The effect of providing recreational activities on the engagement level of long-stay geriatric patients

Can They Do Anything? Ten Single-Subject Studies of the Engagement Level of Hospitalized Demented Patients

The authors used a time-sampling method and a single-case experimental design to see if 10 hospitalized demented patients were more engaged during activity sessions than when they were on the wards. They all participated more fully in the activity sessions. There was some improvement on the Clifton Assessment Procedure for the Elderly scores during phase B when the patients were attending the activity sessions, but it was small and might be attributed to other factors. The individual patients varied greatly in their participation and choice of activities, despite their infirmities.

Evidence behind The Green House and similar models of nursing home care

The Green House and similar models of nursing home care offer a solution to the institutional nature of nursing homes. In The Green House model, small houses are home to 6–12 residents in which care is given as much attention as treatment and is provided by a consistent, self-directed team of staff who are responsible for all care, including preparing meals in a centrally located open kitchen. Residents have private rooms and bathrooms that open onto a central living area. Although a nurse is available 24 h a day and the clinical care team is nearby and visits the home to provide care, the sense is that one is receiving care in a family-type setting. While these homes are expanding rapidly and seem to embody a better culture of nursing home care, their future growth may depend on the evidence that supports or refutes the quality of care that they provide.

Promoting well-being and independence for people with dementia

This paper reviews the research evidence relating to non-pharmacological interventions with people with dementia aiming to improve well-being and independence. There have been a number of attempts to improve the person's level of independent functioning through programmes training and supporting self-care skills, mobility, continence, orientation and participation in activities. Well-being has been less often directly addressed, although recently studies have begun to specifically target aspects of it. Increased independence does not necessarily lead to greater well-being, and it is clear that the greatest potential for increasing function is in tackling the excess disability which many care giving situations in effect impose on the person with dementia. In carrying out research in this area, the limitations of randomized controlled trials are evident, and there is much to be said for the reporting of series of carefully controlled single-case studies in addition to group studies. Further development of methods of measuring well-being in people with dementia is also required.

Using research to implement change: the introduction of group activities on a psychiatric unit

Staff in a psychiatric unit of a general hospital proposed the introduction of a programme of structured group activities, based on their casual observation that patients were sometimes unoccupied and bored. It was decided to collect data systematically in order to inform the implementation of activities. An activities record sheet was developed to list all activities taking place over a 1-week period. Questionnaires were administered to patients (n = 23) and staff (n = 20) on the unit to seek their views on the value, type, timing, frequency and location of activities as well as on other related aspects. Overall, staff made practical and realistic suggestions regarding the implementation of structured group activities. The data collected, although useful in planning change, raised questions about the poor quality of patients' responses and the low response rate (50%) from staff. Implications of these and other issues are discussed.

The effect of an intervention programme on interactions on a continuing care ward for older people

This study describes a project designed to enhance the quality of life of older people on a continuing care ward. The aim of the interventions used was to increase staff/resident interaction levels. The programme interventions focused on staff education and extra ward activities. Interaction levels were measured using a previously published observation schedule which was adapted for use with this client group. Inter-rater reliability measures indicated that the adapted measure was still reliable. The patients on the ward were also assessed to establish their level of dependency. The findings indicated that, for the majority of observational categories, there were no significant differences, but those that were found were in the opposite direction to that predicted and indicated a reduction in interaction levels. Possible explanations for this finding are discussed.

Nurse/patient dependency-a review of different approaches with particular reference to studies of the dependency of elderly patients

The dependency of elderly patients is the outcome of interaction effects between the patient and his or her environment, and over a protracted stay in hospital, environmental factors can be as influential in determining a patient's dependency as the patient's medical or physical condition. Rigid institutional regimes and inadvertent reinforcement of dependent behaviours by nursing staff appear to play an important part in the development of institutionally induced dependency. Studies of patient dependency which assume that dependency arises largely from the physical or mental condition of the patient lack validity because the major source of variation in nursing activity is seen as an almost mechanistic response to patients' dependency. It is argued that, rather than patient dependency 'causing' nursing actions, nursing actions can cause patients to become more or less dependent.