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Lövenmark A, Hammar LM. Being used for the greater good while fighting on the frontline: care staff's experiences of working with older people during the COVID-19 pandemic in Sweden. BMC Geriatr 2024; 24:135. [PMID: 38321402 PMCID: PMC10848549 DOI: 10.1186/s12877-023-04644-0] [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: 05/26/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024] Open
Abstract
BAKGROUND Worldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives. METHODOLOGY The study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis. RESULTS The results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before. CONCLUSIONS The pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed.
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Affiliation(s)
- Annica Lövenmark
- The School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
| | - Lena Marmstål Hammar
- The School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- The School of Health and Welfare, Dalarna University, Falun, Sweden
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Craftman ÅG, Pakpour AH, Calderon H, Meling A, Browall M, Lundh Hagelin C. Home care assistants' attitudes and perceptions of caring for people at the end of life in their homes in Sweden. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2648-e2656. [PMID: 35018690 DOI: 10.1111/hsc.13708] [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: 08/19/2021] [Revised: 11/17/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
The ageing population is increasing worldwide, with older people often having multimorbidity and a need for help with activities and personal care. Home Care Assistants (HCAs) are central to the provision of care in the home. They meet older people approaching the end of life and their relatives. Little is known about HCAs attitudes towards caring for a dying person and how aspects such as education, age, earlier care experiences, care education and experience of caring for dying older people affect their attitudes. The aim was to describe HCAs' attitudes towards the care of dying persons living in their ordinary homes. This cross-sectional study used the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) for data collection during December 2017 and January 2018, and descriptive statistics and regression analysis for data analysis. The participants were HCAs (n = 127, 96% of those eligible) in a municipality in central Sweden. An overall positive attitude was reported. About 32% lacked formal HCA education although 93% had experience of interacting with a dying person. Age, HCA education, internal palliative care education, number of years' experience and previous experience of caring for a dying person were independently associated with HCAs' attitudes. In the multivariate regression analysis, age and years of experience were the only significant predictors of HCAs' attitudes towards caring for dying care recipients. Young employees without HCA education and experience of a dying person might be vulnerable in situations involving caring for a dying person. Communicating about death and dying, forming a relationship with the care recipient and the family, and providing care when a person is dying can be challenging. Implications: Young employees without HCA education and experience of interacting with a dying person needs to be prepared for the situation. This needs to be considered by stakeholders and social and healthcare organisations.
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Affiliation(s)
- Åsa G Craftman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | | | - Anna Meling
- Hälso- och sjukvårdsorganisationen, Finspång, Sweden
| | - Maria Browall
- IMPROVE, Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Deptartment of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina Lundh Hagelin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal Bräcke University College, Stockholm, Sweden
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Shore CB, Maben J, Mold F, Winkley K, Cook A, Stenner K. Delegation of medication administration from registered nurses to non-registered support workers in community care settings: A systematic review with critical interpretive synthesis. Int J Nurs Stud 2022; 126:104121. [PMID: 34896760 PMCID: PMC8803545 DOI: 10.1016/j.ijnurstu.2021.104121] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Healthcare workforces are currently facing multiple challenges, including aging populations; increasing prevalence of long-term conditions; and shortfall of registered nurses. Employing non-registered support workers is common across many countries to expand service capacity of nursing teams. One task delegated to non-registered support workers is medication administration, which is considered a complex task, with associated risks. This is an important topic given the predicted global increase in patients requiring assistance with medication in community settings. This review explores the evidence on delegation of medication administration from registered nurse to non-registered support workers within community settings, to better understand factors that influence the process of delegation and its impact on service delivery and patient care. METHODS The review followed key principles of Critical Interpretative Synthesis and was structured around Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Literature searches were conducted in MEDLINE, CINAHL, Embase, and ProQuest-British Nursing Index databases. Twenty studies were included. RESULTS Findings are reported under four themes: 1, Regulatory and contextual factors; 2, Individual and team level factors; 3, Outcomes of delegation; and 4, Process of implementation and evaluation. Delegation was found to be a complex phenomenon, influenced by a myriad of interconnecting factors at the macro, meso, micro level. At the macro level, the consistency and clarity of government and state level regulations was found to facilitate or impede delegation of medication administration. Lack of clarity at the macro level, impacted at meso and micro levels, resulting in confusion around what medication administration could be delegated and who held responsibility. At the micro level, central to the interpretation of success was the relationship between the delegator and delegatee. This relationship was influenced by personal views, educational and systems factors. Many benefits were reported as an outcome of delegation, including service efficiency and improved patient care. The implementation of delegating medication administration was influenced by regulatory factors, communication, stakeholder engagement, and service champions. CONCLUSION Delegation of medication administration is a complex process influenced by many interrelating factors. Due to the increased risk associated with medication administration, clear and consistent regulatory and governance frameworks and procedures are crucial. Delegation of medication administration is more acceptable within a framework that adequately supports the process, backed by appropriate policy, skills, training, and supervisory arrangements. There is a need for further research around implementation, clinical outcomes and medication errors associated with delegation of medication administration.
