Joy-of-life in cognitively intact nursing home residents: the impact of the nurse-patient interaction

Understanding joy amongst older people: A scoping review

To date there has been little focus on the concept of joy amongst older people in the literature. The objective of this scoping review was to understand the extent and type of evidence about joy and older people. Searches were run in ten databases in January 2022 (re-run January 2023). Eligible studies included people aged 65 and over living in their usual place of residence and described the experience or evaluation of joy. Screening was conducted independently by two reviewers and data were extracted by one reviewer and checked by a second. We included 11 papers reporting both qualitative (n = 5) and quantitative (n = 6) studies involving 1,487 participants with a mean age of 81.6 years. Seven of the studies were based in care or nursing homes with four in community settings. Five studies reported the experience of joy, three reported on the assessment of joy, and three examined the association between joy and other factors. Social connections and participation in activities that are meaningful to the individual are important sources of joy. Joy amongst older people has received little attention in the literature despite it being highlighted as being important to older people themselves in relation to their health and wellbeing.

Translation and validation of the Persian version of the caring nurse-patient interaction scale (CNPI-23)

INTRODUCTION AND OBJECTIVES

Although there is great emphasis on nursing care interaction, there is a lack of knowledge about the quality of nurse-patient care interactions in Iran. The lack of knowledge is mainly related to a lack of short Persian instruments that measure nurse-patient interaction from a caring perspective. The present study aimed to validate a Persian version of the nurse and patient versions of the Caring Nurse-Patient Interaction scale (CNPI-23).

METHODS

The scale (CNPI-23) was translated to Persian using the forward-backward translation method. After translation and re-translation, the scale was given to 15 nurses and faculty members of Kerman University of Medical Sciences, and CVI and CVR indices were calculated based on their opinions. The analytical cross-sectional study was conducted in Kerman/Iran in 2022. In this study, 230 working nurses and 230 hospitalized patients in hospitals affiliated with Kerman University of Medical Sciences were recruited using the convenience method to complete the 23-item Caring Nurse-Patient Interaction scale. Exploratory and confirmatory factor analyses were used to analyze the validity of the scale, and Cronbach's alpha and Raykov's rho indices were also calculated to evaluate internal consistency and composite reliability. Data were analyzed using R 4-1-2 software.

RESULTS

The scale was completed by 230 nurses and 230 patients. It included four dimensions: humanitarian care, clinical care, comforting care, and communication care. The results of the content validity ratio (CVR) and content validity index (CVI) were acceptable for all items. The minimum value of reliability was 0.49. All the items were approved at the end of the content validity assessment. In the patients' scale, these four factors explained 81% of the total variance, and for the exploratory model, all the indices show the adequacy of the model. All factor loadings were significant and higher than 0.5. Raycov's rho and Cronbach's alpha indices for all numbers were higher than 0.7. The findings of the exploratory factor analysis showed that the nurses' scale reflected four caring domains, which explained about 62% of the total variance, and the results of Raycov's rho and Cronbach's alpha indices confirmed the final fit of this model.

CONCLUSION

In general, the Persian version of the Caring Nurse-Patient Interaction scale has good validity and reliability and can be used to evaluate the quality of care interaction between Persian-speaking nurses and patients.

Quality of life and nurse-patient interaction among NH residents: Loneliness is detrimental, while nurse-patient interaction is fundamental

AIMS AND OBJECTIVES

To investigate the association between perceived nurse-patient interaction and quality-of-life among nursing home residents, adjusted for loneliness, anxiety and depression.

BACKGROUND

Symptoms of anxiety and depression are known to residents of nursing homes along with cognitive impairment, physical inactivity and low quality-of-life. Anxiety, depression and loneliness are found detrimental to NH residents' quality-of-life. The nurse-patient relationship is important for patient's well-being, both in terms of illness and symptom management.

DESIGN

Cross-sectional design.

