Caregivers in older peoples' care: perception of quality of care, working conditions, competence and personal health

"A becoming in the meeting": the interpretations of competence in home care from the perspectives of older people and registered nurses - a meta-ethnography

AIM

The aim of this meta-ethnography was to identify and synthesize qualitative studies focusing on older people's and registered nurses' interpretations of competence in home care.

METHODS

The meta-ethnography followed the six phases developed by Noblit and Hare (1988).

RESULTS

In Phase 6, the translation process of the included studies, three themes were identified: i) temporality-the feeling of being of value; ii) dignity-a person, not just a patient; and iii) mutuality of being-togetherness. A synthesis was developed, and the phrase "a becoming in the meeting" emerged.

CONCLUSION

The sense of becoming includes progress, which means becoming something other than before in relation with others and refers to what constitutes the meeting between the older person and the registered nurse working in home care. Competence originates from becoming in the meeting, and registered nurses should therefore value what they do and hold on to this aspect of caring competence that centres on a caring relationship. It is important for registered nurses working in home care to be able to cultivate a caring relationship.

Quality of care during rural care transitions: a qualitative study on structural conditions

BACKGROUND

Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses' perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas.

METHODS

We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian's definition of structures regarding the quality of care.

RESULTS

The structural conditions were represented by three themes; (I) "Distances and inaccessibility" explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) "Competence of the actors" explains continuity, knowledge and collaboration among the individuals involved. (III) "Levels of organizational governance" explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others.

CONCLUSIONS

Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet.

Oral care - identifying quality improvement areas

PURPOSE

The purpose of this paper is to describe and compare nurses' and healthcare assistants' oral care quality perceptions, including perceived reality (PR) and subjective importance (SI), to identify improvement areas in intensive care and short-term care, and to explore potential nursing satisfaction predictors regarding oral care.

DESIGN/METHODOLOGY/APPROACH

Swedish staff, 154 within intensive care and 278 within short-term care responded to a modified quality of care from a patient perspective questionnaire. Descriptive and analytical statistics were used.

FINDINGS

Staff scored oral care quality both high and low in relation to PR and SI. Improvement areas were identified, despite high satisfaction values regarding oral care. Setting, SI and PR explained 51.5 percent of the variance in staff satisfaction regarding oral care quality.

PRACTICAL IMPLICATIONS

Quality improvements could guide oral care development.

ORIGINALITY/VALUE

This study describes oral care by comparing nurse perceptions of how important they perceive different oral care aspects and to what extent these oral care aspects are performed.

Oral care quality-Do humanity aspects matter? Nursing staff's and older people's perceptions

Aim

(a) To describe and compare perceptions of humanity aspects of oral care quality in relation to nursing staff in short‐term care units and intensive care units and older people in short‐term care units and their person‐related conditions; and (b) to compare humanity aspects of oral care quality perceptions between nursing staff and older people in short‐term care units.

Design

Cross‐sectional study. Self‐reported questionnaire and clinical assessments.

Methods

Nursing staff (N = 417) and older people (N = 74) completed the modified Quality of Care from a Patient Perspective instrument and person‐related items. Older people's oral health status was clinically assessed using the Revised Oral Assessment Guide. Data were analysed using descriptive and analytic statistics. The data were collected from 2013–2016.

Results

Nursing staff's perceptions of humanity aspects of oral care quality were related to gender, work role and care environment. Older people's perceptions of humanity aspects of oral care quality were related to self‐reported physical health. Nursing staff in short‐term care units perceived the subjective importance of humanity aspects of oral care quality higher compared with older people in short‐term care units.

Professional pride: A qualitative descriptive study of nursing home staff's experiences of how a quality development project influenced their work

AIMS AND OBJECTIVES

To explore and describe how daily work at a nursing home had been influenced by a quality improvement project, from the perspective of direct care staff.

BACKGROUND

Deficiencies in nursing home care are widely reported, often with a focus on lack of competence among direct care staff. The present trend in quality development in nursing homes brings direct care staff's perspectives into focus through participatory action research approaches. Still, little is known about how staff experience the impact of such projects on their everyday work.

