Older people's experiences of care in nursing homes: a meta-synthesis

Exploring the gender-sensitive feelings of nurses towards residents with intimate and sexual needs in dementia nursing care

INTRODUCTION

Person-centered care emphasizes close care relations regardless of gender. However, when residents with dementia express intimate or sexual needs, nurses may struggle with their own emotions and need to include personal boundaries.

METHODS

277 (vocational) nurses from 25 Dutch nursing homes completed a survey, including the Feeling Word Checklist for a resident with perceived sexual needs and another for a resident with perceived intimate needs.

RESULTS

Positive-nurturing sentiments towards residents prevail, yet residents expressing intimate needs elicit higher levels of positive-nurturing and lower levels of negative emotions than those with sexual needs. Male residents, who expressed more pronounced sexual needs, received less affection and interest from female nurses who felt especially close to female residents with intimate needs.

CONCLUSION

Close care relations established through nurses' personal emotions inadvertently introduce gender-sensitive and differing emotions towards residents. Nurses' capability to include personal boundaries benefits the relationship and well-being of both parties.

The Greenhouse Model of Nursing Home Care: A Scoping Review

The study aimed to comprehensively review and assess evidence-based outcomes of the Greenhouse model. We systematically reviewed, assessed, and reported on relevant literature using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines for the scoping review. We identified qualitative or quantitative studies that met our inclusion criteria from PubMed, Medline, CINAHL, and EBSCOhost. The review yielded 41,515 articles published between January 2015 and December 2022; eleven articles met the inclusion criteria and were included in the analysis. The emerging themes were organizational culture, clinical outcomes, and business effects. The Greenhouse model offers a favorable organizational culture with opportunities to enhance clinical and business outcomes. The scoping review was registered in Prospero: CRD42023389048.

Burnout Among Nursing Home Care Aides and the Effects on Resident Outcomes

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014-2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work-life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.

Ambiguities in Preventing Infections in Nursing Homes: Care Workers Experiences and Implications for Future Policies

Preventing infections in nursing homes is highly challenging, given the ambiguous nature of nursing homes as care institutions and places to live. Yet, little is known about how care workers experience preventing infections in this context. Understanding the ambiguities experienced by care workers in nursing homes when enacting infection prevention is crucial to preparing for future health crises. This study investigates and identifies the ambiguities care workers faced and experienced when preventing infections during the COVID-19 pandemic. Interviews and observations were combined to capture narratives and behaviors related to infection prevention and care work. By using thematic analysis, three types of ambiguity were identified: (a) an Ambiguous sense of purpose, (b) Environmental ambiguity, and (c) Information ambiguity. The findings provide a nuanced understanding of the ambiguities care workers face and experience in nursing homes when preventing infections and indicate that such ambiguities impact their behaviors and attitudes. From this study, it is possible to conclude that policymakers must consider nursing homes' ambiguous characteristics in infection prevention programs.

Patients' experiences of day surgery and recovery: A meta-ethnography

AIM

To explore and synthesise findings from qualitative studies on adult patients' experiences of day surgery and the processes of recovery.

BACKGROUND

There has been a shift in the practice of elective surgery, from inpatient to ambulatory treatment. Accordingly, more patients are undergoing day surgery and expected to care for themselves at home. To our knowledge, an updated metasynthesis on patients' experiences of day surgery across diverse contexts and continents is lacking.

DESIGN

Meta-ethnography.

METHODS

MEDLINE, EMBASE and CINAHL were systematically searched for qualitative research in English published between 2006 and 2023. Noblit and Hare's meta-ethnographic approach guided the synthesis of findings from 12 qualitative studies, and the eMERGe Reporting Guidance was used in the writing of this article.

RESULTS

Four themes were revealed: (1) requests for tailored information, (2) challenges of recognising and understanding postoperative symptoms, (3) being dependent on continuous professional and personal support and (4) calling for individual adaptation.

CONCLUSION

Our meta-ethnography indicates there is a need to improve information provision to better prepare patients for the processes of day surgery and recovery and promote their self-care abilities. Our findings highlight the importance of ensuring adequate levels of individualised care and support throughout the treatment process.

RELEVANCE TO CLINICAL PRACTICE

To improve quality of care in day surgery practice, implementation of interventions to enhance information provision and promote self-care during recovery at home may be considered. Pre-admission appointments that incorporate provision of tailored information and assessment of the patients' individual needs of care and support, home conditions and access to assistance from family/friends can be recommended.

Emily's struggle for dignity: An idiographic case study of a woman with multiple sclerosis

Dignity is one of the essential values and central concepts in nursing care. Dignity can be threatened due to radical life changes; therefore, this idiographic case study aimed to explore the sense of dignity experienced by a woman with multiple sclerosis. An interpretative phenomenological analysis was adopted, using data collected through a face-to-face semistructured interview with Emily, a 45-year-old woman. The study was approved by the local ethics committee. Six personal experiential themes were identified: To be ruled by a sick body; Silent progression; Loss of independence as a burden for the family; Will to fight for the meaning of life; Maintaining dignity-in-relation; Dignified care in a period of greater vulnerability. Emily's dignity is based on the effort to fight for a meaningful life, utilization of her full potential, maintain independence in activities of daily living and support in relationships. Continuous changes in functional ability, loss of self-control and an uncertain future have a negative impact on the experience of her dignity. In the context of dignified health care, she considers individual care and maintaining autonomy important. The idiographic case study can contribute to a better understanding of the experience of a woman suffering from multiple sclerosis. It is possible to carry out interventions that aim to support her dignity, improve her quality of life and contribute to individually oriented health care.

Perspectives on existential loneliness. Narrations by older people in different care contexts

The aim was to explore existential loneliness in different long-term care contexts as narrated by older people. A qualitative secondary analysis was performed of 22 interviews with older people in residential care, home care, and specialized palliative care. The analysis started with naive reading of interviews from each care context. As these readings showed similarity with Eriksson's theory of the suffering human being, the three different concepts of suffering were used as an analytic grid. Our result indicates that suffering and existential loneliness are interrelated for frail older people. Some situations and circumstances that trigger existential loneliness are the same in the three care contexts while others differ. In residential and home care, unnecessary waiting, not feeling at home and not being encountered with respect and dignity can trigger existential loneliness while seeing and hearing others suffering can give rise to existential loneliness in residential care. In specialized palliative care, feelings of guilt and remorse are prominent in relation to existential loneliness. In conclusion, different healthcare contexts have various conditions for providing care that meet the existential needs of older people. Hopefully our results will be used as a basis for discussions in multi-professional teams and among managers.

