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Spilsbury K, Charlwood A, Thompson C, Haunch K, Valizade D, Devi R, Jackson C, Alldred DP, Arthur A, Brown L, Edwards P, Fenton W, Gage H, Glover M, Hanratty B, Meyer J, Waton A. Relationship between staff and quality of care in care homes: StaRQ mixed methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-139. [PMID: 38634535 DOI: 10.3310/gwtt8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Quality of life and care varies between and within the care homes in which almost half a million older people live and over half a million direct care staff (registered nurses and care assistants) work. The reasons are complex, understudied and sometimes oversimplified, but staff and their work are a significant influence. Objective(s) To explore variations in the care home nursing and support workforce; how resident and relatives' needs in care homes are linked to care home staffing; how different staffing models impact on care quality, outcomes and costs; how workforce numbers, skill mix and stability meet residents' needs; the contributions of the care home workforce to enhancing quality of care; staff relationships as a platform for implementation by providers. Design Mixed-method (QUAL-QUANT) parallel design with five work packages. WP1 - two evidence syntheses (one realist); WP2 - cross-sectional survey of routine staffing and rated quality from care home regulator; WP3 - analysis of longitudinal data from a corporate provider of staffing characteristics and quality indicators, including safety; WP4 - secondary analysis of care home regulator reports; WP5 - social network analysis of networks likely to influence quality innovation. We expressed our synthesised findings as a logic model. Setting English care homes, with and without nursing, with various ownership structures, size and location, with varying quality ratings. Participants Managers, residents, families and care home staff. Findings Staffing's contribution to quality and personalised care requires: managerial and staff stability and consistency; sufficient staff to develop 'familial' relationships between staff and residents, and staff-staff reciprocity, 'knowing' residents, and skills and competence training beyond induction; supported, well-led staff seeing modelled behaviours from supervisors; autonomy to act. Outcome measures that capture the relationship between staffing and quality include: the extent to which resident needs and preferences are met and culturally appropriate; resident and family satisfaction; extent of residents living with purpose; safe care (including clinical outcomes); staff well-being and job satisfaction were important, but underacknowledged. Limitations Many of our findings stem from self-reported and routine data with known biases - such as under reporting of adverse incidents; our analysis may reflect these biases. COVID-19 required adapting our original protocol to make it feasible. Consequently, the effects of the pandemic are reflected in our research methods and findings. Our findings are based on data from a single care home operator and so may not be generalised to the wider population of care homes. Conclusions Innovative and multiple methods and theory can successfully highlight the nuanced relationship between staffing and quality in care homes. Modifiable characteristics such as visible philosophies of care and high-quality training, reinforced by behavioural and relational role modelling by leaders can make the difference when sufficient amounts of consistent staff are employed. Greater staffing capacity alone is unlikely to enhance quality in a cost-effective manner. Social network analysis can help identify the right people to aid adoption and spread of quality and innovation. Future research should focus on richer, iterative, evaluative testing and development of our logic model using theoretically and empirically defensible - rather than available - inputs and outcomes. Study registration This study is registered as PROSPERO CRD42021241066 and Research Registry registration: 1062. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/144/29) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Andy Charlwood
- Leeds University Business School, University of Leeds, Leeds, UK
| | - Carl Thompson
- School of Healthcare, University of Leeds, Leeds, UK
| | - Kirsty Haunch
- School of Healthcare, University of Leeds, Leeds, UK
| | - Danat Valizade
- Leeds University Business School, University of Leeds, Leeds, UK
| | - Reena Devi
- School of Healthcare, University of Leeds, Leeds, UK
| | | | | | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lucy Brown
- The Florence Nightingale Foundation, London, UK
| | | | | | - Heather Gage
- School of Biosciences and Medicine, University of Surrey, Surrey, UK
| | - Matthew Glover
- School of Biosciences and Medicine, University of Surrey, Surrey, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Julienne Meyer
- School of Health Sciences, City University of London, London, UK
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Backman A, Lindkvist M, Lövheim H, Sjögren K, Edvardsson D. Exploring the impact of nursing home managers' leadership on staff job satisfaction, health and intention to leave in nursing homes. J Clin Nurs 2023; 32:7227-7237. [PMID: 37283193 DOI: 10.1111/jocn.16781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/03/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
AIMS AND OBJECTIVES To explore the impact of nursing home leadership and staffing characteristics on staff job satisfaction, health and intention to leave. BACKGROUND The number of older people has outpaced growth in the nursing home workforce worldwide. Identifying predictors with the potential to positively impact staff job satisfaction, health and intentions to leave are important. Leadership of the nursing home manager can be one such predictor. DESIGN Cross-sectional design. METHODS A sample of 2985 direct care staff in 190 nursing homes in 43 randomly selected municipalities in Sweden completed surveys on leadership, job satisfaction, self-rated health and intention to leave (response rate 52%). Descriptive statistics and Generalised Estimating Equations were conducted. The STROBE reporting checklist was applied. RESULTS Nursing home managers' leadership was positively related to job satisfaction, self-rated health and low intention to leave. Lower staff educational levels were related to poorer health and lower job satisfaction. CONCLUSIONS Nursing home leadership plays a significant role in the job satisfaction, self-reported health and intention to leave of direct care staff. Low education levels among staff seem to negatively influence staff health and job satisfaction, suggesting that educational initiatives for less-educated staff could be beneficial for improving staff health and job satisfaction. RELEVANCE TO CLINICAL PRACTICE Managers seeking to improve staff job satisfaction can consider how they support, coach and provide feedback. Recognising staff achievement at work can contribute to high job satisfaction. One important implication for managers is to offer continuing education to staff with lower or no education, given the large amount of uneducated direct care workers in aged care and the impact this may have on staff job satisfaction and health. NO PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required to outcome measures in this study. Direct care staff and managers contributed with data.