DESIGN

The study was designed as an interpretive descriptive study, based on interviews with nursing home staff. The methods were conducted in accordance with the SRQR guidelines.

RESULTS

The analysis revealed that the participants reasoned on whether the improvement project contributed to their possibilities perform their work at the unit for the benefit of the residents. This was strongly connected to their professional pride. The participants reflected on this through three changes generated by the project: (a) participating in project activities-supporting or threatening daily work at the unit, (b) from performing individual duties towards a shared responsibility and (c) confirming and strengthening competence that brings the everyday situation of residents into focus.

CONCLUSION

The importance of professional pride identified in this study points towards a need for reducing barriers for direct care staff to express and develop competences they regard as part of their professional identity. The findings also shed some light on competence that brings the everyday situation of residents into focus as a driving force behind lack of compliance and resistance to change.

RELEVANCE TO CLINICAL PRACTICE

The findings indicate a call for quality development designs to reduce barriers for care staff to express and develop knowledge that they regard as part of their professional identity.

Measuring nurses' perception of work environment: a scoping review of questionnaires

Background

Nurses’ work environment has been shown to be associated with quality of care and organizational outcomes. In order to monitor the work environment, it is useful for all stakeholders to know the questionnaires that assess or evaluate conditions for delivering nursing care. The aim of this article is: to review the literature for assessed survey questionnaires that measure nurses’ perception of their work environment, make a brief assessment, and map the content domains included in a selection of questionnaires.

Methods

The search included electronic databases of internationally published literature, international websites, and hand searches of reference lists. Eligible papers describing a questionnaire had to be; a) suitable for nurses working in direct care in general hospitals, nursing homes or home healthcare settings; and b) constructed to measure work environment characteristics that are amenable to change and related to patient and organizational outcomes; and c) presented along with an assessment of their measurement properties.

Results

The search yielded 5077 unique articles. For the final synthesis, 65 articles met inclusion criteria, consisting of 34 questionnaires measuring nursing work environments in different settings. Most of the questionnaires that we found were developed, and tested, for registered nurses in a general hospital setting. Six questionnaires were developed specifically for use in nursing home settings and one for home healthcare. The content domains covered by the questionnaires were both overlapping and unique and the terminology in use was inconsistent. The most common content domains in the work environment questionnaires were supportive managers, collaborative relationships with peers, busyness, professional practice and autonomy.

Conclusions

The findings from this review enhance the understanding of how “work environment” can be measured by an overview of existing questionnaires and domains. Our results indicate that there are very many work environment questionnaires with varying content.

Electronic supplementary material

The online version of this article (10.1186/s12912-017-0256-9) contains supplementary material, which is available to authorized users.

The Changing Role of Health Care Professionals in Nursing Homes: A Systematic Literature Review of a Decade of Change

Although the role of health care professionals is known to have changed over the last years, few formal efforts have been made to examine this change through means of a scientific review. Therefore, the goal of this paper was to investigate the changing role of health care professionals in nursing homes, as well as the conditions that make this change possible. A systematic review of health care literature published in the last decade (2007-2017) was utilized to address these goals. Our findings suggest that although health care in nursing homes is shifting from task-oriented care to relation-oriented care (e.g., through an increased focus on patient dignity), various obstacles (e.g., negative self-image, work pressure, and a lack of developmental opportunities), needs (e.g., shared values, personal development, personal empowerment, team development, and demonstrating expertise), and competences (e.g., communication skills, attentiveness, negotiation skills, flexibility, teamwork, expertise, and coaching and leadership skills) still need to be addressed in order to successfully facilitate this change. As such, this paper provides various implications for health care research, health care institutions, practitioners, HR professionals and managers, and occupational health research.

Everyday Functioning Benefits from an Assisted Living Platform amongst Frail Older Adults and Their Caregivers

Ambient assisted living technologies (AAL) are regarded as a promising solution to support aging in place. Yet, their efficacy has to be demonstrated in terms of benefits for independent living and for work conditions of caregivers. Hence, the purpose of this study was to assess the benefits of a multi-task AAL platform for both Frail older Individuals (FIs) and professional caregivers with respect to everyday functioning and caregiver burden. In this context, a 6-month field study involved 32 FIs living at home (half of them were equipped by the platform and the remaining half were not, as a control condition) and their caregivers. Everyday functioning measures were reported by frail participants and caregivers. Self-reported burden measures of caregiver were also collected. The main results showed that the caregiver's estimates of everyday functioning of equipped participants were unchanged across time, while they decreased for the control participants. Also, a reduction of self-reported objective burden was obtained after 6 months of AAL intervention for the equipped group, compared to the control group. Overall, these results highlighted the potential of AAL as a relevant environmental support for preventing both functional losses in FIs and objective burden professional caregiver.

