Resident and family member perceptions of cultural diversity in aged care homes

Seeking residents' views regarding Australian residential aged care: A scoping review

OBJECTIVE

This scoping review aimed to explore topics on which the views of residents of Australian residential aged care facilities (RACFs) have been sought.

METHODS

Scoping review methodology as outlined by Arksey and O'Malley was used to identify, explore and report on the range of literature regarding views of RACF residents. Seven electronic databases were searched using broad search terms relevant to the RACF context. Descriptive numerical analysis was completed for publication year, journal name and target profession, research methods and participant types. Thematic analysis then focussed on the aims of the included studies.

RESULTS

Four thousand two hundred and ninety studies were screened, and 104 publications met the inclusion criteria. A broad range of topics were explored by researchers, with the largest number of papers focused on residents' views of systems within RACFs (n = 24) and new programs and interventions (n = 21). Smaller topic areas included health conditions and health-care services (n = 13), socialisation (n = 13), physical activity (n = 3), self-care (n = 4), leisure (n = 4), general everyday life (n = 20) and aspects of the residential aged care environment (n = 15). There was limited exploration of meaningful activity (n = 13). The inclusion of residents with cognitive impairment was inconsistent, and the voices of other stakeholders were often privileged.

CONCLUSION

Voices of residents must be heard in order to prioritise the health and well-being of this population. More research which focuses on what is important to residents is needed and must include residents with cognitive impairment more effectively. Identification of optimal research methods with this population would make an important contribution in this area.

The needs of older people with dementia from culturally and linguistically diverse backgrounds living in residential aged care: An integrative review

AIMS AND OBJECTIVES

To synthesise information about the needs of older people with dementia from culturally and linguistically diverse backgrounds living in residential aged care from the perspectives of the residents, families and care staff.

BACKGROUND

Older people with dementia from culturally and linguistically diverse backgrounds living in residential aged care have care needs that are complex. Identifying these needs is critical to ensure quality care is delivered.

DESIGN

An integrative review of literature.

METHODS

Five databases were searched for relevant articles: APA PsychINFO, CINAHL, MEDLINE, Scopus and Google Scholar. The search and screening were guided by PRISMA guidelines and Whittemore and Knafl's five-step framework.

RESULTS

Fifteen papers were included in this review consisting of 4 quantitative, 9 qualitative and 2 mixed method studies. Two themes described the needs of older people with dementia from culturally and linguistically diverse backgrounds living in residential aged care. The first was related to culture-specific needs, and the second was related to dementia-specific care needs. Culture-specific needs comprised of three subthemes: (a) common language, (b) traditional food, and (c) social and spiritual requirements. Dementia-specific needs comprised of (a) focusing on comfort in addition to clinical requirements and (b) individualised care that addresses behavioural symptoms of dementia.

CONCLUSIONS

Identifying and meeting the needs of older people with dementia from culturally and linguistically diverse backgrounds will improve quality care delivery in addition to increased caregiving satisfaction among residents, families and care staff, and the management of behaviours that characterise dementia.

RELEVANCE TO CLINICAL PRACTICE

Care needs of older people with dementia from culturally and linguistically diverse backgrounds living in the residential setting can be complex. Education and training of care staff including nurses must be considered so that provision of care is inclusive of the cultural and dementia needs for older people in residential aged care.

Caring behaviours of culturally diverse personal care attendants from the perspective of older people living in residential aged care settings

This study aimed to determine whether older residents perceive differences in the care they receive from personal care attendants (PCAs) of similar cultural backgrounds versus those from other cultural backgrounds. The challenges encountered when receiving care from culturally diverse PCAs were also explored. A directed qualitative content analysis approach was utilised. Results showed that PCAs' personalities were perceived to have a greater impact on all aspects of care delivery than their cultural backgrounds. PCAs from other cultural backgrounds were also perceived to be more observant, pleasant, and sociable than their local counterparts, despite the communication challenges due to their limited English proficiency. This study indicates that migrant PCAs can significantly contribute to addressing workforce shortages in the aged care industry without compromising care quality, but it also highlights the need for long-term strategies to improve meaningful interaction between culturally diverse PCAs and residents and foster a positive work environment.

