1
|
Bölenius K, Lämås K, Edvardsson D. Older adults' experiences of self-determination when needing homecare services-an interview study. BMC Geriatr 2023; 23:824. [PMID: 38066429 PMCID: PMC10709827 DOI: 10.1186/s12877-023-04533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Self-determination has been shown to be an important factor in mental health and wellbeing, but from the homecare recipients' point of view, autonomy and self-determination is not fully integrated into homecare services. The aim of this study was to explore older adults' experiences of self-determination when needing homecare services. METHODS In 2018, a qualitative descriptive study was conducted and a convenience sample of 15 older adults from 3 homecare service facilities were invited to participate in individual interviews. Data were analysed using qualitative content analyse. RESULTS The theme Transitioning from self-determination as independence towards self-determination as shared decision-making emerged through the older adults' narratives. This 'transition' is one in which older adult's understanding of self-determination and self-esteem was transitioning towards the acceptance of shared decision-making. The person's inner strength and willingness to make decisions was promoting to enact and preserve independence. Accepting one's dependence on others and being in a positive atmosphere were described as promoting self-determination and shared decision-making, and vice versa. The above overarching theme permeated all subthemes, which included: mobilising inner strength to enact independence; accepting increasing dependence on others; and being influenced by the atmosphere. CONCLUSIONS The study contributes increased understanding of older adults' experiences of self-determination. The results can act as a guide when planning future person-centred care interventions in the context of homecare services and help improve homecare services' ability to meet the needs of older adults. To summarise, older adults' reflections on their own self-determination highlighted relationships with other people as important for shared decision-making, which could help preserve older adults' autonomy and self-esteem.
Collapse
Affiliation(s)
- Karin Bölenius
- Department of Nursing, Umeå University, Umeå, 90187, Sweden.
| | - Kristina Lämås
- Department of Nursing, Umeå University, Umeå, 90187, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, 90187, Sweden
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Ziembicka DM, Lukaszuk B, Marcinowicz L. Evaluation of the functioning of long-term at-home nursing care in Poland from the perspective of care providers: Mixed methods study. J Clin Nurs 2023; 32:485-493. [PMID: 35225374 DOI: 10.1111/jocn.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/19/2022] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to analyse and evaluate the functioning of long-term at-home nursing care (LTHNC) based on the opinions of its service providers. BACKGROUND Long-term at-home nursing care is a form of care for patients who do not need hospital treatment but need systematic nursing care because of their health problems. LTHNC in Poland involves guaranteed care services financed from universal health insurance contributions pursuant to contracts with the National Health Fund (NHF); the program has existed since 2004. DESIGN A sequential-explanatory mixed-method design was used. The study was carried out using both quantitative and qualitative research methods. METHODS A questionnaire was distributed amongst 1119 care providers (the response rate was 38.2%). The qualitative research comprised semi-structured interviews with ten care providers, namely three nurses managing LTHNC facilities and seven nurses directly providing services as part of LTHNC. The STROBE checklist was used in reporting this study. RESULTS We found that the main reasons for contracting LTHNC services were the increasing demand for this form of care, financial motives and an opportunity to introduce new organisational solutions. Our study shows that LTHNC is beneficial not only for the patients, but also for the nurses who provide the care. On the one hand, LTHNC provides positive results for patients and their caregivers (family members), and on the other hand, it affords a sense of satisfaction to the nurses and contributes to the development of their professional independence. CONCLUSIONS According to care providers, improving accessibility through increasing the number of contracted services as well as raising the pay for 1 day of care per patient may improve the functioning of LTHNC. RELEVANCE TO CLINICAL PRACTICE The results of our study are a source of information for those who organise health care and administer resources on how to improve the functioning of LTHNC.
Collapse
Affiliation(s)
| | - Bartlomiej Lukaszuk
- Department of Physiology, Medical University of Bialystok, Bialystok, Poland
| | - Ludmila Marcinowicz
- Department of Obstetrics, Gynaecology and Maternity Care, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
3
|
Wang Q, Fan K, Li P. Effect of the Use of Home and Community Care Services on the Multidimensional Health of Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15402. [PMID: 36430119 PMCID: PMC9690765 DOI: 10.3390/ijerph192215402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Home and community care is an important way to actively respond to population aging and to promote healthy aging. This study aims to estimate the effect of using home and community care services on the multidimensional health of older adults. We used data from the China Health and Retirement Longitudinal Study conducted in 2018 and relied mainly on the propensity score matching method for data analysis. The results showed that using home and community care increased the probability of maintaining and improving physical health by 2.9%, decreased the score of depression by 0.471, and improved the score of cognitive function by 0.704. Using home and community care also increased the probability of actively participating in life by 4.1% and elevated the score of life satisfaction by 0.088. The heterogeneity analysis showed that the use of home and community care had a significant effect on promoting all health indicators in rural older adults and a more obvious promoting effect on the social adaptation of urban older adults. Using home and community care significantly promoted the multidimensional health of people aged 60 to 79 years but had no impact among people aged ≥ 80 years. The use of home and community care significantly improved all health indicators in non-disabled older adults. Whereas, it only improved the levels of cognitive function and life satisfaction in disabled older people. Using this form of care significantly improved all health indicators in those with low socio-economic status, but it only had a partial positive effect on the multidimensional health of those with high socio-economic status. Our results are of importance to the government as they may be used to further improve the quality of home and community care services for the targeted older population.