Perspectives on residential involvement and engagement in everyday life-a qualitative study

Background: Worldwide, the population is ageing, and the need for nursing homes is increasing. institutionalization and a culture change from task-orientated care delivery towards increased involvement and engagement in a meaningful everyday life are evolving and, thus, contributing to nursing home residents' quality of life and well-being.Aims/Objectives: To explore nursing home staff's and local managers' perspectives on everyday life with a specific focus on involvement and engagement.Material and Methods: Positioned within interpretivism and hermeneutics, a qualitative exploratory design was applied using individual and group interviews for data generation and abductive thematic analysis as the analytical method.Results: Through the analyses, three main themes appeared-A good day-Everyday life in a nursing home, Doing together-involvement in Everyday life and Involvement in Everyday life-difficult to practice-together with four subthemes-Home and people within, Knowing and relating to the person, If they can - they must and Service and Habits.Conclusions: Fulfilling the needs of both residents and the institution was found to be challenging by nursing home staff and local managers.Significance: A different approach to care, facilitated by, for example, occupational therapists, might be required to enable increased involvement and engagement in everyday life.

Exploring nursing home resident and their care partner priorities for care using the Action-Project Method

BACKGROUND

Nursing home (NH) residents' experiences are embedded within their relationships to others. Our objectives were to describe how residents and care partners (family or staff members) jointly construct, discuss, and act on care priorities.

METHODS

We used Action-Project Method, a qualitative method focused on action within social context. We recruited 15 residents and 12 care partners (5 family and 7 staff members) from 3 urban NHs in Alberta, Canada. Residents and care partners participated in a video-recorded conversation about their experiences in the NH, then individually reviewed the video-recording to add context to the conversation. Following transcription, preliminary narrative construction, and participant feedback, the research team conducted in-depth analysis to identify participant actions, goals, and projects, including those jointly shared by dyad members.

RESULTS

All participants' intentions could be broadly described as "making time in the NH as good as possible" and projects were grouped into five categories: resident identity, relationships (both presence and absence), advocacy, positivity, and respectful care. Participants often raised issues of short-staffing as a significant barrier to respectful care. Care partners, especially staff, used positivity to redirect residents from difficult topics. Joint projects could be identified in some, but not all, cases.

CONCLUSIONS

We found that maintaining a sense of identity, fostering relationships, and receiving respectful care were important to residents but that short-staffing created barriers. Methods to capture these aspects of the resident experience are needed but should not be influenced by care partners' tendency towards positivity in resident interactions.

Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study

Older adults in long-term care are sedentary. Standing is recommended to reduce sedentary time, but there is limited research on long-term care residents' acceptability of standing interventions. The acceptability of the Stand If You Can (SIYC) randomized clinical trial among long-term care residents was explored using a single intrinsic qualitative case study design. The five month intervention consisted of supervised 100 min standing sessions per week. Participants completed post-intervention interviews, which were analyzed using the Thematic Framework Analysis through the lens of an acceptability framework. The 10 participants (7 female), age 73 to 102 years, stood a median of 53% of the intervention offered time (range 20%-94%). The participants reported acceptability in many aspects of the Theoretical Framework of Acceptability. Standing is a simple intervention to decrease sedentary time and seems to be accepted among long-term care residents when burden is not perceived as too high.

'After mealtime is before mealtime' - an ethnographic exploration of nursing home residents' practices of dealing with meal requirements

BACKGROUND

In nursing homes, food is part of the care provided to residents, causing it to be strictly organised within the institutional framework. Moreover, once food has been integrated into the institutional logic, structural and economic aspects regarding organisation of food and eating may dictate individual and social needs, as a theoretical perspective informed by Goffman's notion of the 'total social institution' suggests. This paper describes nursing home residents' practices of dealing with meal requirements in two Austrian nursing homes, to understand how food integrates into the daily routine and how the institutional setting influences the social and material arrangement of food.

METHODS

An ethnographic design was chosen to gain an in-depth understanding. Two urban nursing homes were studied over 21 months (approx. 800 h of participant observation and ethnographic interviews collected). Data analysis took place iteratively, following Grounded Theory strategies.

RESULTS

As the thick descriptions resulting from this procedure show, observing everyday practices of eating in nursing homes reveals complex dimensions of residents being subject to institutional logics, and also demonstrates that residents develop elaborate strategies to deal with the institutional circumstances.

CONCLUSION

A better understanding of the resulting tensions between the restrictions of living in a formal organisation and the agencies of residents described, may contribute to better understanding the effects of structural constraints and to designing more flexible processes.

Middle managers' ethos as an inner motive in developing a caring culture

BACKGROUND

Middle managers play a key role in promoting a caring culture in nursing homes. However, there is limited knowledge about middle managers' inner motives and their experiences of their responsibility in developing a caring culture.

RESEARCH AIM

The aim of the study is to get a deeper understanding of middle managers' motives and their experiences of their responsibility to develop a caring culture in nursing homes.

RESEARCH DESIGN

A qualitative design with a hermeneutic approach inspired by Gadamer was chosen which guided the interpretation of data. Qualitative semi-structured interviews were conducted.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected from thirteen middle managers in nursing homes, in six municipalities in northern Norway in September and October 2021.

ETHICAL CONSIDERATIONS

The study was approved by the Norwegian Centre for Research Data. Oral and written informed consent was obtained from participants.

FINDINGS

The findings show that the middle managers had non- egoistic motives to promote a caring culture as expressed in their attitudes and actions. They felt responsible to promote a caring culture where both patients and staff experienced care and were respected and recognized as unique individuals. Middle managers as good role models are responsible for being present and raising awareness of the importance of care in the nursing home culture by systematically reflecting on care values. However, a strong focus on the financial and administrative demands limits the middle managers' possibilities to promote a caring culture and prevented them from always acting as they wanted to act, which often causes moral distress.

