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Trinca V, Wu SA, Dakkak H, Iraniparast M, Cammer A, Lengyel C, O'rourke HM, Rowe N, Slaughter SE, Carrier N, Quiring S, Harvie R, Keller H. Characteristics Associated with Relationship-Centred and Task-Focused Mealtime Practices in Older Adult Care Settings. CAN J DIET PRACT RES 2024; 85:66-75. [PMID: 38572747 DOI: 10.3148/cjdpr-2023-023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Purpose: To assess care home and staff characteristics associated with task-focused (TF) and relationship-centred care (RCC) mealtime practices prior to the COVID-19 pandemic.Methods: Staff working in Canadian and American care homes were invited to complete a 23-item online survey assessing their perceptions of mealtime care, with one item assessing 26 potential care practices from the Mealtime Relational Care Checklist (relationship-centred = 15; task-focused = 11) reported to occur in the home prior to the pandemic. Multivariate linear regression evaluated staff and care home characteristics associated with mealtime practices.Results: Six hundred and eighty-six respondents completed all questions used in this analysis. Mean TF and RCC mealtime practices were 4.89 ± 1.99 and 9.69 ± 2.96, respectively. Staff age was associated with TF and RCC practices with those 40-55 years reporting fewer TF and those 18-39 years reporting fewer RCC practices. Those providing direct care were more likely to report TF practices. Dissatisfaction with mealtimes was associated with more TF and fewer RCC practices. Homes that were not making changes to promote RCC pre-pandemic had more TF and fewer RCC practices. Newer care homes were associated with more RCC, while small homes (≤49 beds) had more TF practices.Conclusions: Mealtime practices are associated with staff and home factors. These factors should be considered in efforts to improve RCC practices in Canadian homes.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Sarah A Wu
- School of Nursing, University of British Columbia, Vancouver, BC
| | - Hana Dakkak
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Maryam Iraniparast
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB
| | - Hannah M O'rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Natalie Rowe
- Faculty of Creative Industries, School of Design, Fanshawe College, London, ON
| | - Susan E Slaughter
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Natalie Carrier
- Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB
| | | | - Ruth Harvie
- Department of Human Nutrition, St. Francis Xavier University, Antigonish, NS
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
- Schlegel-UW Research Institute for Aging, Waterloo, ON
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Zidén L, Erhag HF, Wijk H. Person-centered care as a tool to reduce behavioral and psychological symptoms in older adults with dementia living in residential care facilities. Geriatr Nurs 2024; 57:51-57. [PMID: 38522128 DOI: 10.1016/j.gerinurse.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
Among older adults living in dementia residential care facilities (RCF) behavioral and psychological symptoms (BPSD) are common, affecting the quality of life (QOL) for the residents as well as being challenging for the staff. The person-centered care (PCC) approach addresses BPSD by giving trained staff mandate to focus on the relation and to adapt the encounter and the environment to increase QoL for the person with dementia. The aims with this study were to improve PCC, decrease BPSD and improve QOL among older persons with dementia living in RCFs, and to explore leaders' and healthcare staff's experiences of a PCC intervention. An educational program was implemented at two RCFs. Data was collected through questionnaires, from national quality registries and through focus group interviews. A significant increase in PCC and QOL at three months was seen. However, no significant difference in BPSD was seen. The interviews showed the importance of a trust-based relationship, and support from an active management to improve PCC, as well as changing old patterns and recognising competence among staff. Factors that affect implementation of PCC in RCF are discussed in the article.
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Affiliation(s)
- Lena Zidén
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Dept of Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Hanna Falk Erhag
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Dept of Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden; Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Ageing and Health - AgeCap, University of Gothenburg, Sweden.
| | - Helle Wijk
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Sweden; Chalmers University, Gothenburg, Sweden.
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Ikeda S, Aoyanagi M, Nakaya R, Yoshimura M, Sumi N. Factors Related to Person-Centered Care for Older Patients With Cancer and Dementia in Designated Cancer Hospitals. Cancer Nurs 2024:00002820-990000000-00222. [PMID: 38442015 DOI: 10.1097/ncc.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Person-centered care (PCC) should be promoted for patients with cancer and dementia who are likely to be hindered from pursuing a meaningful life owing to their will not being reflected in the cancer treatment process. OBJECTIVE This study aimed to clarify the factors related to nurses' practice of PCC for older patients with cancer and dementia in designated cancer hospitals. METHODS An online cross-sectional survey was administered to nurses working at designated cancer hospitals in Japan. The survey items included demographic data and factors assumed to be related to nursing practice and practice of PCC. RESULTS A multiple regression analysis indicated that the factors related to the practice of PCC were attitude toward patients with dementia (β = 0.264, P < .001), holding conferences (β = 0.255, P < .001), knowledge about cancer nursing (β = 0.168, P < .001), knowledge about dementia (β = 0.128, P = .003), and participation in dementia care training (β = 0.088, P = .032). CONCLUSIONS Nurses' practice of PCC may not be sufficient to provide personalized care tailored to patients' cognitive function. The factors related to PCC are attitude toward patients with dementia, holding conferences, knowledge about cancer and dementia, and dementia care training. IMPLICATIONS FOR PRACTICE To promote PCC for patients with cancer and dementia, nurses should learn about these conditions with an interest in patients and collaborate with other professionals. Future studies should use cluster sampling and focus on the extent of cancer or dementia symptoms.
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Affiliation(s)
- Setsuka Ikeda
- Author Affiliations: KKR Sapporo Medical Center (Ms Ikeda); School of Health Sciences, Sapporo Medical University (Dr Aoyanagi); Hokkaido University Hospital (Mr Nakaya); Faculty of Health Sciences, Japan Health Care University (Ms Yoshimura); and Faculty of Health Sciences, Hokkaido University (Dr Sumi), Japan
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Chen H, Song J, Zhang N, Li N, Jiang Q, Lu X, Liu L, Liu Y. Confidence in dementia care and care approach toward dementia among the nursing staff in long-term care facilities in China: a cross-sectional survey. Front Public Health 2023; 11:1182631. [PMID: 37663834 PMCID: PMC10470637 DOI: 10.3389/fpubh.2023.1182631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Confidence and appropriate care approach toward dementia among nursing staff (nurses and care assistants) are crucial manifestations of competency to deal with the complexity of dementia care in long-term care facilities (LTCFs). The purpose of this study was to investigate the confidence in dementia care and care approach among nursing staff in LTCFs in mainland China. Methods A cross-sectional study design was utilized in LTCFs in Shandong Province, mainland China. A convenient sample included of 317 nursing staff drawn from 15 LTCFs. Survey questions included (a) demographics, (b) dementia knowledge, (c) dementia care confidence, and (d) approach to care for people with dementia. Data were analyzed with descriptive statistics. Factors associated with confidence and care approach for people with dementia were examined using Pearson's correlation and multivariate regression analyses. Results Dementia care confidence was generally moderate. Factors affecting confidence to care for people with dementia included educational level, months of caring dementia patients, and dementia knowledge. Most nursing staff did not use a person-centered care approach which was significantly associated with their age, dementia-learning experience, and knowledge and confidence toward caring for people with dementia. Conclusion A positive correlation was identified between confidence to care for people with dementia and nursing staff care approach. Clinical recommendations are provided to further develop education strategies tailored for nursing staff to meet the growing demand for dementia care services.
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Affiliation(s)
- Haiwen Chen
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jie Song
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Nan Zhang
- Jinan Social Welfare Institute, Jinan, China
| | - Na Li
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qianqian Jiang
- Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaohan Lu
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Lin Liu
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yue Liu
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
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Damiaens A, Van Hecke A, Foulon V. Medication Decision-Making and the Medicines' Pathway in Nursing Homes: Experiences and Expectations of Involvement of Residents and Informal Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5936. [PMID: 37297540 PMCID: PMC10253180 DOI: 10.3390/ijerph20115936] [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: 02/15/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Information on how residents and their informal caregivers are involved in the medicines' pathway in nursing homes is scarce. Likewise, it is not known how they would prefer to be involved therein. METHODS A generic qualitative study using semi-structured interviews with 17 residents and 10 informal caregivers from four nursing homes was performed. Interview transcripts were analyzed using an inductive thematic framework. RESULTS Four themes were derived to describe resident and informal caregiver involvement in the medicines' pathway. First, residents and informal caregivers show behaviors of involvement across the medicines' pathway. Second, their attitude towards involvement was mainly one of resignation, but variation was noted in their involvement preferences, ranging from minimal information to active participation needs. Third, institutional and personal factors were found to contribute to the resigned attitude. Last, situations were identified that drive residents and informal caregivers to act, regardless of their resigned attitude. CONCLUSIONS Resident and informal caregiver involvement in the medicines' pathway is limited. Nevertheless, interviews show that information and participation needs are present and show potential for residents' and informal caregivers' contribution to the medicines' pathway. Future research should explore initiatives to increase the understanding and acknowledgement of opportunities for involvement and to empower residents and informal caregivers to take on their roles.