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Affiliation(s)
- Colin B Shore
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, Priestly Road, Surrey Research Park, Guildford, Surrey GU2 7YH, United Kingdom.
| | - Jill Maben
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, Priestly Road, Surrey Research Park, Guildford, Surrey GU2 7YH, United Kingdom.
| | - Freda Mold
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, Priestly Road, Surrey Research Park, Guildford, Surrey GU2 7YH, United Kingdom.
| | - Kirsty Winkley
- King's College London & Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, United Kingdom.
| | - Angela Cook
- Head of Nursing and Quality, Shropshire Community Health NHS Trust, William Farr House, Mytton Oak, Road, Shrewsbury SY3 8XL, United Kingdom.
| | - Karen Stenner
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, Priestly Road, Surrey Research Park, Guildford, Surrey GU2 7YH, United Kingdom.
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Brookman C, Sayin F, Denton M, Davies S, Zeytinoglu I. Community-based personal support workers' satisfaction with job-related training at the organization in Ontario, Canada: Implications for future training. Health Sci Rep 2022; 5:e478. [PMID: 35229044 PMCID: PMC8865063 DOI: 10.1002/hsr2.478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS Complexity of community-based homecare for older adults has increased significantly in the past decade in Ontario, Canada. Personal support workers (PSWs), who are unregulated and vary in formal education, provide the majority of community homecare work for increasingly complex clients. This paper seeks to understand community-based PSWs' satisfaction with opportunities for job-related training at their employing organization to provide the skills and knowledge to meet the demands of their evolving role. METHODS Data for this paper are from a cross-sectional survey of 1746 community-based PSWs in Ontario, Canada entitled, "The PSW Health and Safety Matters Survey" www.pswshaveasay.ca. This survey was part of a research project "Keeping Community Based PSWs Safe in a Changing World of Work," funded by the Ontario Ministry of Labour. The data were analyzed using descriptive statistics, correlations, multivariate regression, and thematic analysis. RESULTS Quantitative analysis revealed most community homecare organizations offer PSWs job-related training to help them retain and update their skills and that PSWs have a moderate level of satisfaction with their job-related training. The analysis revealed that PSWs' satisfaction with organizational training is greater when the organization provides work-related training on challenging tasks, lifting and transferring tasks, and tasks delegated by nurses and supervisors. Data from the open-ended question highlighted seven key themes for desired training by PSWs: safe body mechanics for moving/lifting clients, managing aggression primarily with clients, infection control, CPR/first aid, mental illness, equipment training, and basic health and safety. CONCLUSION Implications for factors associated with PSWs' satisfaction with opportunities for job-related training are discussed along with recommendations for mitigating variability in education and training to meet the demands of their evolving role.
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Affiliation(s)
- Catherine Brookman
- Human Resources and Management, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
| | - Firat Sayin
- School of BusinessSt. Mary's UniversityHalifaxNova ScotiaCanada
| | - Margaret Denton
- Health Aging & Society, Faculty of Social SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Sharon Davies
- Human Resources and Management, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
| | - Isik Zeytinoglu
- Human Resources and Management, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
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Sandberg L, Borell L, Rosenberg L. Risks as dilemmas for home care staff caring for persons with dementia. Aging Ment Health 2021; 25:1701-1708. [PMID: 32336124 DOI: 10.1080/13607863.2020.1758914] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Many persons with dementia live at home with support from home care services. Despite this, research is scarce concerning how risks in daily life among persons with dementia are perceived and handled by home care staff. This study aimed to explore how home care staff identify risks in the everyday lives of persons with dementia, and to inquire into how they reasoned about their own actions related to those risks. METHOD A qualitative approach was applied for the study. Both individual interviews and focus groups were conducted with home care staff (n = 23). Data was analysed using a constant comparative method. RESULTS Identifying, reasoning and acting upon risks in the everyday lives of persons with dementia were related to several dilemmas for the home care staff. These dilemmas are described and elaborated on in three categories: 1) Strategies for tracking risks, 2) Dilemmas concerning where to draw the line and deciding when to act, and 3) Dilemmas when acting on risks. CONCLUSION The study provides new knowledge about the dilemmas that staff in home care services may face and how they reason about managing risks in the homes of persons with dementia. The study shows that the staff had to weigh risk and safety against the autonomy of persons with dementia. Based on these findings, we want to highlight the importance of competence among home care staff and the organizational conditions that must exist in order to manage the challenges of risky situations.