Collapse
Affiliation(s)
| | | | - Peng Li
- Correspondence: ; Tel.: +86-0411-84707804
| |
Collapse
|
4
|
Lämås K, Bölenius K, Sandman PO, Lindkvist M, Edvardsson D. Effects of a person-centred and health-promoting intervention in home care services- a non-randomized controlled trial. BMC Geriatr 2021; 21:720. [PMID: 34922494 PMCID: PMC8684168 DOI: 10.1186/s12877-021-02661-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home care recipients have reported little self-determination and opportunity to influence their own care. Person-centred care focusing on involvement has improved the quality of life of older adults in health care and nursing homes; however, knowledge about the effects of person-centred interventions in aged care at home is sparse. The aim of this study was to study the effects of a person-centred and health-promoting intervention, compared with usual care, on health-related quality of life, thriving and self-determination among older adults, and on job satisfaction, stress of conscience and level of person-centred care among care staff. METHODS This is a non-randomized controlled trial with a before/after design. Participants from five home care districts in one municipality in northern Sweden were recruited to an intervention or control group. We evaluated health-related quality of life, thriving and self-determination among older home care recipients, and job satisfaction, person-centred care and stress of conscience among care staff. Evaluation was performed by questionnaires and responses were analysed using parametric and non-parametric statistical analyses. RESULTS Eighty-one older adults and 48 staff were included in the study. A clinically moderate and statistically significant difference between the intervention and control groups was found in thriving and negative emotions among older adults. The intervention contributed to maintaining high thriving levels, in contrast to decreased thriving in the control group (intervention: + 1, control: - 4, p 0.026, CI: - 10. 766, - 0.717). However, the intervention group rated an increase in negative emotions, while the control group was unchanged (intervention: - 7 control: + - 0, p 0.048, CI: - 17.435, - 0.098). No significant effects were found among staff. CONCLUSIONS The intervention contributed to maintaining high levels of thriving in contrast to low levels found in the control group, and it seems reasonable to consider the intervention focus on staff as more person-centred and health-promoting. The finding that the intervention group had increase in negative emotions is difficult to interpret, and warrants further exploration. Even though the results are sparse, the challenges discussed may be of importance for future studies in the context of HCS. TRIAL REGISTRATION NCT02846246. Date of registration: 27 July 2016.
Collapse
Affiliation(s)
- Kristina Lämås
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.
| | - Karin Bölenius
- Department of Nursing, Umeå University, 90187, Umeå, Sweden
| | | | - Marie Lindkvist
- Department of Statistics, Umeå School of Business, Economics and Statistics (USBE), Umeå University, Umeå, Sweden.,Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| |
Collapse
|
5
|
van der Linden MC, van den Wijngaard IR, van der Linden S, van der Linden N. Night-time confusion in an elderly woman post-stroke. BMJ Case Rep 2020; 13:13/5/e230693. [PMID: 32444438 DOI: 10.1136/bcr-2019-230693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
For patients with acute ischaemic stroke, faster recanalisation improves the chances of a disability-free life and a quick discharge from the hospital. Hospital discharge, certainly after suffering a major life-changing event such as a stroke, is a complex and vulnerable phase in the patient's journey. Elderly are particularly vulnerable to the stressors caused by hospitalisation. Recently hospitalised patients are not only recovering from their acute illness; they also experience a period of generalised risk for a range of adverse events. At the same time, elderly generally prefer living in their own homes and should be discharged from the hospital and return home as quickly as possible. Both premature and delayed discharge are potential threats to patient well-being. We present a 90-year-old patient who underwent successful thrombectomy but suffered from night-time confusion at the hospital and discuss the transition process from hospital to home.
Collapse
Affiliation(s)
| | | | | | - Naomi van der Linden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Göransson C, Wengström Y, Ziegert K, Langius-Eklöf A, Blomberg K. Self-care ability and sense of security among older persons when using an app as a tool for support. Scand J Caring Sci 2019; 34:772-781. [PMID: 31769888 DOI: 10.1111/scs.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/02/2019] [Indexed: 01/01/2023]
Abstract
THE STUDY'S RATIONALE The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences. AIMS AND OBJECTIVES To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns. METHODOLOGICAL DESIGN AND JUSTIFICATION The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding. ETHICAL ISSUES AND APPROVAL Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent. RESEARCH METHODS Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach. MEASUREMENTS AND INTERVENTION The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses. RESULTS The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards. STUDY LIMITATIONS The small sample size for statistical analysis. CONCLUSIONS This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.
Collapse
Affiliation(s)
- Carina Göransson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Yvonne Wengström
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
7
|
Walker N, Dissanayaka NN, Scott T, Manchha A, Pachana NA. Shaping attitudes: The association between prior contact with residential aged care and resistance to enter residential aged care. Int J Older People Nurs 2019; 14:e12268. [PMID: 31486587 DOI: 10.1111/opn.12268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/08/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ageing population is increasing, and negative attitudes towards older people are all too common and largely overlooked. However, little research has examined how ageist, prejudice, and discrimination, that often occur in healthcare settings, impact the community's perceptions of entering Residential Aged Care (RAC) in the future. In particular, studies have not investigated how contact with RAC influences individuals' attitudes towards RAC facilities, residents and staff. This study is the first to examine individuals' resistance towards living in RAC using the contact hypothesis, a theory of prejudice reduction. AIMS To explore how positive or negative contact with RAC residents and staff impacts individuals' behavioural intentions towards entering RAC in the future. To examine whether perceptions of trust, independence and RAC staff mediate the relationship between contact and behavioural intentions towards entering RAC in the future. DESIGN A cross-sectional survey design. METHOD Data were collected via online surveys using contact (positive or negative), trust, independence, perceptions of RAC staff and resistance levels (mild refusal or extreme refusal) measures. Participants (n = 373) from Australia and USA were recruited using social media, word of mouth and Amazons Mechanical Turk. FINDINGS Individuals who experienced negative contact with RAC residents and staff were more likely to report intense resistance to RAC, "I would rather die than enter RAC". Whereas, positive contact with RAC residents and staff was associated with reductions in the adverse appraisal of RAC staff; a diminished perception that individuals lost their independence, and an increased trust in RAC residents, facilities and staff. Participants from USA reported greater levels of resistance towards RAC in comparison with participants from Australia. This study demonstrates how interactions with RAC residents, facilities and staff are critical in shaping attitudes towards RAC. IMPLICATIONS FOR PRACTICE It is recommended that the public are exposed to opportunities where they can experience positive contact with RAC. RAC facilities can promote interaction between the public and RAC residents through encouraging participation in community partnership programs/intergenerational programs.