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Affiliation(s)
- Amber Damiaens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Ann Van Hecke
- Department of Nursing Director, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
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Lole L, Conway J, Oorloff A, Duffy C. The role of day-respite centres in supporting people with dementia to age in place: An interpretive phenomenological study. Health Promot J Austr 2023; 34:193-201. [PMID: 36053853 DOI: 10.1002/hpja.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/29/2022] [Accepted: 07/23/2022] [Indexed: 01/27/2023] Open
Abstract
ISSUE ADDRESSED Day-respite care opportunities for people with dementia help prevent informal carer burnout and enable ageing in place. Care workers in these settings are an under-researched workforce who play a pivotal role in providing an engaging and supportive environment for clients with dementia. This study aimed to understand their experiences of providing care for people with dementia. METHODS An interpretive phenomenological analysis explored the factors that challenge and enable day-respite centre workers of the sole facility in one regional Australian town to provide, what they perceive to be high-quality, person-centred care for people with dementia. Thematic analysis revealed four themes relating to the experience of providing care to people with dementia in this day-respite centre. RESULTS Care challenges associated with the symptoms of dementia were recognised by participants; however, these issues were mitigated by the powerful enabling factors, including a strong focus on dementia-friendly care, operating within the centre. Thematic analysis yielded four themes of a person-centred workplace culture and strategy, embedded communication practices, provision of a safe and engaging environment and positive staff attributes. These themes were perceived to make participants' jobs more enjoyable, as well as improve their clients' and carers' quality of life. CONCLUSIONS Day-respite centres offer a valuable resource for people with dementia and their carers, and their success depends on several key environmental and workforce factors. Accordingly, other facilities targeted at caring for this population should assess the feasibility of adopting similar strategies, including selecting and training specialised care staff, adapting the care environment to suit clients' physical and behavioural needs. and establishing routine multi-channel communication methods that effectively connect staff with other care providers, their clients, and their clients' carers. SO WHAT?: The lessons learned in this research could be implemented throughout the wider web of dementia care. Strategies might include the careful selection and training of staff; the provision of dedicated, safe dementia-friendly wards; and routine communication key stakeholders to ensure met-needs care. While there would be a need to scale such care to suit different individual care providers, even seemingly simple strategies would likely have positive effects in optimising care for people diagnosed with this debilitating neurocognitive disease.
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Affiliation(s)
- Lisa Lole
- School of Health, Medical, and Applied Sciences, Central Queensland University Australia, Bundaberg, QLD, Australia
| | - Jessica Conway
- School of Health, Medical, and Applied Sciences, Central Queensland University Australia, Bundaberg, QLD, Australia
| | - Anthea Oorloff
- School of Health, Medical, and Applied Sciences, Central Queensland University Australia, Bundaberg, QLD, Australia
| | - Cameron Duffy
- Wide Bay Hospital and Health Service, Queensland Health, Brisbane, QLD, Australia
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Xu L, Lou Y, Li C, Tao X, Engström M. Person-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:749. [PMID: 36613070 PMCID: PMC9819840 DOI: 10.3390/ijerph20010749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Nursing home residents' well-being is often proxy-rated in studies, and few studies have explored the association between resident-rated person-centered climate, garden greenery, and resident-rated well-being. A cross-sectional study was conducted. Questionnaire data from a convenient sample of 470 nursing home residents in a city in Southeast China in 2021 were analyzed using multiple linear regressions, with block-wise models. The instruments used were the Person-centered Climate Questionnaire-Patient version, the Nursing Home Greenery Index, and, for well-being, the EuroQol-Visual Analogue Scale, the Life Satisfaction Questionnaire, and the 9-item Patient Health Questionnaire (depression symptoms). In the unadjusted models, the person-centered climate was positively associated with general health (β 0.29, p < 0.001), person-centered climate and greenery with life satisfaction (β 0.39, and 0.18; both p < 0.001), and negatively with depression (β -0.28, and β -0.23, both p < 0.001). After adjusting for personal and nursing home characteristics, the associations between person-centered climate, greenery, and well-being remained statistically significant. The three models explained 36%, 35%, and 21% of the variance in general health, life satisfaction, and depression, respectively. This study provides knowledge on person-centered climate in long-term care and the access to greenery.
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Affiliation(s)
- Lijuan Xu
- Medicine College, Lishui University, No. 1 Xueyuan Road, Lishui 323000, China
| | - Yan Lou
- Medicine College, Lishui University, No. 1 Xueyuan Road, Lishui 323000, China
| | - Caifu Li
- Medicine College, Lishui University, No. 1 Xueyuan Road, Lishui 323000, China
| | - Xuemei Tao
- Medicine College, Lishui University, No. 1 Xueyuan Road, Lishui 323000, China
| | - Maria Engström
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, 801 76 Gävle, Sweden
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Richter C, Fleischer S, Langner H, Meyer G, Balzer K, Köpke S, Sönnichsen A, Löscher S, Berg A. Factors influencing the implementation of person-centred care in nursing homes by practice development champions: a qualitative process evaluation of a cluster-randomised controlled trial (EPCentCare) using Normalization Process Theory. BMC Nurs 2022; 21:182. [PMID: 35804407 PMCID: PMC9264574 DOI: 10.1186/s12912-022-00963-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Person-centred care (PCC) has been suggested as the preferred model of dementia care in all settings. The EPCentCare study showed that an adapted PCC approach was difficult to implement and had no effect on prescription of antipsychotics in nursing home residents in Germany. This paper reports the qualitative process evaluation to identify facilitators and barriers of the implementation of PCC in German nursing homes from the perspective of participating practice development champions. Methods Five individual and 14 group interviews were conducted with 66 participants (staff and managers) from 18 nursing homes. The analysis was based on inductive coding to identify factors influencing the PCC implementation process. Identified factors were systematised and structured by mapping them to the four constructs (coherence, cognitive participation, collective action, reflexive monitoring) of the Normalization Process Theory (NPT) as a framework that explains implementation processes. Results Facilitating implementation factors included among others broadening of the care perspective (coherence), tolerance development within the care team regarding challenging behaviour (cognitive participation), testing new approaches to solutions as a multi-professional team (collective action), and perception of effects of PCC measures (reflexive monitoring). Among the facilitating factors reported in all the NPT constructs, thus affecting the entire implementation process, were the involvement of relatives, multi-professional teamwork and effective collaboration with physicians. Barriers implied uncertainties about the implementation and expectation of a higher workload (coherence), concerns about the feasibility of PCC implementation in terms of human resources (cognitive participation), lack of a person-centred attitude by colleagues or the institution (collective action), and doubts about the effects of PCC (reflexive monitoring). Barriers influencing the entire implementation process comprised insufficient time resources, lack of support, lack of involvement of the multi-professional team, and difficulties regarding communication with the attending physicians. Conclusions The findings provide a comprehensive and detailed overview of facilitators and barriers structured along the implementation process. Thus, our findings may assist both researchers and clinicians to develop and reflect more efficiently on PCC implementation processes in nursing homes. Trial registration ClinicalTrials.gov identifier: NCT02295462; November 20, 2014. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00963-6.
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Affiliation(s)
- Christin Richter
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Steffen Fleischer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Henriette Langner
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Katrin Balzer
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Löscher
- Institute for General Practice, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Almuth Berg
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Stevens ML, Karstad K, Januario LB, Mathiassen SE, Rugulies R, Hallman DM, Holtermann A. Nursing Home, Ward and Worker Level Determinants of Perceived Quantitative Work Demands: A Multi-Level Cross-Sectional Analysis in Eldercare. Ann Work Expo Health 2022; 66:1033-1043. [PMID: 35737960 PMCID: PMC9551322 DOI: 10.1093/annweh/wxac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Perceived quantitative demands at work have been associated with poor mental and physical health, long-term sickness absence and subsequent early retirement. Identifying modifiable determinants of perceived quantitative demands at different levels of the organization is key to developing effective interventions. The aim of the study was to identify determinants of perceived quantitative demands at work and examine the extent to which they occur at different levels of the eldercare organisation (i.e. the worker, ward and nursing home levels). Methods We collected data on 383 eldercare workers in 95 wards at 20 nursing homes in Denmark using workplace observations and questionnaires to workers and their managers. Perceived quantitative work demands were assessed using two items from the Copenhagen Psychosocial Questionnaire, II. We identified contributions to overall variability from the three organisational levels using variance components analysis, and examined associations between determinants at these three levels and quantitative demands. Results Almost all (90.9%) the variability in perceived quantitative demands occurred between eldercare workers (within wards). Determinants significantly associated with lower quantitative demands were: having a job as a care helper, working fixed evening shifts, being born outside Denmark, having lower influence at work, higher quality of leadership and lower emotional demands. None of the investigated physical factors (e.g. resident handlings, push/pull tasks, step-count) were associated with perceived quantitative demands. Conclusion We found that the variability in perceived quantitative demands occurred primarily between eldercare workers within wards. Our study indicates that psychosocial work environment factors are the strongest modifiable determinants of perceived quantitative demands in eldercare, while organisational factors related to job position, shift, and resident-staff ratio also play a role. Interventions should test if changes in these determinants can reduce perceived quantitative demands at work in eldercare.