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Affiliation(s)
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine in Umeå, Umeå, Sweden
| | - Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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O’Neill M, Ryan A, Tracey A, Laird L. 'The Primacy of 'Home': An exploration of how older adults' transition to life in a care home towards the end of the first year. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e478-e492. [PMID: 33242367 PMCID: PMC9292794 DOI: 10.1111/hsc.13232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/18/2020] [Accepted: 10/20/2020] [Indexed: 05/12/2023]
Abstract
This grounded theory study sought to explore how older adults' experience the transition from living at home to a care home with a specific focus on the latter part of the first year of the move. The study was carried out within a large Health Trust in the UK between August 2017 and May 2019. Purposive sampling was used in the initial stages of data collection. Thereafter and consistent with grounded theory methodology, theoretical sampling was employed to undertake semi-structured interviews with 17 individuals from eight care homes between 5 and 12 months after the move. This paper reports five key categories which were: (a) The lasting effect of first Impressions 'They helped me make my mind up' (b) On a Journey 'I just take it one day at a time', (c) Staying connected and feeling 'at home' 'You get something good out of it you know…you get hope'. (d) Managing loss and grief 'It was important for me to say cheerio to the house' and (e) Caring relationships 'I didn't realise that I was lonely until I had company'. Together these five categories formed the basis of the core category 'The Primacy of 'Home' which participants identified as a place they would like to feel valued, nurtured and have a sense of belonging. This study identifies that it is important for individual preferences and expectations to be managed from the outset of the move. Individuals and families need to be supported to have honest and caring conversations to promote acceptance and adaptation to living in a care home while continuing to embrace the heart of 'home'. Key recommendations from this study include the need to raise awareness of the significance of the ongoing psychological and emotional well-being needs of older people which should be considered in policy directives and clinical practice.
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Affiliation(s)
- Marie O’Neill
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
| | - Assumpta Ryan
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
| | - Anne Tracey
- School of PsychologyUlster UniversityColeraine, Co LondonderryNorthern Ireland
| | - Liz Laird
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
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Yaghmour SM. Impact of settings and culture on nurses' knowledge of and attitudes and perceptions towards people with dementia: An integrative literature review. Nurs Open 2021; 9:66-93. [PMID: 34719132 PMCID: PMC8685848 DOI: 10.1002/nop2.1106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/10/2021] [Accepted: 10/14/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Well-trained nurses are required to support dementia patients; however, the quality of the provided dementia nursing care can be impacted by nurses' knowledge, attitudes and perceptions towards people with dementia. AIM To obtain an overview of the current nursing practice towards people with dementia around the world. DESIGN An integrated literature review was conducted based on Whittemore and Knafl's method. RESULTS A total of 72 articles met the inclusion criteria. Three main themes were identified: (1) nurses' knowledge, attitudes and perceptions towards dementia; (2) nursing experience of caring for people with dementia in acute and community care settings; and (3) dementia nursing care across health regions. CONCLUSION Nurses play the role of facilitators in the efficient delivery of quality care for dementia patients. A variety of attitudes and perceptions towards people with dementia were found to be triggered by the severity of dementia, religion, ethnicity and gender. IMPLICATIONS FOR PRACTICE Healthcare organisations and educational settings need to coordinate and function together to improve nurses' knowledge and encourage positive attitudes towards people with dementia.
