A recipe for thriving in nursing homes: A meta-ethnography

The association among thriving in life, quality of life, and suicidal ideation in Chinese urban older adults: the moderating effects of attitude toward own aging

BACKGROUND

As the global trend of population aging intensifies, the health and well-being of the older population has gradually become a focus of attention for the global community. This study assessed the status of thriving in life among Chinese urban older adults and identified its relationship with attitude toward own aging and quality of life (QoL). It also tested whether attitude toward own aging moderates the association between thriving in life and Qol or between thriving in life and suicidal ideation.

METHODS

Primary data were collected through a cross-sectional survey among urban older adults from three provinces in China. They were invited to complete an anonymous survey using face-to-face interviews from December 2019 to January 2020. Data from 764 older adults were analyzed.

RESULTS

Approximately 44.39% of participants reported positive responses toward the four domains of thriving in life. Thriving in life and attitude toward own aging had a significant association with QoL. Thriving in life was a protective factor for suicidal ideation for older adults. Moreover, attitude toward own aging moderated the association between thriving in life and QoL and that between thriving in life and suicidal ideation.

CONCLUSIONS

Chinese urban older adults were reportedly thriving in life, which contributed to increased QoL and reduced suicidal ideation. Notably, the study revealed that more positive attitudes towards own aging were associated with higher levels of thriving in life, better QoL, and reduced suicidal ideation. Targeted interventions for older adults should be devised to promote thriving in life and prevent negative attitudes of older people towards their own aging, further raising QoL and reducing suicidal ideation.

Promoting resident thriving in nursing homes: A qualitative study

Aim

To explore how staff promote resident thriving in an Australian nursing home.

Design

Qualitative research design using content analysis.

Methods

Interviews were held with 14 nursing staff working in an Australian nursing home in March/April 2018. Data were analysed using qualitative content analysis.

Results

Four themes were revealed: promoting personalized care; promoting opportunities for autonomy; promoting connection and meaning; and promoting a curated environment.

Conclusions

Staff promoted resident thriving in relation to everyday care, activities, capabilities, relationships and the lived environment. Interventions that were perceived to promote thriving were described relative to the nurse, the resident, the care team and the wider nursing home context.

Implications for the Profession and/or Patient Care

The findings provide novel insight into the understanding and application of the concept of thriving in long‐term care from nursing staffs' perspective.

Impact

What Problem did the Study Address?

Nursing home staff are uniquely positioned to support resident thriving through person‐centred care, yet little is known about how staff support promotion of thriving for nursing home residents in their everyday practice.

What were the Main Findings?

Nursing home staff perceived that they promoted thriving by personalizing care and supporting autonomy, connection, meaning and pleasure for residents.

Where and on Whom will the Research have an Impact?

These findings are of interest for the clinicians, educators and researchers who develop, implement and evaluate interventions to improve place‐related well‐being in nursing homes.

Reporting Method

CORE‐Q checklist.

Patient or Public Contribution

No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience.

Older peoples' lived experiences of personalised care in care homes: A meta-ethnography

BACKGROUND

Guidance and policy on personalised (or person-centred) care of older people living in care homes advocates that all residents must have their preferences considered, and that all care provided must be reasonably adjusted to meet the person's specific needs. Despite this, research that considers what matters to residents in terms of the care they receive is limited.

OBJECTIVES

Our review aims to explore care home residents' lived experiences of personalised care and understand what really matters to them.

METHODS

Six electronic databases (CINHAL, Medline (Ovid), Embase, PubMed, Web of Science & PsychInfo) and Google Scholar (grey literature) were searched to identify qualitative studies relating to personalised care in care home settings, which also included resident (voices) quotes. The literature review and synthesis are reported using eMERGe guidance.

RESULTS

Fifteen studies met the inclusion criteria for our meta-ethnography. Four conceptual categories (the challenge of fitting into institutional care, the passing of time, holding onto a sense of self and a desire to feel at home) and two key concepts (creating a culture of purposeful living and caring and forming and maintaining meaningful & empowering relationships) were identified. Finally, a conceptual framework of understanding represents what personally matters to residents in terms of their care.

CONCLUSION

Our meta-ethnography, guided by residents' lived experiences of personalised care, offers a new perspective of what personally matters to residents in terms of the care they receive. The conceptual framework of understanding highlights the importance of moving from an institutional position of doing for residents to a person-centred position of doing with residents.

IMPLICATIONS FOR PRACTICE

Our findings highlight the importance of understanding the differences between personalised and person-centred care for policy and practice. Further considerations are required on how this might be applied through nurse and care home professionals' education and work practices.

A qualitative hermeneutical understanding of spiritual care in old age when living in a nursing home: The residents' voices

AIM

To explore and gain a broader understanding of residents' viewpoints and experiences of spiritual care when living in a nursing home.

DESIGN

A qualitative hermeneutical interview study inspired by Gadamer's philosophical hermeneutics.

METHODS

Thirty-eight individual interviews of 14 male and 24 female residents; of these, 24 had a dementia diagnosis. The setting was one large Norwegian nursing home providing long-term care. FACIT-Sp-12 was used as a guide for the interview, in addition to two open-ended questions about thriving and spiritual care.

FINDINGS

The older residents' voices portray a broad and diverse understanding of spiritual care, and four themes emerged: (1) Spiritual at-homeness, (2) Spiritual awareness, (3) Philosophy of life and (4) Interconnectedness.