Residents' experiences of encounters with staff and communication in nursing homes during the Covid-19 pandemic: a qualitative interview study

BACKGROUND

The Covid-19 pandemic and associated visiting restrictions have challenged communication with others for older people residing in nursing homes.

AIM

The aim of this study was to explore residents' experiences of encounters and communication with staff and relatives and friends during the Covid-19 pandemic.

DESIGN

An exploratory study with an inductive approach.

METHODS

Semi-structured telephone interviews with 16 Swedish nursing home residents were conducted. Data were analyzed using qualitative content analysis; the study reports according to the COREQ checklist.

RESULTS

Three main categories emerged: (1) Mixed feelings and experiences of encounters with nursing staff, (2) Adapting to hampered communication and finding strategies to overcome language barriers, and (3) Facing pandemic restrictions and living an adjusted life. Nine subcategories are reported within these categories. Residents mainly reported good encounters with staff and receiving the care they needed, but unhelpful encounters were also reported. To manage communication with staff with limited Swedish language skills, residents developed several strategies. During the visiting ban, residents felt secure but also lonely. Staying connected with the outside world required residents to use the phone and handle other digital aids, such as video calls, but lack of technical skills among staff hindered frequent use of video calls.

CONCLUSION

This study highlights how residents can feel safe in extreme situations, but increased competence, including digital literacy and language skills, among staff is required. Care providers should provide relevant information to residents and staff and employ competent staff. Findings indicate that communication plans need to include enabling communication for residents both within and outside nursing homes, taking staff language skills into consideration.

Relatives' perspectives on encounters and communication in nursing homes during the Covid-19 pandemic: a qualitative interview study

Background

Relatives of nursing home (NH) residents have experienced national or local restrictions on visiting their elderly family member during the Covid-19 pandemic. Today, many NHs have a multicultural environment, as staff, residents and their relatives speak different languages. Thus far, studies of remote communication with staff with limited language skills during the Covid-19 pandemic are lacking.

Aim

The aim of the present study was to explore relatives’ experiences of encounters and communication with staff and residents in NHs during the Covid-19 pandemic.

Method

An explorative qualitative study using semi-structured telephone interviews with 17 relatives of NH residents (12 women and 5 men). Data were analyzed using qualitative content analysis to identify four main categories and nine sub-categories.

Results

Communicating during visiting restrictions was challenging, and relatives experienced ups and downs when trying to stay in contact with NH residents and staff. Relatives received general information, but desired information about residents’ everyday life without having to ask for it. Moreover, remote communication was difficult for residents with hearing impairment or dementia. Even relatives who understood different languages had to develop strategies to communicate with staff with limited language skills in Swedish and English. Relatives did not mention using translating applications to facilitate communication.

Conclusion

During visiting restrictions, relatives lacked information about residents’ everyday life and found communication with staff with limited language skills challenging. For this reason, and to enable communication with staff with limited language skills, there is a need to find practical and technical solutions for facilitating remote communication between relatives, residents and staff at NHs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03364-1.

Influence of Diversity Nursing on Patients' Rehabilitation in Cardiology Treatment

With the improvement of living standards, people have more and more physical health problems. Among them, high-risk cardiovascular diseases such as hypertension, diabetes, and coronary heart disease are the most prominent. The number of cardiology patients is increasing year by year. Effectively improving the treatment of cardiology patients and speeding up the recovery of cardiology patients have become a social problem. This article aims to explore the impact of diverse nursing care on patients in cardiology treatment. This article first gives a detailed introduction to the treatment of diverse nursing and cardiology diseases, then takes 300 cardiology patients in our hospital as experimental subjects, and conducts a controlled experiment of nursing intervention, which is categorized into an experimental group of 150 cases (including 35 cases of hypertension, 46 cases of diabetes, 28 cases of coronary heart disease, 24 cases of angina pectoris, and 17 cases of multiple complications) and a control group of 150 cases (including 30 cases of hypertension, 47 cases of diabetes, 39 cases of coronary heart disease, 21 cases of angina pectoris, and 13 cases of multiple complications). The experimental results showed the following: the general information of the two groups of patients was not statistically different (P > 0.05); after the nursing intervention, the blood glucose levels of the two groups of patients decreased, but the experimental group decreased more significantly and the blood glucose control effect was more obvious; after the intervention, in the experimental group that implemented diversified nursing interventions, the patient's condition management effect was better and their scores were between 8 and 10; the mental state self-evaluation of the two groups of patients was significantly different from the domestic reference value (P < 0.05), and there is a very significant statistical difference between the two groups after nursing intervention (P < 0.01); after nursing intervention, compared with the control group, the quality of life of the experimental group improved more significantly and the highest score reached about 70; the overall satisfaction of the experimental group with nursing work reached 92%, while the satisfaction of the control group with nursing work was only 44.67%. Studies have shown that diversified care has a positive impact on the rehabilitation of patients in cardiology treatment.

