view of LTC, there is emerging evidence that older adult LTC residents "do well" or thrive in this environment.
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Affiliation(s)
- Louise Sullivan
- a Department of Nursing , Salve Regina University , Newport , United States
| | - Danny G Willis
- b School of Nursing, University of Wisconsin Madison , Madison , United States
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26
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Backhaus R, Beerens HC, van Rossum E, Verbeek H, Hamers JPH. Editorial: Rethinking the Staff-Quality Relationship in Nursing Homes. J Nutr Health Aging 2018; 22:634-638. [PMID: 29806851 DOI: 10.1007/s12603-018-1027-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R Backhaus
- Ramona Backhaus, Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Department of Health Services Research, P.O. Box 616, 6200 MD Maastricht, The Netherlands, Telephone: 0031-43 3882286,
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Sato M, Sugimoto M, Yamaguchi K, Kawaguchi T. Evaluation of nursing interventions using minimally invasive assessments methods for patients in a persistent vegetative state. Psychogeriatrics 2017; 17:406-413. [PMID: 28378507 DOI: 10.1111/psyg.12265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to evaluate the effects of nursing interventions using minimally invasive or non-invasive methods conducive to frequent use in order to assess patients in a persistent vegetative state (PVS). METHODS We provided three nursing interventions-sitting the patient in an upright position, footbath care, and oral care-to PVS patients (n = 11) and elderly bedridden subjects with consciousness (n = 6) for 3 weeks in addition to ordinary nursing treatments. The Kohnan Score, plasma cortisol and adrenaline levels, General Well-Being Schedule score, and facial expression assessments were used as evaluation methods. RESULTS The Kohnan Score of PVS patients declined significantly, indicating that the interventions increased patients' consciousness levels, but none of the other parameters showed significant change in either group. The change in Kohnan Score showed dependent trends for facial expression at baseline, cortisol change during the intervention, and the term of PVS. CONCLUSIONS The data suggest three indices for predicting intervention efficacy in individuals and for assessing an intervention's contribution to quality of life improvement. Among the multiple evaluation methods, Konan Scores was the most effective. Ultimately, the three nursing interventions used in this study and Konan Score led to the optimization of nursing home care and rehabilitation for PVS patients.
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Affiliation(s)
- Mitsue Sato
- Department of Human Arts and Sciences, Graduate School of the University of Human Arts and Sciences, Saitama, Japan.,Nursing Science, Human Care Department, Tohto College of Health Sciences, Fukaya, Japan.,Division of Salivary Gland and Health Medicine, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Masahiro Sugimoto
- Division of Salivary Gland and Health Medicine, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan.,Institute for Advanced Biosciences, Keio University, Tsuruoka, Japan
| | | | - Takeshi Kawaguchi
- Department of Human Arts and Sciences, Graduate School of the University of Human Arts and Sciences, Saitama, Japan
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28
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Mercille J. Neoliberalism and health care: the case of the Irish nursing home sector. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1371277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Julien Mercille
- School of Geography, University College Dublin , Belfield, Ireland
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29
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Roberts AR, Ishler KJ. Family Involvement in the Nursing Home and Perceived Resident Quality of Life. THE GERONTOLOGIST 2017; 58:1033-1043. [DOI: 10.1093/geront/gnx108] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/05/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amy Restorick Roberts
- Department of Family Science and Social Work and Scripps Gerontology Center, Miami University, Oxford, Ohio
| | - Karen J Ishler
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio
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Hogden A, Greenfield D, Brandon M, Debono D, Mumford V, Westbrook J, Braithwaite J. How does accreditation influence staff perceptions of quality in residential aged care? QUALITY IN AGEING AND OLDER ADULTS 2017. [DOI: 10.1108/qaoa-07-2016-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme.
Design/methodology/approach
Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views.
Findings
Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life.
Research limitations/implications
For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question.
Originality/value
This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.
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31
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Ronald LA, McGregor MJ, Harrington C, Pollock A, Lexchin J. Observational Evidence of For-Profit Delivery and Inferior Nursing Home Care: When Is There Enough Evidence for Policy Change? PLoS Med 2016; 13:e1001995. [PMID: 27093442 PMCID: PMC4836753 DOI: 10.1371/journal.pmed.1001995] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Margaret McGregor and colleagues consider Bradford Hill's framework for examining causation in observational research for the association between nursing home care quality and for-profit ownership.
