The culture of a Taiwanese nursing home

An integrative review of research evaluating organisational culture in residential aged care facilities

BACKGROUND

Evidence suggests that the culture of healthcare organisations, including residential aged care facilities (RACFs), is linked to the quality of care offered. The number of people living in RACFs has increased globally, and in turn, attention has been placed on care quality. This review aimed to identify how organisational culture is studied, sought to elucidate the results of previous studies, and aimed to establish what interventions are being used to improve organisational culture in RACFs.

METHODS

We employed an integrative review design to provide a comprehensive understanding of organisational culture. Five academic data bases were searched (Ovid Medline, Scopus, PsycInfo, CINAHL, Embase). Articles were included if they were empirical studies, published in peer reviewed journals in English, conducted in a RACF setting, and were focused on organisational culture/climate.

RESULTS

Ninety-two articles were included. Fifty-nine studies (64.1%) utilised a quantitative approach, while 24 (26.0%) were qualitative, and nine used mixed methods (9.8%). Twenty-two (23.9%) aimed to describe the culture within RACFs, while 65 (70.7%) attempted to understand the relationship between culture and other variables, demonstrating mixed and indeterminate associations. Only five (5.4%) evaluated an intervention.

CONCLUSIONS

This review highlights the heterogenous nature of this research area, whereby differences in how culture is demarcated, conceptualised, and operationalised, has likely contributed to mixed findings. Future research which is underpinned by a sound theoretical basis is needed to increase the availability of empirical evidence on which culture change interventions can be based.

The Role of the Built Environment on the Quality of Life for Residents in Long-Term Care Facilities in Asia: A Scoping Review

Background and Objectives

The quality of the built environmental features in long-term care (LTC) homes significantly influences residents’ functioning (e.g., wayfinding, self-care, and social interaction) and well-being. There is limited research on the characteristics of the built environment of LTC and its influence on residents’ quality of life in countries in the Asia–Pacific region (e.g., East Asia and South Asia). The older adult population in this region is expected to increase significantly in the coming decades. There are distinctive perceptions of nursing home, nursing home environments, and sociocultural norms in this geographic region. Given this context, a better understanding of the built environment of LTC facilities in this region can inform design professionals and policymakers for evidence-based decision-making. The present study undertakes a scoping review of the empirical research on the characteristics and influence of the built environment of LTC facilities on residents’ quality of life in the Asia–Pacific context.

Research Design and Methods

Online relevant databases were used to identify articles published 2000–2021, from which we selected 33 publications.

Results

Three substantive themes were generated from the synthesis of the selected publications. These themes are (a) perceptions of nursing home, (b) impact of the built environment on residents’ quality of life, and (c) assessment of the LTC built environment.

Discussion and Implications

We identified research gaps in understanding the role of the built environment in nursing homes in the particular geographic context and future research directions. Five planning and design principles for LTC were derived from the synthesis of key findings to inform design professionals and policymakers.

Older residents' perceptions of loneliness in long-term care facilities: A qualitative study

Loneliness is a negative emotional feeling often experienced by older residents in long-term care facilities (LTCFs). Previous studies have shown that loneliness is related to depression, inferior quality of life, cardiovascular disease, and suicidal thoughts. Thus, it is important to understand older residents' viewpoints about loneliness to provide better care in the long-term care context. This study aimed to explore residents' perceptions of loneliness in LTCFs. For this qualitative research, data were collected from two LTCFs in northern Taiwan, and purposive sampling was used. In-depth interviews with 16 older residents were conducted using a semi-structured interview guide. Content analysis was performed to analyse the data. Four themes with nine subthemes were generated. The themes were: being cut off from continually meaningful relationships, experiencing tears of pain, feeling alone, and lacking a sense of belonging. The findings of this study can provide information for health care professionals to better understand older residents' views on loneliness and remind them to re-examine care protocols for psychological health care. Thus, this study found that in order to prevent or alleviate older residents' feelings of loneliness, the LTCFs should maintain continually meaningful relationships, accompany them, and give them a sense of belonging. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to report this study.

