1
|
Ristolainen H, Van Regenmortel S, De Donder L, Vercauteren T, Lehtiö J, Tiilikainen E. Patterns of Multidimensional Social Exclusion Among Older Home Care Services Recipients. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae118. [PMID: 39012036 PMCID: PMC11310456 DOI: 10.1093/geronb/gbae118] [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: 02/20/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVES The guiding principle of current aging policies has been to promote older adults to live in their private homes, but little attention has been paid to social exclusion of older adults receiving home-based care. The aim of this study is to increase understanding on different patterns of multidimensional social exclusion among older adults receiving formal home care services, and through this to shed light on the possible challenges of current aging-in-place policies. METHODS The survey data were collected in 2022 among older adults aged 65 to 102 years receiving home care services in Finland and merged with administrative data (n = 733). A latent class analysis was used to identify different types of social exclusion. Multinomial logistic regression modeling examined factors associated with different social exclusion types. RESULTS Four social exclusion types were identified: (1) not excluded (16.9%), (2) homebound economically excluded (40.1%), (3) excluded from social relations (28.6%), and (4) multidimensionally excluded (14.3%). Poor self-rated health and poor functional ability significantly increase the risk of being multidimensionally excluded or homebound economically excluded. The group using home care and medical services the most are the most multidimensionally excluded. The group living in urban areas are more likely to be excluded from social relations. DISCUSSION Different types of social exclusion should be acknowledged when addressing social exclusion among home care clients. Enhanced measures should be developed to support older adults using home and healthcare services the most, as they are at high risk of severe exclusion.
Collapse
Affiliation(s)
- Hanna Ristolainen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sofie Van Regenmortel
- Society and Ageing Research Lab, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Liesbeth De Donder
- Society and Ageing Research Lab, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Toon Vercauteren
- Society and Ageing Research Lab, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Johanna Lehtiö
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Elisa Tiilikainen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
2
|
Hynnekleiv II, Jensen JK, Giske T, Lausund H, Maeland E, Heggdal K. Patients' and Nurses' experiences of caring in nursing: An integrative literature review across clinical practices. J Clin Nurs 2024; 33:1233-1255. [PMID: 38093547 DOI: 10.1111/jocn.16964] [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] [Received: 04/24/2023] [Revised: 10/12/2023] [Accepted: 11/01/2023] [Indexed: 03/08/2024]
Abstract
AIM To summarise, interpret and synthesize research findings on patients' and nurses' experiences of caring in nursing across clinical practices. BACKGROUND Caring is a universal element of nursing; however, economic restrictions often negatively impact health services, and time shortages and limited numbers of staff may characterize care encounters. It is unclear how these contextual conditions affect patients' and nurses' experiences of caring. DESIGN AND METHODS This integrative literature review covers papers published between 2000 and 2022. Four databases-PubMed, PsycINFO (via Ovid), MEDLINE (via Ovid) and CINAHL (via EBSCO)-were systematically searched for eligible papers in May 2022. The included studies were critically appraised. Content analysis was performed to interpret and synthesize the findings. In accordance with the EQUATOR guidelines, the PRISMA 2020 and PRISMA-S checklists were used. An Integrative review methodology guided the process. FINDINGS In total, 33 studies were included in the review. Three themes captured the experiences of caring in nursing: (1) the complexity of the nursing care context, (2) the professionalism of the nurse, and (3) the trusting patient-nurse relationship. CONCLUSION The experience of caring in nursing depended on nurses' competence and discretion in the personal encounter framed by the nursing context. The caring relationship was based on reciprocity, but it remains asymmetrical, as the nurse had the power and responsibility to empower the patient. Barriers, such as increased demands for efficiency and resource scarcity, may hinder the experience of caring in nursing. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE By promoting an ongoing discussion of caring in nursing, nurse management can systematically support nurses in reflecting on their practice in diverse and complex clinical contexts. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was made due to the study design.
Collapse
Affiliation(s)
| | - Jørghild K Jensen
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Tove Giske
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Hilde Lausund
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Elisabeth Maeland
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Kristin Heggdal
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| |
Collapse
|
3
|
Ethier A, Dubois MF, Savaria V, Carrier A. Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography. BMC Health Serv Res 2024; 24:296. [PMID: 38448879 PMCID: PMC10918893 DOI: 10.1186/s12913-024-10709-6] [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: 10/03/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Case managers play a vital role in integrating the necessary services to optimise health-related goals and outcomes. Studies suggest that in home care, case managers encounter tensions in their day-to-day work, that is, disjuncture between what they should do, in theory, and what they actually do, in practice. However, direct exploration of these tensions is lacking. As such, this study aimed to describe the tensions encountered by case managers in public home care for older adults in Quebec and their influence on day-to-day work. METHODS An institutional ethnography was conducted through observations of work, interviews and a survey with case managers working in home care in Quebec. Data were analysed using institutional ethnography first-level analysis procedures. This included mapping the work sequences as well as identifying the tensions experienced by case managers through the words they used. RESULTS Three main tensions were identified. First, case managers perceive that, despite working to return hospitalised older adults at home safely, their work also aims to help free up hospital beds. Thus, they often find themselves needing to respond quickly to hospital-related inquiries or expedite requests for home care services. Second, they are supposed to delegate the care to "partners" (e.g., private organisations). However, they feel that they are in effect managing the quality of the services provided by the "partners." Consequently, they go to great lengths to ensure that good care will be provided. Finally, they must choose between meeting organisational requirements (e.g., reporting statistics about the work, documenting information in the older adults' file, doing mandatory assessments) and spending time providing direct care. This often leads to prioritising direct care provision over administrative tasks, resulting in minimal reporting of essential information. CONCLUSION The results are discussed using the three lenses of professional practice context analyses (i.e., accountability, ethics, and professional-as-worker) to formulate recommendations for practice and research. They suggest that, despite their important role, case managers have limited power in home care (e.g., with partners, with the hospital).