METHODS

Data were collected in 2017 and 2018 from 188 residents in 27 nursing homes resided in two large urban municipalities in Middle and Western Norway. The inclusion criteria were: (1) local authority's decision of long-term NH care; (2) residential stay 3 months or longer; (3) informed consent competency recognised by responsible doctor and nurse; (4) capable of being interviewed, and (5) aged 65 years or older. This article is executed in accordance with STROBE statement.

RESULTS

Adjusting for age, sex, anxiety, depression and loneliness, perceived nurse-patient interaction was statistically significant to quality-of-life. While anxiety and depression showed insignificant estimates, loneliness demonstrated a significant relation with quality-of-life. Nurse-patient interaction and loneliness explained together 25% of the variation in quality-of-life.

CONCLUSION

This study suggests that loneliness is frequent as well as more detrimental to quality-of-life among nursing home residents compared to anxiety and depression. Furthermore, the present results show that the nurse-patient interaction represents an essential health-promoting resource for Quality-of-life in this population.

RELEVANCE TO CLINICAL PRACTICE

Staff nurses need to exercise their awareness of loneliness to meet residents' needs. Nursing educations should provide knowledge about nurse-patient interaction, and students as well as staff nurses in NHs should be trained, for instance by simulation, to use the nurse-patient interaction as a health-promoting resource. Finally, loneliness represents a bigger challenge than depression and anxiety; accordingly, building nurses that are capable of meeting patients' needs and facilitate care that counteracts loneliness is highly warranted.

Qualitative inquiry of a community dance program for older adults in Singapore

Dance programs promote physical and psychosocial well-being. However, studies focusing on the experiences of older adults in dancing are limited. This study aims to develop a community dance program (CDP) for older adults at senior activity centers in Singapore, as well as to explore the older adults' and student instructors' experiences of the CDP. A qualitative inquiry of semi-structured and in-depth focus group discussions was conducted. In total, 20 older adults and 10 student dance instructors participated in the study. Student instructors who were undergraduate students from a dance society were trained in how to provide step-by-step instructions for the older adults. An inductive approach of thematic analysis was undertaken. Three main themes were identified: (i) promotion of physical, cognitive, and psychosocial health with dance; (ii) imagination is power-travel through dance; and (iii) further enhancement of the dance program. The themes highlighted the prominence of CDP in improving memory, physical health, mood, and social interactions-thus mitigating the risk of social isolation. The findings illustrated the benefits of CDP in cultivating intergenerational bonds amongst older adults and student instructors.

How is leadership experienced in joy-of-life-nursing-homes compared to ordinary nursing homes: a qualitative study

Background

Nursing homes are under strong pressure to provide good care to the patients. In Norway, municipalities have applied the ‘Joy-of-Life-Nursing-Homes’ (JoLNH) strategy which is based on a health-promoting approach building on the older persons’ resources. Meanwhile job satisfaction is closely related to less intention to leave, less turnover and reduced sick leave. The knowledge about adjustable influences related with job satisfaction might help nursing home leaders to minimize turnover and preserve high quality of care. This study explores leadership in Norwegian nursing homes with and without implementation of JoLNH: How does leadership influence the work environment and how is leadership experienced in JoLNH compared to ordinary Nursing Homes?

Method

We used a qualitative approach and interviewed 19 health care personnel working in nursing homes in two Norwegian municipalities. The analysis was conducted following Kvale’s approach to qualitative analysis.

Results

The main categories after the data condensing were [1] the importance of leadership, and [2] the importance of leadership for the work environment in a municipality with (a) and without (b) an implementation of the JoLNH strategy.

Conclusions

The health care personnel in the municipality with an implementation of JoLNH emphasize that the leader’s influence may lead to increased motivation among the staff and better control of changes and implementation processes. Our findings may indicate that the employee from a JoLNH municipality experience a more trustful relationship to the leader.

