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Bagchus C, Zee MS, van der Steen JT, Klapwijk MS, Dekker NL, Onwuteaka-Philipsen BD, Pasman HRW. Challenges in recognizing and discussing changes in a resident's condition in the palliative phase: focus group discussions with nursing staff working in nursing homes about their experiences. BMC Palliat Care 2024; 23:144. [PMID: 38858719 PMCID: PMC11163817 DOI: 10.1186/s12904-024-01479-3] [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: 09/27/2023] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Most nursing home residents have complex care needs, require palliative care and eventually die in these facilities. Timely recognition of changes in a resident's condition is crucial for providing appropriate care. Observations by nursing staff play a significant role in identifying and interpreting these changes. METHODS Focus group discussions were conducted with nursing staff from ten nursing homes in the Netherlands to explore their experiences and challenges in recognizing and discussing changes in a resident's condition. These discussions were analysed following the principles of thematic analysis. RESULTS The analysis of the challenges nursing staff face in identifying and interpreting changes in a resident's condition, resulted in three themes. First, that recognizing changes is considered complex, because it requires specialized knowledge and skills that is generally not part of their education and must partly be learned in practice. This also depends on how familiar the nursing staff is with the resident. Furthermore, different people observe residents through different lenses, depending on their relation and experiences with residents. This could lead to disagreements about the resident's condition. Lastly, organizational structures such as the resources available to document and discuss a resident's condition and the hierarchy between nursing home professionals often hindered discussions and sharing observations. CONCLUSION Nursing staff's experiences highlight the complexity of recognizing and discussing changes in nursing home residents' conditions. While supporting the observational skills of nursing staff is important, it is not enough to improve the quality of care for nursing home residents with palliative care needs. As nursing staff experiences challenges at different, interrelated levels, improving the process of recognizing and discussing changes in nursing home residents requires an integrated approach in which the organization strengthens the position of nursing staff. It is important that their observations become a valued and integrated and part of nursing home care.
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Affiliation(s)
- C Bagchus
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
- Faculty of Health, University of Applied Sciences Leiden, Leiden, the Netherlands
| | - M S Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - J T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Primary and Community Care and Radboudumc Alzheimer center, Radboud university medical center, P.O. Box 9600, 6500 HB, Nijmegen, The Netherlands
| | - M S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - N Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, the Netherlands
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - H R W Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands.
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Ariander A, Olaison A, Andersson C, Sjödahl R, Nilsson L, Kastbom L. Ethical challenges causing moral distress: nursing home staff's experiences of working during the COVID-19 pandemic. Scand J Prim Health Care 2024; 42:266-275. [PMID: 38334427 PMCID: PMC11003312 DOI: 10.1080/02813432.2024.2308573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic. DESIGN Individual interviews. Latent qualitative content analysis. SETTING Ten nursing homes in Sweden. SUBJECTS Physicians, nurses and nurse assistants working in Swedish nursing homes. MAIN OUTCOME MEASURES Participants' experiences of working in nursing homes during the COVID-19 pandemic. RESULTS Four manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover - a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories. CONCLUSION During the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce.
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Affiliation(s)
- Annaclara Ariander
- Primary Health Care Centre in Johannelund and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Olaison
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | | | - Rune Sjödahl
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lisa Kastbom
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Ekholmen and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Gershater MA, Brenner J, Nordberg M, Hommel A. Nurse assistants' perception of caring for older persons who are dying in their own home : An interview study. BMC Palliat Care 2024; 23:70. [PMID: 38468298 DOI: 10.1186/s12904-024-01399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND As the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants' experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants' experiences in caring for dying older persons at home. METHOD An empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis. RESULTS From the nurse assistant's experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants' saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings. CONCLUSION This study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.