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Affiliation(s)
- Matthew L Stevens
- Department of Musculoskeletal Disorders and Physical Workload, The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 København ØDenmark
| | - Kristina Karstad
- Department of Musculoskeletal Disorders and Physical Workload, The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 København ØDenmark
| | - Leticia Bergamin Januario
- Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
| | - Svend Erik Mathiassen
- Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
| | - Reiner Rugulies
- Department of Musculoskeletal Disorders and Physical Workload, The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 København ØDenmark.,Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 København K, Denmark
| | - David M Hallman
- Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
| | - Andreas Holtermann
- Department of Musculoskeletal Disorders and Physical Workload, The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 København ØDenmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Kunz LK, Scheibe S, Wisse B, Boerner K, Zemlin C. From dementia mindsets to emotions and behaviors: Predicting person-centered care in care professionals. DEMENTIA 2022; 21:1618-1635. [PMID: 35514064 PMCID: PMC9234781 DOI: 10.1177/14713012221083392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE High-quality care standards for dementia care are increasingly based on person-centered care principles. To better understand facilitating factors of person-centered care this research focuses on individual characteristics of care professionals. Applying mindset theory to dementia care, we examined dementia mindsets (viewing dementia symptoms as either malleable or fixed) in care professionals. We tested whether there is a positive relationship between a malleable dementia mindset and person-centered care as well as a negative relationship between a fixed dementia mindset and person-centered care. Moreover, we examined whether care professionals' emotional responses in care situations help explain associations between dementia mindsets and person-centered care. RESEARCH DESIGN AND METHOD In two cross-sectional studies, care professionals of long-term care facilities (total N = 370) completed a measure of dementia mindsets and reported their emotional and behavioral responses to five care scenarios. Regression and mediation analyses were performed. FINDINGS The tested hypotheses were partially supported. A fixed dementia mindset predicted reported person-centered care negatively, while a malleable dementia mindset did not. Mediation analyses suggest that reduced negative emotions may underlie the association between a malleable mindset and reported person-centered care, while reduced positive emotions in care situations may underlie the association of a fixed mindset and reported person-centered care. Study 2 partially replicated these findings. A fixed mindset and positive emotional responses were the most robust predictors of reported person-centered care. DISCUSSION AND IMPLICATIONS This study extends knowledge on facilitators (positive emotional responses to care situations) and barriers (fixed dementia mindset) to person-centered care in care professionals working with persons with dementia. We discuss how dementia mindsets and emotional responses to care situations may be a fruitful target for trainings for care professionals.
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Affiliation(s)
- Lena K Kunz
- Department of Psychology, 403520University of Groningen, Groningen, The Netherlands
| | - Susanne Scheibe
- Department of Psychology, 403520University of Groningen, Groningen, The Netherlands
| | - Barbara Wisse
- Department of Psychology, 403520University of Groningen, Groningen, The Netherlands
| | - Kathrin Boerner
- Department of Gerontology, 14708University of Massachusetts Boston, Boston, MA, USA
| | - Claudia Zemlin
- Department of Human Medicine, 163484University of Witten/Herdecke, Witten, Germany; Dementia Care Unit, Vitanas GmbH & Co. KGaA, Germany
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11
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Is the Systemic Agency Capacity of Long-Term Care Organizations Enabling Person-Centered Care during the COVID-19 Pandemic? A Repeated Cross-Sectional Study of Organizational Resilience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095045. [PMID: 35564440 PMCID: PMC9103543 DOI: 10.3390/ijerph19095045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemic has strained long-term care organization staff and placed new demands on them. This study examines the role of the general ability and power of a long-term care organization to act and react collectively as a social system, which is called systemic agency capacity, in safeguarding the provision of person-centered care during a crisis. The question of how the systemic agency capacity of long-term care organizations helps to ensure person-centered care during the pandemic is an open research question. We conducted a pooled cross-sectional study on long-term care organizations in Germany during the first and second waves of the pandemic (April 2020 and December 2020–January 2021). The sample consisted of 503 (first wave) and 294 leaders (second wave) of long-term care organizations. The top managers of these facilities were asked to report their perceptions of their facility’s agency capacity, measured by the AGIL scale, and the extent to which the facility provides person-centered care. We found a significant positive association between the leaders’ perceptions of systemic agency capacity and their perceptions of delivered person-centered care, which did not change over time. The results tentatively support the idea that fostering the systemic agency capacity of long-term care organizations facilitates their ability to provide quality routine care despite environmental shocks such as the COVID-19 pandemic.
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Stevens ML, Karstad K, Mathiassen SE, Januario LB, Rugulies R, Hallman DM, Holtermann A. Associations between perceived quantitative work demands at different organisational levels and pain and sickness absence in eldercare workers: a multi-level longitudinal analysis. Int Arch Occup Environ Health 2022; 95:993-1001. [PMID: 35441893 PMCID: PMC9203390 DOI: 10.1007/s00420-022-01850-y] [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] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Eldercare work is characterised by high quantitative work demands and high occurrence of musculoskeletal pain and sickness absence. Our aim was to investigate the association between quantitative demands aggregated at the different organizational levels of eldercare and low back pain (LBP) and sickness absence due to pain among workers. METHODS This study was conducted in 527 eldercare workers from 105 wards across 20 nursing homes in Denmark. We collected workers' perceived quantitative demands at baseline and workers' LBP and sickness absence repeatedly over the following year. We aggregated worker-level quantitative demands to the ward and nursing home-levels, and used mixed-effects regression models to investigate the associations between quantitative demands at different organizational levels and LBP and sickness absence over 1 year. RESULTS Across all models, increased quantitative demands (0-100 scale) at the worker-level was associated with an increased likelihood (OR 1.02) and intensity of LBP (β = 0.01). We did not identify any associations between quantitative demands at the ward-level and either of our outcomes. Across all models, increased quantitative demands at the nursing home-level was associated with increased days with sickness absence due to pain (β = 0.03 to 0.06). CONCLUSION In eldercare, workers' perceived quantitative demands are associated with the presence and intensity of LBP. Further, quantitative demands across the overall nursing home-level are associated with sickness absence due to pain among eldercare workers. These results are of relevance to developing organisational interventions targeting quantitative demands to reduce sickness absence in eldercare.
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Affiliation(s)
- Matthew L. Stevens
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 København Ø, Denmark
| | - Kristina Karstad
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 København Ø, Denmark
| | - Svend Erik Mathiassen
- Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Leticia Bergamin Januario
- Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Reiner Rugulies
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 København Ø, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - David M. Hallman
- Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Andreas Holtermann
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 København Ø, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Jang SJ, Kim EH, Lee H. Moral sensitivity and person-centered care among mental health nurses in South Korea: A cross-sectional study. J Nurs Manag 2022; 30:2227-2235. [PMID: 35119156 DOI: 10.1111/jonm.13554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022]
Abstract
AIM To identify the predictors of mental health nurses' person-centered care, including moral sensitivity. BACKGROUND Person-centered care meets patients' ethical needs by protecting their autonomy and dignity, and respecting their choices; it is essential to enhance patient outcomes. Therefore, it is important to identify the predictors of the practice of advocating patients' rights and dignity, and providing person-centered care among mental health nurses to foster competency and ensure the highest quality of care. METHODS This cross-sectional study included 220 mental health nurses in South Korea. It measured their general and work-related characteristics, moral sensitivity, and person-centered care. Multiple regression analysis was conducted to identify the person-centered care predictors. RESULTS The most potent person-centered care predictor was moral sensitivity (β=.35, p<.001). Other predictors included prior biomedical ethics education (β=.15, p=.013) and marital status (β=.14, p=.025). The regression model had 28.0% explanatory power. CONCLUSIONS Mental health nurses' moral sensitivity must be increased to improve their person-centered care. IMPLICATIONS FOR NURSING MANAGEMENT Nurses should receive continuous education to remain aware of and maintain a high level of moral sensitivity and be encouraged to continue the person-centered practice. Organizational and policy support is needed to promote the practice of person-centered care in the workplace.
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Affiliation(s)
- Sun Joo Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Eun Hye Kim
- Dawongongdongche, Mental Rehabilitation Facilities, Daejeon, Republic of Korea
| | - Haeyoung Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
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McCabe M, Beattie E, Karantzas G, Busija L, Mellor D, von Treuer K, Goodenough B, Bennett M, Byers J. An evaluation of a consumer directed care training program for nursing home staff. Geriatr Nurs 2021; 43:227-234. [PMID: 34952305 DOI: 10.1016/j.gerinurse.2021.12.003] [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] [Received: 09/30/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study evaluated a training program to support the delivery of consumer directed care (CDC). It was hypothesized that both interventions, compared to the control condition, would demonstrate increased levels of CDC in nursing homes, increased staff practice of CDC, and improved resident QoL. The training plus support group was expected to show greater gains, compared to the training only group. MATERIALS AND METHODS In a cluster RCT design, 33 nursing homes were randomly allocated to one of three conditions: training plus support, training only, and care as usual. Outcome measures included level of CDC within each home, staff practice of CDC, and resident QoL. RESULTS AND DISCUSSION Hypotheses for this study were partially supported. Nursing homes became more CDC-oriented but with minimal changes in staff practice of CDC. Resident QoL also demonstrated limited change. The findings are discussed in terms of organizational barriers to change within nursing homes.
