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Wang J, Liu W, Peng D, Xiao M, Zhao Q. The use of physical restraints in Chinese long-term care facilities and its risk factors: An observational and cross-sectional study. J Adv Nurs 2020; 76:2597-2609. [PMID: 33463735 DOI: 10.1111/jan.14486] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/28/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022]
Abstract
AIM To investigate the use of physical restraints among Chinese long-term care facilities older adults and to identify its risk factors. DESIGN Observational and cross-sectional study. METHODS A total of 1,026 older adults from six long-term care facilities in Chongqing were recruited by cluster sampling method from July - November 2019. Data on physical restraint use and older adults' characteristics were collected using physical restraints observation forms and older adults' records. Organizational data were collected by questionnaires asking nursing managers. The independent risk factors for physical restraints use were assessed using chi-square test and binary logistic regression. RESULTS The study found that the prevalence of physical restraints in six long-term care facilities in China was 25.83%. Waist belt (55.47%) and wrist restraint (52.83%) were most frequently used. Only 61.51% of physical restraints were signed with informed consent. 71.70% of physical restraints were caused by the prevention of falls, 89.06% of physical restraints were without nursing documentation, and 13.58% restrained older adults were observed to have physical complications. According to the binary logistic regression analysis, facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risk, physical agitation, and indwelling tubes emerged as important risk factors for the use of physical restraints. CONCLUSION The use of physical restraints among Chinese long-term care facilities older adults was at a relatively high level and lack standardized and regulated practices. Moreover, Physical restraint use was associated with facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risks, physical agitation, and indwelling tube. IMPACT This study will provide an effective reference for nursing staff in long-term care facilities to assess high-risk older adults in their use of physical restraints, which can support them to implement effective minimized restraint approaches to targeted people.
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Affiliation(s)
- Jun Wang
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daomei Peng
- The First Social Welfare Home of Chongqing, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Hanratty B, Craig D, Brittain K, Spilsbury K, Vines J, Wilson P. Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - John Vines
- Northumbria School of Design, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
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Person-centered care in Norwegian nursing homes and its relation to organizational factors and staff characteristics: a cross-sectional survey. Int Psychogeriatr 2018; 30:1279-1290. [PMID: 29198221 PMCID: PMC6190067 DOI: 10.1017/s1041610217002708] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED ABSTRACTBackground:Person-centered care (PCC) is regarded as good quality care for persons with dementia. This study aimed to explore and understand the association between PCC and organizational, staff and unit characteristics in nursing homes (NHs). METHODS Staff from 175 NH units in Norway (n = 1,161) completed a survey, including measures of PCC and questions about staff characteristics and work-related psychosocial factors. In addition, data about organizational and structural factors and assessment of the physical environment in the units were obtained. The distribution of these factors in regular units (RUs) and special care units (SCUs) is described, and the differences between the two types of units are analyzed. Furthermore, multilevel linear regression analyses explored the extent to which variables were associated with PCC. RESULTS Higher levels of PCC were associated with a greater job satisfaction, three years or more of health-related education, a lower level of quantitative demands and role conflict, a higher level of perception of mastery, empowering leadership, innovative climate and perception of group work, in addition to the type of unit and the physical environment in the NH unit designed for people with dementia. SCU and staff job satisfaction explained most of the variation in PCC. CONCLUSION This study shows an association between PCC and organizational, staff and unit characteristics in NH. These findings indicate that providing PCC in NH care is closely linked to how the staff experiences their job situation in addition to both organizational and structural factors and the physical environment. Attention needs to be given to such factors when planning NH care.
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Braaten KL, Malmedal W. Preventing physical abuse of nursing home residents- as seen from the nursing staff's perspective. Nurs Open 2017; 4:274-281. [PMID: 29085653 PMCID: PMC5653394 DOI: 10.1002/nop2.98] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/17/2017] [Indexed: 12/02/2022] Open
Abstract
Aim This study aims to capture first‐hand information from nursing home staff's own understanding regarding what they think and have experienced about prevention of physical abuse of nursing home residents and what measures they consider useful to implement in their daily work. Design The design is qualitative. Methods A convenient sample of staff in three nursing homes was used and data were collected during three focus group interviews. The total number of informants was 14. Thematic content analysis was used. The data collection period was from December 2015–February 2016. Results According to the staff, several factors contribute to the prevention of physical abuse of residents in nursing homes. There is a requirement for increased competence among staff about the concept of abuse and known risk factors. Good communication skills and trusting relationships are important factors, as well as a culture that fosters openness where ethical dilemmas can be discussed.