CONCLUSION

Accepting one's life situation in a nursing home can foster a feeling of belonging, leading to feeling more at-home. Spiritual well-being, including finding purpose, spiritual awareness and beliefs, was found to be interconnected with spiritual at-homeness in the nursing home.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study provides insights into older nursing home residents' viewpoints on spiritual care, including persons living with dementia.

IMPACT

The study addressed the limited evidence regarding how older residents themselves experience and express spiritual care. Listening to older nursing home residents' voices provides a unique contribution to the research field. As several individuals with dementia contributed to the findings, this study mirrors the current population of residents in nursing homes. The findings may inform healthcare provision and policymakers and impact upon spiritual care in the field of older people nursing and dementia care services.

REPORTING METHOD

The COREQ guideline.

PATIENT OR PUBLIC CONTRIBUTION

Participation through interviews of nursing home residents.

Existential well-being for the oldest old in nursing homes: a meta-ethnography

Ideas of well-being in old age are often anchored in the successful ageing paradigm, foregrounding independence, activeness and autonomy. However, for those oldest old living in nursing homes, these goals are largely out of reach. In this article, we use the meta-ethnographic method to explore and reinterpret existing findings on the ways in which well-being is experienced (or not) by the oldest old in institutional care settings. We frame our findings in existential well-being theory, which understands wellbeing as a sense of ‘dwelling-mobility’. Our analysis resulted in the following themes: (a) institutionalisation as both restrictive and liberating; (b) reciprocity and mattering: the importance of being seen; (c) the need for kinship and the problem of ruptured sociality; (d) rethinking agency: situated, delegated and supported; and (e) lowered expectations: receiving care is not a passive act. We conclude that while institutional care environments are not always conducive to well-being, this does not have to be so. By shifting our focus from successful ageing ideals onto relationally situated care practices, a possibility for existential well-being opens up, even in situations of decline and care dependency.

Exploring changes to resident thriving and associated factors in Swedish nursing homes: A repeated cross-sectional study

OBJECTIVE

This study aimed to explore changes to resident thriving in Swedish nursing homes over a 5-year period and describe changes in associated factors.

METHODS

Cross-sectional data were collected from a randomised sample of Swedish nursing homes in 2013/2014 (baseline) and 2018/2019 (follow-up). Descriptive statistics, independent samples t-tests, and chi squared tests were used to statistically evaluate differences between the samples. Simple and multiple linear regression analyses were used to explore associations between thriving and the study variables.

RESULTS

Resident characteristics were relatively consistent between the full baseline (N = 4831) and follow-up (N = 3894) samples. Within a sub-sample of nursing homes that participated in both data collections mean thriving scores were found to have increased from 152.9 to 155.2 (p ≤ 0.003; d =0.09) and overall neuropsychiatric index scores had decreased from 16.0 to 14.3 (p ≤ 0.004; d =0.09), as had the prevalence of several neuropsychiatric symptoms. Thriving was found to have a positive association with the neuropsychiatric symptom of elation/euphoria, and negative associations with the symptoms of aggression/agitation, depression/dysphoria, apathy, and irritability.

CONCLUSIONS

The results show an increase in overall thriving scores and a decrease in overall neuropsychiatric scores between baseline and follow-up. This study confirmed associations between thriving and certain neuropsychiatric symptoms and established comparative knowledge regarding changes in resident thriving, characteristics, and symptom prevalence. These findings could inform future care and organisational policies to support thriving in nursing homes, particularly among residents at risk of lower thriving due to cognitive impairment or neuropsychiatric symptoms.

Effects of a person-centred and thriving-promoting intervention on nursing home residents' experiences of thriving and person-centredness of the environment

AIM

To evaluate the effects of a person-centred and thriving-promoting intervention on nursing home residents´ experiences of thriving and person-centredness of the environment, and to evaluate if the effects varied between female and male residents.

DESIGN

A multi-centre, non-equivalent controlled group before-after intervention design.

METHODS

Six nursing homes in Australia, Norway and Sweden were allocated to either intervention or control group. The intervention comprised a staff educational programme. A survey using proxy-ratings by staff was administered before (T0), immediately after (T1) and six months after (T2) the intervention. The sample varied between 205 and 292 residents. Linear regression models were used to explore effects.

RESULTS

Statistically significant effects were found on experiences of thriving and person-centredness of the environment. These effects were significant for male residents but not for female residents. The results emphasize the importance of individually tailored social and recreational activities.

‘100 metres to the liquor store and 300 meters to the cemetary’ – individual, social, environmental and organisational facilitators and barriers to thriving in Swedish sheltered housing models

In Sweden, sheltered housing is a housing model that provides accessible apartments with elevated social possibilities for older people. The environment within sheltered housing is expected to support resident health and reduce the need for care services. A previous study has shown that with increasing levels of depressive mood and decreasing levels of self-rated health and functional status, those residing in sheltered housing report higher levels of thriving compared to those ageing in place. Therefore, the aim of this study was to illuminate aspects of sheltered housing that are facilitators and/or barriers to thriving. Seven semi-structured group interviews in five different sheltered housing accommodations in Sweden were conducted between April 2019 and January 2020 (N = 38). The results, analysed using qualitative content analysis and presented in a model developed by Grol and Wensing, illuminate the four main categories of facilitators and barriers to thriving: individual factors, social context, environmental factors and organisational context. The results of this study show that the factors that influence experiences of thriving in sheltered housing are multifaceted and interconnected. Although the supportive environment provided in sheltered housing seems to contribute to thriving, the limited consideration towards the shifting health of residents is a barrier to thriving. The results of this study may assist in implementing tailored interventions to help support thriving on various levels.