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Affiliation(s)
- Marita McCabe
- Swinburne University of Technology; PO Box 218 (H95), Hawthorn VIC Australia 3122.
| | - Elizabeth Beattie
- Queensland University of Technology; Building N, Kelvin Grove Campus, Kelvin Grove, QLD, Australia 4059
| | - Gery Karantzas
- Deakin University; School of Psychology, 221 Burwood Highway, Burwood, VIC, Australia 3125
| | - Ljoudmila Busija
- Monash University; Level 4, 553 St Kilda Road, Melbourne, VIC, Australia 3004
| | - David Mellor
- Deakin University; School of Psychology, 221 Burwood Highway, Burwood, VIC Australia 3125
| | - Kathryn von Treuer
- Cairnmillar Institute; 391-393 Tooronga Road, Hawthorn East, VIC, Australia 3123
| | - Belinda Goodenough
- Dementia Training Australia; Building 232 (Mike Codd), University of Wollongong, Innovation Campus, Squires Way, North Wollongong, NSW, Australia 2522
| | - Michelle Bennett
- Australian Catholic University; PO Box 968, North Sydney, NSW, Australia 2059
| | - Jessica Byers
- Swinburne University of Technology; PO Box 218 (H95), Hawthorn, VIC, Australia 3122
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The influence of job crafting on the quality of care provided by nursing home employees: The moderating effect of organizational identification. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractOur goal was to analyze the positive effect of job crafting activities involving nursing home employees on their perceived quality of care, and the moderating effect of organizational identification. A two-wave non-experimental design (with an interval of 12 months) was used. The Job Crafting Questionnaire, the Identification-Commitment Inventory, and the Quality of Care Questionnaire (QoC) were administered to 226 nursing home employees in two waves. The results of the hierarchical regression analyses found significant association between job crafting subdimensions and quality of care twelve months later. Organizational identification was shown to play a moderating role in these relationships when analyzing the effect of cognitive crafting. In this sense, the effect of cognitive crafting on quality of care is only found with high levels of identification. The findings highlight the importance of the job crafting dimensions (task, relational and cognitive) when it comes to enhancing quality of care in residential homes for the elderly. This is especially relevant for cognitive crafting among employees with high levels of organizational identification. This research provides managers with guidance when allocating job crafting opportunities aimed at making improvements in quality of care. In this respect, organizations must offer job crafting training to stimulate and support their employees and, on the other hand, managers should encourage employees to craft their jobs, gearing their needs, abilities, and goals to corporate values and competencies.
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Rosengren K, Brannefors P, Carlstrom E. Adoption of the concept of person-centred care into discourse in Europe: a systematic literature review. J Health Organ Manag 2021; 35:265-280. [PMID: 34523306 PMCID: PMC9136870 DOI: 10.1108/jhom-01-2021-0008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket). DESIGN/METHODOLOGY/APPROACH A literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n = 139), Medline (n = 245), Scopus (n = 493) and Google (n = 317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems. FINDINGS Results from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n = 481, 40.3%), Sweden (n = 231, 19.3%), the Netherlands (n = 80, 6.7%), Northern Ireland (n = 79, 6.6%) and Norway (n = 61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n = 999), as opposed to the Bismarck model, which was mostly supported by grey literature (n = 190). PRACTICAL IMPLICATIONS Adoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe. SOCIAL IMPLICATIONS Evidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare. ORIGINALITY/VALUE Our findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation-from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.
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Affiliation(s)
- Kristina Rosengren
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
| | - Petra Brannefors
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
| | - Eric Carlstrom
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
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Sverdrup K, Bergh S, Selbæk G, Benth JŠ, Husebø B, Røen IM, Thingstad P, Tangen GG. Exploring life-space in the nursing home. An observational longitudinal study. BMC Geriatr 2021; 21:396. [PMID: 34187380 PMCID: PMC8243900 DOI: 10.1186/s12877-021-02345-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time. METHODS In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time. RESULTS We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period. CONCLUSION From NH admission most NH residents' LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.
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Affiliation(s)
- Karen Sverdrup
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway. .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. .,Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Bettina Husebø
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Bergen, Norway
| | - Irene Mari Røen
- Centre for Development of Institutional and Home Care Services, Innlandet (Hedmark), Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Gro Gujord Tangen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Van Diepen C, Fors A, Ekman I, Bertilsson M, Hensing G. Associations between person-centred care and job strain, stress of conscience, and intent to leave among hospital personnel. J Clin Nurs 2021; 31:612-622. [PMID: 34145671 DOI: 10.1111/jocn.15919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
AIM To determine the associations between person-centred care (PCC) and job strain, stress of conscience and intent to leave among healthcare professionals in Swedish hospital departments. BACKGROUND Hospitals have experienced difficulty in retaining qualified healthcare personnel. Previous studies have shown that working in a person-centred environment could offset this challenge, but research is scarce. DESIGN A cross-sectional survey design using the STROBE checklist. METHODS Healthcare professionals (n = 94) in six hospital departments in Sweden completed a survey measuring perceived PCC, job strain, stress of conscience and intent to leave. Data were collected from April 2019 to April 2020. Bivariate analysis was used to describe the sample and correlations between the explanatory variables and perceived PCC and its subscales. Regression analyses were performed to explore the associations between perceived PCC and job strain, stress of conscience and intent to leave. RESULTS The organisational and environmental support subscale of perceived PCC showed significant correlations with all explanatory variables, while the extent of personalising care subscale only correlated with job strain and intent to leave. The regression analyses showed that higher perceived PCC was associated with higher job strain, less stress of conscience and less intent to leave. CONCLUSION Higher perceived PCC is associated with work-related factors in hospital departments. There is scope for further research in this area.
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Affiliation(s)
- Cornelia Van Diepen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Monica Bertilsson
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hoffmann AL, Bergmann JM, Mueller-Widmer R, Palm R. Dementia specific care structures in nursing homes-Study protocol of a telephone-based survey study in a nationwide random sample. J Adv Nurs 2021; 77:3518-3530. [PMID: 33955063 DOI: 10.1111/jan.14873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 01/03/2023]
Abstract
AIM To describe a study protocol for a survey study in German nursing homes that (1) plans to enhance a typology of care units (2) and investigates the association between different care unit types and the provision of dementia-specific interventions based on a stratified randomized sample. BACKGROUND Many nursing homes in Germany provide Dementia Special Care Units. Existing definitions often do no justice to the complexity of their context. In this study, we define context as structural and organizational variables. It is necessary to define an empirical based set of indicators to characterize care units with respect to dementia care. DESIGN Observational survey study with a cross-sectional design. METHODS We will use a stratified random nationwide sample of 160 German nursing homes. Stratification variables are federal state and the existence of a Dementia Special Care Unit. The sampling frame from which the participating nursing homes are selected is a list with the total population of German nursing homes (n = 11.658). Data will be gathered on the level of the nursing homes and one of their care units via computer-assisted telephone interviews with a standardized questionnaire. The distribution of the assessed variables (contextual characteristics) will be described in absolute and relative frequencies for the whole sample in the first step in order to describe dementia-specific care structures. In the second step, factor analysis of mixed data (FAMD) with hierarchical clustering (HC) will be applied to analyze relationships between variables. The study was ethically approved in October 2018. DISCUSSION The typology can be used in future studies to define the context of care units in nursing homes. This may improve the interpretation of findings from future studies that investigated interventions in nursing homes. IMPACT The typology will visualize and describe the complexity of contextual characteristics of several care units.
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Affiliation(s)
- Anna Louisa Hoffmann
- German Centre for Neurodegenerative Diseases, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H, Witten, Germany
| | | | | | - Rebecca Palm
- German Centre for Neurodegenerative Diseases, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H, Witten, Germany
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A predictive model of the perceptions of patient-centered care among nurses in long-term care hospitals: A cross-sectional study. Geriatr Nurs 2021; 42:687-693. [PMID: 33831715 DOI: 10.1016/j.gerinurse.2021.02.019] [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] [Received: 11/24/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/21/2022]
Abstract
This study aimed to propose and examine a predictive model of the impacts of organizational and individual factors on the perceptions of patient-centered care (PCC) among nurses working in long-term care hospitals. A cross-sectional study was conducted at six hospitals in South Korea. Data collected from 187 nurses were analyzed using structural equation modeling. Findings showed that the model explained the impacts of the factors on how nurses perceive PCC, it explaining 47% of the variation in PCC. Organizational factors had stronger influences on PCC [innovative organizational culture (β = 0.34), teamwork (β = 0.30)] compared to individual factors [compassion (β = 0.15), self-leadership (β = 0.07)]. The hypothesized model has potential for determining the factors that influence the perceptions of PCC among nurses working in long-term care hospitals. Further strategies should focus on organizational factors in strategies for improving long-term care nurses' perceptions of PCC.
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Haugland BØ, Giske T. Nursing Students Explore Meaningful Activities for Nursing Home Residents: Enlivening the Residents by Cultivating Their Spark of Life. NURSING REPORTS 2021; 11:217-228. [PMID: 34968200 PMCID: PMC8608132 DOI: 10.3390/nursrep11020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
International research focuses on person-centered care, quality of life, and quality of care for people living in long-term care facilities, and that it can be challenging to improve the quality of life for residents with dementia. The aim of this study was to explore ways of developing appropriate person-centered activities for nursing home residents based on what would be meaningful for them. A qualitative explorative design was chosen. Twelve students each year over a three-year period participated in the study (altogether 36). Each student tailored joyful and meaningful activities for two nursing home residents and wrote eight reflection journals each (altogether 284). Additional data came from eight focus group interviews with the students. Data were analyzed using qualitative content analysis. The main theme was “Enlivening the residents by cultivating their spark of life”. Two main categories were identified: (1) “Journeying to meaningful and enlivening (enjoyable) activities”, and (2) “Expressions of enlivening”, It is possible to tailor meaningful and enlivening activities together with the individual person with dementia. Involvement and engagement are necessary to understand the verbal and nonverbal expressions and communicate with the individual resident.