Collapse
Affiliation(s)
- Nicole Walker
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nadeeka N Dissanayaka
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Neurology, Royal Brisbane & Woman's Hospital, Brisbane, Queensland, Australia
| | - Theresa Scott
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Asmita Manchha
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
8
|
Ślusarska B, Bartoszek A, Kocka K, Deluga A, Chrzan-Rodak A, Nowicki G. Quality of life predictors in informal caregivers of seniors with a functional performance deficit - an example of home care in Poland. Clin Interv Aging 2019; 14:889-903. [PMID: 31190775 PMCID: PMC6529176 DOI: 10.2147/cia.s191984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/07/2019] [Indexed: 01/25/2023] Open
Abstract
Background: There is insufficient research into informal caregivers' quality of life (QoL) in Poland. The purpose of this work is to study predictors that considerably affect QoL of informal caregivers (IC) providing home care for seniors with chronic diseases and a functional performance deficit. Materials and methods: In the cross-sectional research design, ICs were randomly chosen among the geriatric population receiving care in 5 primary health care settings. The WHOQoL-AGE questionnaire was used to assess QoL of ICs (n=138). The Barthel scale and Polish version of the Abbreviated Mental Test Score (AMTS) were applied to assess individuals with chronic diseases and functional and mental performance deficits (n=138). The Geriatric Depression Scale Short Form (GDS-SF) was used to measure the extent of risk of depressive symptoms in care-receivers. A hierarchical regression analysis was carried out to determine predictors of caregivers' QoL. Results: Mean values in the group of seniors provided with home care were as follows: the Barthel scale M=43.20, SD=27.06, the AMTS M=7.78 (SD=1.65), and the GDS-SF M=7.34 (SD=3.10). QoL of ICs (the WHOQoL-AGE) was M=70.14 (SD=15.31). Significant predictors of caregivers' QoL turned out to be support in care given by others β =0.605, p<0.001, experience in care β =-0.220; p<0.001, caregivers' health self-assessment β =0.174, p<0.001, and depressive disorders in care-receivers GDS β = -0.178, p<0.001. Conclusions: The QoL of ICs who provide care for individuals with chronic diseases and a functional performance deficit improves with an increase in the support they receive from others, their higher health self-assessment, and greater experience in care. An increase in depressive symptoms in care-receivers determines a lower level of caregivers' QoL.
Collapse
Affiliation(s)
- Barbara Ślusarska
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Bartoszek
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Kocka
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Alina Deluga
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Chrzan-Rodak
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Nowicki
- Department of Family Medicine and Community Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
9
|
Kim H, Zhao YL, Kim N, Ahn YH. Home modifications for older people with cognitive impairments: Mediation analysis of caregivers' information needs and perceptions of fall risks. Int J Older People Nurs 2019; 14:e12240. [PMID: 31099499 DOI: 10.1111/opn.12240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/13/2019] [Accepted: 04/15/2019] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES The aims were to (a) identify how many older people with cognitive impairments are living in modified homes and (b) explore associated factors, and (c) examine the mediating effects that their caregivers' information needs and perceptions of fall risk and other factors. BACKGROUND Older people and their informal caregivers may consider implementing home modifications as an effective strategy for fall prevention. However, there is a lack of information on which older people's homes receive modifications and the various factors associated with such modifications among community-dwelling older people with cognitive impairments. DESIGN This cross-sectional and correlational study utilises a secondary data analysis. METHODS The data for this secondary analysis were taken from the 2015 National Online Survey of Caregivers, which includes information provided by 226 adult caregivers for older people with cognitive impairments. Descriptive analyses, hierarchical binary logistic regression and structural equation modelling were performed based on the Andersen and Newman framework of health services utilisation. RESULTS Overall, 46.5% of the older people lived in modified homes. Older people's impaired activities for daily living (ADLs), caregivers' information needs and perceptions of fall risk were all associated with home modifications (all p values<0.05). Caregivers' information needs mediated the relationship between impaired ADLs and home modifications (indirect effect = 0.026, p < 0.05), whereas the caregivers' perceptions of fall risk did not. CONCLUSIONS Older people with both cognitive and functional impairments are more likely to modify their home on behalf of care recipient's staying at home. Caregivers' information needs should thus be prioritized when considering home modifications to facilitate caring for older people with impaired ADLs. IMPLICATION FOR PRACTICE Nurses and other healthcare professionals should be prepared to offer appropriate information and comprehensive assessments of older people's conditions with regard to home modifications.
Collapse
Affiliation(s)
- Heejung Kim
- College of Nursing, Yonsei University, Seodaemun-gu, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Seodaemun-gu, Seoul, Korea
| | | | - Namhee Kim
- College of Nursing, Yonsei University, Seodaemun-gu, Seoul, Korea
| | - Yong Han Ahn
- Department of Architecture and Architectural Engineering, Hanyang University-ERICA, Ansan, Sangnok-gu, Korea
| |
Collapse
|
10
|
|
11
|
Göransson C, Wengström Y, Ziegert K, Langius-Eklöf A, Eriksson I, Kihlgren A, Blomberg K. Perspectives of health and self-care among older persons-To be implemented in an interactive information and communication technology-platform. J Clin Nurs 2017; 26:4745-4755. [PMID: 28334519 DOI: 10.1111/jocn.13827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To acquire knowledge regarding the contents to be implemented in an interactive information and communication technology-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves. BACKGROUND The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals. DESIGN Descriptive qualitative design. METHODS This study was based on three samplings: a scoping review of the literature (n = 20 articles), interviews with healthcare professionals (n = 5) and a secondary analysis of interviews with older persons (n = 8) and nursing assistants (n = 7). The data were analysed using qualitative content analysis. RESULTS Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons. CONCLUSIONS The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive information and communication technology-platform for use in regular daily care assessments. Descriptions of self-care were limited indicating a possible gap in knowledge that requires further research. RELEVANCE TO CLINICAL PRACTICE Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing.