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Affiliation(s)
- Magdalena Annersten Gershater
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, Malmö, 206 05, Sweden.
| | - Josefin Brenner
- Department of Health and Social Care, Home Care Kungsparken, Malmö Municipality, Västra Kanalgatan 4, Malmö, 211 41, Sweden
| | - Malin Nordberg
- Department of Health and Social Care, Malmö Municipality, Villa Vikhem, Vikhems bygata 100, Staffanstorp, 245 46, Sweden
| | - Ami Hommel
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, Malmö, 206 05, Sweden
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Chang F, Östlund B, Kuoppamäki S. Domesticating Social Alarm Systems in Nursing Homes: Qualitative Study of Differences in the Perspectives of Assistant Nurses. J Med Internet Res 2023; 25:e44692. [PMID: 37145835 DOI: 10.2196/44692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/07/2023] [Accepted: 03/12/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND New social alarm solutions are viewed as a promising approach to alleviate the global challenge of an aging population and a shortage of care staff. However, the uptake of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses in advancing these implementations, but the dynamics by which implementations are created and shaped in their daily practices and relations have received less attention. OBJECTIVE Based on domestication theory, this paper aims to identify the differences in the perspectives of assistant nurses when integrating a social alarm system into daily practices. METHODS We interviewed assistant nurses (n=23) working in nursing homes to understand their perceptions and practices during the uptake of social alarm systems. RESULTS During the four domestication phases, assistant nurses were facing different challenges including (1) system conceptualization; (2) spatial employment of social alarm devices; (3) treatment of unexpected issues; and (4) evaluation of inconsistent competence in technology use. Our findings elaborate on how assistant nurses have distinct goals, focus on different facets, and developed diverse coping strategies to facilitate the system domestication in different phases. CONCLUSIONS Our findings reveal a divide among assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions within a group.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Britt Östlund
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sanna Kuoppamäki
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
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Åvik Persson H, Ahlström G, Årestedt K, Behm L, Drevenhorn E, Sandgren A. Palliative care delivery at nursing homes before and after an educational intervention from professionals' perspective: A pre-post design. Scand J Caring Sci 2023; 37:229-242. [PMID: 35524431 DOI: 10.1111/scs.13084] [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: 10/21/2021] [Revised: 03/09/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge-Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals' experience of palliative care delivery before and after the educational intervention. METHODS The educational intervention for nursing home professionals consisted of five 2-h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire 'Your experience of palliative care' was completed 1 month before (baseline) and after (follow-up) the intervention. Descriptive and inferential statistics were calculated. RESULTS The positive effects at follow-up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons' wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. CONCLUSIONS This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow-up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change.
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Affiliation(s)
- Helene Åvik Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Lina Behm
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Eva Drevenhorn
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Holmberg B, Godskesen T. Dignity in bodily care at the end of life in a nursing home: an ethnographic study. BMC Geriatr 2022; 22:593. [PMID: 35871666 PMCID: PMC9310487 DOI: 10.1186/s12877-022-03244-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nursing homes (NHs) are populated by the frailest older people who have multiple physical or mental conditions and palliative care needs that may convey the violation of dignity. Although dignity is a commonly used concept and a core value of end-of-life care, it is assumed to be complex, ambiguous, and multivalent. Thus, the aim of this study was to explore aspects of dignity in older persons' everyday lives in a NH. DESIGN A focused ethnographic study design. METHODS Data consisted of 170 h of fieldwork, including observations (n = 39) with residents (n = 19) and assistant nurses (n = 22) in a Swedish NH. Interviews were undertaken with residents several times (in total, n = 35, mean 70 min/resident). To study dignity and dignity-related concerns, we used the Chochinov model of dignity to direct the deductive analysis. RESULTS The study showed that residents suffered from illness-related concerns that inhibited their possibilities to live a dignified life at the NH. Their failing bodies were the most significant threat to their dignity, as loss of abilities was constantly progressing. Together with a fear of becoming more dependent, this caused feelings of agony, loneliness, and meaninglessness. The most dignity-conserving repertoire came from within themselves. Their self-knowledge had provided them with tools to distinguish what was still possible from what they just had to accept. Socially, the residents' dignity depended on assistant nurses' routines and behaviour. Their dignity was violated by long waiting times, lack of integrity in care, deteriorating routines, and also by distanced and sometimes harsh encounters with assistant nurses. Because the residents cherished autonomy and self-determination, while still needing much help, these circumstances placed them in a vulnerable situation. CONCLUSIONS According to residents' narratives, important dignity-conserving abilities came from within themselves. Dignity-conserving interventions did occur, such as emphatic listening and bodily care, performed in respect for residents' preferences. However, no strategies for future crises or preparing for death were observed. To protect residents' dignity, NHs must apply a palliative care approach to provide holistic care that comprises attention to personal, bodily, social, spiritual, and psychological needs to increase well-being and prevent suffering.