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Affiliation(s)
| | - Wenche Malmedal
- Department of Public Health and Nursing Norwegian University of Technology and Science Trondheim Norway
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Abstract
Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients' perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents ( n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ2 tests and one-way between-groups ANOVA were performed to characterise the clusters ( p<0.05). Findings Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents' care quality perceptions.
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Affiliation(s)
| | - Liv Berit Fagerli
- Faculty of Health and Social Sciences, Østfold University College , Halden, Norway
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Diehl H, Graverholt B, Espehaug B, Lund H. Implementing guidelines in nursing homes: a systematic review. BMC Health Serv Res 2016; 16:298. [PMID: 27456352 PMCID: PMC4960750 DOI: 10.1186/s12913-016-1550-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. METHODS A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. RESULTS Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. CONCLUSIONS Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROTOCOL REGISTRATION PROSPERO 2014: CRD42014007664.
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Affiliation(s)
- Heinz Diehl
- Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063 Bergen, Norway
| | - Birgitte Graverholt
- Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063 Bergen, Norway
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063 Bergen, Norway
| | - Hans Lund
- Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063 Bergen, Norway
- Department of Sports Science and Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Harrington C, Armstrong H, Halladay M, Havig AK, Jacobsen FF, MacDonald M, Panos J, Pearsall K, Pollock A, Ross L. Comparison of Nursing Home Financial Transparency and Accountability in Four Locations. AGEING INTERNATIONAL 2015. [DOI: 10.1007/s12126-015-9233-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hofmann H, Schorro E, Haastert B, Meyer G. Use of physical restraints in nursing homes: a multicentre cross-sectional study. BMC Geriatr 2015; 15:129. [PMID: 26489664 PMCID: PMC4617908 DOI: 10.1186/s12877-015-0125-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Although many countries have implemented strict legal rules, the prevalence of physical restraints in nursing homes seems to remain high. In Switzerland, data related to the frequency of physical restraints are scarce and little is known about associations with resident and nursing home characteristics. The aim of this study was to investigate the prevalence and types of physical restraints in nursing homes in two Swiss cantons and to explore whether resident-related and organisational factors are associated with the use of physical restraints. Methods We conducted a multicentre cross-sectional study. Twenty nursing homes with 1362 residents from two culturally different cantons were included. Data on physical restraints and residents’ characteristics were extracted from residents’ records (11/2013 to 2/2014). Organisational data were collected by questionnaires addressing nursing home directors or nursing managers. Sample size calculation and outcome analysis took cluster-adjustment into account. Descriptive statistics and multiple logistic regression analysis with nursing homes as random effect were used for investigation. Results The prevalence of residents with at least one physical restraint was 26.8 % (95 % confidence interval [CI] 19.8–33.8). Centre prevalence ranged from 2.6 to 61.2 %. Bilateral bedrails were most frequently used (20.3 %, 95 % CI 13.5–27.1). Length of residence, degrees of care dependency and mobility limitation were significantly positively associated with the use of physical restraint, but none of the organisational characteristics was significantly associated. Conclusion Approximately a quarter of the nursing home residents included in our study experienced physical restraints. Since variation between nursing homes was pronounced, it seems to be worthwhile to explore nursing homes with particularly low and high use of physical restraints in future research, especially by using qualitative methods. There is a need for effective interventions aiming at restraint-free nursing care. Development of interventional approaches should consider specific residents’ characteristics associated with restraint use.