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Person-centred Australian residential aged care services: how well do actions match the claims? AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Recent inquiries into residential aged care services, including the 2018–2019 Australian Royal Commission into Aged Care Quality and Safety, have informed revisions to the 2019 Australian Aged Care Quality Standards. Reforms to the Standards include a greater focus on person-centred services, consumer-directed care and authentic participation in decision-making on service provision by residents and their family members. In respect of person-centred services, the revised Standards reflect the four elements of the ‘Valuing, Individualised Care, Personal Perspective, Social Environment’ (or VIPS) framework for quality aged (social) care services in the United Kingdom. This qualitative study investigated whether the quality of services in a convenience sample of seven Australian aged care homes, which claimed to be person-centred, aligned with the four elements and 24 indicators of the VIPS framework. Data were obtained via semi-structured interviews with a volunteer sample of people associated with these seven aged care homes: 12 residents, 15 family members and 18 staff members in various roles. Data were analysed deductively with a priori reference to the 24 VIPS framework indicators, achieving data saturation for four common themes which indicated more person-centredness and ten common themes indicating less person-centredness. Only two of seven homes adhered to the four elements and 24 indicators of the VIPS framework across most service offerings. The remaining five homes offered some aspects of a person-centred service. The study findings provide insight to the factors which support and hamper the implementation of the VIPS-informed indicators of a person-centred aged care service and, therefore, what is needed to help meet person-centred requirements as outlined in the 2019 Australian Aged Care Quality Standards.
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Martínez T, Postigo Á, Cuesta M, Muñiz J. Person-Centred Care for older people: Convergence and assessment of users' relatives' and staff's perspectives. J Adv Nurs 2021; 77:2916-2927. [PMID: 33694190 DOI: 10.1111/jan.14821] [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] [Received: 03/09/2020] [Revised: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 01/20/2023]
Abstract
AIM Develop two psychometrically sound questionnaires to assess users' and relatives' opinions of Person-Centred Care. Evaluate the convergence between the perspectives of the different agents involved in Person-Centred Care in the older people: Users, relatives and staff. Examine the relationships between Person-Centred Care and care quality and the users' perceived psychological well-being. DESIGN We used the psychometric technology involved in the development and analysis of tests for the first objective. For the second and third objectives, we used a descriptive-correlational design. METHOD The sample comprised 636 clients of older people care residences, 742 relatives and 844 healthcare professionals. The mean age of the centre residents was 81.62 years old (SD = 9.51), the mean age of relatives was 56.7 (SD = 10.15) and the mean age of healthcare professionals was 39.94 (SD = 10.56). Data collection lasted 10 months, between May 2017 and March 2018. Two new Person-Centred Care instruments were developed and the correlations between different agents were calculated. RESULTS The newly developed measurement instruments demonstrated a unidimensional structure and high internal consistency and stability over time (users: α = .96, ω = .96, r = .91; relatives: α = .97, ω = .97, r = .95). There was high convergence between the Person-Centred Care evaluations from the staff, users and relatives, with correlations ranging between .62 and .76. CONCLUSION The new measurement instruments were reliable and valid. The opinions of the staff, users and relatives about Person-Centred Care in the residential centres were in good agreement. Furthermore, Person-Centred Care was associated with care quality and residents' psychological well-being. IMPACT A gap in the literature is an examination of the extent to which assessments of Person-Centred Care made by staff agree with those by users of the services and their relatives. In order to do that, two new measuring instruments were developed, which showed excellent psychometric properties, and are able to reliably, validly evaluate Person-Centred Care.
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Affiliation(s)
- Teresa Martínez
- Services and Social Rights Council of the Principality of Asturias, Oviedo, Spain
| | - Álvaro Postigo
- Department of Psychology, University of Oviedo, Oviedo, Spain
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Kim S, Tak SH. [Validity and Reliability of the Korean Version of Person-Centered Practice Inventory-Staff for Nurses]. J Korean Acad Nurs 2021; 51:363-379. [PMID: 34215713 DOI: 10.4040/jkan.21027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the validity and reliability of the Korean version of Person-Centered Practice Inventory-Staff (PCPI-S) for nurses. METHODS The English PCPI-S was translated into Korean with forward and backward translation. Data were collected from 338 nurses at one general hospital in Korea. Construct validity was evaluated with confirmatory factor analysis, convergent validity, and discriminant validity. Known-group validity was also evaluated. Cronbach's α was used to assess the reliability. RESULTS The PCPI-S Korean version consisted of 51 items in three areas: prerequisites, the care environment, and person-centered process. The comparative fit index (CFI) and values of person-centered care process were improved after engagement and having sympathetic presence items were combined as one component. The construct validity of PCPI-S Korean version was verified using four-factor structures (.05 < RMSEA < .10, AGFI > .70, CFI > .70, and AIC). The convergent validity and discriminant validity of the entire PCPI-S question were verified using a two-factor structures (AVE > .50, construct reliability > .70). There was an acceptable known-group validity with a significant correlation between the PCPI-S level and the degree of person-centered care awareness and education. Internal consistency was reliable with Cronbach's α .95. CONCLUSION The Korean version of PCPI-S is valid and reliable. It can be used as a standardized Korean version of person-centered care measurement tool.
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Affiliation(s)
- Sohyun Kim
- College of Nursing, Seoul National University, Seoul, Korea
| | - Sunghee H Tak
- The Research Institute of Nursing Science · College of Nursing, Seoul National University, Seoul, Korea.
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Trinca V, Chaudhury H, Slaughter SE, Lengyel C, Carrier N, Keller H. Making the Most of Mealtimes (M3): Association Between Relationship-Centered Care Practices, and Number of Staff and Residents at Mealtimes in Canadian Long-Term Care Homes. J Am Med Dir Assoc 2020; 22:1927-1932.e1. [PMID: 33338445 DOI: 10.1016/j.jamda.2020.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 10/07/2020] [Accepted: 11/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine if (1) number of staff or residents, when considering home-level factors and presence of family/volunteers, are associated with relationship-centered care practices at mealtimes in general and dementia care units in long-term care (LTC); and (2) the association between number of staff and relationship-centered care is moderated by number of residents and family/volunteers, profit status or chain affiliation. DESIGN Secondary analysis of the Making the Most of Mealtimes (M3) cross-sectional multisite study. SETTING AND PARTICIPANTS Thirty-two Canadian LTC homes (Alberta, Manitoba, Ontario, and New Brunswick) and 639 residents were recruited. Eighty-two units were included, with 58 being general and 24 being dementia care units. METHODS Trained research coordinators completed the Mealtime Scan (MTS) for LTC at 4 to 6 mealtimes in each unit to determine number of staff, residents, and family or volunteers present. Relationship-centered care was assessed using the Mealtime Relational Care Checklist. The director of care or food services manager completed a home survey describing home sector and chain affiliation. Multivariable analyses were stratified by type of unit. RESULTS In general care units, the number of residents was negatively (P = .009), and number of staff positively (P < .001) associated with relationship-centered care (F9,48 = 5.48, P < .001). For dementia care units, the associations were nonsignificant (F5,18 = 2.74, P = .05). The association between staffing and relationship-centered care was not moderated by any variables in either general or dementia care units. CONCLUSION AND IMPLICATIONS Number of staff in general care units may increase relationship-centered care at mealtimes in LTC. Number of residents or staff did not significantly affect relationship-centered care in dementia care units, suggesting that other factors such as additional training may better explain relationship-centered care in these units. Mandating minimum staffing and additional training at the federal level should be considered to ensure that staff have the capacity to deliver relationship-centered care at mealtimes, which is considered a best practice.
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Affiliation(s)
- Vanessa Trinca
- University of Waterloo Department of Kinesiology, Waterloo, Ontario, Canada
| | - Habib Chaudhury
- Simon Fraser University, Department of Gerontology, Vancouver, British Columbia, Canada
| | - Susan E Slaughter
- University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada
| | - Christina Lengyel
- University of Manitoba, Department of Food and Human Nutritional Sciences, Winnipeg, Manitoba, Canada
| | - Natalie Carrier
- Université de Moncton, Faculté des sciences de la santé et des services communautaires, Moncton, New Brunswick, Canada
| | - Heather Keller
- University of Waterloo Department of Kinesiology, Waterloo, Ontario, Canada; Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada.
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van Diepen C, Fors A, Ekman I, Hensing G. Association between person-centred care and healthcare providers' job satisfaction and work-related health: a scoping review. BMJ Open 2020; 10:e042658. [PMID: 33293327 PMCID: PMC7722824 DOI: 10.1136/bmjopen-2020-042658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This scoping review aimed to explore and describe the research on associations between person-centred care (PCC) and healthcare provider outcomes, for example, job satisfaction and work-related health. DESIGN Scoping review. ELIGIBILITY CRITERIA Studies were included if they were empirical studies that analysed associations between PCC measurement tools and healthcare providers outcomes. SEARCH STRATEGY Searches in PubMed, CINAHL, Psychinfo and SCOPUS databases were conducted to identify relevant studies published between 2001 and 2019. Two authors independently screened studies for inclusion. RESULTS Eighteen studies fulfilled the inclusion criteria. Twelve studies were cross-sectional, four quasi-experimental, one longitudinal and one randomised controlled trial. The studies were carried out in Sweden, The Netherlands, the USA, Australia, Norway and Germany in residential care, nursing homes, safety net clinics, a hospital and community care. The healthcare provider outcomes consisted of job satisfaction, burnout, stress of conscience, psychosocial work environment, job strain and intent to leave. The cross-sectional studies found significant associations, whereas the longitudinal studies revealed no significant effects of PCC on healthcare provider outcomes over time. CONCLUSION Most studies established a positive association between PCC and healthcare provider outcomes. However, due to the methodological variation, a robust conclusion could not be generated. Further research is required to establish the viability of implementing PCC for the improvement of job satisfaction and work-related health outcomes through rigorous and consistent research.