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Affiliation(s)
- Bodil Holmberg
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Box 11189, 100 61 Stockholm, Sweden
| | - Tove Godskesen
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Box 11189, 100 61 Stockholm, Sweden
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, SE-751 22 Uppsala, Sweden
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7
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Palliative care education for care workers in aged care: A scoping review. Collegian 2022. [DOI: 10.1016/j.colegn.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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An exploration of the views of staff on cultural aspects of end-of-life care in Japanese long-term care facilities: a qualitative study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Long-term care facilities are increasingly important places for palliative and end-of-life care provision in Japan. While the importance of culture has been noted for palliative and end-of-life care, an exploration of its influence on care provision in long-term care settings has received little direct attention in Japan. Exploring staff views and beliefs in palliative and end-of-life care in these settings can potentially enhance our understanding of culturally oriented care and facilitate the development of tailored and more effective support practices. This study aimed to explore the cultural views and beliefs regarding palliative and end-of-life care among the staff in Japanese long-term care facilities. A qualitative exploratory study was conducted using focus groups with facility staff (N = 71) and semi-structured interviews with facility managers (N = 10) in the Kanto region of Japan. Thematic analysis was conducted according to Braun and Clarke's approach. The findings are presented in five key themes: ‘Changes in society's and family's end-of-life perspectives’, ‘Values and beliefs regarding death and dying’, ‘Anxiety and regret’, ‘Tensions in doing the right thing’ and ‘Ways of alleviating pressure’. The findings indicate that the provision of palliative and end-of-life care is underpinned by cultural nuances that influence care providers' approach and delivery. Recognising and understanding the cultural beliefs of staff around death, dying and end-of-life care are important in meeting the needs of residents. Palliative care education for staff in these settings should include cultural considerations that reflect changing societal views on death and dying.
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Ahlström G, Rosén H, Persson EI. Quality of Life among Next of Kin of Frail Older People in Nursing Homes: An Interview Study after an Educational Intervention concerning Palliative Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052648. [PMID: 35270339 PMCID: PMC8909579 DOI: 10.3390/ijerph19052648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
One cornerstone of palliative care is improving the family’s quality of life (QoL). The principles of palliative care have not been sufficiently applied in nursing homes. The aim of this study was to investigate the experiences of QoL of next of kin of frail older persons in nursing homes after an educational intervention concerning palliative care. This qualitative interview study with 37 next of kin used an abductive design with deductive and inductive content analysis. The deductive analysis confirmed the three themes of QoL from the study before the implementation: (1) orientation to the new life-situation, (2) challenges in the relationship, and (3) the significance of the quality of care in the nursing home. The inductive analysis resulted in the sub-theme “Unspoken palliative care”. Being the next of kin of an older person living in a nursing home can be distressing despite round-the-clock care, so staff need to apply a more explicitly palliative care perspective. Future research needs to evaluate the influence of meaning-focused coping on next of kin’s QoL and integrate this knowledge in psychosocial interventions. Clinical Trial Database for Clinical Research: KUPA project NCT02708498.
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Mattsson K, Rosendahl S. Teaching Gerontology in Transcultural Academics: A Phenomenographic Study of Thai and Swedish Nurse Educators' Conceptions of Gerontological Nursing. J Transcult Nurs 2022; 33:446-455. [PMID: 35000509 PMCID: PMC9082963 DOI: 10.1177/10436596211068432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION There is an urgent need for registered nurses with gerontological competence within long-term care (LTC) of older adults. Despite increases of life expectancy, LTC for older adults is not emphasized in nursing curricula in neither Sweden nor Thailand. Thus, the aim was to explore conceptions on gerontological nursing (GN) among Swedish and Thai nurse educators. METHOD A qualitative phenomenographic method, based on open-ended interviews with five Thai and nine Swedish nurse educators was conducted. RESULTS The results indicate a paradox between the educators' knowledge about the implications of global aging, their hope of own aging, and LTC. The ethical responsibility of being credible and a source of inspiration in teaching about aging are focused, while GN seem to be less important. DISCUSSION To increase students' interest in GN, measures need to be taken within the educational arenas, where the educators' own conceptions toward GN, cultural aspects of aging, and LTC are discussed.