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Affiliation(s)
- Hedi Hofmann
- Department of Health, University of Applied Sciences, Rosenbergstrasse 59, P.O. Box, CH-9001, St.Gallen, Switzerland. .,Department of Nursing Science, Witten/Herdecke University, Witten, Germany.
| | - Ewald Schorro
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany. .,School of Health, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland.
| | | | - Gabriele Meyer
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany. .,Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Hammar LM, Swall A, Meranius MS. Ethical aspects of caregivers' experience with persons with dementia at mealtimes. Nurs Ethics 2015; 23:624-35. [PMID: 25977521 DOI: 10.1177/0969733015580812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persons with dementia are at risk of malnutrition and thus in need of assistance during mealtimes. Research suggest interventions for caregivers to learn how to facilitate mealtimes and eating, while other suggest a working environment enabling the encounter needed to provide high-quality care. However, the phenomenon of caring for this unique population needs to be elucidated from several perspectives before suggesting suitable implications that ensure their optimal health. OBJECTIVES To illustrate the meanings within caregivers' experiences of caring for persons with dementia during mealtime situations. We also measured weight and food intake among individuals with dementia to explain better the phenomenon of caring for them during mealtimes. METHODS Mixed method including focus group interviews with seven caregivers analyzed using phenomenological hermeneutics. In addition, for nine persons with dementia, weight and food intake were collected and descriptive statistics were calculated. ETHICAL CONSIDERATIONS Ethical review was obtained from an ethics committee, and all caregivers signed a consent form after being informed on the issue of research ethics. Relatives for persons with dementia were informed and signed the consent. In addition, throughout the study, the persons' expressions were observed aiming to respect their vulnerability, integrity, and dignity. FINDINGS One theme emerged from interviews (struggling between having the knowledge and not the opportunity), which was built upon three subthemes (being engaged and trying; feeling abandoned and insufficient; being concerned and feeling guilty). Seven of nine persons with dementia lost a minimum of 1.3 kg of weight and ate a maximum of 49.7% of the food served. CONCLUSION Caregivers struggle because they have knowledge about how to provide high-quality care but are unable to provide this care due to organizational structures. The weight loss and insufficient eating among the persons with dementia may support this conclusion. Sufficient time for adequate care should be provided.
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Affiliation(s)
| | - Anna Swall
- Karolinska Institute, Sweden; Sophiahemmet College University, Sweden
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Rosvik J, Engedal K, Kirkevold O. Factors to make the VIPS practice model more effective in the treatment of neuropsychiatric symptoms in nursing home residents with dementia. Dement Geriatr Cogn Disord 2015; 37:335-46. [PMID: 24503517 DOI: 10.1159/000357773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS A recent cluster-randomized controlled study showed that the VIPS practice model (VPM) for person-centred care had a significant effect on neuropsychiatric symptoms in nursing home residents with dementia. The randomized controlled trial (RCT) indicated that a substantial proportion of the total variance of the effects was related to conditions in the particular unit (ward). We have explored which factors explain the variance of the effect of the VPM. METHODS The VPM subset of data from the RCT was explored using multilevel linear regression. The dependent variables were the change in scores on the Neuropsychiatric Inventory Questionnaire (NPI-Q) and the Cornell Scale for Depression in Dementia (CSDD). RESULTS The unit in which the resident was living explained 22% of the VPM's total variance of the effect on the NPI-Q and 13% of that on the CSDD. The intraclass correlation coefficient at the unit level was explained mainly by unit size on both scales and was considerably higher than at the institutional level. CONCLUSION The unit is the most influential level when implementing person-centred dementia care by use of the VPM. The unit size explains most of the variance of the effect of the VPM, and the effects were best in the small units.
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Affiliation(s)
- Janne Rosvik
- Ageing and Health, Norwegian Centre for Research, Education and Service Development, Vestfold Hospital Trust, Tønsberg, Norway
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Egede-Nissen V, Jakobsen R, Sellevold GS, Sørlie V. Time ethics for persons with dementia in care homes. Nurs Ethics 2012; 20:51-60. [PMID: 22918063 DOI: 10.1177/0969733012448968] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to explore situations experienced by 12 health-care providers working in two nursing homes. Individual interviews, using a narrative approach, were conducted. A phenomenological-hermeneutical method, developed for researching life experiences, was applied in the analysis. The findings showed that good care situations are experienced when the time culture is flexible, the carers act in a sovereign time rhythm, not mentioning clock time or time as a stress factor. The results are discussed in terms of anthropological and sociological theory: time as event and action and flexible time cultures. Care settings for persons with dementia represent many challenges, such as a heavy workload and time strain. Time ethics is a construction, understanding time used in caring for persons suffering from dementia, which involves a mature, responsible and flexible nursing approach to these patients.