Collapse
Affiliation(s)
- Alexandra Ethier
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Faculté de médecine et sciences de la santé, Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Virginie Savaria
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Annie Carrier
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| |
Collapse
|
4
|
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
|
5
|
Ristolainen H, Forma L, Hawkins J, Tiilikainen E. Study protocol of a mixed method pragmatic quasi-experimental trial to evaluate the day activity services targeted at older home care clients in Finland. BMC Geriatr 2022; 22:810. [PMID: 36271337 PMCID: PMC9587541 DOI: 10.1186/s12877-022-03512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background In Finland, the ‘day activity service’ is targeted at older home care clients who are unable to participate in other available activities due to poor health or functional disabilities. The aim of the day activity service is to support home care client’s ability to live at home and to enhance their wellbeing and social inclusion. This mixed method study examines the effectiveness, cost-effectiveness and process of the day activity service. Methods The target sample size is 200 participants. The intervention group (n = 100) is composed of home care clients who begin to participate in the day activity service. The comparison group (n = 100) are home care clients who do not participate in the day activity service, and whose functioning and care needs are similar to the participants of the intervention group. The primary outcome is social inclusion (ESIS-scale). Secondary outcomes are loneliness (single item and De Jong Gierveld Loneliness Scale) and social care related quality of life (ASCOT). Baseline, three-month and six-month follow-up surveys are gathered from intervention and comparison group participants in order to compare outcomes between groups pre- and post-intervention. Costs of health and social services, based on administrative data, and the costs of the intervention are utilized in examining the cost-effectiveness of the intervention with the above-described measurements. Qualitative data are collected by interviewing the intervention participants (n = 10) and professionals working at the day activity centres and older people’s services (4 focus groups) to explore the perceived outcomes and process of the intervention to find out how and why the intervention is effective or ineffective. Discussion The study seeks to produce a comprehensive understanding of the effectiveness, cost-effectiveness and implementation process of the day activity service. Trial registration ISRCTN13146087, Registration date 03/04/2022.
Collapse
Affiliation(s)
- Hanna Ristolainen
- University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.
| | - Leena Forma
- Laurea University of Applied Sciences, Ratatie 22, 01300, Vantaa, Finland.,Faculty of Social Sciences and Gerontology Research Center (GEREC), Tampere University, Kalevantie 4, 33100, Tampere, Finland
| | - Jemma Hawkins
- Faculty of Social Sciences and Gerontology Research Center (GEREC), Tampere University, Kalevantie 4, 33100, Tampere, Finland
| | | |
Collapse
|
6
|
Kajander-Unkuri S, Kämäräinen P, Hartikainen T, Turjamaa R. Effectiveness of a combined web-based and simulation-based continuing education on home-care professionals' competence to evaluate older people's acute care needs in Finland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1765-e1774. [PMID: 34644436 DOI: 10.1111/hsc.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/18/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Home-care professionals need competences to ensure that they evaluate their older peoples' health conditions, especially in acute care situations. This study aims to investigate the effectiveness of combined web-based and simulation-based continuing education on home-care professionals' competence regarding evaluating older people's needs for acute care. A quasi-experimental pre-test-post-test study was conducted with home-care professionals who were working in older people's care in Finland. Home-care professionals (N = 254) had participated in combined web-based and simulation-based continuing education in 2017-2019. Data were collected using a questionnaire developed for this study before (n = 171) and after (n = 83) the education. The data were analysed statistically. The mean competence score was 3.22 ± 0.51 before the education and 3.92 ± 0.57 after the education. Improvements were detected in overall competence and in all eight subscales. Improvements were highest in health assessment and consultation and the lowest in type 2 diabetes, but this was already the highest level of self-assessed competence in the pre-test assessment. The combined web-based and simulation-based continuing education was effective in increasing the home-care professionals' competence in evaluating older people's needs for acute care. Evaluating older people's needs for acute care should be embedded in curricula and continuing education programmes.
Collapse
Affiliation(s)
- Satu Kajander-Unkuri
- Department of Nursing Science, University of Turku, Turku, Finland
- Diaconia University of Applied Sciences, Helsinki, Finland
| | - Pauliina Kämäräinen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Social and Health Services, City of Kuopio, Finland
| | | | - Riitta Turjamaa
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Savonia University of Applied Sciences, Kuopio, Finland
| |
Collapse
|
7
|
Breen R, Savundranayagam MY, Orange JB, Kothari A. Quality home care for persons living with dementia: Personal support workers' perspectives in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2497-e2506. [PMID: 34951066 DOI: 10.1111/hsc.13692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi-structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person-centered; (2) provided by PSW with dementia-specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia-specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front-line workers' perspectives and how they can help revise current healthcare policies and inform future policy development.
Collapse
Affiliation(s)
- Rachel Breen
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
| | | | - Joseph B Orange
- School of Communications Sciences and Disorders, University of Western Ontario, London, Ontario, Canada
| | - Anita Kothari
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
8
|
Ma G, Hou J, Peng S, Luo L, Xu R, Liu Y, Fan Y, Shi Z, Zhang C, Zhang J. Nurses' Willingness and Demand for Internet +home Care Services and Its Influencing Factors in Different Levels of Hospitals in China - A Nationwide Survey. Risk Manag Healthc Policy 2022; 15:1395-1405. [PMID: 35911086 PMCID: PMC9326896 DOI: 10.2147/rmhp.s367412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The present study aimed to investigate nurses’ willingness and demand for Internet +home care services in different levels of hospitals in China and analyze the influencing factors. Participants and Methods From October 1 to December 31, 2021, 5714 nurses from 15 hospitals in five regions of China were recruited in this cross-sectional study using a two-stage random sampling method. A self-designed questionnaire with good reliability and validity was used to measure nurses’ willingness and demand for Internet +home care services. χ2 test, Welch t-test, and multiple linear regression analyses were used to analyze the data. Results Nurses were highly willing to provide Internet +home care services. Statistical differences were found in the willingness to provide Internet +home care services and the preference for service distance, service platform, and single service fee between nurses in different levels of hospitals (both P<0.05). The willingness to provide “catheter maintenance service” and “rehabilitation nursing service” of nurses in different levels of hospitals were statistically significant (both P<0.05). Nurses’ demand for Internet +home care services increased with the level of their hospital. Multiple linear regression showed that professional title, educational level, monthly family income, and mortgage or car loan influence nurses’ demand for Internet +home care services. Conclusion Nurses’ willingness and demand for Internet +home care services vary with the level of their hospitals. It is recommended that government and hospitals regulate the service items, the service distance, single service fee, and other contents according to nurses’ willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of the Internet +home care services.
Collapse
Affiliation(s)
- Guiyuan Ma
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Jianmei Hou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Sha Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Lingxia Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Ran Xu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Yanhui Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Yuhua Fan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Zhengkun Shi
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Cailan Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Xiangya School of Nursing, Central South University, Changsha, People's Republic of China.,National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| |
Collapse
|
9
|
Ma G, Hou J, Peng S, Liu Y, Shi Z, Fan Y, Zhang J. Construction of Internet +home Care Quality Supervision Indicators in China Based on the Delphi Method. Healthc Policy 2022; 15:1325-1341. [PMID: 35855767 PMCID: PMC9288219 DOI: 10.2147/rmhp.s368592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background With the aging of China’s population, the incidence rate of chronic diseases is rising. At the same time, residents’ health awareness is also increasing. Implementing Internet +home care is an inevitable trend in adapting social development. Currently, Internet +home care is in the pilot stage in China, relevant institutional measures are neither standardized nor perfect, and there is no set of quality supervision indicators (QSIs). Purpose The construction of Internet +home care QSIs in China will provide a theoretical basis for Internet +home care quality supervision. Materials and Methods The Service-Quality model was used as the theoretical framework, and a literature review, semi-structured interviews, focus group discussions, and Delphi consultations determined the contents of the QSIs and the weight of each indicator. Results Internet +home care QSIs were constructed and included 5 first-level indicators, 17 secondary indicators, and 69 tertiary indicators. The effective recovery rates of the two rounds of Delphi expert consultation were 100% and 85%, the expert authority coefficients were 0.810 and 0.833, and the Kendall harmony coefficients were 0.189 and 0.125 (P<0.01). The final set of Internet +home care QSIs was as follows: tangibility (4 secondary and 16 tertiary indicators), reliability (4 secondary and 19 tertiary indicators), guarantee (5 secondary and 20 tertiary indicators), responsiveness (2 secondary and 8 tertiary indicators), and empathy (2 secondary and 6 tertiary indicators). Conclusion The construction of Internet +home care QSIs based on the SERVQUAL model is scientifically valid, and the indicators are reliable. They provide guidance and reference values for the continuous improvement and promotion of Internet +home care. This work also provides a theoretical basis for researching and developing an Internet +home care quality supervision platform.