CONCLUSION

Being in contact with inner motives, enables the leader to promote a homelike and caring culture where both patients and staff feels respected and recognized as unique individuals. This study highlights the importance of systematic reflection on caring values in nursing homes which leads to value awareness among all actors.

Barriers to and facilitators of ethical encounters at the end of life in a nursing home: an ethnographic study

Background

Among a growing population of older persons, many affected by multiple diseases and complex needs, are cared for in nursing homes. Previous studies of nursing homes have highlighted the importance of personalised palliative care. Nevertheless, we know little about whether everyday care practice involving assistant nurses and frail older persons accomplishes ethical encounters, especially in assisted bodily care. Therefore, the aim of this study was to understand and conceptualize the encounter between residents and assistant nurses in bodily care-situations at the end of life in a nursing home.

Methods

Focused ethnographic design was used. Residents and assistant nurses from one nursing home in an urban Swedish area participated in this study. Data were collected for 6 months and consisted of 170 h of fieldwork, including participant observation and interviews. Observations and digitally recorded interviews were analysed thematically. Five public community stakeholders contributed to the analysis by discussing preliminary results and clinical implications in a focus group.

Results

Four themes, each encompassing both barriers to and facilitators of ethical encounters in assisted bodily care, were identified: Coping with the impact of workplace demands; Interacting in dialogue and communication; Experiencing involvement in the provision of assisted bodily care; and Adapting to good care and comfort.

Conclusions

The findings suggest that accomplishing ethical encounters in assisted bodily care practice in a nursing home context has many barriers that are related to communication, relationships, and quality of care. Barriers included lack of resources, ineffective communication, and work values, which hinder ethical encounters. Nevertheless, moral sensitivity, genuine interest in resident engagement, and collaborative practices facilitated ethical encounters and are thus central to person-centred care. Uniquely, assistant nurses must be aware of their responsibility for performing their tasks in response to residents’ vulnerability. We therefore suggest that moral deliberation over issues of communication, compassion, decision-making, and behavior, with particular consideration for the care relationship. To further improve the quality of care, organisations must provide resources for the building of relationships, as well as time for assistant nurses to recover after long shifts. Additional research is warranted, including implementation of ethically grounded palliative care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01024-0.

Family care prior to the admission of the elderly in a nursing home and continuity in family care: A comparative study of Colombia and Spain

This study examined the background before admission to a nursing home and the conditions for the continuity of care, of the relatives of older adults of Colombia and Spain. The study sample comprised 546 participants: 278 and 268 from Colombia and Spain, respectively. Structured interviews were conducted with the older adults’ relatives. Sociodemographic similarities predominated, although in the Colombian sample there were significantly more unrelated people. Similarities in previous and current care conditions also predominated too. Cluster 1 included all the cases of Colombian low-resource nursing homes, and Cluster 2 included all the relatives of Colombian high-resource nursing homes and all the Spanish centers. The type of nursing home was the variable more important to identify the abovementioned clusters. Conclusions: Family members from Colombia and Spain continue to care for the elderly admitted to geriatric homes. The type of geriatric center is what establishes the differences in the users.

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Spanish and Colombian family caregivers continue to provide care to the elderly after their admission to the residence.

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There are more similarities than differences between Spanish and Colombian family caregivers.

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Reconciling work-family implies a difficult balance, especially among women, who are more overloaded.

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The deterioration of the health of the elderly was the most frequent reason for admission.

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There are differences between relationships and provision of care in the elderly living in low-income residences in Colombia with respect to the rest of the Colombian and Spanish sample.

Experiences with dignity among older people confined to beds living in a nursing home: A qualitative descriptive study

AIM

The aim of this study is to explore the concept of dignity from the experience of older people with limited mobility and confined to beds while living in a nursing home.

BACKGROUND

Nursing staff have an important impact on the dignity of those older people confined to beds in nursing homes. Individuals' uniqueness with respecting dignity should be ensured.

METHODS

A qualitative descriptive study was conducted. The study was carried out with 19 older people who were immobile and confined to bed and living in nursing homes. The individual in-depth interviews were conducted between July and October 2021. Inductive thematic analysis was used to synthesize data.

RESULTS

The main theme 'Dignity of older people confined to bed' emerged from subthemes 'Emotions', 'Lived experience' and 'Failure to maintain care'. The participants expressed their dissatisfaction towards the nursing staff's disrespectful care, which evoked feelings of insignificance and inferiority.

CONCLUSION

Undignified and disrespectful nursing care can cause feelings of suffering, sadness and anger in older people confined to their beds. Nurses must listen to this group of older people and learn from their experiences. Compassionate, person-centred care with kindness and empathy should be provided by all those providing and receiving care in nursing homes.

IMPLICATIONS FOR NURSING MANAGEMENT

To provide dignified care, nursing staff must understand the importance of person-centred, individually oriented nursing care for older people living with immobility in nursing homes.

Meaning of Respect for Older People in Family Relationships

Background: Older people have various physical and mental health needs and often receive help from their family members to perform their daily life activities. This research aimed to explore the meaning of respect for older people in family relationships. Methods: A qualitative study using a content analysis approach was conducted. Semi-structured interviews were performed with sixteen older people and four family members. Results: Three main categories were developed: “respect for personal interests”, “kind and sincere respect” and “respect for autonomy”. Understanding of the meaning of respect for older people was influenced by special expectations from family members in terms of meeting personal needs, consideration of preferences and interests and empowerment and support to help preserve older people’s independence and autonomy. Conclusions: Family members should be informed and educated with regard to their expected roles in family relationships, and should consider respect as an important factor affecting older people’s well-being.

Qualitative Review on Domains of Quality of Life Important for Patients, Social Care Users, and Informal Carers to Inform the Development of the EQ-HWB

OBJECTIVES

To identify the themes to inform the content of a new generic measure, the EQ-HWB (EQ Health and Wellbeing), that can be used in economic evaluation across health, social care, and public health, based on the views of users and beneficiaries of these services including informal carers.