Life Quality in Care Homes: Chinese and Danish Older Adults' Perspectives

The demand for care homes appears to be emerging as a key future trend in response to the burgeoning population of older adults, with the need for care provision increasing accordingly. Life quality, happiness and well-being are important factors associated with the care of older residents. This qualitative study explores how older adults moving into care homes view their life quality, from their own perspectives, in two quite different cultural contexts, Chinese and Danish. Older care residents in Shanghai and Denmark participated in the study by means of semi-structured and in-depth interviews. An interpretive phenomenological analysis approach was used for data analysis. Four interrelated themes were identified: positive transfer; positive environment; positive capability and positive experience. The findings demonstrated that older adults considered their quality of life as the result of a dynamic process. Their pursuit of a harmonious status, centered on "change" as the core value, which encompassed both the simplicities and complexities of life. Both older adult groups cared more about their emotional wellbeing, which focused mainly on positive emotions being stimulated while negative emotions were shunned. In the situations when they were "harmonized" by society systems, there was an important emotional thread which continued throughout their whole life that was strongly associated with life quality which was the relationship with family members - be it in the past, present or future.

Patterns of communicating care and caring in the intensive care unit

Aim

To explore the perceptions and experiences of nurses in communicating the care and caring in the intensive care unit (ICU).

Design

A focused ethnography.

Methods

This study was conducted in an Australian metropolitan hospital, in which data were gathered from multiple sources: participant observations, document reviews, interviews, and participant's additional written information ‐ over six months (April‐September, 2014). The data were analysed thematically.

Findings

This study addressed inclusively communicating care and caring to patients, families, nurses and other health professionals in ICU. The findings identified main themes concerning the changing patterns of communicating the care and caring in ICU, various patterns of communication used, enablers and barriers of communicating care and caring, and significant issues in communicating care and caring in ICU. Documentation of patients’ psychological and emotional needs, and nurses’ caring behaviours are crucial. These findings need further consideration from all stakeholders.

The experience of palliative care among older Chinese people in nursing homes: A scoping review

OBJECTIVE

To identify the gaps in understanding the experience of older Chinese people receiving palliative care in nursing homes.

DESIGN

A nine-step scoping review methodology was used to search for relevant literature.

METHODS

Sixteen databases were searched for relevant studies published in English from January 1990 to August 2019. The grey literature was searched for relevant theses pertaining to the topic.

RESULTS

A total of 18 studies from the United States (n = 2), mainland China (n = 1), Hong Kong (n = 13), Taiwan (n = 2) and one thesis from Hong Kong were included in the final analysis. The findings were categorised into four themes: (1) advance care planning preferences; (2) decision-making process related to palliative care; (3) palliative care experiences and barriers; and (4) practice to improve palliative care.

CONCLUSIONS

Given the distinctive experiences of older Chinese residents in nursing homes when faced with death and dying, cultural beliefs strongly influenced their attitudes and behaviours in receiving end-of-life care. As Chinese immigrants have become a major ethnic group in western countries, there is benefit in recognising that older Chinese people living in nursing homes and needing palliative care will face specific challenges. Culturally appropriate interventions to address older Chinese people's existential stress, grief related to loss, communication and dietary requirements, and other barriers should be developed and implemented.

Comparing sleep quality in institutionalized and non-institutionalized elderly individuals

Objectives: Sleep is a physiological function essential to general health and well-being. Insomnia is a sleep disorder frequently reported by older adults. Institutionalization in nursing care homes may contribute to increase the risk of sleep disorders in this population. The aim of this exploratory study was to compare sleep quality among a group of institutionalized (GI) and a group of non-institutionalized (GNI) elderly individuals.Method: We selected 100 individuals over 65 years of age. Participants were divided into two groups (N = 50 in each group) according to their institutionalization status (GI and GNI). The following assessment instruments were used: Pittsburgh Sleep Quality Inventory (PSQI), Epworth Sonolence Scale (ESS) and Geriatric Depression Scale (GDS). Study groups were compared in their sociodemographic, social and clinical characteristics with statistical analysis performed to detect correlations between variables.Results: GI elderly presented worse overall sleep quality and higher levels of daytime somnolence and depressive symptoms. A positive correlation was found between sleep quality, daytime sleepiness (ESS) (p < 0.01) and depressive symptoms (GDS) (p < 0.01).Conclusions: Our results are consistent with the possibility that elderly individuals admitted to long-term care and residential institutions present with worse sleep quality. Higher levels of depressive symptoms, lower occupational activity and sunlight exposure are specifically associated with a worse sleep quality. Further studies with larger and more diverse samples, including community-dwelling individuals, may be important to consolidate these findings.