Older adults' perspective of intergenerational programme at senior day care centre in Singapore: A descriptive qualitative study

Population ageing resulting from declining fertility and extended life expectancy has been occurring rapidly throughout the world. Older adults are faced with multiple physical, psychological and social changes that challenge their sense of self and capacity for healthy ageing. Intergenerational programmes (IGP) in communities have been developed to address a variety of social issues brought about by the population ageing. These programmes focus on promoting intergenerational social contact, supporting educational programmes and facilitating intellectual and/or physical activities in the older adults. This study intended to explore the perception of community-dwelling older adults towards an IGP in a senior day care centre in Singapore. Purposive sampling was adopted to recruit 15 participants for the study. Individual face-to-face interviews were conducted until data saturation was achieved. Interviews were audio-taped and transcribed verbatim. Thematic analysis was carried out. Four themes and 13 sub-themes emerged: (1) IGP enhances memory and strength; (2) social interaction between older adults and younger generation; (3) emotional responses to IGP; and (4) attitudes and perception towards the younger generation. The current study illustrated the dynamic social interaction between older adults and the younger generation, as well as the perceived benefits of the IGP. The relationship formed between the two generations entailed companionship, mutual care, trust and affection. Participation in the IGP provided the older adults an opportunity for active engagement in society and development. Continuous effort must be put in to ensure continuity of integration and empowerment of older adults, including the removal of obstacles and barriers that exclude or discriminate against them. The study findings will help facilitate the customisation of IGP to meet the needs of the older adults. With a well-planned and structured IGP, significant physical, emotional and psychosocial outcomes could benefit the older adults and the younger generation.

"Joy of life" in nursing homes. Healthcare personnel experiences of the implementation of the national strategy. A qualitative study with content analysis of interviews

Background

Nursing homes are under strong pressure to provide good care to the residents. In Norway, municipalities have applied the ‘Joy-of-Life-Nursing-Home’ strategy to increase a health-promoting perception that focuses on the older persons` resources. Implementations represent introducing changes to the healthcare personnel; however, changing one’s working approaches, routines and working culture may be demanding. On this background, we explored how the ‘Joy-of-Life-Nursing-Home’ strategy is perceived by the employees in retrospective, over a period after the implementation and which challenges the employees experience with this implementation.

Method

We used a qualitative approach and interviewed 14 healthcare personnel working in nursing homes in one Norwegian municipality, which had implemented the ‘Joy-of-Life-Nursing-Home’ strategy. The analysis was conducted following Kvale’s approach to qualitative content analysis.

Results

The main categories were: (a) the characteristics of care activities before implementations of ‘Joy-of-Life-Nursing-Home’, (b) how ‘Joy-of-Life-Nursing-Home’ influenced the care activities, and (c) challenges with the implementation of ‘Joy-of-Life-Nursing-Home’. Some of the informants spoke well about the implementation concerning the care quality stating “to see the joy in the eyes of the resident then I feel we have succeeded”. For informants who experienced resistance toward the implementation, they felt it was too much to document, it was too complicated, and the requirements were too many.

Conclusions

Quality of care seems to have increased after the implementation, as perceived by the informants. Nevertheless, the fact that the informants seemed to be divided into two different groups related to their main perspective of the implementation is concerning. One group has positive experiences with the implementations process and the benefits of it, while the other group focuses on lack of benefits and problems with the implementation process. To understand what facilitates and hinders the implementation, research on contextual factors like work environment and leadership is recommended.

Impact of sense of coherence, resilience and loneliness on quality of life amongst older adults in long-term care: A correlational study using the salutogenic model

AIMS

This study aimed to identify the predicting factors of quality of life (QoL) from a set of psychosocial, sociodemographic and clinical variables amongst older adults in a long-term care setting.

DESIGN

A cross-sectional, descriptive correlational study.