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11
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Li X, Dorstyn D, Mpofu E, O Neill L, Li Q, Zhang C, Ingman S. Nursing assistants and resident satisfaction in long-term care: A systematic review. Geriatr Nurs 2021; 42:1323-1331. [PMID: 34560527 DOI: 10.1016/j.gerinurse.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The number of nursing assistants (NAs) in the long-term care industry is on the rise, helping to service the needs of an increasingly aging population. Understanding influences on NAs service qualities and resident satisfaction is important to sustainable long-term care services. To date, the research evidence about NAs factors and resident satisfaction has not been synthesized. We aimed to address this gap in the evidence. RESEARCH DESIGN AND METHODS Utilizing a mixed-methods systematic review, we searched PubMed, PsycINFO, AgeLine, MEDLINE, Scopus, and Google Scholar databases for journal articles with primary data published from database inception to March 2021. Both qualitative and quantitative literature were considered and a narrative summary provided. Study reporting quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists and Critical Appraisal Skills Programme Checklist. RESULTS A total of 25 articles, spanning 9 countries and regions, were included in the review. Study reporting quality was good. A positive relationship between aged-care resident satisfaction and NAs job satisfaction (n = 8) was identified. Resident satisfaction was enhanced through NA training programs (n = 7), quality of daily interaction with NAs (n = 6), and the overall contribution of NAs in promoting residents` experiences (n = 4) DISCUSSION: The current findings highlight the important role of NAs in improving resident care in long-term care settings. Nursing home administrators need to better understand the value of NAs and to provide supports for growth and development in their work. Continuing the professional development of NAs can not only improve their skills but also benefit resident satisfaction and organizational sustainability.
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Affiliation(s)
- Xiaoli Li
- College of Health and Public Service, University of North Texas, 410 S. Avenue C, Denton, TX 76201, United States.
| | - Diana Dorstyn
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Elias Mpofu
- College of Health and Public Service, University of North Texas, 410 S. Avenue C, Denton, TX 76201, United States
| | - Liam O Neill
- College of Health and Public Service, University of North Texas, 410 S. Avenue C, Denton, TX 76201, United States
| | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, U.S
| | - Chi Zhang
- School of Economics, Shandong University, Jinan, China
| | - Stan Ingman
- College of Health and Public Service, University of North Texas, 410 S. Avenue C, Denton, TX 76201, United States
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Åvik Persson H, Ahlström G, Ekwall A. Professionals' Expectations and Preparedness to Implement Knowledge-Based Palliative Care at Nursing Homes before an Educational Intervention: A Focus Group Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178977. [PMID: 34501567 PMCID: PMC8431503 DOI: 10.3390/ijerph18178977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/10/2023]
Abstract
The provision of knowledge-based palliative care is rare in nursing homes. There are obstacles to practically performing this because it can be difficult to identify when the final stage of life begins for older persons. Educational interventions in palliative care in nursing homes are a challenge, and joint efforts are needed in an organisation, including preparedness. The aim was to explore professionals' expectations and preparedness to implement knowledge-based palliative care in nursing homes before an educational intervention. This study has a qualitative focus group design, and a total of 48 professionals working in nursing homes were interviewed with a semi-structured interview guide. Qualitative content analysis with an inductive approach was used for the analysis. One major theme was identified: professionals were hopeful yet doubtful about the organisation's readiness. The main categories of increased knowledge, consensus in the team, and a vision for the future illustrate the hopefulness, while insufficient resources and prioritisation illustrate the doubts about the organisation's readiness. This study contributes valuable knowledge about professionals' expectations and preparedness, which are essential for researchers to consider in the planning phase of an implementation study. The successful implementation of changes needs to involve strategies that circumvent the identified obstacles to organisations' readiness.