Collapse
Affiliation(s)
- Guiyuan Ma
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Jianmei Hou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Sha Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Yanhui Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Zhengkun Shi
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Yuhua Fan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China.,Mobile Health-Ministry of Education Laboratory, Changsha, 410008, People's Republic of China
| |
Collapse
|
10
|
Herrler A, Kukla H, Vennedey V, Stock S. Which features of ambulatory healthcare are preferred by people aged 80 and over? Findings from a systematic review of qualitative studies and appraisal of confidence using GRADE-CERQual. BMC Geriatr 2022; 22:428. [PMID: 35578168 PMCID: PMC9109291 DOI: 10.1186/s12877-022-03006-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite healthcare providers' goal of patient-centeredness, current models for the ambulatory (i.e., outpatient) care of older people have not as yet systematically incorporated their views. Moreover, there is no systematic overview of the preferable features of ambulatory care from the perspective of people aged 80 and over. Therefore, the aim of this study was to summarize their specific wishes and preferences regarding ambulatory care from qualitative studies. METHODS The study was based on qualitative studies identified in a prior systematic review. Firstly, the findings of the qualitative studies were meta-summarized, following Sandelowski and Barroso. Secondly, a list of preferred features of care from the perspective of older people was derived from the included studies' findings through inductive coding. Thirdly, the review findings were appraised using the GRADE-CERQual tool to determine the level of confidence in the qualitative evidence. The appraisal comprised four domains: methodological limitations, coherence, data adequacy, and data relevance. Two reviewers independently evaluated every review finding in each domain. The final appraisals were discussed and ultimately summarized for the respective review finding (high, moderate, low, or very low confidence). RESULTS The 22 qualitative studies included in the systematic review were mainly conducted in Northern and Western Europe (n = 15). In total, the studies comprised a sample of 330 participants (n = 5 to n = 42) with a mean or median age of 80 and over. From the studies' findings, 23 preferred features of ambulatory care were identified. Eight features concerned care relationships (e.g., "Older people wish to receive personal attention"), and 15 features concerned healthcare structures (e.g., "Older want more time for their care"). The findings emphasized that older people wish to build strong relationships with their care providers. The majority of the review findings reached a moderate or high confidence appraisal. CONCLUSIONS While the listed features of healthcare structures are common elements of care models for older people (e.g., Geriatric Care Model), aspects of care relationships are somewhat underrepresented or are not addressed explicitly at all. Future research should further explore the identified preferred features and their impact on patient and care outcomes.
Collapse
Affiliation(s)
- Angélique Herrler
- Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany.
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935, Cologne, Germany.
| | - Helena Kukla
- Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935, Cologne, Germany
| |
Collapse
|
11
|
Visiers‐Jiménez L, Palese A, Brugnolli A, Cadorin L, Salminen L, Leino‐Kilpi H, Löyttyniemi E, Nemcová J, Simão de Oliveira C, Rua M, Zeleníková R, Kajander‐Unkuri S. Nursing students' self-directed learning abilities and related factors at graduation: A multi-country cross-sectional study. Nurs Open 2022; 9:1688-1699. [PMID: 35156324 PMCID: PMC8994957 DOI: 10.1002/nop2.1193] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/11/2022] [Accepted: 01/30/2022] [Indexed: 11/06/2022] Open
Abstract
AIM To describe nursing students' level of self-directed learning abilities and identify possible factors related to it at graduation in six European countries. DESIGN A cross-sectional comparative design across the countries. METHODS The study was conducted from February 2018 to September 2019. Nursing students (N = 4,135) from the Czech Republic, Finland, Italy, Portugal, Slovakia and Spain were invited to respond to the research instruments (the Self-Rating Scale of Self-Directed Learning and the Nurse Competence Scale) at graduation. The data were analysed using the chi-square test, Pearson correlation coefficient and the linear model. RESULTS The nursing students' (N = 1,746) overall self-directed learning abilities were at high level in all countries. Statistically significant differences occurred between countries. Spanish nursing students reported the highest level of self-directed learning abilities while students from the Czech Republic reported the lowest. Higher level of self-directed learning abilities was related to several factors, particularly with the self-assessed level of competence and country.
Collapse
Affiliation(s)
- Laura Visiers‐Jiménez
- Department of Nursing ScienceFundación San Juan de DiosCentro de Ciencias de la Salud San RafaelUniversidad Antonio de NebrijaMadridSpain
| | - Alvisa Palese
- Department of Medical SciencesUniversity of UdineUdineItaly
| | - Anna Brugnolli
- Department of Public HealthAzienda Provinciale per i Servizi SanitariTrentoItaly
| | - Lucia Cadorin
- Department of Medical SciencesUniversity of UdineUdineItaly
| | - Leena Salminen
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Turku University HospitalUniversity of TurkuTurkuFinland
| | - Helena Leino‐Kilpi
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Turku University HospitalUniversity of TurkuTurkuFinland
| | | | - Jana Nemcová
- Department of Nursing ScienceJessenius Faculty of Medicine in MartinComenius University in BratislavaMartinSlovakia
| | | | - Marília Rua
- School of Health SciencesUniversity of AveiroAveiroPortugal
| | - Renáta Zeleníková
- Department of Nursing and MidwiferyFaculty of MedicineUniversity of OstravaOstravaCzech Republic
| | - Satu Kajander‐Unkuri
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Diaconia University of Applied SciencesHelsinkiFinland
| | | |
Collapse
|
12
|
Pierse T, Keogh F, Challis D, O'Shea E. Resource allocation in dementia care: comparing the views of people with dementia, carers and health and social care professionals under constrained and unconstrained budget scenarios. Aging Ment Health 2022; 26:679-687. [PMID: 33663288 DOI: 10.1080/13607863.2021.1889969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND People with dementia and their carers have a wide range of health and social care needs. People with dementia, carers and health and social care professionals (HSCPs) all have different perspectives on dementia care. Differences among these groups are important for commissioners of services and for front-line HSCPs. OBJECTIVE To compare the service recommendations of people with dementia and carers with those of HSCPs, under different budgetary conditions. METHODS A mixed-methods approach, which builds on the Balance of Care method, was used. Nine workshops were held with 41 participants from three groups: people with dementia, carers and HSCPs. Participants were asked to make decisions on a set of services for case types of dementia under two scenarios: a no budget constraint (NBC) scenario and a budget constraint (BC) scenario. RESULTS While each group allocated resources in broadly similar overall proportions, important differences in emphasis emerged: (i) people with dementia and carers placed more emphasis on psychosocial supports than HSCPs; (ii) carers put more emphasis on respite opportunities for carers; and (iii) carers identified residential care as the most suitable setting for the person with dementia more frequently than health care professionals. CONCLUSION Our findings suggest that the importance of psychosocial interventions, including counselling and peer support programmes, are currently underestimated by HSCPs. The provision of in-home respite is highly valued by carers. Even with unconstrained resources, some carers do not judge home care to be a viable option for dementia case types with high-level care needs.