METHOD

The study was conducted in a nursing home and a day care centre from July to December 2019. Two hundred older adults were recruited. Guided by the salutogenic model, the sense of coherence (SOC) scale, Connor-Davidson resilience scale, de Jong Gierveld loneliness scale and World Health Organization quality of life instrument-older adults (WHOQOL-OLD) were used. The sociodemographic and clinical profiles of participants were collected. Descriptive statistics, Pearson product-moment correlation coefficient, independent-samples t test, one-way analysis of variance and stepwise regression were utilised in the analysis.

RESULTS

The mean score for WHOQOL-OLD was 94.42 ± 19.55. The highest mean score was observed in the "Death and Dying" facet, while the lowest mean scores were reflected in the "Autonomy" and "Intimacy" facets of QoL. Regardless of resident type, most QoL scores were similar across different variables. Based on the stepwise regression, higher manageability and meaningfulness in SOC, higher resilience, lower social loneliness, lower emotional loneliness and hearing impairments are significantly associated with higher QoL.

CONCLUSION

Manageability, meaningfulness and resilience should be enhanced while ameliorating feelings of loneliness to improve the QoL amongst older adults receiving long-term care. Age, marital status, educational level, care arrangement, body mass index, performance in activities of daily living, comorbidities and hearing and mobility impairments could influence QoL and thus warrant more attention.

IMPACT

Future interventions can be conducted in group sessions to facilitate social interaction and alleviate loneliness. More resources should be allocated to enhance older adults' care arrangements and coping mechanisms to provide them with the support, as they face challenges in daily life due to mobility impairment and other restrictions.

Visitor restrictions during the COVID-19 pandemic: An ethical case study

To prevent and reduce the transmission of the coronavirus to vulnerable populations, the World Health Organization recommended the restriction of visitors to nursing homes. It was recognised that such restrictions could have profound impact on residents and their families. Nonetheless, these measures were strictly imposed over a prolonged period in many countries; impeding families from remaining involved in their relatives' care and diluting the meaningful connections for residents with society. It is timely to explore the impact of public health measures on people living in nursing homes from an ethical perspective. In order to foreground the ethical dimensions of the implications of visitor restrictions in nursing homes, we compiled an ethical case that reflects some recent experiences of nursing homes residents and their families, in the Irish Republic. We describe a series of events encountered by a woman and her family during the first wave of the pandemic in 2020 and we deploy an ethical decision-making tool to guide and structure our analysis. Our case analysis draws attention to ethical principles that are relevant to explicating the ethical duties and obligations that arise in relation to the interests, well-being, and safety of residents and their families, as well as nursing home staff and the wider community during a pandemic. These include the right of autonomy, trust, minimising harm, and proportionality. We conclude that a number of different strategies should be adopted by nursing homes and relevant regulatory bodies. This includes honest, regular communication between the nursing home staff, the resident and their family. Central to communications is the resident's wishes, their current clinical status and the all-important wider public health obligations. National strategies include mass vaccination, the timely provision of guidance documents and interventions from regulatory bodies that are patient-centred, adaptable, and cost effective.

Nursing Students Explore Meaningful Activities for Nursing Home Residents: Enlivening the Residents by Cultivating Their Spark of Life

International research focuses on person-centered care, quality of life, and quality of care for people living in long-term care facilities, and that it can be challenging to improve the quality of life for residents with dementia. The aim of this study was to explore ways of developing appropriate person-centered activities for nursing home residents based on what would be meaningful for them. A qualitative explorative design was chosen. Twelve students each year over a three-year period participated in the study (altogether 36). Each student tailored joyful and meaningful activities for two nursing home residents and wrote eight reflection journals each (altogether 284). Additional data came from eight focus group interviews with the students. Data were analyzed using qualitative content analysis. The main theme was “Enlivening the residents by cultivating their spark of life”. Two main categories were identified: (1) “Journeying to meaningful and enlivening (enjoyable) activities”, and (2) “Expressions of enlivening”, It is possible to tailor meaningful and enlivening activities together with the individual person with dementia. Involvement and engagement are necessary to understand the verbal and nonverbal expressions and communicate with the individual resident.