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13
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Johansson T, Tishelman C, Cohen J, Eriksson LE, Goliath I. Continuums of Change in a Competence-Building Initiative Addressing End-of-Life Communication in Swedish Elder Care. QUALITATIVE HEALTH RESEARCH 2021; 31:1904-1917. [PMID: 33980082 PMCID: PMC8446900 DOI: 10.1177/10497323211012986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Conversations about values for the end-of-life (EoL) between residents, relatives, and staff may allow EoL preparation and enable value-concordant care, but remain rare in residential care home (RCH) practice. In this article, longitudinal qualitative analysis was used to explore changes in staff discussions about EoL conversations throughout workshop series based on reflection and knowledge exchange to promote EoL communication in RCHs. We identified three overall continuums of change: EoL conversations became perceived as more feasible and valuable; conceptualizations of quality EoL care shifted from being generalizable to acknowledging individual variation; and staff's role in facilitating EoL communication as a prerequisite for care decision-making was emphasized. Two mechanisms influenced changes: cognitively and emotionally approaching one's own mortality and shifting perspectives of EoL care. This study adds nuance and details about changes in staff reasoning, and the mechanisms that underlie them, which are important aspects to consider in future EoL competence-building initiatives.
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Affiliation(s)
| | - Carol Tishelman
- Karolinska Institutet, Stockholm,
Sweden
- Stockholm Healthcare Services,
Region Stockholm, Stockholm, Sweden
| | - Joachim Cohen
- Vrije Universiteit Brussel &
Ghent University, Brussels, Belgium
| | - Lars E. Eriksson
- Karolinska Institutet, Stockholm,
Sweden
- City University of London,
London, United Kingdom
- Karolinska University Hospital,
Stockholm, Sweden
| | - Ida Goliath
- Karolinska Institutet, Stockholm,
Sweden
- Stockholm Gerontology Research
Center, Stockholm, Sweden
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14
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Ahlström G, Markeling NS, Liljenberg U, Rosén H. Breaking Up and a New Beginning When One's Partner Goes into a Nursing Home: An Interview Study. Healthcare (Basel) 2021; 9:healthcare9060672. [PMID: 34199811 PMCID: PMC8226602 DOI: 10.3390/healthcare9060672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
In aging societies worldwide, spouses take on great responsibility for care when their partner continues to live at home. Nursing home placement occurs when the partner becomes too frail due to multimorbidity, and this will cause a change in the spouse’s life. This study aimed to explore the spouse’s experience of their partner’s move to a nursing home. Two interviews were conducted at 9-month intervals within the project entitled “Implementation of Knowledge-Based Palliative Care in Nursing Homes”. Thirteen spouses from both urban and rural areas were included, with an age-range of 60–86 years (median 72). Qualitative content analysis was performed. The main findings were captured in two themes: Breaking up of close coexistence and Towards a new form of daily life. The first encompassed processing loneliness, separation and grief, exhaustion, increased burden, and a sense of guilt. The second encompassed a sense of freedom, relief, acceptance, support and comfort. Professionals in both home care and nursing home care need to develop and provide a support programme conveying knowledge of the transition process to prevent poor quality of life and depression among the spouses. Such a programme should be adaptable to individual needs and should ideally be drawn up in consultation with both partners.
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Affiliation(s)
- Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
- Correspondence: ; Tel.: +46-702-747767
| | | | | | - Helena Rosén
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
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Lavik MH, Gripsrud BH, Ramvi E. How Do Migrant Nursing Home Staff Relate to Religion in Their Work With Patients Who Are Approaching Death? J Holist Nurs 2020; 39:254-269. [PMID: 33238800 PMCID: PMC8427817 DOI: 10.1177/0898010120973544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To investigate how migrant nursing home staff relate to religion in their care for patients who are approaching death. METHOD AND THEORY Individual in-depth interviews were conducted with 16 migrant health care workers from five nursing homes in Norway. The overall analytic approach was hermeneutical. The parts and the whole were interpreted in light of each other to gain a "thick description" of the data material in order to show the ways in which experiential meaning-making draws on cultural webs of sign ificance. FINDINGS Religion held various meanings for the migrant health care workers interviewed. Religious and cultural competence and knowledge of migrant nursing home staff was neither asked for by the management nor discussed in the staff group. The way our participants related to religion at work was therefore based on individual preferences and internalized practices. CONCLUSION AND IMPLICATION FOR PRACTICE Organized reflection groups among staff are needed in order to integrate and develop religious literacy in the multicultural nursing home setting. Such reflection groups can help the individual staff member to perform holistic nursing, that is, to be attentive of the interconnectedness of biological, social, psychosocial, and spiritual aspects in a human being.