METHODS

A qualitative review was undertaken. Systematic and citation searches were undertaken focusing on qualitative evidence of the impact on quality of life from reviews for selected health conditions, informal carers, social care users, and primary qualitative work used in the development of selected measures. A subset of studies was included in the review. Framework analysis and synthesis were undertaken based on a conceptual model.

RESULTS

A total of 42 reviews and 24 primary studies were selected for inclusion in the review. Extraction and synthesis resulted in 7 high-level themes (with subthemes): (1) feelings and emotions (sadness, anxiety, hope, frustration, safety, guilt/shame); (2) cognition (concentration, memory, confusion, thinking clearly); (3) self-identity (dignity/respect, self-esteem); (4) "coping, autonomy, and control" relationships; (5) social connections (loneliness, social engagement, stigma, support, friendship, belonging, burden); (6) physical sensations (pain, discomfort, sleep, fatigue); and (7) activity (self-care, meaningful activities, mobility, communication, hearing, vision). Apart from physical sensations, most of the other themes and subthemes were relevant across both health and social care, including for informal carers.

CONCLUSIONS

The findings from this broad review identified themes that go beyond health and that are relevant to patients, informal carers, and social care users. The themes and subthemes informed the domains for the EQ-HWB.

Everyday Life and Social Contacts of Dementia and Non-Dementia Residents over 80 Years in Long-Term Inpatient Care: A Multi-Level Analysis on the Effect of Staffing

The relationship between nurse staffing, physical outcomes of residents, as well as quality of care receives major attention. The impact of staffing levels on residents’ ability to organize their everyday life and maintain social contacts, however, has not been analyzed to date. This study examines whether a relationship between the staff-to-resident ratio for registered nurses and nursing home residents with and without dementia aged over 80 exists. Secondary data collected in the project inQS (indikatorengestützte Qualitätsförderung) were used (n = 1782, mean age = 88.14). The analyzed cross-sectional data were collected in winter 2019 in facilities of the Diocesan Caritas Association in Germany. A sum score formed from variables measuring residents’ abilities to independently organize their everyday life and maintain social contacts functioned as the dependent variable. A multi-level regression analysis was performed. The results revealed that the ability of residents without dementia was significantly associated with the staff-to-resident ratio of registered nurses. This was not true for residents with dementia. For the latter, however, whether the facility offers a segregated care unit turned out to be significant. Additional and longitudinal research is indispensable to explain the inequality between the two groups analyzed.

Perceptions and Experiences of Older Persons in Two Types of Institution in France: Foster Care Family Institution and Medico-Social One

Background: The rapid increase in the number of older people with loss of autonomy and requiring human support, medical services, and adapted accommodation is a challenge in many countries. Beside institutions for older people, foster care families may offer an interesting innovative and affordable alternative that should to be evaluated. As the place of living has a major impact on the quality of life, our objective was to compare the perceptions and experience of older adults depending on the type of accommodation in which they live in. Methods: This study was based on a mixed method approach, with a quantitative assessment and a qualitative study with semi-structured interviews conducted with older people living in two different types of institutions: medico-social institution and foster care families. We explored the perceptions and the quality of life of the participants. Results: Institutionalization, chosen or not, can represent a trauma for older people as it disrupts their personal habits. Participants described medico-social institutions as an institutional framework supported by a strict professional team and rules, as impersonal structures (i.e., somewhat neutral), and as offering a very present, prepared, and respected reception protocol on the first day of arrival, which remained marked in memories. On the other hand, foster care families were considered as more spontaneous and family-oriented structures relying on internal and negotiable rules, offering personalized and close support in the face of loss of autonomy, but in which the reception protocol on the first day of arrival was almost absent. Conclusions: Foster care families and medico-social institutions presented different advantages and disadvantages from the point of view of the participants. This can help health policy makers to rethink the way seniors are housed by taking into consideration their perception and quality of life.

Institutional routines and interpersonal conflicts among elderly in a Long-Term Care Facility

OBJECTIVE

To describe the influence of institutional routines on interpersonal conflicts among institutionalized elderly women.

METHOD

A qualitative study, with an ethnographic framework, performed with 17 elderly women in a Long-Term Care Facility. The field immersion occurred from August 2017 to May 2018. The data were produced by participant observation and fieldnotes and analyzed through the sociocultural perspective with theoretical tools related to the total institutions described by Erving Goffman.

RESULTS

External bonds outside the institution and the routines were trigger factors of conflicts in the Long-Term Care Facility. The dissatisfaction with the lack of external bonds was noticed in the impossibility of leaving with family members, receiving visits, objects, money, foods, or attention. The standardization and collectivization of internal routines of basic activities generated dissatisfaction and challenged the elderly women's tolerance towards the norms. Such situations facilitated interpersonal conflicts in the institutional environment.

CONCLUSION

The conflicts occurred among elderly women and professionals, and among them, from the insubordination of the elderly, based on the idea of reaffirming their individualities.

Caring behaviours perceived by elderly residents and their associated factors in nursing homes in Zhengzhou City of China: A qualitative study

Caring is an evidence-supported behaviour or activity which can meet nursing home residents' needs. China has an ever-increasing number of care-dependent individuals in nursing homes. It is important to explore the caring behaviours and to understand the factors associated with the caring behaviours perceived by elderly residents in nursing homes. This will contribute to an evidence-based approach with which to assist healthcare services. This study aims to explore the perceived caring needs, associated behaviours, and their associated factors identified by elderly residents in nursing homes. Fourteen semi-structured interviews were conducted with elderly residents from five nursing homes in three districts across Zhengzhou City, China. Interviews were transcribed verbatim and analysed using the Colaizzi phenomenological method. Five themes and fourteen sub-themes were identified. The availability of health services, a livable environment, and social communication were the main caring needs identified. Nursing assistant factors and resident factors were the main influencers. This study provides valuable information on the need to carry out standardised training of nursing assistants and how to adjust the goal of care in nursing home residents. The medical support, psychological counselling, livable environment, recreational and cultural services as well as caring literacy about nursing assistants in the nursing homes, however, need to be further enhanced to meet the residents' diversified caring needs.