Collapse
Affiliation(s)
- Carina Göransson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Yvonne Wengström
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ann Langius-Eklöf
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Irene Eriksson
- School of Life Sciences, University of Skövde, Skövde, Sweden
| | - Annica Kihlgren
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
12
|
Algilani S, Langius-Eklöf A, Kihlgren A, Blomberg K. An interactive ICT platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing - development and feasibility. J Clin Nurs 2017; 26:1575-1583. [PMID: 27381423 DOI: 10.1111/jocn.13468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To develop and test feasibility and acceptability of an interactive ICT platform integrated in a tablet for collecting and managing patient-reported concerns of older adults in home care. BACKGROUND Using different ICT applications, for example interactive tablets for self-assessment of health and health issues based on health monitoring as well as other somatic and psychiatric monitoring systems may improve quality of life, staff and patient communication and feelings of being reassured. The European Commission hypothesises that introduction of ICT applications to the older population will enable improved health. However, evidence-based and user-based applications are scarce. DESIGN The design is underpinned by the Medical Research Council's complex intervention evaluation framework. A mixed-method approach was used combining interviews with older adults and healthcare professionals, and logged quantitative data. METHODS In cooperation with a health management company, a platform operated by an interactive application for reporting and managing health-related problems in real time was developed. Eight older adults receiving home care were recruited to test feasibility. They were equipped with the application and reported three times weekly over four weeks, and afterwards interviewed about their experiences. Three nurses caring for them were interviewed. The logged data were extracted as a coded file. RESULTS The older adults reported as instructed, in total 107 reports (Mean 13). The most frequent concerns were pain, fatigue and dizziness. The older adults experienced the application as meaningful with overall positive effects as well as potential benefits for the nurses involved. CONCLUSIONS The overall findings in this study indicated high feasibility among older adults using the ICT platform. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations. RELEVANCE TO CLINICAL PRACTICE An ICT platform increased the older adults' perception of involvement and facilitated communication between the patient and nurses.
Collapse
Affiliation(s)
- Samal Algilani
- Nutrition and Physical Activity Research Centre (NUPARC), Faculty of Medicine, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Annica Kihlgren
- Nutrition and Physical Activity Research Centre (NUPARC), Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
13
|
Dawson S, Gerace A, Muir-Cochrane E, O'Kane D, Henderson J, Lawn S, Fuller J. Carers' experiences of accessing and navigating mental health care for older people in a rural area in Australia. Aging Ment Health 2017; 21:216-223. [PMID: 26304291 DOI: 10.1080/13607863.2015.1078283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Mental health care for older people is primarily delivered in the community and is largely dependent on informal carers. Mental health policy encourages partnerships between carers and service providers to facilitate service access, coordination and positive experience of care. However, carers often lack information and support from services, with the potential for carer burden, and negative impacts on their own health and capacity to fulfil caring tasks. This paper explores rural carers' experiences of accessing care from a range of services for older people with mental health problems. METHOD The Pathways Interview Schedule was used to facilitate 9 in-depth care journey interviews with 11 carers of older people with a mental health problem. Interviews explored their journeys to and through mental health, aged care, primary care and social care services. Framework analysis was used to explore carers' experiences and perceptions of care with a focus on access enablers and barriers. RESULTS Carers had a significant role in navigating services and operationalising care for their relative. Enablers to accessing care included carer knowledge and workers actively involving carers in planning. Barriers included carer mental health literacy, consumer and carer readiness for services, and worker misinterpretation of confidentiality and privacy laws. CONCLUSION Carers should be considered key partners in mental health care planning that crosses service sectors. For this to occur, changes are required at the worker level, including increased communication between mental health workers and carers, and the service level, involving training for staff in interpreting confidentiality and privacy policy.
Collapse
Affiliation(s)
- Suzanne Dawson
- a School of Nursing & Midwifery , Flinders University , Adelaide , Australia
| | - Adam Gerace
- a School of Nursing & Midwifery , Flinders University , Adelaide , Australia
| | | | - Deb O'Kane
- a School of Nursing & Midwifery , Flinders University , Adelaide , Australia
| | - Julie Henderson
- a School of Nursing & Midwifery , Flinders University , Adelaide , Australia
| | - Sharon Lawn
- b School of Medicine , Flinders University , Adelaide , Australia
| | - Jeffrey Fuller
- a School of Nursing & Midwifery , Flinders University , Adelaide , Australia
| |
Collapse
|
14
|
Smebye KL, Kirkevold M, Engedal K. Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC Health Serv Res 2016; 16:21. [PMID: 26787190 PMCID: PMC4717656 DOI: 10.1186/s12913-015-1217-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being. The theoretical framework for this study consisted of the concepts of autonomy, beneficence, non-maleficence, paternalism and from the ethics of care. The aim of this study was to explore ethical dilemmas concerning autonomy that were identified when persons with dementia wished to live at home. METHODS This Norwegian study had a qualitative, hermeneutic design and was based on nine cases. Each case consisted of of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 i.e. dementia of moderate degree (4) able to communicate verbally and (5) expressed a wish to live at home. The family carers and professional caregivers registered in the patients' records were included in the study. An interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. By means of deductive analysis, autonomy-related ethical dilemmas were identified. The final interpretation was based on perspectives from the theoretical framework. RESULTS The analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer's and professional caregiver's need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer. CONCLUSIONS In order to remain living in their own homes, people with dementia accepted their dependence on others in order to uphold their actual autonomy and live in accordance with their identified values. Paternalism could be justified in light of beneficence and non-maleficence and within an ethics of care.
Collapse
Affiliation(s)
| | - Marit Kirkevold
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Blindern, P.B. 1130, 0318 Oslo, Norway
- Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Knut Engedal
- Norwegian Centre for Aging and Health, Vestfold Health Trust, 3130 Tønsberg, Norway
| |
Collapse
|
15
|
Fuller J, Oster C, Muir Cochrane E, Dawson S, Lawn S, Henderson J, O'Kane D, Gerace A, McPhail R, Sparkes D, Fuller M, Reed RL. Testing a model of facilitated reflection on network feedback: a mixed method study on integration of rural mental healthcare services for older people. BMJ Open 2015; 5:e008593. [PMID: 26560057 PMCID: PMC4654302 DOI: 10.1136/bmjopen-2015-008593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To test a management model of facilitated reflection on network feedback as a means to engage services in problem solving the delivery of integrated primary mental healthcare to older people. DESIGN Participatory mixed methods case study evaluating the impact of a network management model using organisational network feedback (through social network analysis, key informant interviews and policy review). INTERVENTION A model of facilitated network reflection using network theory and methods. SETTING A rural community in South Australia. PARTICIPANTS 32 staff from 24 services and 12 senior service managers from mental health, primary care and social care services. RESULTS Health and social care organisations identified that they operated in clustered self-managed networks within sectors, with no overarching purposive older people's mental healthcare network. The model of facilitated reflection revealed service goal and role conflicts. These discussions helped local services to identify as a network, and begin the problem-solving communication and referral links. A Governance Group assisted this process. Barriers to integrated servicing through a network included service funding tied to performance of direct care tasks and the lack of a clear lead network administration organisation. CONCLUSIONS A model of facilitated reflection helped organisations to identify as a network, but revealed sensitivity about organisational roles and goals, which demonstrated that conflict should be expected. Networked servicing needed a neutral network administration organisation with cross-sectoral credibility, a mandate and the resources to monitor the network, to deal with conflict, negotiate commitment among the service managers, and provide opportunities for different sectors to meet and problem solve. This requires consistency and sustained intersectoral policies that include strategies and funding to facilitate and maintain health and social care networks in rural communities.