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Lin L, Liu X, McGilton KS, Yuan Y, Li H, Dong B, Xie C, Wang H, Li H, Tian L. Level of nurse supportive supervision and its influencing factors in long-term care facilities. Geriatr Nurs 2021; 42:1316-1322. [PMID: 34560526 DOI: 10.1016/j.gerinurse.2021.08.018] [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: 06/03/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Quality of care provided by personal support workers (PSWs) in long-term care facilities (LTCFs) is associated with the supportive supervisory performance of registered nurses (RNs). To determine the level of supportive supervision of RNs and its influencing factors in LTCFs in East China, a cross-sectional survey was conducted in 12 LTCFs using self-designed sociodemographic questionnaires and the Chinese version of the Supportive Supervisory Scale. A total of 643 PSWs supervised by 260 RNs were surveyed. The average supportive supervision score was 59.60 ± 7.53, representing a moderate level of supervisory support. Supportive supervision was found to be positively correlated with the PSW's years of working, the RN's education, position, number of years in nursing, having access to managerial training as well as the RN/PSW ratio in the unit (p < 0.05). These factors can be modified to potentially influence the supportive capacity of nurse supervisors in LTCFs.
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Affiliation(s)
- Lu Lin
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Xiaoming Liu
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China
| | - Katherine S McGilton
- Toronto Rehabilitation Institute-UHN, Toronto, ON, Canada; University of Toronto, ON, Canada
| | - Yang Yuan
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Haixia Li
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215006, People's Republic of China
| | - Bei Dong
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Congyan Xie
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Hong Wang
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215006, People's Republic of China
| | - Huiling Li
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China.
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6
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Bach-Mortensen AM, Barlow J. Outsourced austerity or improved services? A systematic review and thematic synthesis of the experiences of social care providers and commissioners in quasi-markets. Soc Sci Med 2021; 276:113844. [PMID: 33773477 DOI: 10.1016/j.socscimed.2021.113844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Social care services are commonly delivered by a combination of for-profit, public, and non-profit sector providers. These services are often commissioned in quasi-markets, in which providers from all sectors compete for public service contracts. The outsourcing of social services to private providers has resulted in a predominantly for-profit provision. Despite the rationale that open bidding facilitates better services and improved consumer choice, the outsourcing of social care has been criticized for prioritising cost-efficiency above service quality and effectiveness. However, the experiences and perspectives of those operating within quasi-markets (providers and commissioners) are poorly understood. To address this gap, we systematically identified, appraised, and thematically synthesised existing qualitative research on social care commissioners and providers (for-profit, public, and non-profit) published in the last 20 years (2000-2020). Twenty-six studies examining the perspectives of social care providers and commissioners relating to the quasi-market provision of social care were included. The synthesis demonstrates consistent concern among non-profit and public providers with regard to spending cuts in the care sector, whereas for-profit providers were primarily concerned with creating a profitable market strategy by carefully analysing opportunities in the commissioning system. All provider types described flaws in the commissioning process, especially with regards to the contracting conditions, which were reported to force providers into deteriorating employment conditions, and also to negatively impact quality of care. These findings suggest that in a commissioning environment characterised by austerity and public budget cuts, it is insufficient to assume that increasing the market share of non-profits will alleviate issues grounded in insufficient funding and flawed contracting criteria. In other words, no ownership type can compensate for inadequate funding of social care services.
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Affiliation(s)
- Anders Malthe Bach-Mortensen
- University of Oxford, Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, UK.
| | - Jane Barlow
- University of Oxford, Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, UK
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Tian L, Li H, Dong B, Xie C, Wang H, Lin L. The supportive supervisory scale: psychometric properties in Chinese health care aides samples. Health Qual Life Outcomes 2021; 19:60. [PMID: 33622357 PMCID: PMC7903650 DOI: 10.1186/s12955-021-01706-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To sinicize the Supportive Supervisory Scale (SSS) and analyze the psychometric properties of the Chinese version of SSS (SSS-C). Methods The SSS (the original English version) was firstly sinicized and adjusted, then its psychometric properties were examined in 300 health care aides from four long-term care (LTC) facilities. SPSS 22.0 was used to process the data and calculate the reliability and validity. Results The 15-item SSS-C had satisfactory internal consistency (Cronbach’s α coefficient = 0.852), split half reliability (Spearman-Brown coefficient = 0.834) and test–retest reliability (Pearson correlation coefficient = 0.784), and three factors were extracted. If the four items with their communality < 0.4 were deleted, the remaining 11 items could explain 55.654% of the total variance. The discriminant validity of the SSS-C varied significantly between sites. Conclusions The Chinese version of SSS can be used to effectively measure the supervisory support of the nurses within the LTC settings.