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Development of residential care services facilitated for persons with dementia in Norway. Aging Clin Exp Res 2012; 24:1-5. [PMID: 22643302 DOI: 10.1007/bf03325351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In the 1980s, special care units devoted to persons with dementia (SCU) were established, and in the 1990s, a new system of sheltered housing for persons with dementia (SH) was inaugurated. AIM The aim of this study was to examine the establishment of SCUs and SH units and to explore the effects of varying patient-staff ratios and unit sizes. METHOD On five occasions (1996/1997, 2000/2001, 2004/2005, 2008, 2010/2011), a detailed questionnaire was sent by post to all Norwegian municipalities. It contained questions about the provision of services for persons with dementia. RESULTS In 1996/1997, 70% of the municipalities had SCUs and 13.3% of the beds in Norwegian nursing homes were in SCUs. In 2010/11, 87% of the municipalities had such services, which filled 23.8% of the beds in nursing homes. The number of beds in SH units increased from 856 beds in 1996/1997 to 2181 beds in 2010/11. SCUs have on average three patients per carer on an ordinary weekday day-time shift. These numbers have been quite stable throughout the study period. The ratio is about 3.5 patients per carer in the SH units and is also stable. CONCLUSIONS The rate of increase in the provision of institutional beds facilitated for persons with dementia has been slow in Norway over the last 14 years. Both SCUs and SH units seem to have stable staffing ratios and the number of beds in each unit is also stable.
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Willumsen T, Karlsen L, Naess R, Bjørntvedt S. Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Gerodontology 2011; 29:e748-55. [PMID: 22023222 DOI: 10.1111/j.1741-2358.2011.00554.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To explore nursing home patients' oral hygiene and their nurses' assessments of barriers to improvement. BACKGROUND In nursing homes, nurses are responsible for patients' oral hygiene. MATERIALS AND METHODS This study assessed the oral hygiene of 358 patients in 11 Norwegian nursing homes. 494 nurses in the same nursing homes participated in a questionnaire study. RESULTS More than 40% of patients had unacceptable oral hygiene. 'More than 10 teeth' gave OR = 2, 1 (p = 0.013) and 'resist being helped' OR = 2.5 (p = 0.018) for unacceptable oral hygiene. Eighty percent of the nurses believed knowledge of oral health was important, and 9.1% often considered taking care of patients' teeth unpleasant. Half of the nurses reported lack of time to give regular oral care, and 97% experienced resistant behaviour in patients. Resistant behaviour often left oral care undone. Twenty-one percent of the nurses had considered making legal decisions about use of force or restraints to overcome resistance to teeth cleaning. CONCLUSION Oral hygiene in the nursing homes needed to be improved. Resistant behaviour is a major barrier. To overcome this barrier nurses' education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients are important factors.
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Du Moulin MFMT, van Haastregt JCM, Hamers JPH. Monitoring quality of care in nursing homes and making information available for the general public: state of the art. PATIENT EDUCATION AND COUNSELING 2010; 78:288-296. [PMID: 20171037 DOI: 10.1016/j.pec.2010.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/15/2010] [Accepted: 01/17/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To improve quality of care, nursing homes need to assess and monitor their performance. This study aims to gain insight in the availability and contents of publicly accessible quality systems in northwestern Europe and the USA. METHODS This study employed a systematic search consisting of searching bibliographic sources from 2005 to September 2009, personal communication with experts, a conventional internet search, and hand-searching of references. RESULTS Ten out of the 14 included countries use a quality systems. There is a large variety in type and number of indicators assessed. In general more attention is paid to the assessment of structure and process indicators, compared to outcome indicators. The countries differ in the way the results are made available to the general public. CONCLUSION It can be concluded that monitoring and publicizing data on quality of care in nursing homes is becoming increasingly widespread. However, the systems still need further development and refinement. PRACTICE IMPLICATIONS The systems need to be further developed regarding validity and reliability. Furthermore, the uniformity of the systems should be increased, more attention must be paid to the assessment of patient satisfaction, and additional insight must be gained in the user-friendliness of the systems.
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Affiliation(s)
- Monique F M T Du Moulin
- Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Department of Health Care and Nursing Science, 6200 MD Maastricht, The Netherlands.
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