Resident and family engagement in medication management in aged care facilities: a systematic review

Introduction: Medication-related harms may occur if residents and families are not involved when important medication decisions are made. We examined how residents and families engage in the management of residents' medications in aged care facilities.Areas covered: A systematic review was undertaken, which was registered with PROSPERO (CRD42020152700). Electronic databases were searched from inception until 27 August 2020 using MEDLINE/PubMed, CINAHL, PsycINFO and EMBASE. Data synthesis was undertaken using thematic analysis.Expert opinion: Forty studies were included. Communication tended to be unidirectional comprising consultations where residents and families provided medication information to health care providers or where health care providers provided medication information to residents and families. Many challenges prevailed that prevented effective engagement, including families' hesitation about making decisions, and the lack of adequately-trained health care providers. Testing of interventions often did not include residents or families in developing these interventions or in examining how they participated in medication decisions following implementation of interventions. Areas for improvement comprise actively involving residents and families in planning interventions for resident-centered care. Health care providers need to have greater appreciation of families' ability to detect dynamic changes in residents' behavior, which can be used to enable optimal alterations in medication therapy.

What is and what ought to be: A meta-synthesis of residential aged care staffs' perspectives on quality care

BACKGROUND

As places of both residence and work, what constitutes "good quality care" in residential aged care requires consideration of staffs' perspectives.

OBJECTIVE

A meta-synthesis of the qualitative literature was conducted exploring residential aged care staff perspectives on "quality of care."

METHODS

Six electronic databases were searched for articles that met the screening inclusion criteria. This meta-synthesis was informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and included studies were critically appraised using JBI SUMARI. Two independent reviewers conducted thematic network mapping and analysis of included articles, with oversight from three additional reviewers.

RESULTS

Forty-seven articles were included, with findings summarised into four organising themes and nine basic themes. The four organising themes about quality care from staff perspectives include direct care, professional values and competence, the care environment and organisational/regulatory factors.

CONCLUSION

Staff describe a wide range of factors that they perceived to influence the quality of care. Some may feel motivated to leave employment in aged care, due to organisational pressures that make staff unable to uphold what they perceive as an acceptable standard of care. There is tension between professional values and organisation/regulatory factors-regulation should be enacted at a level that supports good practice and staff's moral integrity.

RELEVANCE TO CLINICAL PRACTICE

This review found that while person-centred care is now well established as the benchmark of quality care in residential aged care homes, achieving it in reality remains challenged by limitations on staff members' time, resources and sometimes their competencies and the regularity of their employment.

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

Background

Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care.

Methods

The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis.

Results

Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters.

Conclusions

Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

Self-Reported Satisfaction of Older Adult Residents in Nursing Homes: Development of a Conceptual Framework

BACKGROUND AND OBJECTIVES

Resident satisfaction is an integral part of nursing home (NH) quality of care. However, there is no uniform categorization framework to classify self-reported satisfaction of older adult residents in NHs. This scoping review systematically investigated the studies reporting data on older residents' satisfaction to evaluate the quality of NH service and to create a conceptual model for older residents' satisfaction.

RESEARCH DESIGN AND METHODS

We used Donabedian's structure-process-outcome model as a theoretical framework. In three electronic databases (PubMed, Scopus, and CINAHL), potential studies were searched using specific inclusion criteria identifying original studies that investigated older adult residents' satisfaction in NHs.

RESULTS

Fifteen studies, including 264,133 residents and 15,577 NHs, were selected for this review. Although a wide variety of resident satisfaction measures were used in the included studies, all these indicators reflect five primary domains: Psychological, Clinical, Social, Environmental, and Spiritual, with the common focus of improving the quality of life of residents. Though technical competence is a fundamental aspect of healthcare service, we found autonomy, environment, meaningful activities, and interpersonal quality of professionals as the most important predictors for the resident's satisfaction.

DISCUSSION AND IMPLICATIONS

The current review has synthesized a broad range of satisfaction measures, which will help future researchers and policymakers provide guidance for further improvement of NH care services and as a heuristic device to spur research. Future research is needed to apply this conceptual framework for comparisons of self-reported resident satisfaction in other institutional settings across countries.

Met and unmet needs of dependent older people according to the Camberwell Assessment of Need for the Elderly (CANE): A scoping review

In order to address the complexity of needs of dependent older people, multidimensional and person-centered needs assessment is required. The objective of this review is to describe met and unmet needs of dependent older people, living in the community or in institutions, and the factors associated with those needs. Selection criteria included papers about need asessment which employed the Camberwell Assesment of Need for the Elderly (CANE). A search through MEDLINE, SCOPUS, WOS and CINHAL databases was carried out. Twenty-one articles were finally included. Unmet needs were found more frequently in psychosocial areas (mainly in "company", "daytime activities" and "psychological distress") and in institutionalized population. In addition, unmet needs were often associated with depressive symptoms, dependency, and caregiver burden. Discrepancies between self-reported needs and needs perceived by formal and informal caregivers were identified. It is important that professionals and caregivers try to make visible the perspective of older people and their psychological and social needs, particularly when the person is dependent, depressed or cognitively impaired.

Meeting centres support programme highly appreciated by people with dementia and carers: a European cross-country evaluation

BACKGROUND

The Meeting Centres Support Programme (MCSP) offers a combined approach to providing practical, emotional and social support to people living with mild to moderately severe dementia and their family carers in the community.

METHODS

A mixed methods explanatory design was used. The evaluation took place within the framework of the international Joint Programme - Neurodegenerative Disease Research (JPND) - MEETINGDEM study in nine Meeting Centres in Italy, Poland and the United Kingdom. Eighty-seven people with dementia and 81 family carers completed a user evaluation survey after three months and 83 people with dementia and 84 carers after 6 months of participation in MCSP. Thirty-two people with dementia and 30 carers took part in focus groups after nine months.

RESULTS

The percentage of people with dementia who were very satisfied with the programme increased significantly over time (p = 0.05). The majority of carers reported that they felt less burdened after three months of participation in MCSP (48.1% much less; 35.4% a little less). After six months, this percentage increased significantly to 91% (p = 0.04, 57.7% much less; 33.3% little less). Focus group analysis showed that people with dementia and carers in all countries/centres improved their ability to maintain emotional balance.