Collapse
Affiliation(s)
- Tom Pierse
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
| | - Fiona Keogh
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
| | - David Challis
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
13
|
Larsson Gerdin A, Hellzén O, Rising-Holmström M. Nurses' experiences of encounters in home care: a phenomenological hermeneutic study. Int J Qual Stud Health Well-being 2021; 16:1983950. [PMID: 34633907 PMCID: PMC8525981 DOI: 10.1080/17482631.2021.1983950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE nurses working in home care often encounter patients with multiple diagnoses in unpredictable environments. This may cause ethical and emotional challenges and influence nurses' daily work. The aim of this study was to illuminate the meaning of nurses' lived experiences of encountering patients in home care. METHODS narrative interviews were conducted with 11 nurses. These interviews were audiotaped and transcribed verbatim and analysed using a phenomenological hermeneutic approach. FINDINGS the findings are presented under three main themes: (1)"Being receptive to the other" (with subthemes "Caring about the encounter," and "Establishing trusting relationships"). (2) "Need to handle Handling the unpredictable" (with subthemes "Being alone in the encounter" and "Being experienced and competent"). (3) "Managing frustration" (with subthemes "Feeling insufficient" and "Feeling restricted". Having overall nursing responsibility challenged the nurse's self-confidence in providing care trustfully. CONCLUSIONS encountering patients in home care means relating to the other unconditionally, which aim to highlight patients' needs. Being a nurse in home care is both emotionally demanding and rewarding. Having the courage to face their own and the patients' vulnerabilities will entail the promotion of natural receptivity and responsiveness to patients' needs.
Collapse
Affiliation(s)
| | - Ove Hellzén
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden
| | | |
Collapse
|
14
|
Herrler A, Kukla H, Vennedey V, Stock S. What matters to people aged 80 and over regarding ambulatory care? A systematic review and meta-synthesis of qualitative studies. Eur J Ageing 2021; 19:325-339. [PMID: 36052193 PMCID: PMC9424416 DOI: 10.1007/s10433-021-00633-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 04/23/2023] Open
Abstract
AbstractThe growing percentage of the population aged 80 and over is challenging for healthcare systems, as frailty and other complex health issues are common in this age group. In order to provide patient-centered ambulatory healthcare, their preferences and expectations need to be explored. Therefore, the aim of this study was to systematically search for and synthesize qualitative evidence on how people aged 80 and over believe ambulatory healthcare (medical and nursing care) should be delivered to them. Medline, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar were searched for full research reports of qualitative studies focusing on the preferences, wishes, needs, expectations and experiences of people aged 80 and over regarding ambulatory medical and nursing care. The results were screened by two independent reviewers using a two-step approach. The included studies were meta-synthesized using Thomas and Harden’s ‘thematic synthesis’ approach in order to gain a new, second-order interpretation of the findings of the primary studies. In the intermediate synthesis step, 14 aspects of healthcare structures and care relationships were identified as relevant. Based on these, three underlying wishes were found: feeling safe, feeling like a meaningful human being, and maintaining control and independence. The results of this review are in line with other research, such as reviews focusing on the preferences of the younger age group (65–80). However, the importance of aspects of care relationships as an integral part of favorable ambulatory healthcare and the wish to be strengthened as a meaningful human being are emphasized more strongly.
Collapse
|
15
|
Hoel KA, Rokstad AMM, Feiring IH, Lichtwarck B, Selbæk G, Bergh S. Person-centered dementia care in home care services - highly recommended but still challenging to obtain: a qualitative interview study. BMC Health Serv Res 2021; 21:723. [PMID: 34294078 PMCID: PMC8299610 DOI: 10.1186/s12913-021-06722-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is one of the main causes of disability and dependence in older people, and people with dementia need comprehensive healthcare services, preferably in their own homes. A well-organized home care service designed for people with dementia is necessary to meet their needs for health- and social care. Therefore, it is important to gain knowledge about how people with dementia experience the home care service and if the service responds to their wishes and needs. The aim of this study was to explore the experience of home care services among people with dementia, to understand the continuity in services, how the service was adapted to people with dementia, and how the patient experienced person-centered care and shared decision-making. METHODS We used a qualitative, exploratory design based on a phenomenological-hermeneutic approach and performed individual in-depth interviews with persons with dementia. A convenience sample of 12 persons with moderate to severe degrees of dementia from four Norwegian municipalities participated in the study. The interviews were conducted in February 2019. RESULTS The findings identified that the participants appreciated the possibility to stay safely in their own homes and mostly experienced good support from staff. They expressed various views and understanding of the service and experienced limited opportunities for user involvement and individualized, tailored service. The overall theme summarizing the findings was: "It is difficult for people with dementia to understand and influence home care services, but the services facilitate the possibility to stay at home and feel safe with support from staff." CONCLUSION The participants did not fully understand the organization of the care and support they received from the home care services, but they adapted to the service without asking for changes based on their needs or desires. Although person-centered care is recommended both nationally and internationally, the participants experienced little inclusion in defining the service they received, and it was perceived as unclear how they could participate in shared decision-making.
Collapse
Affiliation(s)
- Kari-Anne Hoel
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway.