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Affiliation(s)
- Cornelia van Diepen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sverdrup K, Bergh S, Selbæk G, Benth JŠ, Røen IM, Husebo B, Tangen GG. Trajectories of physical performance in nursing home residents with dementia. Aging Clin Exp Res 2020; 32:2603-2610. [PMID: 32060802 PMCID: PMC7680334 DOI: 10.1007/s40520-020-01499-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 12/22/2022]
Abstract
Background In nursing homes (NH) the prevalence of dementia ranges from 50 to 84% and most residents have extensive physical-performance impairments. However, from time of admission, development of physical performance in NH residents with dementia remains unexplored. Aims To explore the overall trend in physical performance, associated characteristics, and groups following distinct trajectories from time of admission, in NH residents with dementia. Methods We followed newly admitted NH residents diagnosed with dementia (N = 583) from 47 NHs across Norway for 3 years. Individual assessments were conducted biannually, and main outcome measure was the Short Physical Performance Battery (SPPB). Facility-level characteristics included unit size, staff-to-resident ratio, and quality of the physical environment (Special Care Unit Environmental Quality Scale, SCUEQS). Results From time of admission, NH residents with dementia showed a significant overall decline in physical performance. Further, we identified three distinct trajectory groups with significantly different baseline physical-performance status (“good,” “moderate,” and “poor”), differences between groups maintained and all declined across time. Younger age, good general medical health, less-severe dementia, and less musculoskeletal pain were associated with both an average higher overall trend and better baseline group-belonging. Additionally, less apathy and more psychosis were associated with a higher overall trend, and agitation was associated with poorer baseline group-belonging. Conclusions To prevent excessive decline in physical performance in this population, NH clinicians should focus efforts specifically on assessment of physical performance at admission and on identification and management of musculoskeletal pain and neuropsychiatric symptoms. Electronic supplementary material The online version of this article (10.1007/s40520-020-01499-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Sverdrup
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Sverre Bergh
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Irene M Røen
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Centre for Development of Institutional and Home Care Services, Hamar, Hedmark, Norway
| | - Bettina Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
| | - Gro G Tangen
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Lee K, Mileski M, Fohn J, Frye L, Brooks L. Facilitators and Barriers Surrounding the Role of Administration in Employee Job Satisfaction in Long-Term Care Facilities: A Systematic Review. Healthcare (Basel) 2020; 8:healthcare8040360. [PMID: 32987752 PMCID: PMC7712567 DOI: 10.3390/healthcare8040360] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
Previous literature has shown how associate engagement has positively impacted on productivity, job satisfaction, safety, retention, consumer sentiment, and financial performance in hospitals and healthcare systems. However, a lack of research showing the relationship between associate engagement and job satisfaction within the long-term care environment has existed. Our objective was to investigate characteristics within the long-term care environment that promote and detract from associate job satisfaction and extrapolate the best practices in maintaining job satisfaction and engagement. This systematic review queried CINAHL, PubMed (MEDLINE), and Academic Search Ultimate databases for peer-reviewed publications for facilitators and barriers commensurate with employee job satisfaction in long-term care facilities using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Kruse Protocols. The authors identified 11 facilitators for job satisfaction and 18 barriers to job satisfaction in the 60 selected articles. The top four facilitators were Supportive Leadership, Capable and Motivated Employees, Positive Organizational Values, and Social Support Mechanisms. The top four barriers were condescending management style, high job demands, lack of self-care, and lack of training with medically complex patients. The systematic review revealed the importance of maintaining satisfied employees in the long-term care workplace through am emphasis leadership and on the facilitators identified to best serve their associates and improve care for residents.
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Zhang H, Qin S, Zhang L, Feng Z, Fan C. A psychological investigation of coronavirus disease 2019 (COVID-19) patients in mobile cabin hospitals in Wuhan. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:941. [PMID: 32953741 PMCID: PMC7475439 DOI: 10.21037/atm-20-4907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background This study investigated the depression, anxiety, and insomnia levels of coronavirus disease 2019 (COVID-19) patients admitted to two mobile cabin hospitals in Jianghan District (Wuhan, China). Methods Thirty COVID-19 (eight mild type and twenty-two common type) patients were evaluated using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder 7 Questionnaire, the Insomnia Severity Index, and a semi-structured interview. Results All 30 patients reported varying degrees of anxiety, depression, and insomnia. The levels of depression and anxiety in mild type COVID-19 patients were significantly lower than those in common type COVID-19 patients. Significant improvements in depression (P<0.001) and anxiety (P<0.001) levels were found in the COVID-19 patients at the second evaluation compared with the baseline (admittance to hospital). More than 80% patients agreed that medical security, support from other patients, and a better living environment were the main reasons for improvements to their adverse psychological states. Conclusions Varying degrees of anxiety, depression, and insomnia frequently occur in patients with COVID-19. Standard treatment protocols and patient-centered care in the mobile cabin hospitals in this study provided the chance for COVID-19 patients to successfully improve their mental health during the outbreak of the pandemic.
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Affiliation(s)
- Haobin Zhang
- The Big Data Institute, Guangdong Create Environmental Technology Company Limited, Guangzhou, China
| | - Si Qin
- Department of Dermatology, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lei Zhang
- Department of Second General Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhuxiao Feng
- Department of Psychiatry, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Changhe Fan
- Department of Psychiatry, Guangdong Second Provincial General Hospital, Guangzhou, China
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Kok JS, Oude Voshaar RC, Scherder EJA. Psychotropic drug use in residents with dementia living in small-scaled special care facilities; a longitudinal study. Aging Ment Health 2020; 24:689-696. [PMID: 30835505 DOI: 10.1080/13607863.2019.1584784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Over the past decade, a trend has been noticed in the Netherlands to replace large-scaled special care units (SCUs) caring for 20-30 residents with dementia by small-scaled SCUs caring for up to 8 residents. Systematic evaluations, however, have yielded a differentiated picture of the effects. As the impact on psychotropic drug use has hardly been addressed thus far, we examined the (potential) impact of psychotropic drug use when moving residents with dementia from large-scaled to small-scaled SCUs.Methods: We conducted a non-randomized, controlled study with a six-month follow-up. Among 145 residents with dementia living a large-scaled SCUs for dementia caring for 20-30 residents per unit, a total of 77 residents were moved to small-scaled SCUs caring for up to 8 residents per unit. Psychotropic drug use, classified according to the Anatomical Therapeutic Chemical Classification (ATC) system was monitored at 2 months before replacement, as well as at 3 and 6 months thereafter. Repeated measures ANOVAs were conducted for the mean Defined Daily Doses (DDDs) of both groups.Results: No significant differences between both groups in psychotropic medication use were found over a period of 8 months.Conclusion: Prescription of psychotropic drugs does not change after a transfer from a large-scaled SCU to a small-scaled SCU of patients with moderate to severe dementia.Current Controlled Trials: ISRCTN11151241.
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Affiliation(s)
- Jeroen S Kok
- Lentis
- Dignis, Mental Health Care Institute, Zuidlaren, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
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Tomaselli G, Buttigieg SC, Rosano A, Cassar M, Grima G. Person-Centered Care From a Relational Ethics Perspective for the Delivery of High Quality and Safe Healthcare: A Scoping Review. Front Public Health 2020; 8:44. [PMID: 32211362 PMCID: PMC7067745 DOI: 10.3389/fpubh.2020.00044] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of this scoping review is to explore whether or not person-centered care (PCC), in its quest to deliver high quality and safe health care, has a relational-ethics perspective. To do so, we first need to relate the extant literature pertaining to PCC and relational ethics. To this extent, the specific features that define PCC and relational ethics were identified. PCC dimensions include: patient and provider concordance, improved health outcomes, improved patient safety, individual expectations, patients' integration within the environment, patient as a person, patient as an active part of society, dialogue and interaction, sharing experience, and documentation of patient's (person's) narrative. Relational ethics framework includes the following actions: mutual respect, engagement, embodied knowledge, environment, and uncertainty. Methods: Data were retrieved through multiple keywords search on PubMed, Medline, and Scopus. Inclusion/exclusion criteria were set, and these were based on year of publication (2008-2018), language, paper focus, research method and document types. A total of 23 articles (N = 23) were selected and reviewed. Content analysis was conducted in order to identify and compare the main features of PCC and relational ethics. Results: The most important relational ethics action referred to in conjunction with PCC features is environment (referred to as person's integration within a social environment/community). This is followed by mutual respect, engagement and embodied knowledge. These were the salient relational ethics actions both directly and indirectly linked to PCC. Uncertainty was the less recurrent relational ethical action mentioned. Conclusions: This paper revealed that while PCC features embrace most of the relational ethics approaches, these are not exploited in their entirety and therefore PCC emerges as a unique ethical stance in healthcare. PCC's ethical approach goes beyond what is explained within provider-patient relational ethics and emphasizes that the patient is an active person and a partner in care with capabilities and resources. This distinction enables us to explain the paradigm shift from "patient-centered" to "person-centered" care. The healthcare provider partnership and co-creation of the healthcare plan contributes to the delivery of high quality, safe and cost-contained healthcare.