Collapse
Affiliation(s)
- Jeffrey Fuller
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Candice Oster
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Eimear Muir Cochrane
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Suzanne Dawson
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Sharon Lawn
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Julie Henderson
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Deb O'Kane
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Adam Gerace
- School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Ruth McPhail
- Country Health South Australia Local Health Network Mental Health Services, Adelaide, South Australia, Australia
| | - Deb Sparkes
- Southern Adelaide-Fleurieu-Kangaroo Island Medicare Local, Adelaide, South Australia, Australia
| | - Michelle Fuller
- City of Victor Harbor, Victor Harbour, South Australia, Australia
| | - Richard L Reed
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
16
|
Van Waeyenberg T, Decramer A, Anseel F. Home nurses' turnover intentions: the impact of informal supervisory feedback and self-efficacy. J Adv Nurs 2015; 71:2867-78. [DOI: 10.1111/jan.12747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Adelien Decramer
- Department of HRM and Organizational Behavior; Ghent University; Belgium
| | - Frederik Anseel
- Department of Personnel Management; Work and Organizational Psychology; Ghent University; Belgium
| |
Collapse
|
17
|
Borowiak E, Kostka J, Kostka T. Comparative analysis of the expected demands for nursing care services among older people from urban, rural, and institutional environments. Clin Interv Aging 2015; 10:405-12. [PMID: 25673980 PMCID: PMC4321418 DOI: 10.2147/cia.s72534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Demand for nursing and social services may vary depending on the socio-demographic variables, health status, receipt of formal and informal care provided, and place of residence. Objectives To conduct a comparative analysis of the expectations of older people from urban, rural, and institutional environments concerning nursing care with respect to the care provided and elements of a comprehensive geriatric assessment. Material and methods The study comprised 2,627 individuals above the age of 65 years living in urban (n=935) and rural (n=812) areas as well as nursing homes (n=880). Results Family care was most often expected both in urban (56.6%) and rural (54.7%) environments, followed by care provided simultaneously by a family and nurse (urban – 18.8%; rural – 26.1%) and realized only by a nurse (urban – 24.6%; rural – 19.2%). Not surprisingly, nursing home residents most commonly expected nursing care (57.5%) but 33.1% preferred care provided by family or friends and neighbors. In the whole cohort of people living in the home environment (n=1,718), those living with family demonstrated willingness to use primarily care implemented by the family (62.0%), while respondents living alone more often expected nursing services (30.3%). In the logistic regression model, among the respondents living in the city, only the form of care already received determined the expectations for nursing care. Among the respondents living in the county, the presence of musculoskeletal disorders, better nutritional status, and current care provided by family decreased expectations for nursing care. Higher cognitive functioning, symptoms of depression, and living alone increased the willingness to obtain nursing care. Conclusion Older inhabitants of urban areas, rural areas, and those residing in institutions have different expectations for individual nursing care. Nearly 45% of seniors living in the community expect to obtain nursing care, while only 1.6% do not expect any social or nursing help. While the expectations for the provision of nursing care are significantly increased by living alone, they are decreased by having access to care provided by family. Support for families to take care of elderly relatives would appear to be essential for an effective nursing and social care system.
Collapse
Affiliation(s)
- Ewa Borowiak
- Department of Geriatrics, Medical University of Lodz, Poland ; Institute of Nursing, Medical University of Lodz, Poland
| | - Joanna Kostka
- Department of Physical Medicine, Medical University of Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Poland
| |
Collapse
|
18
|
Karlsson CE, Ernsth Bravell M, Ek K, Bergh I. Home healthcare teams’ assessments of pain in care recipients living with dementia: a Swedish exploratory study. Int J Older People Nurs 2014; 10:190-200. [DOI: 10.1111/opn.12072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 07/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Kristina Ek
- School of Life Sciences; University of Skövde; Skövde Sweden
| | - Ingrid Bergh
- School of Life Sciences; University of Skövde; Skövde Sweden
| |
Collapse
|
19
|
Fuller J, Oster C, Dawson S, O'Kane D, Lawn S, Henderson J, Gerace A, Reed R, Nosworthy A, Galley P, McPhail R, Cochrane EM. Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: protocol for a mixed methods case study. BMJ Open 2014; 4:e006304. [PMID: 25227632 PMCID: PMC4166139 DOI: 10.1136/bmjopen-2014-006304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION An integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated servicing should occur, although interorganisational relations theory suggests a reflective network approach using evaluation feedback. This research will test a network management approach to help regional primary healthcare organisations improve mental health service integration. METHODS AND ANALYSIS This mixed methods case study in rural South Australia will test facilitated reflection within a network of health and social care services to determine if this leads to improved integration. Engagement of services will occur through a governance group and a series of three 1-day service stakeholder workshops. Facilitated reflection and evaluation feedback will use information from a review of health sector and local operational policies, a network survey about current service links, gaps and enablers and interviews with older people and their carers about their help seeking journeys. Quantitative and qualitative analysis will describe the policy enablers and explore the current and ideal links between services. The facilitated reflection will be developed to maximise engagement of senior management in the governance group and the service staff at the operational level in the workshops. Benefit will be assessed through indicators of improved service coordination, collective ownership of service problems, strengthened partnerships, agreed local protocols and the use of feedback for accountability. ETHICS, BENEFITS AND DISSEMINATION Ethics approval will deal with the sensitivities of organisational network research where data anonymity is not preserved. The benefit will be the tested utility of a facilitated reflective process for a network of health and social care services to manage linked primary mental healthcare for older people in a rural region. Dissemination will make use of the sectoral networks of the governance group.