CONCLUSIONS

The MCSP is highly appreciated by people with dementia and carers in all countries and it confirms the results of previous research into MCSP in the Netherlands. Our findings indicate that MCSP is a model that can help its users to increase their capacity to deal with the challenges caused by dementia and can promote emotional balance.

Development and Exploration of Psychometric Properties of the Family Adjustment Questionnaire for Admitting an Older Adult to a Nursing Home (CAFIAR)

Background: Admitting an older adult to a nursing home involves significant adjustment efforts by the family. Our goal was to prepare an assessment instrument for this, given that there was none to date. Method: Participants-134 relatives from different nursing homes in the region of Murcia. Instruments-structured interview for socio-demographic information, satisfaction with the nursing home, well-being and health self-assessment, Radloff's Depression Questionnaire (CES-D), and the first version of CAFIAR. Results: A 15-item instrument with three factors was obtained: Factor 1 (Unease due to admitting an older adult to a nursing home), Factor 2 (Relief), and Factor 3 (Nostalgia and concern for the older adult), in addition to a general adjustment index, with a Cronbach's alpha of 0.74. The general adjustment index and the subscales that demonstrate poor adjustment were significantly correlated with depression and a worse health self-assessment, while the Relief subscale, which indicates better adjustment, was significantly correlated with well-being and a positive health self-assessment. Conclusions: The family adjustment in admitting an older adult to a nursing home questionnaire (CAFIAR) has adequate psychometric properties to assess family adaptation in admitting an older adult to an institution.

Factors associated with nursing home adjustment in older adults: A systematic review

BACKGROUND

An ageing population has resulted in increased numbers of older adults moving to a nursing home, and the challenges triggered by relocation are highlighted. Various factors are identified to be associated with relocation and psychological adjustment to living in a nursing home. However, no systematic review has synthesised the evidence, and its associated factors remain unclear.

OBJECTIVE

To examine and synthesise the best available evidence on the factors associated with adjustment to living in a care facility.

DESIGN

Systematic review.

DATA SOURCES

Nine electronic databases were searched from database inception to March 2020: Pubmed, Embase, CINAHL, PsycINFO, Cochrane library, China National Knowledge Infrastructure, China Wanfang Database, Chinese Biomedical Literature Database, Chinese Periodical Full-text Database.

REVIEW METHODS

The references listed in the included studies were manually checked. The quality of the eligible studies was assessed using the 11-item checklist of the Agency for Healthcare Research and Quality.

RESULTS

A total of 20 studies were included in this review, with 17 cross-sectional studies, and three longitudinal study. 19 studies were rated as moderate quality and the other one was high quality. 17 measures were used to assess nursing home adjustment. Six distinct categories of the associated factors for nursing home adjustment were identified: demographic characteristics (n = 11), physiological factors (n = 3), psychological factors (n = 9), social factors (n = 9), relocation factors (n = 6), and facility factors (n = 5).

CONCLUSIONS

Decision-making control, self-efficacy, social support, activities of daily living, and length of stay should all be taken into account when assisting resident scoping with a relocation to a nursing home. Infuture research, multiple areas can be considered when improving the level of nursing home adjustment, as well as interventions and health policies.

REGISTRATION NUMBER

PROSPERO CRD 42018115935.

TWEETABLE ABSTRACT

A systematic review of the factors associated with adjustment to living in a care facility.

The necessity and possibilities of playfulness in narrative care with older adults

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long-term care, we show the possibilities of playfulness in the co-composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times.

Themes Related to Experienced Quality of Care in Nursing Homes From the Resident's Perspective: A Systematic Literature Review and Thematic Synthesis

Background: The culture change from task-centered care to person- and relationship-centered care has resulted in the resident’s voice gaining importance when assessing experienced quality of care in nursing homes. This review aimed to identify which factors contribute to experienced quality of care in nursing homes worldwide from the resident’s perspective. Method: A systematic literature review and thematic data synthesis were performed. The databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and Business Source Complete were searched to identify qualitative studies aimed at retrieving factors related to residents’ experienced quality of care in nursing homes. Only studies in which residents themselves were interviewed were included. Results: This literature review included 27 publications covering 14 countries. Thematic analysis revealed three overarching themes related to residents’ care experiences: (a) The nursing home environment consisted of the physical environment and caring environment, (b) individual aspects of living in the nursing home consisted of personhood and coping with change, and (c) social engagement consisted of meaningful relationships and care provision. Discussion: To achieve high experienced quality of care in nursing homes, residents’ care experiences need to be assessed and used in quality management.

To make and execute decisions throughout life: A person-centred model that facilitates self-determination in residential care, developed through participatory research

AIM

The aim of the study was to develop a model that facilitates self-determination in residential care.

BACKGROUND

The right to decide on one's own life is self-evident to most adult persons. Nevertheless, dependency on others and the routine-based care that sometimes is provided in residential care, limit the residents' possibilities of self-determination.

METHODS

The study had a participatory research design using appreciative inquiry in focus group discussions with staff, residents, and care managers. The research process and the model were audited by two expert groups: a scientific reference group and a dementia-specialist reference group. A theoretical framework of relational autonomy and person-centred care was also used.

RESULTS

By combining practical and theoretical knowledge, the model "To make and execute decisions throughout life" was developed. The core message of "In my way, at my pace, with the help of you" was reinforced by the categories "See me as a competent person", "Show me professional consideration", "Meet me in a trustful relationship", "Give me opportunity to a meaningful and safe day", "Support me in being independent", "Let me have power over my own life", and "Help me to plan my end-of-life care".

CONCLUSION

The model "To make and execute decisions throughout life" provides a base for a person-centred approach to care. By reflecting on the core message and the different categories in the model, staff can be inspired to see their own contribution to the residents' self-determination and find ways to facilitate it despite the many obstacles.

Healthcare middle managers’ capacity and capability to quality improvement

Purpose

The purpose of this study was to identify and critically discuss how healthcare middle managers’ (HMMs) development of the capacity and capability for leadership are experienced to influence quality improvement (QI) in nursing homes.

Design/methodology/approach

This study had a critical hermeneutic perspective with data gathered using focus groups, one individual interview and participative observations. Analysis was guided by a qualitative interpretive approach.