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway.
| | - Anne Marie Mork Rokstad
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Hjorth Feiring
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Geir Selbæk
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sverre Bergh
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| |
Collapse
|
16
|
Claesson M, Josefsson K, Jonasson LL. 'My registered nurse': Older people's experiences of registered nurses' leadership close to them in community home care in Sweden. Int J Older People Nurs 2021; 16:e12399. [PMID: 34216188 DOI: 10.1111/opn.12399] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 01/10/2023]
Abstract
AIM To explore older people's experiences of registered nurses' leadership close to them in community home care. INTRODUCTION In Sweden and throughout the world, the number of people 65 years and older is increasing. While older people are living for more years, living longer can bring more diseases and disabilities, which might lead to the need for home care. Registered nurses are responsible for older people's care needs in their leadership in community home care; this is a part of their professional role as registered nurses, and it implies that they must be multi-artists. DESIGN An explorative and inductive design was used in two communities in western Sweden. METHODS Individual interviews were conducted with older people (n = 12) with at least one year of experience with community home care. Data were analysed using qualitative content analysis. RESULTS The results are presented in the theme 'my registered nurse', including five categories - relationship, professional competence, nursing interventions, coordination and collaboration and organisation - and 15 sub-categories. CONCLUSIONS These findings are based on older people's own experiences. This is specific, as the phenomenon of the RNs leadership is rarely explored from the perspective of older people. IMPLICATIONS FOR PRACTICE There is a need for organisations to create more opportunities for older people to have their own registered nurses leading close to them. This is because registered nurses have specific competences for meeting older people's individual needs and involving them as competent partners in satisfying their care needs.
Collapse
Affiliation(s)
- Maria Claesson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Karin Josefsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Lise-Lotte Jonasson
- Department of Nursing School of Health and Welfare, Jönköping University, Jönköping, Sweden
| |
Collapse
|
17
|
The needs of older people receiving home care: a scoping review. Aging Clin Exp Res 2021; 33:495-504. [PMID: 32086715 DOI: 10.1007/s40520-020-01505-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Most people in a state of illness or reduced self-sufficiency wish to remain in their home environment. Their physiological needs, and their psychological, social, and environmental needs, must be fully met when providing care in their home environment. The aim of this study is to provide an overview of the self-perceived needs of older people living with illness or reduced self-sufficiency and receiving professional home care. METHODS A scoping review of articles published between 2009 and 2018 was conducted by searching six databases and Google Scholar. Inductive thematic analysis was used to analyze data from the articles retrieved. RESULTS 15 articles were included in the analysis. Inductive thematic analysis identified six themes: coping with illness; autonomy; relationship with professionals; quality, safe and secure care; role in society; environment. CONCLUSION/DISCUSSION Older home care patients living with chronic illness and reduced self-sufficiency are able to express their needs and wishes. Care must, therefore, be planned in line with recipients' needs and wishes, which requires a holistic approach.
Collapse
|
18
|
Hoel KA, Rokstad AMM, Feiring IH, Lichtwarck B, Selbaek G, Bergh S. Staff's perspectives on the organization of homecare services to people with dementia-A qualitative study. Nurs Open 2021; 8:1797-1804. [PMID: 33626244 PMCID: PMC8186689 DOI: 10.1002/nop2.822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
Aims The aim of the study was to explore the experiences of homecare staff about the impact of the organization of homecare services for people with dementia. Design This study has a qualitative, exploratory design based on a phenomenological‐hermeneutic approach, using individual in‐depth interviews with homecare staff to collect data. Methods A convenience sample of 14 homecare staff from five municipalities participated in the study. Main topics introduced: (a) how homecare services for people with dementia are organized and (b) challenges in respondents' everyday practice of caring for people with dementia. Interviews were conducted from October to December 2017. Results Three main themes were identified from the interviews. (a) Complexity and need for individualized facilitated homecare services; homecare services were described as complex in regard to both the patient and the service. The complexity of the service made it challenging to tailor the service to the individual patient. (b) The importance of trust and relationships; establishing trust in the relationship between the patient and the staff resulted in better‐quality care. This was crucial for identifying the patient's need for help. (c) Organizational challenges; homecare services could be vulnerable to changes in the organization. Practical tasks and following the daily scheduled task list were often prioritized at the expense of an individually tailored service.
Collapse
Affiliation(s)
- Kari-Anne Hoel
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Anne Marie Mork Rokstad
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway.,Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| | - Ingvild Hjorth Feiring
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Geir Selbaek
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sverre Bergh
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway.,The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway
| |
Collapse
|
19
|
Härkänen M, Franklin BD, Murrells T, Rafferty AM, Vehviläinen-Julkunen K. Factors contributing to reported medication administration incidents in patients' homes - A text mining analysis. J Adv Nurs 2020; 76:3573-3583. [PMID: 33048380 PMCID: PMC7702090 DOI: 10.1111/jan.14532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/03/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients' own homes (reporters' profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. DESIGN A retrospective study using descriptive statistical analysis and text mining. METHODS Medication administration incidents (N = 19,725) reported to have occurred in patients' homes between 2013-2018 in one district in Finland were analysed, describing the data by the reporters' occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. RESULTS Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was 'mild harm' (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were 'communication and flow of information' (25.5%, N = 5,038), 'patient and relatives' (22.6%, N = 4,451), 'practices' (9.9%, N = 1,959), 'education and training' (4.8%, N = 949), and 'work environment and resources' (3.0%, N = 598). CONCLUSION There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. IMPACT These findings about MA incidents that have occurred in patients' homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.
Collapse
Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College London Healthcare NHS Trust, London, UK.,UCL School of Pharmacy, London, UK
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
20
|
Höglander J, Eklund JH, Spreeuwenberg P, Eide H, Sundler AJ, Roter D, Holmström IK. Exploring patient-centered aspects of home care communication: a cross-sectional study. BMC Nurs 2020; 19:91. [PMID: 33013200 PMCID: PMC7526395 DOI: 10.1186/s12912-020-00483-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Communication is a cornerstone in nursing and aims at both information exchange and relationship building. To date, little is known about the naturally occurring communication between older persons and nurses in home care. Communication might heal through different pathways and a patient- or person-centered communication could be important for health and well-being of older persons. However, the delivery of individualized home care is challenged by routines and organizational demands such as time constraints. Therefore, the aim of this study was to explore the patient-centered aspects of home care communication between older persons and registered nurses. Methods In total 37 older persons (aged 65 years or older) and eleven RNs participated in 50 audio-recorded home care visits. Roter Interaction Analysis System (RIAS) was used to code verbal communication. A ratio from these codes, establishing the degree of patient-centeredness, was analyzed using a Generalized Linear Mixed Model. Results The present home care communication contained more socio-emotional than task-oriented communication and the emotional tone was largely positive. The global affect ratings reflected an overall positive tone (m = 39.88, sd = 7.65), with higher ratings on dimensions of, for example, responsiveness/engagement and interactivity or interest were more frequent than those that may be considered as less-positive emotions (m = 15.56, sd = 3.91), e.g. hurried, dominance or anger. The ratio of the degree of patient-centered communication in the home care visits was an average of 1.53, revealing that the communication could be considered as patient-centered. The length of the visits was the only characteristic significantly associated with the degree of patient-centeredness in the communication, with a peak in patient-centeredness in visits 8–9 min long. Sex, age or procedural focus showed no significant effects on the degree of patient-centeredness. Conclusion Overall, the degree of patient-centeredness and a positive emotional tone, which might have a positive outcome on older persons’ health, was high. Longer visits provided a higher degree of patient-centeredness, but no linear increase in patient-centeredness due to length of visit could be observed. The findings can be used for education and training of nurses, and for providing individualized care, e.g. patient- or person-centered care.