Collapse
Affiliation(s)
- Jeffrey Fuller
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Candice Oster
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Suzanne Dawson
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Deb O'Kane
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- School of Medicine, Flinders University, Adelaide, Australia
| | - Julie Henderson
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Adam Gerace
- School of Nursing & Midwifery, Flinders University, Adelaide, Australia
| | - Richard Reed
- School of Medicine, Flinders University, Adelaide, Australia
| | - Ann Nosworthy
- Southern Fleurieu & Kangaroo Island Positive Ageing Taskforce, Victor Harbor, Australia
| | - Philip Galley
- Southern Adelaide-Fleurieu-Kangaroo Island Medicare Local, Bedford Park, Australia
| | - Ruth McPhail
- Country Health South Australia Local Health Network Mental Health Services, Adelaide, Australia
| | | |
Collapse
|
20
|
Gridley K, Brooks J, Glendinning C. Good practice in social care for disabled adults and older people with severe and complex needs: evidence from a scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:234-48. [PMID: 23889999 DOI: 10.1111/hsc.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 05/14/2023]
Abstract
This article reports findings from a scoping review of the literature on good practice in social care for disabled adults and older people with severe and complex needs. Scoping reviews differ from systematic reviews, in that they aim to rapidly map relevant literature across an area of interest. This review formed part of a larger study to identify social care service models with characteristics desired by people with severe and complex needs and scope the evidence of effectiveness. Systematic database searches were conducted for literature published between January 1997 and February 2011 on good practice in UK social care services for three exemplar groups: young adults with life-limiting conditions; adults who had suffered a brain injury or spinal injury and had severe or complex needs; and older people with dementia and complex needs. Five thousand and ninety-eight potentially relevant records were identified through electronic searching and 51 by hand. Eighty-six papers were selected for inclusion, from which 29 studies of specific services were identified. However, only four of these evaluated a service model against a comparison group and only six reported any evidence of costs. Thirty-five papers advocated person-centred support for people with complex needs, but no well-supported evaluation evidence was found in favour of any particular approach to delivering this. The strongest evaluation evidence indicated the effectiveness of a multidisciplinary specialist team for young adults; intensive case management for older people with advanced dementia; a specialist social worker with a budget for domiciliary care working with psycho-geriatric inpatients; and interprofessional training for community mental health professionals. The dearth of robust evaluation evidence identified through this review points to an urgent need for more rigorous evaluation of models of social care for disabled adults and older people with severe and complex needs.
Collapse
Affiliation(s)
- Kate Gridley
- Social Policy Research Unit (SPRU), University of York, York, UK
| | | | | |
Collapse
|
21
|
Slape J. Dementia and Palliative Care: The Spiritual Needs of Family Members. JOURNAL OF RELIGION SPIRITUALITY & AGING 2014. [DOI: 10.1080/15528030.2013.830237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
22
|
Llewellyn M, Longley M, Jarvis P, Garthwaite T. Older people and home care in Wales: findings from a survey of service users. QUALITY IN AGEING AND OLDER ADULTS 2013. [DOI: 10.1108/qaoa-05-2013-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
23
|
Nurses' Experiences of Caring for Older Persons in Transition to Receive Homecare: Being Somewhere in between Competing Values. Nurs Res Pract 2013; 2013:181670. [PMID: 23766895 PMCID: PMC3671552 DOI: 10.1155/2013/181670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/25/2013] [Accepted: 04/25/2013] [Indexed: 11/18/2022] Open
Abstract
Older persons in transition to need professional care in their homes will constitute a large group in municipalities in the future. The aim of this study was to obtain insight into nurses' experiences and perceptions of caring for patients in transition to receive homecare. Eleven home nurses divided into two focus groups were interviewed, and a phenomenological hermeneutical design was used. Four interpretations closely related to each other were revealed: it is essential to have an understanding of the patients' transition history; the nurse' repertoire is challenged in the transition process; care must be adapted to the patients' life world; the excellence of care is threatened by the context. The nurses strived to provide care based upon respect for the independent individual as a living whole. Their ambitions were, however, challenged and threatened by the caring context. The cooperation across organizational levels was pointed out as a critical factor with potential for improvement. This must be taken seriously to support the nurses in their endeavors to provide excellent care.
Collapse
|
24
|
Grundberg A, Ebbeskog B, Dahlgren MA, Religa D. How community-dwelling seniors with multimorbidity conceive the concept of mental health and factors that may influence it: a phenomenographic study. Int J Qual Stud Health Well-being 2012; 7:1-13. [PMID: 23237629 PMCID: PMC3522873 DOI: 10.3402/qhw.v7i0.19716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 11/16/2022] Open
Abstract
Multimorbidity, that is, the coexistence of chronic diseases, is associated with mental health issues among elderly people. In Sweden, seniors with multimorbidity often live at home and receive care from nursing aides and district nurses. The aim of this study was to describe the variation in how community-dwelling seniors with multimorbidity perceive the concept of mental health and what may influence it. Thirteen semi-structured interviews were analysed using a phenomenographic approach. Six qualitatively different ways of understanding the concept of mental health and factors that may influence it, reflecting key variations of meaning, were identified. The discerned categories were: mental health is dependent on desirable feelings and social contacts, mental health is dependent on undesirable feelings and social isolation, mental health is dependent on power of the mind and ability to control thoughts, mental health is dependent on powerlessness of the mind and inability to control thoughts, mental health is dependent on active behaviour and a healthy lifestyle, and mental health is dependent on passive behaviour and physical inactivity. According to the respondents’ view, the concept of mental health can be defined as how an individual feels, thinks, and acts and also includes a positive as well as a negative aspect. Social contacts, physical activity, and optimism may improve mental health while social isolation, ageing, and chronic pain may worsen it. Findings highlight the importance of individually definitions of mental health and that community-dwelling seniors with multimorbidity may describe how multiple chronic conditions can affect their life situation. It is essential to organize the health care system to provide individual health promotion dialogues, and future research should address the prerequisites for conducting mental health promotion dialogues.