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Affiliation(s)
- Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China. .,School of Nursing, Medical College of Soochow University, No. 1 Shizi Street, 215006, Suzhou, People's Republic of China.
| | - Haixia Li
- School of Nursing, Medical College of Soochow University, No. 1 Shizi Street, 215006, Suzhou, People's Republic of China.,Suzhou Jiulong Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, People's Republic of China
| | - Bei Dong
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China.,School of Nursing, Medical College of Soochow University, No. 1 Shizi Street, 215006, Suzhou, People's Republic of China
| | - Congyan Xie
- School of Nursing, Medical College of Soochow University, No. 1 Shizi Street, 215006, Suzhou, People's Republic of China
| | - Hong Wang
- School of Nursing, Medical College of Soochow University, No. 1 Shizi Street, 215006, Suzhou, People's Republic of China.,Suzhou Jiulong Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, People's Republic of China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China. .,School of Nursing, Medical College of Soochow University, No. 1 Shizi Street, 215006, Suzhou, People's Republic of China.
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Haunch K, Thompson C, Arthur A, Edwards P, Goodman C, Hanratty B, Meyer J, Charlwood A, Valizade D, Backhaus R, Verbeek H, Hamers J, Spilsbury K. Understanding the staff behaviours that promote quality for older people living in long term care facilities: A realist review. Int J Nurs Stud 2021; 117:103905. [PMID: 33714766 DOI: 10.1016/j.ijnurstu.2021.103905] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Little is known about how the workforce influences quality in long term care facilities for older people. Staff numbers are important but do not fully explain this relationship. OBJECTIVES To develop theoretical explanations for the relationship between long-term care facility staffing and quality of care as experienced by residents. DESIGN A realist evidence synthesis to understand staff behaviours that promote quality of care for older people living in long-term care facilities. SETTING Long-term residential care facilities PARTICIPANTS: Long-term care facility staff, residents, and relatives METHODS: The realist review, (i) was co-developed with stakeholders to determine initial programme theories, (ii) systematically searched the evidence to test and develop theoretical propositions, and (iii) validated and refined emergent theory with stakeholder groups. RESULTS 66 research papers were included in the review. Three key findings explain the relationship between staffing and quality: (i) quality is influenced by staff behaviours; (ii) behaviours are contingent on relationships nurtured by long-term care facility environment and culture; and (iii) leadership has an important influence on how organisational resources (sufficient staff effectively deployed, with the knowledge, expertise and skills required to meet residents' needs) are used to generate and sustain quality-promoting relationships. Six theoretical propositions explain these findings. CONCLUSION Leaders (at all levels) through their role-modelling behaviours can use organisational resources to endorse and encourage relationships (at all levels) between staff, residents, co-workers and family (relationship centred care) that constitute learning opportunities for staff, and encourage quality as experienced by residents and families.
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Affiliation(s)
- Kirsty Haunch
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Carl Thompson
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom; NIHR ARC Yorkshire and Humber
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | | | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom; NIHR ARC East of England
| | - Barbara Hanratty
- Population Health Sciences Institute, University of Newcastle, United Kingdom; NIHR ARC North East and North Cumbria
| | - Julienne Meyer
- School of Health Sciences, City, University of London, United Kingdom
| | - Andy Charlwood
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Danat Valizade
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Ramona Backhaus
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Jan Hamers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Karen Spilsbury
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom; NIHR ARC Yorkshire and Humber.
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Wu Q, Qian S, Deng C, Yu P. Understanding Interactions Between Caregivers and Care Recipients in Person-Centered Dementia Care: A Rapid Review. Clin Interv Aging 2020; 15:1637-1647. [PMID: 32982198 PMCID: PMC7500833 DOI: 10.2147/cia.s255454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Good interactions are essential in caring for people with dementia. There is a lack of knowledge about interaction approaches used by caregivers in person-centered dementia care. This study aimed to understand interactions in person-centered dementia care. Methods A search for relevant publications was undertaken in 2020 on two electronic databases, MEDLINE with full text and CINAHL Plus with full text. This was supplemented by manual searching of the reference lists of relevant articles. Inclusion and exclusion criteria were applied to determine the relevance of the articles. Data extraction included publication year, country, study setting, aim, design, definition of person-centered dementia care, elements of person-centered dementia care and interaction approaches used by caregivers. A Donabedian quality framework was used to group the elements of person-centered dementia care into three categories: structure, process and outcome. Results A total of 25 articles were included in the review, all from developed countries. A conceptual framework was developed for the delivery of person-centered dementia care. It includes the organizational structure, ie, management and resources, a competent workforce and physical environment; the dementia care process, ie, respectful interaction underpinned by good knowledge about the care recipients in a calm, peaceful environment; and care outcome, ie, the social, psychological, and physical well-being of the care recipients. Interaction approaches used by caregivers in providing person-centered dementia care were classified according to the six purposes of interaction: to know and understand the care recipient, to keep the person happy and satisfied, to make the person feel safe and secure, to calm the person, to support self-identity, and to guide the person in conducting daily activities. Conclusion The delivery of person-centered dementia care needs to consider organizational structure, the dementia care process, and care outcome which together foster a positive environment for meaningful interactions between caregivers and care recipients. The identified interaction approaches could be used by dementia care trainers to develop training materials.