Collapse
Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden
| | - Jakob Håkansson Eklund
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Debra Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
21
|
Moth G, Binderup AT. Community-based homecare nursing in Denmark: exploring factors related to substitution of nurses by ancillary health professionals. Scand J Caring Sci 2020; 35:559-566. [PMID: 32434286 DOI: 10.1111/scs.12871] [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: 08/23/2019] [Revised: 03/03/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Demographic changes and shorter hospital stays have made community-based homecare nursing an increasingly important part of the healthcare organisation. This development may also impact the secondary healthcare system. Optimal use of resources is key to meeting the future challenges. Nevertheless, the research-based knowledge on homecare nursing is scarce. The aim of this study was to examine factors related to homecare nursing tasks that could have been performed by ancillary health professionals. METHODS A population-based survey involving all homecare nurses in the homecare services in one municipality in Denmark was performed. The nurses registered all contacts during daytime for one week using a registration form with a series of items to identify factors related to possible substitution of nurse-performed tasks. Statistical analyses were used to identify associations between specific factors and potential substitution of the performing type of healthcare professional. The study was approved by and is registered at VIA University College in accordance with the General Data Protection Regulation of the EU. RESULTS Homecare nurses registered 941 representative visits in the municipality. Substitution by ancillary health professionals was considered a possibility by the nurses in 28.3% of the cases. When adjusting for age, gender, type of visit, need for extra healthcare services and vulnerability, we established that the nurses more often found that ancillary health professionals could have provided the care in unplanned visits and in visits to patients above 90 years of age. CONCLUSIONS The results indicate potential for optimising the available nursing resources as substitution by ancillary health professionals was considered possible in numerous visits. In view of the increasing demands for community-based homecare nursing, it is important to make the most of the available resources in the future. Substitution of nurses for some tasks could be a feasible solution.
Collapse
Affiliation(s)
- Grete Moth
- Program for Health Technology, Methodology Development and Ethics, VIA Research Centre for Health and Welfare Technology, VIA University College, Denmark.,Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Asbjørn Thalund Binderup
- Program for Health Technology, Methodology Development and Ethics, VIA Research Centre for Health and Welfare Technology, VIA University College, Denmark
| |
Collapse
|
22
|
How smart medication systems are used to support older people's drug regimens: A systematic literature review. Geriatr Nurs 2020; 41:677-684. [PMID: 32192722 DOI: 10.1016/j.gerinurse.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/17/2022]
Abstract
Smart medication systems are used to help older people, and the professionals and family who care for them, to organize and manage their daily drug regimes. However, synthetized knowledge on previous studies about how these improve everyday life is needed. We searched the PubMed, Scopus, CINAHL, PsycINFO, SocINDEX and Cochrane library databases from 2005 to 2019 and this review focused on nine of the 2,424 papers we identified. According to our analysis, smart medication systems make it possible to regulate medication times and doses and detect medication errors. With further development, smart medication systems could be more be effective at preventing medication errors, improving medication adherence by older people and freeing up healthcare professional, so that they can focus on other tasks. However, more research on different systems is needed to improve existing solutions and to understand how they can make older people more independent when it comes to their daily medication.
Collapse
|
23
|
Creating conditions for a sense of security during the evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study. BMC Geriatr 2019; 19:351. [PMID: 31842776 PMCID: PMC6915921 DOI: 10.1186/s12877-019-1372-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge. METHODS This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data. RESULTS Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person's identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other's conditions. The person's self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed. CONCLUSION Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people's self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing.
Collapse
|
24
|
Olsen CF, Bergland A, Debesay J, Bye A, Langaas AG. Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-A meta-synthesis of qualitative studies. PATIENT EDUCATION AND COUNSELING 2019; 102:1991-2000. [PMID: 31160128 DOI: 10.1016/j.pec.2019.05.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim of this article was to synthesize research findings about health care providers' experiences of patient-centered care in the home setting. METHODS This is a meta-synthesis of qualitative findings using the analytical method of meta-ethnography developed by Noblit and Hare. We performed a systematic literature search in seven databases and assessed potential studies against eligibility criteria and quality. Subsequently, 10 primary studies were included for analysis. RESULTS The core theme "being a balance artist" emerged from the synthesis, incorporating the participants' experiences when faced with conflicting and competing responsibilities and needs. Two subthemes-"balancing the older clients' needs against organizational demands" and "balancing the older clients' needs against professional standards"-further elaborated on this core theme. CONCLUSION Health care providers' experiences indicate that organizational factors play a crucial role in shaping the conditions for patient-centered care for older people in the home setting. PRACTICE IMPLICATIONS To motivate and facilitate health care providers to move to a more patient-centered practice, it is important to expand the values of patient-centered care beyond the clinical encounter into the organization.
Collapse
Affiliation(s)
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Anne G Langaas
- Department of Physiotherapy, OsloMet- Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
25
|
Martinsen B, Mortensen AS, Norlyk A. Nordic homecare nursing from the perspective of homecare nurses-a meta-ethnography. Br J Community Nurs 2019; 23:597-604. [PMID: 30521386 DOI: 10.12968/bjcn.2018.23.12.597] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pressure on homecare nursing in the Nordic countries has increased in recent years because of a reorganisation of healthcare systems that has put a focus on very early discharge from hospital as well as demographic changes. This article details an analysis of the findings of 13 published qualitative research reports about Nordic homecare nurses' experiences of their work. Using a process of meta-ethnography, the authors identify five themes within the primary research: home care as a professional practice on foreign ground; home care as a massive time constraint; home care as fair rationing; home care as relationships with relatives as fellow players or opponents; and home care as latent paternalism. These have two main implications for practice: homecare nurses should continuously be taught how to cooperate with partners who are emotionally involved; and also homecare nurses may benefit from training that focuses on the challenges of carrying out professional work in private settings.