Relocation experiences of the elderly to a long-term care facility in Taiwan: a qualitative study

BACKGROUND

Relocation to a long-term care (LTC) facility is a major life change for most elderly people. Following relocation, many elderly experience difficulties in adapting to changes in the living environment. Taiwan is increasingly becoming an "aging society" and the numbers of those who relocate from family residences to long-term residential care facilities have increased over years. However, in-depth evidence on the experiences of the elderly of their stay in LTC facilities in Taiwan is relatively sparse. This study aimed to explore the relocation experiences of the elderly to a LTC facility to inform policy and practice to address their needs effectively.

METHODS

A qualitative study, using semi-structured in-depth interviews, was conducted to explore the experiences of 16 elderly people who have relocated to and lived in a LTC facility in Taiwan for up to a period of 12 months. All interviews were recorded, transcribed, and analyzed using grounded theory approach.

RESULTS

Participants' accounts reflected four interrelated key themes: wish to minimize the burden, but stay connected with the family; perceived barriers to adaptation; valuing tailored care; and acceptance and engagement. Each theme included interrelated subthemes that influenced one another and represented the different stages in the relocation journey. Most participants viewed relocation as a way of minimizing the burden of their care from family members, but desired to keep a close connection with family and friends. Participants recounted experiences of psychological resistance while making the decision to relocate. Fear of losing autonomy and the ability to perform self-care was a major reason for resistance to adapt. Provision of tailored care was accorded much value by the participants. The decision to accept the relocation and to adapt themselves to the new environment due to their needs for constant care was explicit in some accounts.

CONCLUSIONS

Relocation to LTC facility is a dynamic process in the first year of moving into the facility, and involves a range of emotions, feelings and experiences. Adaptation of the elderly into the LTC facility can be maximized if the relocation is well planned with provisions for individually tailored care and family involvement.

Exploring the Organizational Culture in Adult Day Services (ADS) and Its Effect on Healthcare Delivery in Taiwan

Studies conducted in nursing homes/hospitals have shown that organizational culture plays an important role in care delivery and group culture leads to better quality of care. To explore the organizational culture and care delivery in adult day services (ADS) centers in Taiwan, we used both quantitative and qualitative research methods. Quantitative data from the Competing Values Framework (CVF) assessment showed that the group culture was dominant at all three centers. Qualitative data from observation and staff interviews uncovered both group and nongroup cultural elements. The group cultural elements, such as flexible management, teamwork environment, and sharing the same values, contributed to good care; however, the nongroup cultural elements, such as the staff-centered view, hierarchy, and conflicts within the leadership, led to negative staff-staff and staff-clients interactions. Further research is needed to untangle the complexity between quality care delivery and organizational culture.

Nurses' perceptions regarding providing psychological care for older residents in long-term care facilities: A qualitative study

AIMS AND OBJECTIVES

To explore nurses' perceptions regarding providing psychological health care for older residents in long-term care facilities (LTCFs).

BACKGROUND

Loneliness and depressive symptoms are commonly observed among older residents living in LTCFs. Nurses are expected to provide holistic care including physical, psychological and social care for older residents in LTCFs to fulfil their needs. Therefore, understanding nurses' feelings and thoughts regarding providing care for older residents who feel lonely, sad, unhappy or depressed is important for delivering better care.

DESIGN

A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) was used to enhance for reporting quality.

METHODS

Purposive sampling and snowball sampling were applied in Northern Taiwan. One-to-one in-depth interviews were conducted using a semi-structured interview guide. Twenty-one nurses with a mean age of 38.4 years were interviewed. Content analysis was performed for data analysis.

FINDINGS

Four themes were generated from the data: "insufficient psychological healthcare competency," "having a willing heart but not adequate support," "families playing an essential role in residents' mood" and "physical-oriented care model."

CONCLUSIONS

Long-term care facilitie nurses felt that they were not adequately prepared for taking care of older adults' psychological problems before their nursing career or during their practice. Unreasonable nurse-to-resident ratios and an absence of care consensus among healthcare providers can make nurses feel that they have a willing heart but not adequate support. Family members are essential in older residents' emotional status within the Taiwanese cultural context. Physical care evaluation indicators emphasised by LTCF accreditation resulted in the current care practice model.