Collapse
Affiliation(s)
- Ake Grundberg
- Department of Neurobiology, Care Sciences and Society, Alzheimer Disease Research Centre (KI-ADRC), Karolinska Institutet, Stockholm, Sweden.
| | | | | | | |
Collapse
|
25
|
Söderhamn U, Dale B, Sundsli K, Söderhamn O. Nutritional screening of older home-dwelling Norwegians: a comparison between two instruments. Clin Interv Aging 2012; 7:383-91. [PMID: 23049250 PMCID: PMC3459573 DOI: 10.2147/cia.s35986] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background It is important to obtain knowledge about the prevalence of nutritional risk and associated factors among older home-dwelling people in order to be able to meet nutritional challenges in this group in the future and to plan appropriate interventions. The aim of this survey was to investigate the prevalence of home-dwelling older people at nutritional risk and to identify associated factors using two different nutritional screening instruments as self-report instruments. Methods This study had a cross-sectional design. A postal questionnaire, including the Norwegian versions of the Nutritional Form for the Elderly (NUFFE-NO) and Mini Nutritional Assessment – Short Form (MNA-SF), background variables, and health-related questions was sent to a randomized sample of 6033 home-dwelling older people in southern Norway. A total of 2106 (34.9%) subjects were included in the study. Data were analyzed using descriptive statistics and logistic regression analyses. Results When using the NUFFE-NO and MNA-SF, 426 (22.3%) and 258 (13.5%) older persons, respectively, were identified to be at nutritional risk. The risk of undernutrition increased with age. Several predictors for being at risk of undernutrition, including chronic disease/handicap and receiving family help, as well as protective factors, including sufficient food intake and having social contacts, were identified. Conclusion Health professionals must be aware of older people’s vulnerability to risk of undernutrition, perform screening, and have a plan for preventing under-nutrition. For that purpose, MNA-SF and NUFFE-NO can be suggested for screening older people living at home.
Collapse
Affiliation(s)
- Ulrika Söderhamn
- Centre for Caring Research-Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
| | | | | | | |
Collapse
|
26
|
Abstract
SummaryHousing tenure takes a variety of forms, the most common of which are rental and owner-occupation. Currently, in the United Kingdom (UK), approximately 70% of older people live in owner-occupier properties, with the majority of the remainder renting from a public or private landlord. Research has consistently shown higher levels of morbidity and mortality among renters compared with owner-occupiers. However, it is unclear whether this is due to tenure acting as a proxy for other indicators of socio-economic status, such as income, which directly influences health, or whether other characteristics associated with tenure, including housing quality and location, explain the association. Untangling these competing influences of tenure on health is important, as it may provide clues on tackling health inequalities at older ages. Tenure too, appears to be related to the risk of long-stay care admission, with owner-occupiers significantly less likely to leave their home than renters; more work is required to identify why this is the case, as it may provide some insights on facilitating ageing in place.
Collapse
|
27
|
Borowiak E, Kostka T. Comparative characteristics of the home care nursing services used by community-dwelling older people from urban and rural environments. J Adv Nurs 2012; 69:1259-68. [DOI: 10.1111/j.1365-2648.2012.06113.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Ewa Borowiak
- Department of Geriatrics; Institute of Nursing; Medical University of Lodz; Poland
| | - Tomasz Kostka
- Department of Geriatrics; Institute of Rheumatology; Medical University of Lodz; Warsaw; Poland
| |
Collapse
|
28
|
Dale B, Söderhamn U, Söderhamn O. Life situation and identity among single older home-living people: a phenomenological-hermeneutic study. Int J Qual Stud Health Well-being 2012; 7:QHW-7-18456. [PMID: 22848230 PMCID: PMC3406221 DOI: 10.3402/qhw.v7i0.18456] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2012] [Indexed: 11/26/2022] Open
Abstract
Being able to continue living in their own home as long as possible is the general preference for many older people, and this is also in line with the public policy in the Nordic countries. The aim of this study was to elucidate the meaning of self-care and health for perception of life situation and identity among single-living older individuals in rural areas in southern Norway. Eleven older persons with a mean age of 78 years were interviewed and encouraged to narrate their self-care and health experiences. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological–hermeneutic method inspired by the philosophy of Ricoeur. The findings are presented as a naïve reading, an inductive structural analysis characterized by two main themes; i.e., “being able to do” and “being able to be”, and a comprehensive interpretation. The life situation of the interviewed single-living older individuals in rural areas in southern Norway was interpreted as inevitable, appropriate and meaningful. Their identity was constituted by their freedom and self-chosen actions in their personal contexts. The overall impression was that independence and the ability to control and govern their own life in accordance with needs and preferences were ultimate goals for the study participants.
Collapse
Affiliation(s)
- Bjørg Dale
- Centre for Caring Research, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
| | | | | |
Collapse
|
29
|
Martinsson G, Fagerberg I, Lindholm C, Wiklund-Gustin L. Struggling for existence-Life situation experiences of older persons with mental disorders. Int J Qual Stud Health Well-being 2012; 7:QHW-7-18422. [PMID: 22693537 PMCID: PMC3371755 DOI: 10.3402/qhw.v7i0.18422] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2012] [Indexed: 01/25/2023] Open
Abstract
Older persons with mental disorders represent a vulnerable group of people with extensive and complex needs. The older population is rapidly increasing worldwide and, as a result of deinstitutionalization in mental health care, older persons are remaining at home to a greater extent. Although they constitute a large proportion of the population, older persons with mental disorders have been neglected in research as well as in care organizations. As there is little previous knowledge concerning older persons’ experiences of their own situations, this study aimed to illuminate the meaning of the life situation as experienced by older persons with mental disorders (excluding dementia disorders). Interviews were conducted with seven older persons and the text was analyzed using a phenomenological hermeneutical research method, inspired by the philosophy of Paul Ricoeur. “Struggling for existence” emerged as a main theme in the older persons’ narratives, understood as a loss of dignity of identity and involving being troubled and powerless as well as yearning for respect. The older persons fought to master their existence and to be seen for who they are. The study highlights the importance for caregivers, both formal and informal, to avoid focusing on the diagnoses and rather acknowledge the older persons and their lifeworld, be present in the relation and help them rebuild their dignity of identity. This study brings a new understanding about older persons with mental disorders that may help reduce stigma and contribute to planning future mental health care.