Burden incurred by patients and their caregivers after outpatient surgery: a prospective observational study

INTRODUCTION

The burden of patients and their caregivers after outpatient surgery has not been fully examined. The number of outpatient surgeries has dramatically increased in the last several years, particularly in the orthopaedic sector. Patients undergoing outpatient orthopaedic procedures may be expected to have more postdischarge pain than those undergoing nonorthopaedic outpatient procedures. In light of this, assessment of patient and caregiver expectations and actual burden after discharge is of importance.

QUESTIONS/PURPOSES

We assessed the impact of outpatient surgery on recovery of patients and their caregivers in the postoperative period by determining (1) expected versus actual time to resume daily activities, including work; (2) expected versus actual recovery at 7 and 30 days postoperatively; and (3) the number of caregivers that felt emotional or physical disturbances from caring for outpatients.

METHODS

Forty-four adult patients undergoing outpatient surgical procedures and their primary caregivers were enrolled in this prospective survey study, of which 30% were orthopaedic patients. Surveys assessing postoperative recovery were given to patients at six time points, on Postoperative Days 0 to 3, 7, and 30. Surveys assessing the burden of informal caregiving were given to each patient's primary caregiver at four time points, on Postoperative Days 1 to 3 and 7. The enrollment rate was 79% (44 enrolled of 56 approached) and the survey response rate was 100% for patients and 93% (41 of 44) for caregivers.

RESULTS

We found that 16 of 44 patients (36%) needed more time than originally anticipated to resume their daily activities and three of 29 patients (10%) needed more time off from work than originally anticipated. Patients were approximately 66% and 88% fully recovered 7 and 30 days after surgery, respectively. The primary caregivers noted disturbances in emotional (nine of 43, 21%) and physical (17 of 43, 40%) aspects of their daily lives while providing care for patients. Our surveyed patients were from multiple surgical services; however, our results may be generalized to an orthopaedic population, although they may underestimate actual results for this population given their generally higher pain scores.

CONCLUSIONS

Patients may take longer to recover from outpatient surgery than previously recognized. As increased pain and prolonged recovery may be associated with increased caregiver burden, these data are of particular significance to the outpatient orthopaedic surgical population. Informal caregiving after outpatient surgery may be an unrecognized physical and psychologic burden and may have a significant societal impact.

LEVEL OF EVIDENCE

Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

The education received by nursing students regarding nursing older people: a scoping literature review

The situation of an ageing population is a priority for all levels of society globally, particularly related to the subsequent increased demand for care. Nurses are often the primary source of this care; therefore, research is required to develop the curricula of nursing education, to help them meet this demand. The primary aim was to analyse empirical studies that have tackled nursing students' education concerning nursing older people. This analysis was targeted at generating an overall picture of the research in this field in order to determine the areas that require further study. A scoping literature review was conducted through systematic searches in the following electronic databases: Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Education Resources Information Center (ERIC). These searches were limited to studies with an available abstract, in English, which were conducted between 1999 and 2012. Two researchers independently applied the same inclusion and exclusion criteria to select the studies for analysis. In total, 66 articles were included in the analyses. The results were validated by the research team. The primary research areas identified included both the learning outcomes and the implementation of nurses' education in caring for older people. Students' general attitudes towards older people and ageing dominated the studies regarding learning outcomes. There was a large variation in the description of the validity and trustworthiness of the studies, with most being only at a moderate level. A limited number of studies examining the specific learning outcomes and factors influencing the implementation of education exist. Vague reporting about the validity and trustworthiness of the studies limits the use of their findings. More well-designed studies are needed to guide educational strategies to improve students' competence in nursing older people and to promote this field as a career choice.