Enabling at-homeness for residents living in a nursing home: Reflected experience of nursing home staff

Experiences of health care personnel with promoting a sense of home for older adults living in residential care facilities: a qualitative systematic review

OBJECTIVE

The objective of this review was to evaluate the experiences of health care personnel with promoting a sense of home for older adults living in residential care facilities.

INTRODUCTION

Moving to a residential care facility represents a critical moment for older adults. It disrupts the continuity of their lives and distances them from significant people and objects. Health care personnel working in residential care facilities can help create a sense of home for residents. There is a lack of qualitative reviews reporting health care personnel's experiences with promoting a sense of home for older adults living in residential care settings.

INCLUSION CRITERIA

Qualitative studies exploring the experiences of health care personnel with promoting a sense of home for people aged 65 and older living in residential care facilities, including, but not limited to, nursing homes, residential care homes, retirement homes, assisted-living facilities, and skilled nursing facilities were included in the review.

METHODS

This review followed a meta-aggregation approach according to JBI methodology for systematic reviews of qualitative evidence. PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science, and ILISI databases were searched, as well as Google Scholar, OpenGrey, and ProQuest Dissertations and Theses Global. Studies published in English, Italian, French, Portuguese, or Spanish were considered for inclusion. Study selection, critical appraisal, data extraction, and data synthesis were conducted by 2 independent reviewers using the JBI approach and JBI standardized tools. Finally, the ConQual approach was used to assess the confidence level in the study findings.

RESULTS

Seven studies conducted in Canada, the United States, the United Kingdom, Sweden, and the Netherlands between 2014 and 2020 were included. The studies reported the experiences of nurses, nurse aides, and directors of facilities. From the aggregation of 69 findings, 14 categories were generated that were then grouped into 3 synthesized findings describing the experiences of health care personnel as follows: the promotion of residents' sense of home in residential care facilities is influenced by i) the built environment, including private, single rooms with bathrooms, homelike-domestic spaces, personalization of residents' rooms, homelike interior and exterior design, and non-hospital-like environment; ii) the national and local policy and regulations, and work organization, as well as leadership of managers and directors; and iii) the facilities' care culture, including philosophy of care, maintaining autonomy of residents and ties with the community, participation in domestic and recreational activities, and family relationships. Based on the ConQual scores, the confidence level in the synthesized findings was graded as low.

CONCLUSIONS

According to health care personnel, the physical environment, interpersonal and social aspects, regulations, work organization, and the facilities' care culture can contribute to creating a sense of home for older adults in residential care facilities. The evidence derived from this review can help health care personnel, facility directors, and policy-makers identify the changes that should be implemented to promote a sense of home in older adults residing in care facilities.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020214383.

Implementation of a Sense of Home in High-Density Multicultural Singapore Nursing Homes: Challenges and Opportunities

Many studies have introduced principles for creating a sense of home in nursing homes, yet they mostly feature cases from low-density developments in Western countries. This raises a question about how those principles are interpreted and implemented in other cultural contexts, especially in high-density, multicultural environments such as Singapore. This paper examines how a sense of home is implemented in Singapore nursing homes, with a specific focus on the role of the built environment. Participant observations were conducted in five nursing homes in Singapore comprising various architectural design typologies, with the focus on the residents’ everyday interactions with their built environment. The study identified the extent of the presence of a sense of home in Singapore’s nursing homes and the prevalence of an institutional care model. More specifically, the study explicates Singapore nursing home residents’ management of privacy and personalization in shared spaces, illuminates the need for holistic implementation of homelike environments integrated with building designs and care programs and reiterates the pivotal role of social relationships in fostering a sense of home for the residents in the nursing homes.

The Effects of Continuous Care Model of Information-Based Hospital-Family Integration on Colostomy Patients: a Randomized Controlled Trial

The purpose of this research was to examine the effects of continuous care model of information-based hospital-family integration on colostomy patients. Miles' operation is a major operative method for treating low rectal cancer, and this operation results in a permanent colostomy. It is difficult for patients to adapt to their colostomy. Previous studies have applied generally conventional nursing models to colostomy patients. This was a single-blind randomized controlled trial study. The sample of 155 patients who met the inclusion criteria was randomly assigned to either the experimental (n = 81) or control group (n = 74). The control group was provided with a routine standard of care. The experimental group was provided with an experimental treatment that consisted of an information-based (WeChat, blog, QQ, telephone, etc.) hospital-family integration continuous care model. Study variables were collected and instruments were selected as follows: basic information, State-Trait Anxiety Inventory (STAI), a self-efficacy scale, a colostomy complication assessment table, a quality of life scale, and a table of the degree of satisfaction. No statistically significant differences were found in demographic information between the experimental and control groups. In comparison with the control group, subjects in the experimental group had less anxiety and could better cope with anxiety, had a better self-efficacy and quality of life scores, and had fewer complications. The patients in the experimental group were shown to be more satisfied with the care model. In addition, the most useful and popular service is the online social tools WeChat and QQ, because they can communicate with video, and they are more real-time, efficient, and cheap. The continuous care model of information-based hospital-family integration significantly strengthened patients' self-efficacy and confidence, which decreased colostomy complications, ultimately improving the quality of life.

Beyond the evaluative lens: Contextual unpredictabilities of care

Social science and gerontological research on care tends to focus on identifying practices that qualify as "good care" and promoting interventions that might produce it. In this article, we identify this approach to care as the "evaluative lens." We argue that while useful, an evaluative approach to studying care can limit scholars' abilities to attend to the complex and disorderly aspects of care in daily life. Drawing on long-term ethnographic research in three distinct contexts of elder care, we show the central role that contextual unpredictability plays in care experiences. In so doing, we argue for scholarship that recognizes care as a form of becoming, embedded in processual and historically contigent relations.