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Affiliation(s)
- Lisa A. Ronald
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margaret J. McGregor
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Charlene Harrington
- School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Allyson Pollock
- Queen Mary, University of London, London, United Kingdom
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Joel Lexchin
- School of Health Policy and Management at York University, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Kupeli N, Leavey G, Moore K, Harrington J, Lord K, King M, Nazareth I, Sampson EL, Jones L. Context, mechanisms and outcomes in end of life care for people with advanced dementia. BMC Palliat Care 2016; 15:31. [PMID: 26965309 PMCID: PMC4785626 DOI: 10.1186/s12904-016-0103-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/03/2016] [Indexed: 11/29/2022] Open
Abstract
Background The majority of people with dementia in the UK die in care homes. The quality of end of life care in these environments is often suboptimal. The aim of the present study was to explore the context, mechanisms and outcomes for providing good palliative care to people with advanced dementia residing in UK care homes from the perspective of health and social care providers. Method The design of the study was qualitative which involved purposive sampling of health care professionals to undertake interactive interviews within a realist framework. Interviews were completed between September 2012 and October 2013 and were thematically analysed and then conceptualised according to context, mechanisms and outcomes. The settings were private care homes and services provided by the National Health Service including memory clinics, mental health and commissioning services in London, United Kingdom. The participants included 14 health and social care professionals including health care assistants, care home managers, commissioners for older adults’ services and nursing staff. Results Good palliative care for people with advanced dementia is underpinned by the prioritisation of psychosocial and spiritual care, developing relationships with family carers, addressing physical needs including symptom management and continuous, integrated care provided by a multidisciplinary team. Contextual factors that detract from good end of life care included: an emphasis on financial efficiency over person-centred care; a complex health and social care system, societal and family attitudes towards staff; staff training and experience, governance and bureaucratisation; complexity of dementia; advance care planning and staff characteristics. Mechanisms that influence the quality of end of life care include: level of health care professionals’ confidence, family uncertainty about end of life care, resources for improving end of life care and supporting families, and uncertainty about whether dementia specific palliative care is required. Conclusions Contextual factors regarding the care home environment may be obdurate and tend to negatively impact on the quality of end of life dementia care. Local level mechanisms may be more amenable to improvement. However, systemic changes to the care home environment are necessary to promote consistent, equitable and sustainable high quality end of life dementia care across the UK care home sector.
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Affiliation(s)
- Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Londonderry, UK
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kathryn Lord
- Division of Psychiatry, University College London, Londonderry, UK
| | - Michael King
- Division of Psychiatry, University College London, Londonderry, UK
| | - Irwin Nazareth
- Department of Primary Care & Population Health, University College London, Londonderry, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, St. Anns Hospital, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Sense of Coherence among Older Adult Residents of Long-Term Care Facilities in Taiwan: A Cross-Sectional Analysis. PLoS One 2016; 11:e0146912. [PMID: 26751949 PMCID: PMC4709091 DOI: 10.1371/journal.pone.0146912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022] Open
Abstract
Background Growing evidence shows that sense of coherence (SOC) is related to health promotion. Knowledge of SOC among older adults in Taiwan is limited. The present study aimed to investigate SOC status and its relationship to personal and environmental factors among older adult residents of long-term care facilities (LTCFs) in northeastern Taiwan. Methods This cross-sectional study was performed in Yilan, Taiwan. With face-to-face interviews, we obtained data from 104 LTCF residents (aged 65 years and older) using the Chinese version of Antonovsky's short 13-item SOC scale. We also collected the information on personal characteristics, physical and social environmental resources. Multiple linear regression was used to analyze factors potentially influencing SOC. Results Of the participants, the mean score (±standard deviation) of SOC was 58.3 (±8.8), while scores on SOC subscales (comprehensibility, manageability, and meaningfulness) were 23.4 ±4.5, 17.9 ±3.8, and 17.0 ±3.2, respectively. Education level, activities of daily living and number of LTCF staff were found to be independently associated with SOC status after adjusting for demographic characteristics, health status, and environmental resources. In addition, interactions between personal and environmental factors had a crucial influence on SOC status. Conclusions Participants in this study had relatively low SOC scores compared to their counterparts in Western countries. In addition to personal factors, environmental factors can play a significant role in SOC status among older adult LTCF residents. Comprehensive evaluation of SOC status should consider person-environment interaction effects.