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Affiliation(s)
- Qiujuan Wu
- Oncology Department, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.,Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, 2500, Australia
| | - Chao Deng
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2500, Australia.,School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW 2500, Australia
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‘Waiting and Wanting’: older peoples’ initial experiences of adapting to life in a care home: a grounded theory study. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20000872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractA grounded theory approach, consistent with the work of Strauss and Corbin, was used to undertake semi-structured interviews with 17 older people, to explore their experiences of living in a care home, during the four- to six-week period following the move. Purposive sampling was initially adopted, thereafter, theoretical sampling was employed to recruit individuals identified by care managers within older peoples’ community teams and care home managers within a large Health and Social Care Trust in the United Kingdom. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously. Constant comparative analysis underpinned data analysis and data management techniques. Data analysis revealed five distinct categories that captured these experiences. These were: (a) wanting to connect – ‘I am so lost here’, (b) wanting to adapt – ‘Well mentally you have to make the best of it’, (c) waiting for assistance – ‘it's a frustration for me’, (d) ‘waiting on the end’ – I am making no plans’ and (e) wanting to re-establish links with family and home – ‘I love getting home and I like getting out to the town’. Together these five categories formed the basis of the core category, ‘Waiting and Wanting’, which encapsulates the initial adaptation experiences of the men and women in the study. Findings indicate that individuals were dependent on others to create a sense of belonging, independence and wellbeing. Moreover, risk aversive practices were perceived as a threat to individuals’ independence and autonomy. Recommendations include the need to amend policy and practice for the development of a bespoke induction programme for each resident facilitated by a senior member of the care home staff working in partnership with individuals and families, in addition to the health and social care team, to support a more positive transition for new residents, relatives and care home staff.
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McGilton KS, Backman A, Boscart V, Chu C, Gea Sánchez M, Irwin C, Meyer J, Spilsbury K, Zheng N, Zúñiga F. Exploring a Common Data Element for International Research in Long-Term Care Homes: A Measure for Evaluating Nursing Supervisor Effectiveness. Gerontol Geriatr Med 2020; 6:2333721420979812. [PMID: 33426177 PMCID: PMC7758648 DOI: 10.1177/2333721420979812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of this study is to recommend a common data element (CDE) to measure supervisory effectiveness of staff working in LTC homes that can be used in international research. Supervisory effectiveness can serve as a CDE in an effort to establish an international, person-centered LTC research infrastructure in accordance with the aims of the WE-THRIVE group (Worldwide Elements to Harmonize Research in Long Term Care Living Environments). A literature review was completed and then a panel of experts independently reviewed and prioritized appropriateness of the measures with mindfulness of their potential applications to international LTC settings. The selection of a recommended CDE measure was guided by the WE-THRIVE group's focus on capacity rather than deficits, the expected availability of internationally comparable data and the goal to provide a short, ecologically viable measurement, specifically for low- and middle-income countries. Two measures were considered as the CDE for supervisory effectiveness, Benjamin Rose Relationship Scale and the Supervisory Support Scale; however, given that the latter measure has been translated in Spanish and Chinese and has been tested with nursing assistants in both of these countries with good psychometric properties, our group recommends it as the CDE going forward.