IMPLICATIONS FOR PRACTICE

This study provides valuable information for LTCF nurses, managers and directors to develop appropriate strategies to assist nurses in providing better psychological health care for older residents. Evaluation indicators required by LTCF accreditation in Taiwan must be re-examined at the earliest stage.

In Their Voices: Client and Staff Perceptions of the Physical and Social Environments of Adult Day Services Centers in Taiwan

Studies have examined the impact of environments on long-term care residents' quality of life; however, environment gets little attention in adult day services (ADS). The current study gives voice to clients and staff by capturing their perceptions of the physical and social environments of their ADS centers. Data were collected from 23 interviews with staff and clients and 270 hours of participant observations at two ADS centers in Taiwan. The authors triangulated field notes with interview transcriptions and analyzed them with the Grounded Theory coding procedure method. Findings reveal clients' and staff members' perceptions of appropriate and inappropriate physical and social environmental features affecting quality of life at the center and reflecting Taiwanese culture. We address how perceived appropriate features can be sustained or replicated and how perceived inappropriate influences can be remedied. Results can be translated into action research by implementing supportive environments for both staff and clients at ADS centers.

Characteristics of the built environment for people with dementia in East and Southeast Asian nursing homes: a scoping review

ABSTRACTBackground:This scoping review explores the characteristics of the current built environment used to accommodate people with dementia in East and Southeast Asia. It is structured around the eight principles of design found in the Environmental Audit Tool High-Care. In addition, the review examines the level of knowledge and other influences contributing to the development of nursing homes in the region.

METHODS

The review was carried out utilizing the methodological framework recommended by Arksey and O'Malley. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses provided an overarching structural framework for the reporting process and the Population, Intervention, Comparison, Outcomes, and Context framework defined the scope of the review and focused on the research question. Six databases were accessed for the search, and 1,846 publications between 2001 and 2015 were retrieved.

RESULTS

A total of 48 articles from 9 countries met the inclusion criteria. All articles presented discussions that fundamentally included at least one principle of design and with some including all principles. The most prevailing principle discussed, found in 59% of all the articles was the need for familiarity for residents in the environmental design of facilities.

CONCLUSIONS

The review found that the eight principles of design, when applied with cultural sensitivity in countries in East and Southeast Asia can identify gaps in knowledge of the design for dementia enabling environments and suggest areas for improvement. An assessment tool based on the principles of design will be able to provide a guide for stakeholders in the design, development, or modification of nursing home environments.

Qualitative analyses of lived experience for residents in the Elderly Care Departments at the community health service centres in Southwestern China

With its huge ageing population, China faces an enormous challenge for its elderly support and care. One of the proposed solutions was to diversify the elderly support systems. Towards this goal, setting up the Elderly Care Departments in the community health service centres is one of such new Chinese endeavour. This qualitative study was conducted among the residents enrolled in existing Elderly Care Departments established at the community health service centres in Chongqing, a Southwestern Chinese city, to evaluate the lived experience of the residents and to find strategies for improvement. Eighteen participants were recruited from the residents of the Elderly Care Departments of three community health service centres in the city. Data were collected through semi-structured in-depth individual interviews and were analysed utilising the Colaizzi's phenomenological method. Five main themes were identified: Safety and trust; Satisfaction and relief; Gratitude and mutual understanding; Complaints and helplessness; and Worries and apprehension. We found that set-up of the Elderly Care Departments at the community health service centres appeared to be consistent with the idea of integrated care and in general, the current running mode was able to provide the elderly with effective medical, nursing and other cares. The psychological and cultural services at these departments, however, need to be further enhanced.

Effects of horticulture therapy on nursing home older adults in southern Taiwan

PURPOSE

This study aimed to test the effects of horticulture therapy on activities of daily living, happiness, meaning of life, and interpersonal intimacy of nursing home older adults in southern Taiwan.

METHODS

A quasi-experimental study was applied. Eighty-five older adults aged 65 or older who lived in nursing homes in southern Taiwan were recruited conveniently. All participants completed the study: experimental group (n = 41) and control group (n = 44). The experimental group received horticulture therapy for 1 h once a week for 8 weeks, while the control group continued their routine daily activities. The following questionnaires were administered before and after the intervention period: (1) Barthel Index (BI), (2) Chinese Happiness Inventory short version (CHI), (3) Meaning of Life Scale (MLS), and (4) Interpersonal Intimacy Scale (IIS).