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Baud Mermoud V, Morin D. Regards croisés entre l’évaluation de la qualité de vie perçue par le résident hébergé en établissement médico-social et par le soignant référent. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.126.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cohen LW, Zimmerman S, Reed D, Brown P, Bowers BJ, Nolet K, Hudak S, Horn S. The Green House Model of Nursing Home Care in Design and Implementation. Health Serv Res 2015; 51 Suppl 1:352-77. [PMID: 26601799 DOI: 10.1111/1475-6773.12418] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the Green House (GH) model of nursing home (NH) care, and examine how GH homes vary from the model, one another, and their founding (or legacy) NH. DATA SOURCES/STUDY SETTING Data include primary quantitative and qualitative data and secondary quantitative data, derived from 12 GH/legacy NH organizations February 2012-September 2014. STUDY DESIGN This mixed methods, cross-sectional study used structured interviews to obtain information about presence of, and variation in, GH-relevant structures and processes of care. Qualitative questions explored reasons for variation in model implementation. DATA COLLECTION/EXTRACTION METHODS Interview data were analyzed using related-sample tests, and qualitative data were iteratively analyzed using a directed content approach. PRINCIPAL FINDINGS GH homes showed substantial variation in practices to support resident choice and decision making; neither GH nor legacy homes provided complete choice, and all GH homes excluded residents from some key decisions. GH homes were most consistent with the model and one another in elements to create a real home, such as private rooms and baths and open kitchens, and in staff-related elements, such as self-managed work teams and consistent, universal workers. CONCLUSIONS Although variation in model implementation complicates evaluation, if expansion is to continue, it is essential to examine GH elements and their outcomes.
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Affiliation(s)
- Lauren W Cohen
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Kimberly Nolet
- School of Nursing, University of Wisconsin-Madison, Madison, WI
| | | | - Susan Horn
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
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36
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Exploring Innovative Solutions for Quality of Life and Care of Bed-Ridden Nursing Home Residents through Codesign Sessions. J Aging Res 2015; 2015:185054. [PMID: 26543647 PMCID: PMC4620296 DOI: 10.1155/2015/185054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/24/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022] Open
Abstract
Bed-ridden nursing home residents are in need of environments which are homelike and facilitate the provision of care. Design guidance for this group of older people is limited. This study concerned the exploration and generation of innovative environmental enrichment scenarios for bed-ridden residents. This exploration was conducted through a combination of participatory action research with user-centred design involving 56 professional stakeholders in interactive work sessions. This study identified numerous design solutions, both concepts and products that are available on the marketplace and that on a higher level relate to improvements in resident autonomy and the supply of technological items and architectural features. The methodology chosen can be used to explore the creative potential of stakeholders from the domain of healthcare in product innovation.
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37
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Naylor MD, Hirschman KB, Hanlon AL, Abbott KM, Bowles KH, Foust J, Shah S, Zubritsky C. Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports. J Am Med Dir Assoc 2015; 17:44-52. [PMID: 26412018 DOI: 10.1016/j.jamda.2015.07.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings. DESIGN A prospective, observational, longitudinal cohort design. SETTING Nursing homes (NHs), assisted living facilities (ALFs), community. PARTICIPANTS A total of 470 older adults who were first-time recipients of LTSS. MEASUREMENT Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments. RESULTS Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001). CONCLUSIONS Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.
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Affiliation(s)
- Mary D Naylor
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
| | - Karen B Hirschman
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Alexandra L Hanlon
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Katherine M Abbott
- Miami University, Department of Sociology and Gerontology, Scripps Research Center, Oxford, OH
| | - Kathryn H Bowles
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Janice Foust
- College of Nursing and Health Sciences, University of Massachusetts - Boston, Boston, MA
| | - Shivani Shah
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY
| | - Cynthia Zubritsky
- University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, PA
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Picture Your Nursing Home: Exploring the Sense of Home of Older Residents through Photography. J Aging Res 2015; 2015:312931. [PMID: 26346975 PMCID: PMC4541017 DOI: 10.1155/2015/312931] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/25/2015] [Accepted: 04/09/2015] [Indexed: 11/17/2022] Open
Abstract
The quality of the built environment can impact the quality of life and the sense of home of nursing home residents. This study investigated (1) which factors in the physical and social environment correlate with the sense of home of the residents and (2) which environmental factors are most meaningful. Twelve participants engaged in a qualitative study, in which photography was as a supportive tool for subsequent interviews. The data were analysed based on the six phases by Braun and Clarke. The four themes identified are (1) the physical view; (2) mobility and accessibility; (3) space, place, and personal belongings; and (4) the social environment and activities. A holistic understanding of which features of the built environment are appreciated by the residents can lead to the design and retrofitting of nursing homes that are more in line with personal wishes.