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Affiliation(s)
- Gianpaolo Tomaselli
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Sandra C Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Aldo Rosano
- Italian National Agency for Regional Health Services (AGENAS), Rome, Italy
| | - Maria Cassar
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - George Grima
- Faculty of Theology, University of Malta, Msida, Malta
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Kim EM, Shin JH. Factors Influencing Patient-Centered Care by Nursing Staff in Nursing Homes. ACTA ACUST UNITED AC 2020. [DOI: 10.17079/jkgn.2020.22.1.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Management of constipation in long-term care hospitals and its ward manager and organization factors. BMC Nurs 2020; 19:5. [PMID: 31988637 PMCID: PMC6966903 DOI: 10.1186/s12912-020-0398-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/13/2020] [Indexed: 01/28/2023] Open
Abstract
Background Studies examining organizational factors that may influence constipation management in long-term care (LTC) hospitals are lacking. This study aimed to clarify the practice of constipation management in LTC hospitals and to explore its factors, including ward manager’s perception, organizational climate, and constipation assessment. Methods In this cross-sectional questionnaire survey of ward managers and staff nurses working in LTC wards, we determined daily assessment and practices regarding constipation management. We also conducted multivariate analyses to examine factors related to constipation management. Results There was a 20% response rate to the questionnaire. Nearly all LTC wards routinely assessed bowel movement frequency; other assessments were infrequent. Laxatives were used, but the use of dietary fiber and probiotic products was implemented in only 20–30% of wards. The implementation of non-pharmacological management and adequate use of stimulant laxatives were positively associated with the ward manager’s belief and knowledge, organizational climate, the existence of nursing records for constipation assessment, planned nursing care for constipation, and organized conferences and in-hospital study sessions on constipation management. Conclusion Areas to improve constipation management in LTC hospitals include altering the ward manager’s perception, improving hospital’s organizational climate, and introducing standardized assessment/care planning systems.
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K, Viviano N, Jao YL. Reliability and Validity Testing of the Assessment of the Environment for Person-Centered Management of BPSD and Assessment of Policies for Person-Centered Management of BPSD Measures. JOURNAL OF AGING AND ENVIRONMENT 2020; 34:310-331. [PMID: 34378006 PMCID: PMC8351619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to test the reliability and validity of the Assessment of the Environment for Person-Centered Management of BPSD and the Assessment of Policies for Person-Centered Management of BPSD. The sample included 35 long term care facilities. There was evidence of reliability based on internal consistency and test-retest reliability of both measures. There was some evidence of validity based on Rasch model testing and INFIT and OUTFIT statistics. Across both measures there were six items with that were endorsed as present by all facilities. The INFIT and OUTFIT statistics were all within the expected range of .5 to 1.5 with the exception of four high OUTFIT statistics for the Assessment of the Environment for Person-Centered Management of BPSD. For the Assessment of Policies for Person-Centered Management of BPSD there were two items that had high INFIT statistics and six with low OUTFIT statistics and one with high OUTFIT statistics. Measure revisions are suggested including removal of some poor fitting items, items with no variance, and adding items to differentiate those very high in evidence of environments and policies that manage BPSD.
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Affiliation(s)
- Barbara Resnick
- 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
| | | | - Shijun Zhu
- University of Maryland School of Nursing
| | - Jeanette Ellis
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21218
| | | | | | - Nicole Viviano
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21218
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K, Viviano N, Jao YL. Reliability and Validity Testing of the Assessment of the Environment for Person-Centered Management of BPSD and Assessment of Policies for Person-Centered Management of BPSD Measures. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/02763893.2019.1683670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ann Kolanowski
- School of Nursing, Pennsylvania State University, PA, USA
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marie Boltz
- School of Nursing, Pennsylvania State University, PA, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Liza Behrens
- School of Nursing, Pennsylvania State University, PA, USA
| | - Karen Eshraghi
- School of Nursing, Pennsylvania State University, PA, USA
| | - Nicole Viviano
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ying-Ling Jao
- School of Nursing, Pennsylvania State University, PA, USA
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Martínez T, Martínez-Loredo V, Cuesta M, Muñiz J. Assessment of Person-Centered Care in Gerontology Services: A new tool for healthcare professionals. Int J Clin Health Psychol 2020; 20:62-70. [PMID: 32021620 PMCID: PMC6994739 DOI: 10.1016/j.ijchp.2019.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/12/2019] [Indexed: 01/30/2023] Open
Abstract
Background/Objective: Retirement homes and other gerontology services are frequently criticized due to their lack of flexibility and tailored attention, leading to homogeneous treatment which compromises patients' control of their lives. This study aims to develop and validate the first Spanish instrument for healthcare professionals to assess the degree of person-centered attention delivered by senior care centers. Method: A total of 844 healthcare professionals (mean age = 39.94 years old; SD = 10.56) with a mean of 6.56 years (SD = 6.15) of work experience participated in the study. The psychometric properties of the questionnaire developed were analyzed using both classical test theory and item response theory models. Results: The internal structure was unidimensional with an explained variance of 55.23%. Reliability was outstanding: internal consistency (α = .96, ω = .96) and test-retest (r = .88; ICC = .93). The total score was significantly correlated with two similar questionnaires, with associated variance of 58.83% and 55.20% respectively. Conclusions: The new instrument allows healthcare professionals to assess the level of person-centered care provided by gerontology centers with excellent reliability and validity.
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Affiliation(s)
- Teresa Martínez
- Services and Social Rights Council of the Principality of Asturias, Spain
| | | | | | - José Muñiz
- Department of Psychology. Universidad de Oviedo, Spain
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Norman RM, Sjetne IS. Adaptation, modification, and psychometric assessment of a Norwegian version of the Basel extent of rationing of nursing care for nursing homes instrument (BERNCA-NH). BMC Health Serv Res 2019; 19:969. [PMID: 31842833 PMCID: PMC6916531 DOI: 10.1186/s12913-019-4817-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background To our knowledge, no instrument has been developed and tested for measuring unfinished care in Norwegian nursing home settings. The Basel Extent of Rationing of Nursing Care for Nursing Homes instrument (BERNCA-NH) was developed and validated in Switzerland to measure the extent of implicit rationing of nursing care in nursing homes. The BERNCA-NH comprises a list of nursing care activities in which a care worker reports the frequency to which activities were left unfinished over the last 7 working days as a result of lack of time. The aim of this study was to adapt and modify a Norwegian version of the BERNCA-NH intended for all care workers, and assess the instruments’ psychometric properties in a Norwegian nursing home setting. Methods The BERNCA-NH was translated into Norwegian and modified to fit the Norwegian setting with inputs from individual cognitive interviews with informants from the target population. The instrument was then tested in a web-based survey with a final sample of 931 care workers in 162 nursing home units in different parts of Norway. The psychometric evaluation included score distribution, response completeness and confirmatory factor analysis (CFA) of a hypothesised factor structure and evaluation of internal consistency. Hypothesised relation to other variables was assessed through correlations between the subscale scores and three global ratings. Results The Norwegian version of BERNCA-NH comprised four subscales labelled: routine care, ‘when required’ care, documentation and psychosocial care. All subscales demonstrated good internal consistency. The CFA supported the four-factor structure with fit statistics indicating a robust model. There were moderate to strong bivariate associations between the BERNCA-NH subscales and the three global ratings. Three items which were not relevant for all care workers were not included in the subscales and treated as single items. Conclusions This study found good psychometric properties of the Norwegian version BERNCA-NH, assessed in a sample of care workers in Norwegian nursing homes. The results indicate that the instrument can be used to measure unfinished care in similar settings.
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Affiliation(s)
- Rebecka Maria Norman
- Norwegian Institute of Public Health, PO Box 222 Skøyen, NO-0213, Oslo, Norway. .,Department of Health Management and Health Economics, University of Oslo, Faculty of Medicine, Institute of Health and Society, PO Box 1130 Blindern, NO-0318, Oslo, Norway. .,Lovisenberg Diaconal University College, Lovisenberggata 15b, NO-0456, Oslo, Norway.
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Sánchez-Izquierdo M, Santacreu M, Olmos R, Fernández-Ballesteros R. A training intervention to reduce paternalistic care and promote autonomy: a preliminary study. Clin Interv Aging 2019; 14:1515-1525. [PMID: 31692560 PMCID: PMC6717153 DOI: 10.2147/cia.s213644] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/25/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction Paternalism, assuming control of aged care, is a widespread orientation in older adults care. Paternalistic attitudes and practices are commonly understood as a threat to the freedom and autonomy of a person, making patients more dependent. Therefore, the reduction of these attitudes and behaviors is a primary goal for any older adult health and social care situation. The aim of this preliminary study is to develop a behavioral intervention to decrease paternalistic behaviors in formal caregivers and to increase those care behaviors which promote autonomy at post-intervention (1 week) and at follow-up (14 weeks). Methods A sample of 118 professional caregiver volunteers working in day care centers and nursing homes were assigned to quasi-experimental (N=47) and control (N=71) conditions. The intervention consisted of 3 weekly group sessions. Individual and contextual measures were collected: 1) the primary outcome variable was the type of care (paternalistic versus autonomist) measured through the self-report Paternalist/Autonomist Care Assessment (PACA); 2) A 10-item caregiver self-register of paternalistic behaviors was carried out, 3) Finally, in order to assess the potential effects on observed behavior both in caregiver and older adult functioning at a contextual level, the five institutions were assessed through the SERA-RS. Results Compared with the control group, caregivers in the behavioral intervention group displayed significantly lower paternalistic appraisals at posttest and follow-up. Regarding the intervention group, caregivers at posttest and follow-up showed significantly greater occurrence of autonomist behaviors being promoted and lower paternalistic appraisal. The results regarding the effect on the institutions showed better personnel performance and older adult functioning. Conclusion Caregivers who followed the intervention learned to better identify older adult needs; although we did not find significant differences in autonomy occurrence compared with the control group, a behavioral intervention may promote more autonomist environments and, therefore, better personnel and older adult functioning.