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Affiliation(s)
- Linda Sandberg
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Lena Borell
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Lena Rosenberg
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
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Errors linked to medication management in nursing homes: an interview study. BMC Nurs 2021; 20:69. [PMID: 33926436 PMCID: PMC8082477 DOI: 10.1186/s12912-021-00587-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background The number of errors in medication management in nursing homes is increasing, which may lead to potentially life-threatening harm. Few studies on this subject are found in the municipal nursing home setting, and causes need to be identified. The aim of this study was to explore perceptions of errors connected to medication management in nursing homes by exploring the perspective of first-line registered nurses, registered nurses, and non-licensed staff involved in the care of older persons. Methods A qualitative research approach was applied based on semi-structured interviews with 21 participants at their workplaces: Seven in each of the occupational categories of first-line registered nurses, registered nurses, and non-licensed staff. Subcategories were derived from transcribed interviews by content analysis and categorized according to the Man, Technology, and Organization concept of error causation, which is as a framework to identify errors. Results Mistakes in medication management were commonly perceived as a result of human shortcomings and deficiencies in working conditions such as the lack of safe tools to facilitate and secure medication management. The delegation of drug administration to non-licensed staff, the abandonment of routines, carelessness, a lack of knowledge, inadequate verbal communication between colleagues, and a lack of understanding of the difficulties involved in handling the drugs were all considered as risk areas for errors. Organizational hazards were related to the ability to control the delegation, the standard of education, and safety awareness among staff members. Safety issues relating to technology involved devices for handling prescription cards and when staff were not included in the development process of new technological aids. A lack of staff and the lack of time to act safely in the care of the elderly were also perceived as safety hazards, particularly with the non-licensed staff working in nursing homes. Conclusions The staff working in nursing homes perceive that the risks due to medication management are mainly caused by human limitations or technical deficiencies. Organizational factors, such as working conditions, can often facilitate the occurrence of malpractice. To minimize mistakes, care managers need to have a systemwide perspective on safety issues, where organizational issues are essential.
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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.
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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
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Craftman ÅG, Grundberg Å, Westerbotn M. Experiences of home care assistants providing social care to older people: A context in transition. Int J Older People Nurs 2018; 13:e12207. [PMID: 30063125 DOI: 10.1111/opn.12207] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 12/26/2022]
Abstract
AIM The aim was to describe home care assistants' (HCA) experiences of providing social care in older people's own homes. BACKGROUND With the increase in average life expectancy and related growth of the elder population, addressing geriatric care needs has become an increasingly vital issue. However, the frontline workforce faces major challenges in meeting these needs, including a lack of trained professionals entering the field. DESIGN A qualitative inductive design was used. METHODS A descriptive, qualitative study using focus group interviews and content analysis. FINDINGS The findings revealed that HCAs are active in an area facing challenges due to an older home-dwelling generation. Transfer of tasks should be reviewed considering changes to the workforce's skill mix brought on by task shifting. CONCLUSIONS Certain prerequisites are needed to enable unlicensed assistive personnel to perform a good job; they also need to receive affirmation that they are a crucial workforce carrying out multifaceted tasks. To improve and maintain the pull factors of social care work, it is crucial to clarify how older people's requirements influence the daily care relation. IMPLICATIONS FOR PRACTICE The findings highlight HCAs' blurred responsibility when providing nursing and care to older people with multiple chronic conditions and functional disabilities. Increasing expectations are placed upon HCAs to cope with practical situations that are theoretically outside the bounds of social care. The findings contribute knowledge to further development of collaboration between social and health care providers as well as the important affirmation of this unlicensed personnel group in transition. A long-term plan is therefore needed to provide HCAs with the skills and tools they need to deliver care and support to older people with a variety of needs.