Optimising social conditions to improve autonomy in communication and care for ethnic minority residents in nursing homes: A meta-synthesis of qualitative research

A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident population have been widely reported. This systematic review aimed to explore social conditions affecting ethnic minority residents' ability to exercise their autonomy in communication and care while in nursing homes. In total, 19 studies were included in the review. Findings revealed that ethno-specific nursing homes create the ideal social condition for residents to express their care needs and preferences in a language of choice. In nonethno-specific nursing homes, staff cultural competence and nursing home commitment to culturally safe care are crucial social conditions that enable this group of residents to fulfil their autonomy in communicating and in participating in their care. In contrast, social conditions that undermine residents' ability to express their care needs and preferences include low levels of staff cultural awareness and cultural desire, negative attitudes towards residents and limited organisational support for staff to improve culturally responsive and culturally safe care. In conclusion, it is important to optimise the social conditions to support ethnic minority residents to communicate their care needs and preferences.

A critical realist evaluation of advance care planning in care homes

AIMS

To evaluate care planning in advance of end-of-life care in care homes.

DESIGN

A qualitative study.

METHODS

Qualitative data were collected from January 2018-July 2019 (using focus groups and semi-structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation.

RESULTS

Participants comprised of registered nurses (N = 4), care assistants (N = 8), bereaved relatives (N = 7), and domiciliary staff (N = 3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non-registered care home staff and those with non-formal caring roles such as housekeeping.

CONCLUSION

There is a need for more focused education to support registered and non-registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change.

IMPACT

Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high-quality end-of-life care in care homes.

The adaptation of older adults' transition to residential care facilities and cultural factors: a meta-synthesis

Background

The transition to residential care facilities can be stressful for older people, entailing numerous challenges. Many qualitative studies focused on the adjustment and the experiences associated with older adults’ admission to residential care facilities. However, there have been few studies to synthesize qualitative studies and pay attention to the cultural factors influencing adaptation. The aim is to appraise the adaptation of older people’ s transition to the residential care facilities.

Methods

We followed the method of Preferred Reporting Items of Systematic Review and Meta-Analysis (PRISMA). Six databases (CINHAL, Cochrane, Embase, Pubmed, PsycInfo, and Web of Science) were searched systematically from their inception until April 2020 using Medical Subject Headings (MSH) or Subject Headings plus free-text words. The CASP evaluation for qualitative studies was used for quality appraisal and meta-aggregation was used in the data analysis.

Results

Ten studies (from 7 countries on 3 continents) were included in this review. We synthesized two main findings: the impacts of culture on adaptation and the transition process.

Conclusions

Understanding the cultural factors helps nursing staff to gain new insight into older adults’ transition to residential care facilities. The consideration of cultural factors might be incorporated into tailored interventions for residents during transition. Nursing staff is advised to pay attention to the decision-making process before residents’ admission to the residential care facilities, and care plans are best made by residents, family members, and staff members together at the beginning of the decision-making process.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01987-w.

The experiences of the process of planning, starting and organizing a culturally specific nursing home for Finnish-speaking older persons: a qualitative study

BACKGROUND

Globally there are growing multicultural and multilingual societies. As a result of extensive international migration, the number of elderly migrants has increased and will further increase in the future. This makes it necessary for elderly healthcare services to meet elderly migrants' healthcare needs concerning language and cultural barriers. To our knowledge, previous research in the area of culturally specific nursing homes for migrant seniors is still limited. Thus, the study aimed to investigate the experiences of planning, starting and organizing a culturally specific nursing home for Finnish-speaking older persons.