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Affiliation(s)
- Marta Høyland Lavik
- Chaplaincy Department, Stavanger University Hospital, Norway; Stellenbosch University, South Africa
| | - Birgitta Haga Gripsrud
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Norway
| | - Ellen Ramvi
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Norway
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Just DT, O'Rourke HM, Berta WB, Variath C, Cranley LA. Expanding the Concept of End-of-life Care in Long-term Care: A Scoping Review Exploring the Role of Healthcare Assistants. Int J Older People Nurs 2020; 16:e12353. [PMID: 33124160 DOI: 10.1111/opn.12353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The context of care provided in long-term care homes is changing, as an increasing number of older adults are entering long-term care with advance stages of illness and higher care needs. Long-term care homes are quickly becoming the place of death for an increasing number of older adults, despite recent literature identifying inadequate and suboptimal levels of end-of-life care. Within long-term care, healthcare assistants represent 60%-70% of the unregulated workforce and provide 70%-90% of the direct care to residents. Research indicates that a high level of uncertainty exists surrounding the role of healthcare assistants in end-of-life care, with numerous studies reporting the role of healthcare assistants to be 'unclear' with varying levels of responsibilities and autonomy. OBJECTIVE The purpose of this scoping review was to explore healthcare assistants' experiences and perspectives of their role in end-of-life care in long-term care. METHODS We applied Arksey and O'Malley's methodological framework, with recommendations from Levac and colleagues' guiding principles. Electronic databases and the grey literature were searched for relevant articles. Search concepts included end-of-life care and healthcare assistants. Articles were included in this review if they explored healthcare assistants' experiences or perspectives of providing end-of-life care in long-term care. The peaceful end of life theory by Ruland and Moore (1998) was used to organise data extraction and analysis. RESULTS A total of n = 15 articles met the inclusion criteria. The most predominant role-required behaviours reported by healthcare assistants were as follows: psychosocial support to significant others, knows the resident's care wishes and physical care with respect and dignity. The most predominant extra-role behaviours reported by healthcare assistants were as follows: becoming emotionally involved, acting as extended family and ensuring residents do not die alone. CONCLUSIONS Findings from this review expanded the concept of end-of-life care by illustrating the role-required and extra-role behaviours healthcare assistants perform when providing end-of-life care in long-term care. IMPLICATIONS FOR PRACTICE Findings from this scoping review highlight the numerous behaviours healthcare assistants perform outside their role description in order to provide end-of-life care to dying residents in long-term care. These findings could inform policymakers and managers of long-term care homes.
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Affiliation(s)
- Danielle T Just
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Whitney B Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Caroline Variath
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Schenell R, Ozanne A, Strang S, Henoch I. To make and execute decisions throughout life: A person-centred model that facilitates self-determination in residential care, developed through participatory research. Appl Nurs Res 2020; 55:151318. [PMID: 32586648 DOI: 10.1016/j.apnr.2020.151318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
AIM The aim of the study was to develop a model that facilitates self-determination in residential care. BACKGROUND The right to decide on one's own life is self-evident to most adult persons. Nevertheless, dependency on others and the routine-based care that sometimes is provided in residential care, limit the residents' possibilities of self-determination. METHODS The study had a participatory research design using appreciative inquiry in focus group discussions with staff, residents, and care managers. The research process and the model were audited by two expert groups: a scientific reference group and a dementia-specialist reference group. A theoretical framework of relational autonomy and person-centred care was also used. RESULTS By combining practical and theoretical knowledge, the model "To make and execute decisions throughout life" was developed. The core message of "In my way, at my pace, with the help of you" was reinforced by the categories "See me as a competent person", "Show me professional consideration", "Meet me in a trustful relationship", "Give me opportunity to a meaningful and safe day", "Support me in being independent", "Let me have power over my own life", and "Help me to plan my end-of-life care". CONCLUSION The model "To make and execute decisions throughout life" provides a base for a person-centred approach to care. By reflecting on the core message and the different categories in the model, staff can be inspired to see their own contribution to the residents' self-determination and find ways to facilitate it despite the many obstacles.