Collapse
Affiliation(s)
- Bente Martinsen
- Associate Professor, Department of Public Health, Aarhus University, Denmark
| | | | - Annelise Norlyk
- Associate professor, Study director, Aarhus University, Department of Public Health, Denmark
| |
Collapse
|
26
|
Turjamaa R, Pehkonen A, Kangasniemi M. How smart homes are used to support older people: An integrative review. Int J Older People Nurs 2019; 14:e12260. [DOI: 10.1111/opn.12260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/29/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Riitta Turjamaa
- School of Health Care Kuopio Savonia University of Applied Sciences Kuopio Finland
- Department of Nursing Science, Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Aki Pehkonen
- Department of Nursing Science, Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine University of Turku Turku Finland
| |
Collapse
|
27
|
Wergeland Sørbye L, Steindal SA, Kalfoss MH, Vibe OE. Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018. Health Serv Insights 2019; 12:1178632919834318. [PMID: 31043789 PMCID: PMC6446440 DOI: 10.1177/1178632919834318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/16/2019] [Indexed: 11/16/2022] Open
Abstract
In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer- and cardiovascular diagnoses were the strongest predictor for using morphine (P < 0.05). Identification of the residents' needs for opioids is a challenge for palliative care nurses, both ethically and legally.
Collapse
Affiliation(s)
| | | | - Mary H Kalfoss
- Faculty of Health, VID Specialized University, Oslo, Norway
| | | |
Collapse
|
28
|
Scheffelaar A, Hendriks M, Bos N, Luijkx K, van Dulmen S. Protocol for a participatory study for developing qualitative instruments measuring the quality of long-term care relationships. BMJ Open 2018; 8:e022895. [PMID: 30504491 PMCID: PMC6278792 DOI: 10.1136/bmjopen-2018-022895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In long-term care (LTC), it is unclear which qualitative instruments are most effective and useful for monitoring the quality of the care relationship from the client's perspective. In this paper, we describe the research design for a study aimed at finding and optimising the most suitable and useful qualitative instruments for monitoring the care relationship in LTC. METHODS AND ANALYSIS The study will be performed in three organisations providing care to the following client groups: physically or mentally frail elderly, people with mental health problems and people with intellectual disabilities. Using a participatory research method, we will determine which determinants influence the quality of a care relationship and we will evaluate up to six instruments in cooperation with client-researchers. We will also determine whether the instruments (or parts thereof) can be applied across different LTC settings. ETHICS AND DISSEMINATION This study protocol describes a participatory research design for evaluating the quality of the care relationship in LTC. The Medical Ethics Committee of the Radboud University Nijmegen Medical Centre decided that formal approval was not needed under the Dutch Medical Research Involving Human Subjects Act. This research project will result in a toolbox and implementation plan, which can be used by clients and care professionals to measure and improve the care relationship from the client's perspective. The results will also be published in international peer-reviewed journals.
Collapse
Affiliation(s)
- Aukelien Scheffelaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Michelle Hendriks
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Nanne Bos
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Katrien Luijkx
- Tranzo Academic Centre for Transformation in Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| |
Collapse
|
29
|
Megaritis C, Sakellari E, Psychogiou M, Tzenalis A, Krepia V, Charalambous G, Sapountzi-Krepia D. Exploring home care nurses' perceptions regarding their services in economic crisis: A qualitative approach. Nurs Forum 2018; 53:521-528. [PMID: 29968259 DOI: 10.1111/nuf.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article explores the home care nurses' perceptions on the services they provide in Cyprus, which has been hit by a financial crisis. Semistructured interviews were conducted in Greek at the home care nurses' offices. Data were analyzed using qualitative content analysis. The participants' perceptions are described in terms of provision of home care nursing, administration of homecare nursing, job satisfaction, financial issues, and suggesting improvements. The financial crisis influences the home care services with regard to workload increase, staff shortage, and lack of resources. Home care nurses are well engaged in the provision of proper services in order to address the patients' needs. However, the financial crisis has set obstacles in the provision of care.
Collapse
Affiliation(s)
| | - Evanthia Sakellari
- Department of Public and Community Health, University of West Attica, Athens, Greece
| | - Maria Psychogiou
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Vassiliki Krepia
- School of Human Movement and Quality of Life Sciences, Faculty of Nursing, University of Peloponnese, Sparta, Greece.,Sismanogleion Hospital of Attica, Marousi, Greece
| | | | | |
Collapse
|
30
|
Rantanen T, Lehto P, Vuorinen P, Coco K. The adoption of care robots in home care-A survey on the attitudes of Finnish home care personnel. J Clin Nurs 2018; 27:1846-1859. [DOI: 10.1111/jocn.14355] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Paula Lehto
- Laurea University of Applied Sciences; Espoo Finland
| | | | - Kirsi Coco
- Tehy; Helsinki Finland
- University of Eastern Finland; Kuopio Finland
| |
Collapse
|
31
|
Sørbye LW, Sverdrup S, Pay BB. Should frail older adults be in long-term care facilities? J Multidiscip Healthc 2018; 11:99-107. [PMID: 29440911 PMCID: PMC5799852 DOI: 10.2147/jmdh.s155372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIM Home-based nursing care is relatively easy to access in Norway compared to the rest of Europe, and the threshold for applying for assistance is relatively low. The aim of the present study was to analyze factors that enable frail older adults to live in their own homes, with a low level of care burden stress. METHODOLOGY In 2015 and 2016, eight municipalities from different parts of Norway participated in a cross-sectional study. The quantitative part of the project consisted of assessing care of 71 older adults, aged ≥80 years, using a geriatric comprehensive assessment. The qualitative part consisted of semistructured telephone interviews with 14 leaders of nursing homes and home-based nursing care and interviews with 26 close relatives. RESULTS In this sample, 60% of the older adults were living alone, and 79% were at risk of permanent nursing home admission; 31% stated that they would be better-off at a higher caring level, mainly due to living alone. The relatives, their resources, and motivation to provide care seemed to be crucial for how long older adults with heavy care burden could stay at home. The municipalities offered a combination of comprehensive home care, day centers, and revolving short-term stays to enable them to live at home. CONCLUSION The results reveal that the need for home care services is steadily increasing. The relatives are coping with the physical care, far better than the uncertainties and worries about what could happen when the older adults stay alone. The number of beds in institutional care in each municipality depends on various factors, such as the inhabitants' life expectancy, social aspects, geography, well-functioning eldercare pathways, competence of the health professionals, and a well-planned housing policy.