Linking Service Quality Attributes to Meaning-in-Life Outcomes for Residents Who Have Transitioned to an Assisted Living Community

The growing number of persons aged 65 and older, combined with their greater reliance on care outside the family unit, has contributed to the rapid growth of older people residing in assisted living (AL) communities. Given the increased attention paid to service standards in older adults' housing models, this qualitative study was conducted in AL to generate residents' perspectives on service and meaning-in-life outcomes. Utilizing the attributes of service quality through a transition theory lens, the data revealed empathy and responsiveness as most essential to the perceptions of service and meaning-in-life among residents. Theoretical results from this study suggest that linking current service theory to meaning-in-life outcomes would be of benefit to AL service standards research. Practical application of the research outcomes revealed how appropriate personalized attention provided in a timely manner to residents is critical to their well-being, and to their successful transition to AL.

Will an Implementation of "Joy of Life in Nursing Homes" Have Positive Effect for the Work Culture? A Comparison Between Two Norwegian Municipalities

Background

Currently, we are facing a demographic shift to an older population and its consequences worldwide: in the years to come, several older people will need nursing home (NH) care. The work culture is important for care quality in NHs. Some Norwegian municipalities have implemented the Joy of Life Nursing Home (JoLNH) strategy, representing a resource-oriented health-promoting approach. Knowledge about how implementation of the JoLNH approach impacts the work culture is scarce.

Aimss

We hypothesized that the JoLNH strategy impacts positively on the work culture: (1) when comparing measurements at two time points (T1 and T2) and (2) when comparing two municipalities, among which one has implemented the JoLNH and the other has not.

Method

With a 1-year interval, healthcare personnel in 43 NHs located in two large Norwegian municipalities responded to a survey in two waves (T1 and T2). In total, 558 healthcare personnel participated at T1 and 515 at T2. Work culture was assessed by the Systematizing Person-Group Relations Instrument (SPGR).

Findings

The municipality implementing the JOLNH strategy experienced significant increases in SPGR dimensions, representing positive orientations towards a better work culture, whereas those working in the non-JoLNH municipality reported an increase in SPGR dimensions, signifying a worsened work culture.

Discussion

The data indicate that the implemented JoLNH strategy has endorsed positive effects in the work culture. The JoLNH strategy emphasizes on the quality of patient care, which is what healthcare personnel, in general, are much concerned about. Furthermore, attention to task orientation and independent work seem to encourage a better work culture in NHs.

Conclusion

This study suggests that the JoLNH strategy impacts positively on the work culture in Norwegian NHs.

Nurse-patient interaction and self-transcendence: assets for a meaningful life in nursing home residents?

Background

Due to the shift to an older population worldwide and an increased need for 24-h care, finding new and alternative approaches to increase wellbeing among nursing home (NH) residents is highly warranted. To guide clinical practice in boosting wellbeing among NH residents, knowledge about nurse-patient interaction (NPI), inter- (ST1) and intra-personal (ST2) self-transcendence and meaning-in-life (PIL) seems vital. This study tests six hypotheses of the relationships between NPI, ST1, ST2 and PIL among cognitively intact NH residents.

Methods

In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH residents representing 27 NHs responded to NPI, ST, and the PIL scales. Inclusion criteria were: (1) municipality authority’s decision of long-term NH care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations between the latent constructs were tested through structural equation modeling (SEM) using Stata 15.1.

Results

The SEM-model yielded a good fit (χ2 = 146.824, p = 0.021, df = 114, χ2/df = 1.29 RMSEA = 0.040, p-close 0.811, CFI = 0.97, TLI = 0.96, and SRMR = 0.063), supporting five of the six hypothesized relationships between the constructs of NPI, ST1, ST2 and PIL.

Conclusion

NPI significantly relates to both ST1, ST2 and PIL in NH residents. ST revealed a fundamental influence on perceived PIL, while NPI demonstrated a significant indirect influence on PIL, mediated by ST.