Findings

The results show how HMMs’ development of the capacity and capability for leadership are experienced to influence QI in nursing homes through grasping complexity in a conflicting practice. This involves continuous knowledge development and compensating contrasted by resource shortages, role conflicts and the lack of trust and cooperation.

Originality/value

HMMs have a key role in implementing QIs in healthcare. There are few studies on how HMMs develop the capacity and capability for leadership and it is unclear how clinical contexts are influenced by HMMs’ development. This study provides new knowledge supporting a change facilitating HMMs’ developmental processes targeting practical influence; it emphasizes continuity, coherence, presence and trust.

Prioritizing LTSS Quality: Exploring the Views of Older Adults, Families, and Professionals

We conducted a cross-sectional survey involving 349 older adults, family members, and long-term services and supports (LTSS) professionals in Minnesota to assess their views on priorities for residential LTSS quality. We found considerable agreement among the three groups on the highest priorities to ensure the wellbeing of older adults who use LTSS: safety, dignity, and staffing. Relationships were also viewed as a high priority. However, older adults prioritized the physical environment over professionals, and they expressed more varied opinions on priorities overall. Older adults also consistently rated autonomy/choice as less important than other quality domains, a finding worth further exploration.

How to assess experienced quality of care in nursing homes from the client's perspective: results of a qualitative study

BACKGROUND

The culture shift in nursing homes from task-oriented to person-centered care has created a need to assess clients' experienced quality of care (QoC), as this corresponds best with what matters to them. This study aimed to gain insight into how to assess experienced QoC in nursing homes from the client's perspective.

METHOD

A qualitative study was performed consisting of a focus group with client representatives (n = 10), a focus group with nursing home staff (n = 9) and a world café with client representatives and staff recruited from the Living Lab in Ageing & Long-Term Care (n = 24). Three questions about assessing experienced QoC from the client's perspective were addressed during data collection: 1) What content needs to be assessed? 2) What assessment procedures are needed? and, 3) Who needs to be involved in the assessment? Semi-structured questions, photo elicitation and creative writing were used to answer these questions. Conventional content analysis was used to analyze the data.

RESULTS

Participants indicated that experienced QoC mostly occurs within the interactions between clients, family and staff, highlighting the impact of relationships. They suggested assessments should focus on three aspects: 1) knowledge about the client, 2) a responsive approach, and 3) a caring environment. These can be assessed by having conversations with clients, their families and staff, and additionally observing the clients in their living environments. Sufficient time and resources are prerequisites for this. Additionally, the person performing the quality assessments needs to possess certain communication and empathy skills.

CONCLUSION

It is important to include the perspectives of the client, family and staff when assessing experienced QoC, in line with the principles underlying relationship-centered care. In order to be feasible, it is recommended to incorporate quality assessments into the nursing homes' daily routines. Further research with clients, family and staff in nursing homes is needed to develop a feasible, reliable and valid method that assesses experienced QoC from the client's perspective.

Nursing home staff experiences of implementing mentorship programmes: A systematic review and qualitative meta-synthesis

Aim

To determine nursing home staff experiences in mentorship programmes, and staff perceptions of the enablers and barriers to implement mentorship programmes.

Background

Mentorship programmes are perceived as playing an important role in improving the quality of care in nursing homes. However, little is known about research evidence across the global about staff's experiences in the programmes.

Methods

A search for studies published from the earliest available date to April 2019 was undertaken. Two reviewers performed data extraction and an appraisal of eight studies using tools from the Joanna Briggs Institute. A pragmatic meta‐aggregative approach was applied to synthesise the findings. The qualitative research that was included was analysed to identify 63 findings that were organised into 12 categories and combined into three syntheses.

Results

The implementation of effective mentorship programmes is influenced by three factors: mentor capability, opportunity in the mentorship programmes, and motivation in the mentorship programmes.

Conclusions

There are a number of studies of nursing home staff experiences of mentorship programmes. However, systematic reviews that synthesise findings in this field are lacking. It is crucial to tailor the programme design to suit each unique nursing home care setting. We identified barriers and enablers, and learned that no barriers are insurmountable.

Implications for Nursing Management

Findings will inform nurse managers of an ideal environment for the implementation of a successful mentorship programme. Nursing homes need to establish and sustain mentorship programmes to help improve workforce capacity in delivering high‐quality care for residents.

Slow Nursing and Its Holistic Place in Dementia Care: A Secondary Analysis of Qualitative Data From Nurses Working in Nursing Homes

Despite a growing body of research literature within dementia care, research concerning how to provide holistic quality care and its benefit for people with dementia is still scarce. In this study, a secondary analysis of original qualitative data from a former study was employed. Findings demonstrated that slow nursing embodies a holistic caring approach, which may improve the care quality provided to people with dementia. The current findings also provide key knowledge that may contribute to nursing research and education.

A Narrative Care approach for persons living with dementia in institutional care settings

AIMS AND OBJECTIVES

We will provide insights in the theoretical background and key concepts of a Narrative Care approach, such as narrative cultures, narrative curiosity, narrative co-composition and narrative reflective practice.

BACKGROUND

Care understood as narrative practice underscores the importance of experiences and how these shape identities. Important to the quality of care in institutional care settings is the ability of care providers to cope with complexities and uncertainties in older adults' stories, which can be realised by attending to ways that foster and co-compose evolving and forward-looking narratives. Recognising these ongoing co-compositions means that persons living in institutional care settings and care providers live, tell, retell and relive their experiences. A change in the current institutional culture is necessary to implement care as narrative practice. To support such a change, approaches are needed that foster a focus on experiences and relationships and make relational ethics central to care.

METHODS

The proposed Narrative Care approach is the result of an iterative development process involving a literature review, interviews with, and observations of, care providers, dialogues with an advisory committee, and consultation with experts.

MAIN CONTRIBUTIONS

The proposed Narrative Care approach aims to help care providers (a) to recognise the importance of curiosity in a person's verbal and embodied narratives-especially for those living with dementia; (b) to take note of individual experiences in all of their complexity and uncertainty; (c) to respect these narratives; (d) to open up spaces to co-compose new narratives; and (e) to allow care providers to engage in narrative reflective practices that shape who they are and are becoming.

CONCLUSION

The introduced approach responds to the need of implementing strategies to think and work narratively in institutional care settings.