METHODS

An explorative qualitative study using both semi-structured individual interviews and focus group interviews as data collection. Thirteen informants were purposively recruited, two from Finnish-speaking association, seven healthcare professionals and two family members. Data were analysed by qualitative content analysis.

RESULTS

Three categories, each with sub-categories, emerged from the data: 1) Motivation to develop this particular culture-specific nursing home; 2) Organizational issues and 3) Aspirations for the future. The study found that information from policy makers, the localization and activities of the nursing home, having healthcare staff who speak the minority language, organizing the nursing home as a mixture of older members of both the majority and the minority communities, all affected the planning, starting and organization of a culturally specific nursing home.

CONCLUSION

This study found that information, localization, activities and language adapted to elderly migrants affected the planning, starting and organization of a culturally specific nursing home for Finnish-speaking older persons. These findings should support the healthcare organization in planning, managing and organizing sustainable nursing home care for older people belonging to a minority in order to attain the aim of person-centered and equal healthcare.

Evaluation of a nurse-led education program to improve cross-cultural care for older people in aged care

BACKGROUND

Cultural diversity is significant in aged care facilities. Registered nurses play a leading role in the care setting. Nurse-led education interventions to improve the cultural competence of aged care workers are in high demand.

AIM

The aims of the study were to evaluate the effect of a nurse-led cross-cultural care program on cultural competence of Australian and overseas-born care workers.

DESIGN

A pre- and post-evaluation design and a sub-group analysis.

SETTINGS AND PARTICIPANTS

This study was undertaken in four large-sized aged care facilities in Australia. Direct care workers were invited to participate in the study.

METHODS

The intervention lasted 12 months. Data were collected at baseline, 6 months and 12 months using the Clinical Cultural Competency Questionnaire and site champion reports. One-way ANOVA was applied to determine the changes of outcomes over time for the whole group. A mixed effect linear regression model was applied in the sub-group analyses to compare the differences of outcomes between the Australian-born and overseas-born groups.

RESULTS

One hundred and thirteen staff participated in the study including Australian-born (n = 62) and overseas-born (n = 51). Registered nurses were trained as site champions to lead the program. The results showed a statistically significant increase in participants' scores in Knowledge (p = .000), Skills (p = .000), Comfort Level (p = .000), Importance of awareness (p = .01) and Self-Awareness (p = .000) in a 12-month follow-up. The increased scores in the Skills (p = .02) and Comfort Level (p = .001) were higher in the Australian-born group compared to the overseas-born group. The results also showed a statistically significant increase in participants' overall satisfaction scores with the program at 12 months (p = .009). The overseas-born group demonstrated a higher score in Desire to Learn More (p = .016) and Impact of the Program on Practice (p = .014) compared to the Australian-born group.

CONCLUSION

A nurse-led cross-cultural care program can improve aged care workers' cultural competence.

Comparing proxy rated quality of life of people living with dementia in care homes

BACKGROUND

Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes.

METHODS

We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews.

RESULTS

Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as 'Poor' (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents' QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia.

CONCLUSION

Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.

Cultural sensitivity in paediatric nursing care: a concept analysis using the Hybrid method

BACKGROUND

Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing.

AIMS

The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran.

METHODS

The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed.

RESULTS

In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing.

CONCLUSION

With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model.

Improving socially constructed cross-cultural communication in aged care homes: A critical perspective

Cultural diversity between residents and staff is significant in aged care homes in many developed nations in the context of international migration. This diversity can be a challenge to achieving effective cross-cultural communication. The aim of this study was to critically examine how staff and residents initiated effective cross-cultural communication and social cohesion that enabled positive changes to occur. A critical hermeneutic analysis underpinned by Giddens' Structuration Theory was applied to the study. Data were collected by interviews with residents or their family and by focus groups with staff in four aged care homes in Australia. Findings reveal that residents and staff are capable of restructuring communication via a partnership approach. They can also work in collaboration to develop communication resources. When staff demonstrate cultural humility, they empower residents from culturally and linguistically diverse backgrounds to engage in effective communication. Findings also suggest that workforce interventions are required to improve residents' experiences in cross-cultural care. This study challenges aged care homes to establish policies, criteria and procedures in cross-cultural communication. There is also the challenge to provide ongoing education and training for staff to improve their cross-cultural communication capabilities.