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Affiliation(s)
- Katherine S. McGilton
- KITE – Toronto Rehabilitation Institute—UHN, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | - Charlene Chu
- KITE – Toronto Rehabilitation Institute—UHN, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | - Constance Irwin
- KITE – Toronto Rehabilitation Institute—UHN, Toronto, ON, Canada
| | | | | | - Nancy Zheng
- KITE – Toronto Rehabilitation Institute—UHN, Toronto, ON, Canada
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Ericson Lidman E, Strandberg G. Care providers' troubled conscience related to an implementation of a time management system in residential care for older people-a participatory action research study. Scand J Caring Sci 2019; 34:745-753. [PMID: 31657043 DOI: 10.1111/scs.12779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Care providers in residential care for older people often refer to time shortage, a problem that may generate troubled conscience. AIM The aim of the study was to describe a PAR process to assist care providers in municipal residential care for older people to constructively deal with their troubled conscience related to an implemented time management system. METHOD This intervention study was carried out with 14 care providers and their manager in residential care for older people with the support of participatory action research (PAR). The recorded PAR sessions were transcribed and compiled with inspiration from content analysis. ETHICAL CONSIDERATIONS The participants were given oral and written information and gave their written informed consent. FINDINGS The PAR process was found to empower the participants to form their own structure of the practical professional planning, adapted to the residents needs and to their daily work. In this process, participants used their troubled conscience as a driving force and as an asset. CONCLUSION Instead of launching change without any deeper information, it is important to carefully prepare, involve and inform those who are going to execute the change. Meeting places should be arranged wherein care providers have the opportunity to share and reflect on challenging situations that can generate troubled conscience, especially when comprehensive changes in their work are going to be implemented.
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Escrig-Pinol A, Corazzini KN, Blodgett MB, Chu CH, McGilton KS. Supervisory relationships in long-term care facilities: A comparative case study of two facilities using complexity science. J Nurs Manag 2018; 27:311-319. [DOI: 10.1111/jonm.12681] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/20/2018] [Accepted: 06/10/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Astrid Escrig-Pinol
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
- University of Toronto; Dalla Lana School of Public Health; Toronto ON Canada
| | | | - Meagan B. Blodgett
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
| | - Charlene H. Chu
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
| | - Katherine S. McGilton
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
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Goodman C, Norton C, Buswell M, Russell B, Harari D, Harwood R, Roe B, Rycroft-Malone J, Drennan VM, Fader M, Maden M, Cummings K, Bunn F. Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence. Health Technol Assess 2018; 21:1-220. [PMID: 28805188 DOI: 10.3310/hta21420] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. OBJECTIVE To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes. DESIGN A realist synthesis. This was an iterative approach that involved scoping of the literature and consultation with five stakeholder groups, a systematic search and analysis of published and unpublished evidence, and a validation of programme theories with relevant stakeholders. DATA SOURCES The databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, SocAbs, Applied Social Sciences Index and Abstracts, BiblioMap, Sirius, OpenGrey, Social Care Online and the National Research Register. RESULTS The scoping identified six programme theories with related context-mechanism-outcome configurations for testing. These addressed (1) clinician-led support, assessment and review, (2) the contribution of teaching and support for care home staff on how to reduce and manage FI, (3) the causes and prevention of constipation, (4) how the cognitive and physical capacity of the resident affect outcomes, (5) how the potential for recovery, reduction and management of FI is understood by those involved and (6) how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Data extraction was completed on 62 core papers with iterative searches of linked literature. Dementia was a known risk factor for FI, but its affect on the uptake of different interventions and the dementia-specific continence and toileting skills staff required was not addressed. Most care home residents with FI will be doubly incontinent and, therefore, there is limited value in focusing solely on FI or on single causes of FI such as constipation. Clinical assessment, knowledge of the causes of FI and strategies that recognise the individuals' preferences are necessary contextual factors. Valuing the intimate and personal care work that care home staff provide to people living with dementia and addressing the dementia-related challenges when providing continence care within the daily work routines are key to helping to reduce and manage FI in this population. LIMITATIONS The synthesis was constrained by limited evidence specific to FI and people with dementia in care homes and by the lack of dementia-specific evidence on continence aids. CONCLUSIONS This realist synthesis provides a theory-driven understanding of the conditions under which improvement in care for care home residents living with dementia and FI is likely to be successful. FUTURE WORK Future multicomponent interventions need to take account of how the presence of dementia affects the behaviours and choices of those delivering and receiving continence care within a care home environment. STUDY REGISTRATION This study is registered as PROSPERO CRD42014009902. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Marina Buswell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Danielle Harari
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Health and Social Care, King's College London, London, UK
| | - Rowan Harwood
- Health Care of Older People, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | | | - Vari M Drennan
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston and St George's, London, UK
| | - Mandy Fader
- Health Sciences, University of Southampton, Southampton, UK
| | - Michelle Maden
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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Caspar S, Le A, McGilton KS. The Responsive Leadership Intervention: Improving leadership and individualized care in long-term care. Geriatr Nurs 2017; 38:559-566. [DOI: 10.1016/j.gerinurse.2017.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/05/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