Collapse
Affiliation(s)
| | - Sidsel Sverdrup
- Institute of Nursing and Health, VID Specialized University, Oslo, Norway
| | | |
Collapse
|
32
|
Hansen A, Hauge S, Bergland Å. Meeting psychosocial needs for persons with dementia in home care services - a qualitative study of different perceptions and practices among health care providers. BMC Geriatr 2017; 17:211. [PMID: 28893181 PMCID: PMC5594550 DOI: 10.1186/s12877-017-0612-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background The majority of persons with dementia are home-dwelling. To enable these persons to stay in their own homes as long as possible, a holistic, individual and flexible care is recommended. Despite a requirement for meeting psychological, social and physical needs, home care services seem to focus on patients’ physical needs. Accordingly, the aim of this study was to explore how the psychosocial needs of home-dwelling, older persons with dementia were perceived, emphasized and met by home care services. Methods A descriptive, qualitative approach was used. Data were collected through semi-structured focus group interviews with 24 health care providers in home care services from four municipalities. Data were analysed using systematic text condensation. Results This study showed major differences in how health care providers perceived the psychosocial needs of older home-dwelling persons with dementia and how they perceived their responsibilities for meeting those psychosocial needs. The differences in the health care providers’ perceptions seemed to significantly influence the provided care. Three co-existing logics of care were identified: the physical need-oriented logic, the renouncement logic and the integrated logic. Conclusions The differences in how health care providers perceived the psychosocial needs of persons with dementia and their responsibilities for meeting those needs, influenced how the psychosocial needs were met. These differences indicates a need for a clarification of how psychosocial needs should be conceptualized and who should be responsible for meeting these needs. Further, increased competence and increased consciousness of psychosocial needs and how those needs can be met, are essential for delivering high-quality holistic care that enables persons with dementia to live in their own home for as long as possible. Electronic supplementary material The online version of this article (10.1186/s12877-017-0612-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anette Hansen
- University College of Southeast Norway, Faculty of Health and Social Sciences and Centre for Care Research, Postbox 235, 3603, Kongsberg, Norway.
| | - Solveig Hauge
- University College of Southeast Norway, Faculty of Health and Social Sciences and Centre for Care Research, Postbox 235, 3603, Kongsberg, Norway
| | - Ådel Bergland
- Department of Nursing Science and Lovisenberg Diaconal University College, Institute of Health and Society, University of Oslo, Lovisenberggaten 15b, 0456, Oslo, Norway
| |
Collapse
|
33
|
Mei H, Turale S. Coping experience of health concerns and physical disability for older Chinese people: A qualitative, descriptive study. Nurs Health Sci 2017; 19:444-451. [PMID: 28752946 DOI: 10.1111/nhs.12363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 03/31/2017] [Accepted: 04/17/2017] [Indexed: 11/27/2022]
Abstract
In this qualitative, descriptive study, we explored the perspectives of older, community-dwelling Chinese people regarding their experiences of coping with a physical disability and their health concerns. Twenty participants were interviewed in-depth, and data were analyzed using content analysis. Five themes with 13 subthemes emerged that described older people's experiences of coping with health concerns and disability: (i) ignoring health concerns; (ii) managing self; (iii) seeking medical help; (iv) living with physical disability; and (v) relying on limited resources. Most participants did not have sufficient access to health services due to physical disability and financial deficits, so they tended to ignore their health conditions or tackle them independently before seeking medical help. At the same time, they were impacted on by social and cultural factors. Policies are required that offer more resources to community-dwelling people with disabilities in China.
Collapse
Affiliation(s)
- He Mei
- HOPE School of Nursing, Wuhan University, Wuhan, China
| | - Sue Turale
- HOPE School of Nursing, Wuhan University, Wuhan, China
| |
Collapse
|
34
|
Höglander J, Eklund JH, Eide H, Holmström IK, Sundler AJ. Registered Nurses' and nurse assistants' responses to older persons' expressions of emotional needs in home care. J Adv Nurs 2017; 73:2923-2932. [PMID: 28586520 DOI: 10.1111/jan.13356] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/11/2017] [Accepted: 05/23/2017] [Indexed: 01/12/2023]
Abstract
AIM This study aims to explore nurse assistants' and Registered Nurses' responses to older persons' expressions of emotional needs during home care visits. BACKGROUND Communication is a central aspect of care. Older persons might express different emotions and needs during home care visits and such expressions can be challenging to respond to. Little is known about communication in home care or nursing staff responses to older persons' expressed emotional needs. DESIGN Descriptive, cross-sectional design on nursing staff responses to older persons' negative emotions in home care. METHODS Collected data consisted of audio recordings of home care visits between older persons and nursing staff. Data were collected between August 2014-November 2015. The nursing staff responses to older persons' negative emotions in the communication were analysed with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). RESULTS The nursing staff most often give non-explicit responses, providing space for further disclosure of older persons' expressed negative emotions. Such responses were more frequent if the nursing staff had elicited the older persons' expressions of a negative emotion than if such expressions were elicited by the older persons themselves. Most frequent types of responses were backchannel, active invitation or information advice. CONCLUSION The nursing staff responses were mainly non-explicit responses providing space for older persons to tell more about their experiences. Such responses can be discussed in terms of person-centred communication and is important for the comfort of emotional concerns.
Collapse
Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | | | - Hilde Eide
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| |
Collapse
|
35
|
Berland A, Bentsen SB. Medication errors in home care: a qualitative focus group study. J Clin Nurs 2017; 26:3734-3741. [PMID: 28152226 DOI: 10.1111/jocn.13745] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore registered nurses' experiences of medication errors and patient safety in home care. BACKGROUND The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. DESIGN An exploratory qualitative design with focus group interviews was used. METHODS Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. RESULTS Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. CONCLUSION Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. RELEVANCE TO CLINICAL PRACTICE To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications.
Collapse
Affiliation(s)
- Astrid Berland
- Department of Health Education, Stord/Haugesund University College, Haugesund, Norway
| | | |
Collapse
|
36
|
Effects and meanings of a person-centred and health-promoting intervention in home care services - a study protocol of a non-randomised controlled trial. BMC Geriatr 2017; 17:57. [PMID: 28209122 PMCID: PMC5314690 DOI: 10.1186/s12877-017-0445-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/08/2017] [Indexed: 11/12/2022] Open
Abstract
Background The literature indicates that current home care service are largely task oriented with limited focus on the involvement of the older people themselves, and studies show that lack of involvement might reduce older people’s quality of life. Person-centred care has been shown to improve the satisfaction with care and quality of life in older people cared for in hospitals and nursing homes, with limited published evidence about the effects and meanings of person-centred interventions in home care services for older people. This study protocol outlines a study aiming to evaluate such effects and meanings of a person-centred and health-promoting intervention in home aged care services. Methods/design The study will take the form of a non-randomised controlled trial with a before/after approach. It will include 270 older people >65 years receiving home care services, 270 relatives and 65 staff, as well as a matched control group of equal size. All participants will be recruited from a municipality in northern Sweden. The intervention is based on the theoretical concepts of person-centredness and health-promotion, and builds on the four pedagogical phases of: theory apprehension, experimental learning, operationalization, and clinical supervision. Outcome assessments will focus on: a) health and quality of life (primary outcomes), thriving and satisfaction with care for older people; b) caregiver strain, informal caregiving engagement and relatives’ satisfaction with care: c) job satisfaction and stress of conscience among care staff (secondary outcomes). Evaluation will be conducted by means of self-reported questionnaires and qualitative research interviews. Discussion Person-centred home care services have the potential to improve the recurrently reported sub-standard experiences of home care services, and the results can point the way to establishing a more person-centred and health-promoting model for home care services for older people. Trial registration NCT02846246.
Collapse
|