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Affiliation(s)
| | | | - Margareta Westerbotn
- Sophiahemmet University, Stockholm, Sweden.,Department of clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Sandberg L, Borell L, Edvardsson D, Rosenberg L, Boström AM. Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services. J Multidiscip Healthc 2018; 11:255-266. [PMID: 29861636 PMCID: PMC5969065 DOI: 10.2147/jmdh.s155467] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction An increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs. The staff’s well-being is crucial because it can affect the quality of their work, although literature on job strain among home care staff is limited. Aim To describe perceived job strain among home care staff and to examine correlations between job strain, personal factors, and organizational factors. Methods The study applied a cross-sectional survey design. Participants were dementia care specialists who work in home care (n=34) and other home care staff who are not specialized in dementia care (n=35). The Strain in Dementia Care Scale (SDCS) and Creative Climate Questionnaire instruments and demographic variables were used. Descriptive and inferential statistics (including regression modeling) were applied. The regional ethical review board approved the study. Results Home care staff perceived job strain – particularly because they could not provide what they perceived to be necessary care. Dementia care specialists ranked job strain higher (m=5.71) than other staff members (m=4.71; p=0.04). Job strain (for total score and for all five SDCS factors) correlated with being a dementia care specialist. Correlations also occurred between job strain for SDCS factor 2 (difficulties understanding and interpreting) and not having Swedish as first language and SDCS factor 5 (lack of recognition) and stagnated organizational climate. Conclusion The study indicates that home care staff and particularly dementia care specialists perceived high job strain. Future studies are needed to confirm or reject findings from this study.
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Affiliation(s)
- Linda Sandberg
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Lena Borell
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Heidelberg, VIC, Australia.,Department of Nursing, Umea University, Umea, Sweden
| | - Lena Rosenberg
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Department of Nursing, Western Norway University of Applied Sciences, Haugesund, Norway
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Saari M, Xiao S, Rowe A, Patterson E, Killackey T, Raffaghello J, Tourangeau AE. The role of unregulated care providers in home care: A scoping review. J Nurs Manag 2018; 26:782-794. [DOI: 10.1111/jonm.12613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 01/07/2023]
Affiliation(s)
| | - Sarah Xiao
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Alissa Rowe
- Southwest Local Health Integration Network; London ON Canada
| | - Erin Patterson
- School of Health & Life Sciences & Community Services; Conestoga College Institute of Technology and Advanced Learning; Kitchener ON Canada
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Julia Raffaghello
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Ann E. Tourangeau
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
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11
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Saari M, Patterson E, Kelly S, Tourangeau AE. The evolving role of the personal support worker in home care in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:240-249. [PMID: 29119635 DOI: 10.1111/hsc.12514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.
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Affiliation(s)
- Margaret Saari
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada
- Saint Elizabeth Research Centre, Saint Elizabeth Health Care, 90 Allstate Parkway, Suite #300, Markham, ON, Canada
| | - Erin Patterson
- School of Health & Life Sciences and Community Services, Conestoga College, Kitchener, ON, Canada
| | - Shawna Kelly
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Krembil Neuroscience Program, University Health Network, Toronto, ON, Canada
| | - Ann E Tourangeau
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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12
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Roux P, Pereira F, Santiago-Delefosse M, Verloo H. Medication practices and experiences of older adults discharged home from hospital: a feasibility study protocol. Patient Prefer Adherence 2018; 12:1055-1063. [PMID: 29950818 PMCID: PMC6016260 DOI: 10.2147/ppa.s160990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Switzerland's aging population raises pressing questions about maintaining older adults in their home environments and the problems associated with managing complex treatments requiring medication in such contexts. Few studies have examined older adults' experiences of changes in their medication on discharge home following hospitalization for illness or an accident. Similarly, few studies have evaluated the involvement of informal and professional caregivers in the medication practices used with older adults living at home. However, medication practices are complex and understanding them requires an interest in their underlying logic and the interactions that constitute them. This study will explore the feasibility of recruiting older adults and then collecting and analyzing data on their medication practices and their experiences of discharge home after hospitalization for an illness or following an accident. Furthermore, it will describe the involvement of informal caregivers and homecare professionals in these processes. DESIGN AND METHODS The study will use a qualitative methodology. The first phase will be developed in the general medicine and surgery wards of Sion hospital and in the town's community healthcare center. This phase will aim to build a close collaboration between the research team and the health care professionals of Valais hospitals and the community healthcare center. It will enable data collection from professional caregivers to identify the tools, and potentially the interventions, which are used to prepare older adults for hospital discharge and return home, particularly with regard to the medication prescribed to them. In the second phase, semi-structured interviews will be conducted with eight patients aged 75 years old or more who have returned home after hospitalization. Interviews will also be conducted with their informal and professional caregivers. CONCLUSION This feasibility study will enable the identification of tools that leverage improved adhesion to a medical treatment that has been adjusted and stabilized following discharge home from hospital. It will incorporate the points of view of older adults and the different stakeholders involved in the management of their medication and the development of tangible solutions to encourage treatment adhesion on discharge home. This study's findings will enable us to design a much larger future study.