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Buswell M, Goodman C, Roe B, Russell B, Norton C, Harwood R, Fader M, Harari D, Drennan VM, Malone JR, Madden M, Bunn F. What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence. J Am Med Dir Assoc 2017; 18:752-760.e1. [DOI: 10.1016/j.jamda.2017.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 01/06/2023]
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Seiger Cronfalk B, Ternestedt BM, Norberg A. Being a close family member of a person with dementia living in a nursing home. J Clin Nurs 2017; 26:3519-3528. [DOI: 10.1111/jocn.13718] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Berit Seiger Cronfalk
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Stord Haugesund University College; Department of Nursing Science; Haugesund Norway
| | - Britt-Marie Ternestedt
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
| | - Astrid Norberg
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
- Department of Nursing; Umeå University; Umeå Sweden
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Abstract
Participatory action research (PAR) is an approach for dealing with problematic areas in practice. Follow-up studies in which participants describe their participation in PAR in detail are rare. This follow-up study aimed to describe care providers' (CPs) experiences of having participated in a PAR intervention designed to assist them to constructively deal with troubled conscience. Twenty-nine CPs who participated in a PAR intervention were interviewed 2 to 4 months post-intervention. Content analysis was used to analyze the data. The analysis revealed three main categories: the importance of having a communal and collaborative meeting place, perceived changes in daily life, and "It has been good, but it has not solved all of our problems." Using PAR to deal with troubled conscience might be an important organizational investment for the future that can help prevent ill health among CPs and maintain or improve the quality of care.
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McGilton KS, Chu CH, Shaw AC, Wong R, Ploeg J. Outcomes related to effective nurse supervision in long-term care homes: an integrative review. J Nurs Manag 2016; 24:1007-1026. [DOI: 10.1111/jonm.12419] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine S. McGilton
- Department of Research; Toronto Rehabilitation Institute-UHN; Toronto Ontario Canada
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto Ontario Canada
| | - Charlene H. Chu
- Department of Research; Toronto Rehabilitation Institute-UHN; Toronto Ontario Canada
| | | | - Rosalind Wong
- Toronto Western Research Institute; Toronto Ontario Canada
| | - Jenny Ploeg
- McMaster University; Hamilton Ontario Canada
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20
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Talbot R, Brewer G. Care assistant experiences of dementia care in long-term nursing and residential care environments. DEMENTIA 2016; 15:1737-1754. [DOI: 10.1177/1471301215576416] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Care assistants have a unique insight into the lives of service users and those factors which may impede or enhance the delivery of high quality dementia oriented care. To address the paucity of research in this area, the present study examined care assistant experiences of dementia care in British long-term residential and nursing environments. Semi-structured interviews were conducted with eight care assistants and transcripts were analysed using interpretive phenomenological analysis. Super-ordinate themes emerging from the data were psychological wellbeing of the care assistant, barriers to effective dementia care, the dementia reality and organisational issues within the care environment. The study revealed important deficiencies in understanding and varying levels of dementia training. Whilst person centred strategies were being implemented, task orientated care remained dominant. Furthermore, care assistants reported taking the perspectives of those with dementia into account, and actively using these to develop relationship centred care.
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Affiliation(s)
- Rebecca Talbot
- School of Psychology, University of Central Lancashire, Lancashire, UK
| | - Gayle Brewer
- School of Psychology, University of Central Lancashire, Lancashire, UK
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Chu CH, Ploeg J, Wong R, Blain J, McGilton KS. An Integrative Review of the Structures and Processes Related to Nurse Supervisory Performance in Long-Term Care. Worldviews Evid Based Nurs 2016; 13:411-419. [PMID: 27458714 DOI: 10.1111/wvn.12170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Understanding the structures and processes related to the supervisor performance of regulated nurses (registered nurses [RN] and registered practical nurses [RPN]) is critical in order to discern how administrators of long-term care (LTC) homes can facilitate and better support nurses given their important contribution to nurse assistants' job satisfaction and resident outcomes. AIMS The aim of this integrative review is to identify the structures and processes related to supervisory performance of regulated nurses in LTC. METHODS An electronic search of six databases for studies published in English between 2000 and September 2015 was conducted by a librarian. The inclusion criteria were studies focused on RN or RPN supervisory performance in LTC, which included a structure or process related to supervisory performance of the nurse. Screening, quality assessment using the Mixed Methods Assessment Tool, and data extraction for the included studies were conducted independently by two reviewers. RESULTS A total of 22 studies were included in the review. Six nurse structures (e.g., nurses' "perceptions of their supervisory role and authority" as well as their "personal qualities"), and eight organizational structures (e.g., "organizational support (culture) for supervisory and management practices" and "staffing levels") were identified. Six processes of effective supervisory performance were identified, such as "being flexible, understanding, considerate listeners and encourage staff input" as well as "respect, value, recognize, acknowledge and motivate" nursing assistants they supervise. LINKING EVIDENCE TO ACTION The results highlight the nuanced and complex nature of nurses' supervisory performance and the multifaceted approach required to support effective nurse supervisors in LTC. Future research should examine how resident-related structures, as well as other moderators and mediators, may influence supervisory performance. Developing detailed models of effective supervision can inform future interventions targeting modifiable processes related to supervisory performance to thereby change practice and optimize supervisory performance in LTC.