IMPLICATIONS FOR PRACTICE

Narrative Care has the potential to reshape task-oriented, technical notions of care. Concepts such as embodied narratives, relational ethics, narrative co-composition and narrative reflective practice must be integrated in the education of all care providers.

Gender differences in psychosocial determinants of self-perceived health among Portuguese older adults in nursing homes

Objectives: Self-perceived health declines with age, varies by gender and is a predictor of mortality, morbidity, physical and psychological functioning. However, gender differences in health and illness perception are complex and not yet fully understood. This study aimed to explore gender-related differences in psychosocial determinants of self-perceived health among older adults living in nursing homes. Method: Nationwide face-to-face survey of the Portuguese population aged 65 and over. A representative sample of nursing homes residents was obtained through a multistage cluster random sampling of nursing homes, stratified by main Portuguese administrative regions (NUTS II). Results: Overall, 1186 nursing homes residents voluntarily enrolled in this study (participation rate, 93%) and a total of 515 participants (70.1% women) were considered to have adequate cognitive functioning to answer all questionnaires. A significant association between self-rated health and gender was found: 90.6% of all women (95% CI: 85.7-93.9) and 82.3% of all men (95% CI: 72.9-88.9) rated their health as less than good (p = 0.023). Gender-stratified analyses showed differences in psychosocial determinants of self-perceived health. While symptoms of depression and loneliness feelings were the major psychosocial determinants of poor self-perceived health among women, age and subjective financial well-being were the only determinants among men. Conclusion: Factors associated with perceived health, as representative of healthy ageing, were identified by gender, leading to future avenues for fruitful investigation. The acknowledgement of interpersonal and socioeconomic factors that determine the experience of ageing at a national level is crucial to improve the health of elders.

Adjusting to life in a residential aged care facility: Perspectives of people with dementia, family members and facility care staff

AIMS AND OBJECTIVES

To determine factors that facilitate or impede adjustment to residential aged care (RAC) from the perspectives of residents with dementia, families of residents with dementia and facility staff.

BACKGROUND

The transition to a RAC facility can be highly stressful for people with dementia and their families, but we lack an understanding of how people with dementia experience this transition. Knowledge on adjustment to the new environment is essential in order to develop procedures and interventions that better support residents.

DESIGN AND METHODS

This study consisted of interviews with 12 residents with dementia who had resided at a RAC facility for six months or less; 14 family members of RAC residents with dementia; and 12 RAC facility staff members. Parallel interview schedules were constructed, with questions on the experience of relocating to RAC for a person with dementia and views on enablers and barriers to successful adjustment. Thematic analysis guided the analysis of data. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines (see Supplementary File S1).

RESULTS

Adjustment to RAC appeared variable, with several residents reporting poor acceptance of their circumstances several months after the relocation. The three groups were largely congruent regarding the importance of support from families and staff, and the development of new relationships with other residents, but not all residents had succeeded in forming friendships. The provision of meaningful activities and opportunities to exert autonomy day-to-day were seen as critical, but staff experienced challenges in providing individualised care due to lack of dedicated time to engage with residents.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

There is a need for evaluated interventions to help people with dementia to successfully transition to RAC. Attention should be paid to the way in which care is coordinated within the RAC sector, to enable staff to provide individualised approaches to facilitate adjustment.

An ethnographic study in nursing homes in Iran

BACKGROUND:

The approach of death is an undeniable part of ageing and death is the most important concern for elderly people who live in nursing homes. This study examines describes how care home residents feel when they recognise that they are close to death.

AIMS:

The aim of this study was to explore the experiences of elderly residents who are dying in nursing homes as well as their caregivers toward death in an Iranian context.

METHODS:

A focused ethnographic research design was chosen. The research sample consisted of 25 nursing home staff-three nurses, 18 healthcare assistants, two administrators, a social worker and a psychologist-and 10 elderly people in two nursing homes in Iran. Data was collected through field notes, observations and semistructured, in-depth interviews. Data was analysed using thematic analysis.

FINDINGS:

There were two main themes of: seeking the embrace of a calm death; and waiting for death. Within these, four subthemes were identified.

CONCLUSION:

The perceptions of the participants originated from the nursing home culture and their beliefs in eternal life. Training staff about the cultural needs of dying people and end-of-life care would be the most effective way to improve the experience of dying for nursing home residents.

Anterior tooth wear and quality of life in a nursing home population

AIMS

The aim of the study was to assess the extent to which a relationship may exist between the wear of the anterior teeth and quality of life in a population of nursing home residents.

METHODS AND RESULTS

A population (n = 100) of nursing home residents (mean age 75.7 years) was recruited all members of which had at least 4 upper and 4 lower anterior teeth and were assessed as cognitively intact by nursing personnel who were familiar with their behavior. The investigator evaluated the level of tooth wear of each subject according to the Tooth Wear Index of Donachie and Walls (Adapted) and then verbally administered the Geriatric Oral Health Assessment Index (GOHAI) of Atchison and Dolan. Analyses did not reveal significant differences in tooth wear between males and females nor between age and GOHAI score; however, tooth wear was positively related to age and inversely related to quality of life.

CONCLUSIONS

Results suggest that tooth wear is negatively related to quality of life.

"Trapped in an Empty Waiting Room"-The Existential Human Core of Loneliness in Old Age: A Meta-Synthesis

Loneliness in old age has a negative influence on quality of life, health, and survival. To understand the phenomenon of loneliness in old age, the voices of lonely older adults should be heard. Therefore, the purpose of this meta-synthesis was to synthesize scientific studies of older adults' experiences of loneliness. Eleven qualitative articles that met the inclusion criteria were analyzed and synthesized according to Noblit and Hare's meta-ethnographic approach. The analysis revealed the overriding meaning of the existential human core of loneliness in old age expressed through the metaphor "trapped in an empty waiting room." Four interwoven themes were found: (a) the negative emotions of loneliness, (b) the loss of meaningful interpersonal relationships, (c) the influence of loneliness on self-perception, and (d) the older adults' endeavors to deal with loneliness. The joint contribution of family members, health care providers, and volunteers is necessary to break the vicious circle of loneliness.