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Shippee TP, Hong H, Henning-Smith C, Kane RL. Longitudinal Changes in Nursing Home Resident-Reported Quality of Life: The Role of Facility Characteristics. Res Aging 2015; 37:555-80. [PMID: 25651583 PMCID: PMC9907636 DOI: 10.1177/0164027514545975] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Improving quality of nursing homes (NHs) is a major social priority, yet few studies examine the role of facility characteristics for residents' quality of life (QOL). This study goes beyond cross-sectional analyses by examining the predictors of NH residents' QOL on the facility level over time. We used three data sources, namely resident interviews using a multidimensional measure of QOL collected in all Medicaid-certified NHs in Minnesota (N = 369), resident clinical data from the minimum data set, and facility-level characteristics. We examined change in six QOL domains from 2007 to 2010, using random coefficient models. Eighty-one facilities improved across most domains and 85 facilities declined. Size, staffing levels (especially activities staff), and resident case mix are some of the most salient predictors of QOL over time, but predictors differ by facility performance status. Understanding the predictors of facility QOL over time can help identify facility characteristics most appropriate for targeting with policy and programmatic interventions.
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Affiliation(s)
- Tetyana P. Shippee
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Hwanhee Hong
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Carrie Henning-Smith
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Robert L. Kane
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Kehyayan V, Hirdes JP, Tyas SL, Stolee P. Predictors of Long-Term Care Facility Residents’ Self-Reported Quality of Life With Individual and Facility Characteristics in Canada. J Aging Health 2015; 28:503-29. [DOI: 10.1177/0898264315594138] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Identify predictors of long-term care (LTC) facility residents’ self-reported quality of life (QoL). Method: QoL of a convenience sample of 928 residents from 48 volunteer LTC facilities across six Canadian provinces was assessed using the inter–Resident Assessment Instrument (interRAI) Self-Report Nursing Home Quality of Life Survey. Multivariate regression models were used to identify predictors. Results: In logistic regression modeling, residents who were religious and socially engaged, had a positive global disposition, or resided in rural, private, or municipal facilities were less likely to report low QoL. Those with post-secondary education and who were dependent on activities of daily living were more likely to report low QoL. These factors, except for religiosity and residence in municipal facilities, were significant in generalized estimating equation (GEE) modeling. Discussion: QoL is significantly associated with select resident and LTC facility characteristics with implications for improving residents’ QoL and LTC facility programming, and guiding future research and social policy development.
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Hedayati HR, Hadi N, Mostafavi L, Akbarzadeh A, Montazeri A. Quality of Life Among Nursing Home Residents Compared With the Elderly at Home. ACTA ACUST UNITED AC 2014. [DOI: 10.17795/semj22718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tolson D, Dewar B, Jackson GA. Quality of life and care in the nursing home. J Am Med Dir Assoc 2014; 15:154-157. [PMID: 24513224 DOI: 10.1016/j.jamda.2013.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 11/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Debbie Tolson
- Alzheimer Scotland Center for Policy and Practice, The University of the West of Scotland, Hamilton, United Kingdom.
| | - Belinda Dewar
- Institute of Care and Practice Improvement, The University of the West of Scotland, Hamilton, United Kingdom
| | - Graham A Jackson
- Alzheimer Scotland Center for Policy and Practice, The University of the West of Scotland, Hamilton, United Kingdom
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Palm R, Bartholomeyczik S, Roes M, Holle B. Structural characteristics of specialised living units for people with dementia: a cross-sectional study in German nursing homes. Int J Ment Health Syst 2014; 8:39. [PMID: 25360154 PMCID: PMC4213458 DOI: 10.1186/1752-4458-8-39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/12/2014] [Indexed: 11/30/2022] Open
Abstract
Background Living units (LU) specialised for people with dementia are an important feature of nursing homes. Little is known about their structural characteristics, and an international definition is lacking. This study explored characteristics of the environment and staff from defined LU types to identify differences between them. Design Cross-sectional study comparing five types of LUs. LUs were defined based on their living concept (segregated and integrated), size (small and large scale), and funding (extra funded and not extra funded). Differences were identified using descriptive statistics, Chi-Square resp. Kruskal-Wallis-Test and post-hoc analysis with Bonferroni corrections. Results In total, 103 LUs from 51 nursing homes participated: 63 integrated and 40 segregated LUs; 48 integrated and 31 segregated LUs were large. Sixteen large segregated LUs were extra funded. Regarding the environment, a distinctive feature of small LUs was a higher percentage of single rooms. Small integrated LUs provided and served meals more in a homelike manner than other LUs. LUs did not differ in their interior and access for the residents to use outdoor areas. Regarding the staff, small LUs provided more staff, but they were not exclusively assigned to the LUs. Large segregated LUs with additional funding provided more registered nurses and nurses with a special qualification per resident than the other large LUs. Conclusion Nursing homes implemented different features in their specialised LUs. Because single room availability, homelike provision of meals, staff quantity, quality and continuity may influence residents’ outcomes, it is necessary to investigate whether differences are apparent in future evaluation studies of specialised LUs for people with dementia.