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Affiliation(s)
- Charlene H Chu
- Research Associate 2, Toronto Rehabilitation Institute, University Health Network and Doctoral Graduate, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Ploeg
- Professor, School of Nursing and Scientific Director, Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Rosalind Wong
- Research Coordinator, Division of Health Care and Outcomes Research and Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Toronto, Ontario, Canada
| | - Julie Blain
- Research Assistant, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine S McGilton
- Senior Scientist, Toronto Rehabilitation Institute, University Health Network and Associate Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Abstract
Research literature in the dementia field lacks examples of ‘best-practices’ demonstrating concretely how it is possible to support the sense of coherence in people with dementia. The purpose of this study was to elucidate the nurses’ views concerning a caring approach that may support the sense of coherence in people with dementia. The data were collected through participant observation and focus group interviews during a four-month period in 2011. Sixteen registered nurses recruited from two Norwegian nursing homes participated in this study. The data were interpreted using a phenomenological-hermeneutical method. Three themes were identified: ‘being in the moment’, ‘doing one thing at a time’, and ‘creating joy and contentment’. An overall interpretation of these themes is described by the metaphor ‘slow nursing’, a caring approach that may lead to supporting the sense of coherence in people with dementia.
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Affiliation(s)
- Daniela Lillekroken
- Faculty of Health Sciences, Oslo and Akershus University College, Norway
- Faculty of Health and Sport Sciences, University of Agder, Norway
| | - Solveig Hauge
- Faculty of Health and Social Studies, Telemark University College, Norway
| | - Åshild Slettebø
- Faculty of Health and Sport Sciences, University of Agder, Norway
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23
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Norberg A, Ternestedt BM, Lundman B. Moments of homecoming among people with advanced dementia disease in a residential care facility. DEMENTIA 2015; 16:629-641. [DOI: 10.1177/1471301215613699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study concerns moments of homecoming among people with advanced dementia disease living in a residential care facility. Our main finding from participant observations with nine residents was that the residents showed moments of homecoming, i.e. they alternated between verbal and/or nonverbal expressions of feeling at home and of not feeling at home. If care providers understand that they can help people with advanced dementia disease experience moments of homecoming, they can focus on aspects of care that can promote these experiences.
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Affiliation(s)
- Astrid Norberg
- The Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden; Department of Nursing, Umeå University, Umeå, Sweden
| | - Britt-Marie Ternestedt
- The Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Berit Lundman
- Department of Nursing, Umeå University, Umeå, Sweden
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Mazaheri M, Ericson-Lidman E, Zargham-Boroujeni A, Öhlén J, Norberg A. Clear conscience grounded in relations: Expressions of Persian-speaking nurses in Sweden. Nurs Ethics 2015; 24:349-361. [DOI: 10.1177/0969733015603442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts. Research objective: The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia. Research design: A phenomenological hermeneutical method guided the study. Participants and research context: A total of 10 enrolled nurses with Iranian background, aged 33–46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden. Ethical considerations: The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential. Findings: Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day. Conclusion: Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.
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Affiliation(s)
- Monir Mazaheri
- Mälardalen University, Sweden; Tehran University of Medical Sciences, Iran
| | | | | | - Joakim Öhlén
- Ersta Sköndal University College, Sweden; University of Gothenburg, Sweden
| | - Astrid Norberg
- Umeå University, Sweden; Ersta Sköndal University College, Sweden
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Åhlin J, Ericson-Lidman E, Norberg A, Strandberg G. A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people. Scand J Caring Sci 2014; 29:277-87. [DOI: 10.1111/scs.12161] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/10/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Johan Åhlin
- Department of Nursing; Umeå University; Umeå Sweden
| | | | - Astrid Norberg
- Department of Nursing; Umeå University; Umeå Sweden
- Ersta Sköndal University College; Stockholm Sweden
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