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Affiliation(s)
- Pauline Roux
- University of Lausanne, Institute of Psychology, Research Center for Psychology of Health, Aging and Sport Examination, Lausanne, Switzerland
- Correspondence: Pauline Roux, University of Lausanne, Institute of, Psychology, Research Center for, Psychology of Health, Aging and Sport, Examination, Bâtiment Géopolis, CH-1015 Lausanne, Switzerland, Tel +41 21 692 3256, Email
| | - Filipa Pereira
- University of Applied Sciences and Arts Western Switzerland, Department of Nursing Sciences, Sion, Switzerland
| | - Marie Santiago-Delefosse
- University of Lausanne, Institute of Psychology, Research Center for Psychology of Health, Aging and Sport Examination, Lausanne, Switzerland
| | - Henk Verloo
- University of Applied Sciences and Arts Western Switzerland, Department of Nursing Sciences, Sion, Switzerland
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Andersson Å, Frank C, Willman AM, Sandman PO, Hansebo G. Factors contributing to serious adverse events in nursing homes. J Clin Nurs 2017; 27:e354-e362. [PMID: 28618102 DOI: 10.1111/jocn.13914] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 11/25/2022]
Abstract
AIMS AND OBJECTIVES To identify the most common serious adverse events that occurred in nursing homes and their most frequent contributing factors to the improvement of safe nursing care. BACKGROUND There is a need to improve safe nursing care in nursing homes. Residents are often frail and vulnerable with extensive needs for nursing care. A relatively minor adverse event in nursing care can cause serious injury that could have been preventable. DESIGN This was a retrospective study, with a total sample of data regarding adverse events (n = 173) in nursing homes, concerning nursing care reported by healthcare providers in Sweden to the Health and Social Care Inspectorate. The reports were analysed with content analysis, and the frequencies of the adverse events, and their contributing factors, were described with descriptive statistics. RESULTS Medication errors, falls, delayed or inappropriate intervention and missed nursing care contributed to the vast majority (89%) of the serious adverse events. A total of 693 possible contributing factors were identified. The most common contributing factors were (i) lack of competence, (ii) incomplete or lack of documentation, (iii) teamwork failure and (iv) inadequate communication. CONCLUSIONS The contributing factors frequently interacted yet they varied between different groups of serious adverse events. The resident's safety depends on the availability of staff's competence as well as adequate documentation about the resident's condition. Lack of competence was underestimated by healthcare providers. RELEVANCE TO CLINICAL PRACTICE Registered nurses and assistant nurses need to have awareness of contributing factors to adverse events in nursing care. A holistic approach to improve patient safety in nursing homes requires competence of the staff, safe environments as well as resident's and relative's participation.
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Affiliation(s)
- Åsa Andersson
- Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Catharina Frank
- Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Ania Ml Willman
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Per-Olof Sandman
- Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Gransjön Craftman Å, Grape C, Ringnell K, Westerbotn M. Registered nurses' experience of delegating the administration of medicine to unlicensed personnel in residential care homes. J Clin Nurs 2016; 25:3189-3198. [DOI: 10.1111/jocn.13335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Margareta Westerbotn
- Sophiahemmet University; Stockholm Sweden
- Department of Clinical Science and Education; Söodersjukhuset; Karolinska Institutet; Stockholm Sweden
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15
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Grundberg Å, Hansson A, Religa D, Hillerås P. Home care assistants' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity. J Multidiscip Healthc 2016; 9:83-95. [PMID: 26966371 PMCID: PMC4771392 DOI: 10.2147/jmdh.s99388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Elderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs). Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients' mental health status. AIM To describe HCAs' perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity. METHODS We applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs. RESULTS Most HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors' own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health. CONCLUSION The HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of loneliness, and increasing physical activity. The results indicate that the HCAs seemed dependent on supervision by district nurses and on care managers' decisions to support the needed care, to schedule assignments related to the detection of mental health problems, and to promote mental health.
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Affiliation(s)
- Åke Grundberg
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | | | - Dorota Religa
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Pernilla Hillerås
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
- Sophiahemmet University, Stockholm, Sweden
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Aydin R, Unal E, Gokler M, Metintas S, Emiral G, Ozay O, Onsuz F, Isikli B. An evaluation of home health care needs and Quality of Life among the elderly in a semi-rural area of Western Turkey. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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