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Affiliation(s)
| | - Marta Santacreu
- Department of Psychology, National Distance Education University of Spain - UNED, Madrid 28670, Spain
| | - Ricardo Olmos
- Department of Methodology, Autonomous University of Madrid, Madrid 28049, Spain
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Lichtwarck B, Myhre J, Selbaek G, Kirkevold Ø, Rokstad AMM, Benth JŠ, Bergh S. TIME to reduce agitation in persons with dementia in nursing homes. A process evaluation of a complex intervention. BMC Health Serv Res 2019; 19:349. [PMID: 31151437 PMCID: PMC6544967 DOI: 10.1186/s12913-019-4168-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Targeted Intervention Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a three-month cluster randomised controlled trial demonstrated reduction in agitation in nursing home residents with dementia. To ease replication and future implementation, and to clarify possible causal mechanisms, we performed a process evaluation of the intervention based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). METHODS An exploratory and a quasi-experimental design with mixed methods were used. The RE-AIM dimensions were explored by questionnaires to 807 staff members and 46 leading ward nurses in both the intervention nursing homes (INH) and the control nursing homes (CNH), before the start of the trial (baseline), and six and 12 months later. These questionnaires assessed data regarding the reach, effectiveness (staff level) and adoption dimensions. To assess implementation, we used a checklist for performance of the main components in TIME and analysed the minutes from 84 case conferences in the INH. To explore adoption and maintenance, five focus group interviews with 32 participants from the staff in the INH were conducted three to 6 months after the end of the trial. RESULTS Reach: On average 61% (SD 22) of the staff in each ward in the INH attended the training sessions. Effectiveness at staff level: There were no between-group differences throughout the study period for attitudes towards dementia, perceived competence or perception of mastery and social interaction. Adoption: 16 of the 17 INH completed the intervention. IMPLEMENTATION 75% or more of the components of TIME were performed for 91% of the included residents. Maintenance: Most of the nursing homes used TIME three to 6 months after the end of the trial. An easy to grasp model and an engaged leadership facilitated the intervention and maintenance. CONCLUSIONS A high degree of reach, adoption, implementation and maintenance contributed to the effectiveness of TIME at resident level. One other causal assumption of the effectiveness of TIME is the development in the staff of a new, shared and situated knowledge about each individual resident, not reflected by measurements in general knowledge and attitudes. TRIAL REGISTRATION The trial was registered January 6, 2016 with ClinicalTrials.gov ( NCT02655003 ).
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Affiliation(s)
- Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway. .,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Janne Myhre
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Selbaek
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Vestfold, Norway
| | - Øyvind Kirkevold
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Vestfold, Norway.,Departement of Health, Care and Nursing, Faculty of medicine NTNU, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Anne Marie Mork Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Vestfold, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Jūratė Šaltytė Benth
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Sverre Bergh
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Vestfold, Norway
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Bökberg C, Behm L, Wallerstedt B, Ahlström G. Evaluation of person-centeredness in nursing homes after a palliative care intervention: pre- and post-test experimental design. BMC Palliat Care 2019; 18:44. [PMID: 31151438 PMCID: PMC6543575 DOI: 10.1186/s12904-019-0431-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The needs of care based on palliative principles are stressed for all people with progressive and/or life-limiting conditions, regardless of age and the place in which care is provided. Person-centred palliative care strives to make the whole person visible and prioritizes the satisfaction of spiritual, existential, social, and psychological needs to the same extent as physical needs. However, person-centred palliative care for older persons in nursing homes seems to be sparse, possibly because staff in nursing homes do not have sufficient knowledge, skills, and training in managing symptoms and other aspects of palliative care. METHODS This study aimed to evaluate whether an educational intervention had any effect on the staff's perception of providing person-centred palliative care for older persons in nursing homes. METHODS A knowledge-based palliative care intervention consisting of five 2-h seminars during a 6-month period was implemented at 20 nursing homes in Sweden. In total, 365 staff members were participated, 167 in the intervention group and 198 in the control group. Data were collected using two questionnaires, the Person-centred Care Assessment Tool (P-CAT) and the Person-Centred Climate Questionnaire (PCQ-S), answered before (baseline) and 3 months after (follow-up) the educational intervention was completed. Descriptive, comparative, and univariate logistical regression analyses were performed. RESULTS Both the intervention group and the control group revealed high median scores in all subscales at baseline, except for the subscale amount of organizational and environmental support in the P-CAT. The staff's high rating level of person-centred care before the intervention provides limited space for further improvements at follow-up. CONCLUSION This study shows that staff perceived that managers' and the organization's amount of support to them in their everyday work was the only area for improvement in order to maintain person-centred care. The experiences among staff are crucial knowledge in understanding how palliative care can be made person-centred in spite of often limited resources in nursing homes. The dose and intensity of education activities of the intervention model need to be tested in future research to develop the most effective implementation model. TRIAL REGISTRATION NCT02708498 . Date of registration 26 February 2016.
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Affiliation(s)
- Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
| | - Lina Behm
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Birgitta Wallerstedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Centre for Collaborative Palliative Care Linnaeus University, Växjö, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
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Chenoweth L, Stein-Parbury J, Lapkin S, Wang A, Liu Z, Williams A. Effects of person-centered care at the organisational-level for people with dementia. A systematic review. PLoS One 2019; 14:e0212686. [PMID: 30794651 PMCID: PMC6386385 DOI: 10.1371/journal.pone.0212686] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/08/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of the systematic review was to determine the effectiveness of organizational-level person-centered care for people living with dementia in relation to their quality of life, mood, neuropsychiatric symptoms and function. ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialised Register databases, were searched up to June 2018 using the terms dementia OR cognitive impairment OR Alzheimer AND non-pharmacological AND personhood OR person-centered care. Reviewed studies included randomized controlled trials (RCTs), cluster-randomized trials (CRTs) and quasi-experimental studies that compared outcomes of person-centered care and usual (non-person-centered) care, for people with a diagnosis of dementia. The search yielded 12 eligible studies with a total of 2599 people living with dementia in long-term care homes, 600 receiving hospital care and 293 living in extra-care community housing. Random-effects models were used to pool adjusted risk ratios and standard mean differences from all studies; the findings were assessed followed the PRISMA guidelines and GRADE criteria. Statistical heterogeneity was assessed using the I2 method and Chi2 P value; studies with low statistical heterogeneity were analyzed using a random-effects model with restricted maximum likelihood estimation in R. Analyses of pre/post data within 12 months identified: a significant effect for quality of life (standardized mean difference (SMD) 0.16 and 95% CI 0.03 to 0.28; studies = 6; I2 = 22%); non-significant effects for neuropsychiatric symptoms (SMD 0.06, 95% CI -0.08 to 0.19; studies = 4; I2 = 0%) and well-being (SMD 0.15, 95% CI -0.15 to 0.45; studies = 4; I2 = 77%); and no effects for agitation (SMD -0.05 (95% CI -0.17 to -0.07; studies 5; I2 = 0%) and depression (SMD -0.06 and 95% CI -0.27 to 0.15, studies = 5; I2 = 53%). The evidence from this review recommends implementation of person-centered care at the organizational-level to support the quality of life of people with living with dementia.
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Affiliation(s)
- Lynette Chenoweth
- Centre for Healthy Brain Ageing (CHeBA), Faculty of Medicine, The University of New South Wales Sydney, New South Wales, Australia
- * E-mail:
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Samuel Lapkin
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, South Western Sydney Campus, New South Wales, Australia
| | - Alex Wang
- Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Zhixin Liu
- Stats Central, The University of New South Wales Sydney, New South Wales, Australia
| | - Anna Williams
- School of Nursing, Faculty of Medicine, The University of Notre Dame Sydney, New South Wales, Australia
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Abstract
Our successes in improving life expectancy has led to increased years of life lived with multimorbidity and dementia with increased support needs. Much of the support given to frail older people is provided by family and informal support networks with significant impact on their physical, psychological, and financial well-being. Demographic and societal changes are reducing the capacity of family to offer this care. Formal home-based, center-based, and long-term/residential/nursing home care services are predominately provided by untrained care staff working under supervision from nursing staff. Difficulties recruiting and retaining these staff is leading to major challenges to meeting the needs of older people (Chenoweth et al., 2010). This volume contains a number of studies focusing on ways to improve care provided by these services for frail older people. The approach underpinning these papers and many perspectives of good quality care for older people is the need to be person-centered where the older person identifies their own goals for care and assessment of need, employing a holistic and strength-based approach incorporating their interests, values, and capacities (Vernooij-Dassen and Moniz-Cook, 2016).
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The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes. Healthcare (Basel) 2018; 6:healthcare6020044. [PMID: 29738507 PMCID: PMC6023420 DOI: 10.3390/healthcare6020044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods: A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results: Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions: Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.
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