RESULTS

The BI, CHI, MLS, and IIS scores significantly improved in the experimental group (p < .05). After 8 weeks of horticulture therapy, the BI, CHI, and IIS scores of experimental group participants were significantly better than the scores of control group participants (p < .05); however, the MLS scores of two groups showed no significant differences (p = .738).

CONCLUSIONS

Horticulture therapy improved activities of daily living, happiness, and interpersonal intimacy of older adults in nursing homes. We recommend that nursing homes recruit and train personnel to lead horticultural therapy and to incorporate the therapy as routine daily activities in the facilities.

How the perspectives of nursing assistants and frail elderly residents on their daily interaction in nursing homes affect their interaction: a qualitative study

BACKGROUND

Good support from and positive relations with institutional staff can enhance the psychosocial wellbeing of residents admitted to a nursing home. Nursing assistants (NAs) interact most frequently with residents and play an important role in developing good rapport with them. Most studies have described the daily interactions between NAs and residents as task oriented. Only few have attempted to explore the perspectives of NAs and residents on their daily interactions. Therefore, the aim of this study was to identify the types of daily interactions perceived by NAs and residents. We also investigated those intentions/beliefs held by NAs and residents that might direct their interactive behaviors.

METHODS

A descriptive, exploratory, qualitative approach was used to explore the perspectives of 18 NAs (mean age: 51) and 15 residents (mean age: 84.4) on their daily interactions. Unstructured in-depth interviews were used to collect data. All of the interviews were conducted from July to December 2013. The collected data were transcribed verbatim and analyzed by content analysis.

RESULTS

Three types of interactions were found that described the NAs' and residents' perspectives on their daily interactions: (1) physiologically-oriented daily interactions; (2) cordial interactions intended to maintain a harmonious atmosphere; and (3) reciprocal social interactions intended to develop closer rapport. One or more themes reflecting the participants' intentions or beliefs were identified from each group to support each type of interaction.

CONCLUSIONS

An over-emphasis on the formal caring relationship and over-concern about maintaining a harmonious atmosphere contributed to a superficial and distant relationship between the two parties. Building close rapport takes time and involves repeated reciprocal social interactions. The findings showed that with good intentions to establish closer rapport, both NAs and residents did favors for each other. All of those favors were easily integrated in the care provided to the residents without increasing the workload of the NAs. Modifying the training given to NAs and adjusting institutional policies are crucial to raising the competence of the NAs in building good relationships with residents. Positive interactions improve the psychosocial wellbeing of the residents and encourage them to cooperate during the delivery of care, thereby improving their overall health and contributing to the NAs' job satisfaction.

Motivators for physical activity among ambulatory nursing home older residents

The purpose of this study was to explore self-identified motivators for regular physical activity among ambulatory nursing home older residents. A qualitative exploratory design was adopted. Purposive sampling was performed to recruit 18 older residents from two nursing homes in Taiwan. The interview transcripts were analyzed by qualitative content analysis. Five motivators of physical activity emerged from the result of analysis: eagerness for returning home, fear of becoming totally dependent, improving mood state, filling empty time, and previously cultivated habit. Research on physical activity from the perspectives of nursing home older residents has been limited. An empirically grounded understanding from this study could provide clues for promoting and supporting lifelong engagement in physical activity among older residents. The motivators reported in this study should be considered when designing physical activity programs. These motivators can be used to encourage, guide, and provide feedback to support older residents in maintaining physical activity.

The double embarrassment: Understanding the actions of nursing staff in an unexpected situation

A nursing home is a complex multifactorial environment that influences the decisions and actions of nursing staff. Many of the actions performed by nursing staff appear to be straightforward or simple because they are repetitive, encompassing everyday activities such as helping a resident to get up in the morning, shower or get dressed. These daily activities are usually performed smoothly as part of normal care. This article draws on ethnographic data from a study of caring practices in a nursing home with the aim of investigating how a seemingly ordinary, but unexpected, event can develop into a chaotic situation. Staff appeared to have difficulty managing the situation, and they seemed to be disorganized in the application of their skills. First, we describe the situation in detail before investigating and discussing the situation to provide a deeper understanding of the complexity of nursing home practice.