Collapse
Affiliation(s)
- Gunilla Martinsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | | | | |
Collapse
|
30
|
Van Hoi L, Thi Kim Tien N, Van Tien N, Van Dung D, Thi Kim Chuc N, Goran Sahlen K, Lindholm L. Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam. BMC Health Serv Res 2012; 12:36. [PMID: 22333517 PMCID: PMC3305522 DOI: 10.1186/1472-6963-12-36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 02/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background The proportion of people in Vietnam who are 60 years and over has increased rapidly. The emigration of young people and impact of other socioeconomic changes leave more elderly on their own and with less family support. This study assesses the willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam. Methods In 2007, people aged 60 and older and their family representatives, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance Site. They were interviewed using structured questionnaires to assess dependence in activities of daily living (ADLs), willingness to use and to pay for day care centres, mobile care teams, and nursing centres. Respondent socioeconomic characteristics were extracted from the FilaBavi repeated census. Percentages of those willing to use models and the average amount (with 95% confidence intervals) they are willing to pay were estimated. Multivariate analyses were performed to measure the relationship of willingness to use services with ADL index and socioeconomic factors. Four focus group discussions were conducted to explore people's perspectives on the use of services. The first discussion group was with the elderly. The second discussion group was with their household members. Two other discussion groups included community association representatives, one at the communal level and another at the village level. Results Use of mobile team care is the most requested service. The fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than do the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require that services be free-of-charge is two to three times higher than the proportion willing to pay full cost. Households are willing to pay more than the elderly for day care and nursing centres. The elderly are more willing to pay for mobile teams than are their households. Age group, sex, literacy, marital status, living arrangement, living area, working status, poverty, household wealth and dependence in ADLs are factors related to willingness to use services. Conclusions Community-centric elderly care will be used and partly paid for by individuals if it is provided by the government or associations. Capacity building for health professional networks and informal caregivers is essential for developing formal care models. Additional support is needed for the most vulnerable elderly to access services.
Collapse
Affiliation(s)
- Le Van Hoi
- Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Sweden.
| | | | | | | | | | | | | |
Collapse
|
31
|
Finnbakk E, Skovdahl K, Blix ES, Fagerström L. Top-level managers’ and politicians’ worries about future care for older people with complex and acute illnesses - a Nordic study. Int J Older People Nurs 2012; 7:163-72. [DOI: 10.1111/j.1748-3743.2012.00312.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Randström KB, Asplund K, Svedlund M. Impact of environmental factors in home rehabilitation--a qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers. Disabil Rehabil 2011; 34:779-87. [PMID: 22004413 DOI: 10.3109/09638288.2011.619621] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to explore older people's experience of environmental factors that impact on their activity and participation in home rehabilitation. METHOD Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. RESULTS The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. CONCLUSIONS A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.
Collapse
|
33
|
Martinsson G, Wiklund-Gustin L, Lindholm C, Fagerberg I. Being altruistically egoistic-Nursing aides' experiences of caring for older persons with mental disorders. Int J Qual Stud Health Well-being 2011; 6:QHW-6-7530. [PMID: 22007261 PMCID: PMC3193826 DOI: 10.3402/qhw.v6i4.7530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2011] [Indexed: 11/19/2022] Open
Abstract
Older persons with mental disorders, excluding dementia disorders, constitute a vulnerable group of people. With the future international increase in the older population, mental disorders will increase as well, thus entailing new challenges for their caregivers. These older persons often remain in their own homes, and in Sweden they are cared for by nursing aides. With little previous research, an increased workload and facing new strenuous situations, it is important to make use of the knowledge the nursing aides possess and to deepen the understanding of their experiences. The study aimed at illuminating the meaning of caring for older persons with mental disorders as experienced by nursing aides in the municipal home help service. Interviews with nine female nursing aides were performed and analysed with a phenomenological hermeneutical research method inspired by the philosophy of Paul Ricoeur. Being altruistically egoistic emerged as a main theme in the nursing aides’ narratives. The nursing aides’ experiences could be interpreted as a movement between being altruistic and egoistic. The findings revealed a continuous distancing by the nursing aides and their struggle to redress the balance between their altruistic and egoistic actions. Caring for these older persons constitutes a complex situation where distancing functions as a recourse to prioritize oneself and to diminish the value of caring. The study suggests that an increased knowledge base on older persons with mental disorders, followed by continuous supervision, is necessary for the nursing aides to improve the quality of the care given.
Collapse
Affiliation(s)
- Gunilla Martinsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | | | | |
Collapse
|
34
|
Dale B, Söderhamn U, Söderhamn O. Self-care ability among home-dwelling older people in rural areas in southern Norway. Scand J Caring Sci 2011; 26:113-22. [DOI: 10.1111/j.1471-6712.2011.00917.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
35
|
Yamashita T, Jeon H, Bailer AJ, Nelson IM, Mehdizadeh S. Fall Risk Factors in Community-Dwelling Elderly Who Receive Medicaid-Supported Home- and Community-Based Care Services. J Aging Health 2010; 23:682-703. [DOI: 10.1177/0898264310390941] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This study identifies fall risk factors in an understudied population of older people who receive community-based care services. Method: Data were collected from enrollees of Ohio’s Medicaid home- and community-based waiver program (preadmission screening system providing options and resources today [PASSPORT]). A total of 23,182 participants receiving PASSPORT services in 2005/2006 was classified as fallers and nonfallers, and a variety of risk factors for falling was analyzed using logistic regressions. Results: The following factors were identified as risk factors for falling: previous fall history, older age, White race, incontinence, higher number of medications, fewer numbers of activity of daily living limitations, unsteady gait, tremor, grasping strength, and absence of supervision. Discussion: Identifying risk factors for the participants of a Medicaid home- and community-based waiver program are useful for a fall risk assessment, but it would be most helpful if the community-based care service programs incorporate measurements of known fall risk factors into their regular data collection, if not already included.
Collapse
|
36
|
Cultural diversity between hospital and community nurses: implications for continuity of care. Int J Integr Care 2010; 10:e036. [PMID: 20422021 PMCID: PMC2858515 DOI: 10.5334/ijic.508] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/15/2009] [Accepted: 01/19/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. Challenges In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. Discussion We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.
Collapse
|