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Affiliation(s)
- Rebecca Palm
- German Centre for Neurodegenerative Diseases, Stockumer Str. 12, 58453 Witten, Germany ; Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453 Witten, Germany
| | - Sabine Bartholomeyczik
- Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453 Witten, Germany
| | - Martina Roes
- German Centre for Neurodegenerative Diseases, Stockumer Str. 12, 58453 Witten, Germany ; Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453 Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases, Stockumer Str. 12, 58453 Witten, Germany ; Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453 Witten, Germany
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Díaz-Veiga P, Sancho M, García Á, Rivas E, Abad E, Suárez N, Mondragón G, Buiza C, Orbegozo A, Yanguas J. [Effects from the Person Centered-Care Model on quality of life of cognitive impaired persons from gerontological centers]. Rev Esp Geriatr Gerontol 2014; 49:266-71. [PMID: 25110142 DOI: 10.1016/j.regg.2014.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/05/2014] [Accepted: 06/05/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The Model of Person Centered Care has attracted increasing interest for use in gerontology centers. Therefore, the contributions about its impact are scarce in our context. The objective of this paper is to establish the impact that the interventions associated with the Model of Person Centered Care in the «Etxean Ondo» Project have on the quality of life of residents with cognitive impairment. MATERIAL AND METHODS One hundred and ninetten residents with cognitive impairment were selected: 59 in the control group and 60 in the experimental group. Subjects in each group were sorted by cognitive impairment: mild or severe. Changes were implemented in the physical and organizational environments for the promotion of autonomy and wellbeing. Quality of life was assessed before and 6 months after intervention using the Fumat Scales (mild cognitive impairment) and Qualid (severe cognitive impairment). The t-Student test was used for comparison of means. RESULTS In intergroup comparisons, significant differences in the Fumat Scale for the control group with mild cognitive impairment were initially identified. These differences were not recorded in the post assessment. The experimental group with severe cognitive impairment was significantly improved in the Qualid Scale post assessment. In intragroup comparisons, significant improvements were evident in the quality of life of experimental subjects, both with severe cognitive impairment (Qualid) and mild (Fumat). CONCLUSIONS The findings support the effectiveness of the interventions and identify methodological and conceptual issues that have been considered to analyze the Model of Person Centered Care efects.
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Affiliation(s)
| | - Mayte Sancho
- Matia Instituto Gerontológico, San Sebastián, España
| | - Álvaro García
- Matia Instituto Gerontológico, San Sebastián, España
| | - Esther Rivas
- Centro Gerontológico Zubiaurre, Gerozerlan, San Sebastián, España
| | - Elixabet Abad
- Centro Gerontológico Zubiaurre, Gerozerlan, San Sebastián, España
| | - Nerea Suárez
- Centro Gerontológico Argixao, Gerozerlan, San Sebastián, España
| | | | - Cristina Buiza
- Centro Gerontológico Julián Rezola, Fundación Matia, San Sebastián, España
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Shin JH, Park T, Huh IS. Nursing Staffing and Quality of Life in Western New York Nursing Homes. West J Nurs Res 2013; 36:788-805. [PMID: 24258404 DOI: 10.1177/0193945913511154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated the relationship between nurse staffing and quality of life (QOL) in Western New York State nursing homes. This was a cross-sectional, correlational study. The independent variables were hours per resident day (HPRD), skill mix, and turnover rate of nursing staff. The outcomes were measured using the self-reported QOL instrument. No coefficients were statistically significant with registered nurses’ (RNs) HPRD. Certified nursing assistant (CNA) HPRD had a statistically significant positive impact on the spiritual well-being domain. There was a statistically negative relationship between the amount of licensed practical nurse (LPN) HPRD and food enjoyment; and the ratio of more RNs to fewer LPNs and CNAs had a statistically significant negative influence on the meaningful-activity, food-enjoyment, and security domains. The turnover of RNs had a statistically negative relationship with the sum of each domain. None of the coefficients was statistically significant with LPN turnover.
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