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Affiliation(s)
- Ramona Schenell
- University of Gothenburg, the Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, 405 30 Gothenburg, Sweden; The City of Gothenburg, Health Care Unit, Centrum City District Committee, Skånegatan 9A, 41140 Gothenburg, Sweden.
| | - Anneli Ozanne
- University of Gothenburg, the Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, 405 30 Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden.
| | - Susann Strang
- University of Gothenburg, the Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, 405 30 Gothenburg, Sweden.
| | - Ingela Henoch
- University of Gothenburg, the Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, 405 30 Gothenburg, Sweden; Angered Hospital, Box 63, 424 22 Angered, Sweden.
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Abstract
BACKGROUND Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons' wishes, older persons claim they have to adapt to assistant nurses' routines. The provider-receiver incongruence revealed here warrants investigation. AIM To describe the elements of assisted bodily care, as performed in a nursing home. RESEARCH DESIGN Data were collected through thirty-nine observations of assisted bodily care, analyzed with qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home. ETHICAL CONSIDERATIONS The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee. FINDINGS Findings show that assisted bodily care consists of assistant nurses' practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons' wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care. DISCUSSION Assistant nurses try to promote older persons' dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons' lifeworlds may be more important than the amount of time available. CONCLUSION Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all.
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Affiliation(s)
| | - Ingrid Hellström
- 7643Ersta Sköndal Bräcke University College, Sweden; Linköping University, Sweden
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Cronin U, McCarthy J, Cornally N. The Role, Education, and Experience of Health Care Assistants in End-of-Life Care in Long-Term Care: A Scoping Review. J Gerontol Nurs 2020; 46:21-29. [PMID: 31895958 DOI: 10.3928/00989134-20191022-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/09/2019] [Indexed: 11/20/2022]
Abstract
The changing age profile of the human population globally means that the requirement for residential long-term care (LTC) for older adults is escalating, with an associated increase in deaths in these facilities. Health care assistants (HCAs), whose main role is provision of direct care to residents, comprise the largest staff cohort in residential care for older adults. The purpose of this scoping review was to explore three key areas related to HCAs: their role and responsibilities, end-of-life (EOL) education, and their views and experiences of caring for residents at EOL. The literature search included five databases and 32 studies were ultimately reviewed. Key issues were as follows: HCAs feel marginalized and undervalued, they need and desire EOL education, and resident deaths impact negatively on them. The changing care needs for older adults with complex comorbidities at EOL in LTC will place an increased onus on HCAs' skills, knowledge, and personal and professional development. [Journal of Gerontological Nursing, 46(1), 21-29.].
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Rosendahl S, Mattsson K, Yuwanich N. Cross-cultural perspectives on gerontology in nursing education - a qualitative study of nurse educators' experiences. GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:109-120. [PMID: 31319778 DOI: 10.1080/02701960.2019.1645014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study focuses on nurse educators' perspectives on teaching gerontology within nursing curricula in two cultures. An increasing aging multi-cultural population with large caring needs requires not only informal elder care provided by family members, but also professional nursing staff trained in gerontology. The aim of this study was to explore how Swedish and Thai nurse educators describe the role of teaching gerontology within nursing educations in Sweden and Thailand. Method: Qualitative open-ended interviews with 13 Swedish and Thai nurse educators were conducted and analyzed with qualitative content analysis. Findings: There is a lack of gerontological nursing competence in faculty, as well as bureaucracy impeding necessary changes of curricula, together with difficulties in highlighting positive and cultural aspects of aging. Conclusions: Pedagogical strategies need to be developed by nurse educators specialized in cross-cultural gerontology to improve current and future nursing educations in both countries.
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Affiliation(s)
- Sirpa Rosendahl
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Karin Mattsson
- Department of Health Care Sciences, Ersta Sköndal Community College, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS) H1, Karolinska Institutet, Huddinge, Sweden
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Holmberg B, Hellström I, Österlind J. Being a spectator in ambiguity-Family members' perceptions of assisted bodily care in a nursing home. Int J Older People Nurs 2019; 15:e12289. [PMID: 31763780 DOI: 10.1111/opn.12289] [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: 05/05/2019] [Revised: 09/27/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to explore family members' perceptions of assisted bodily care in a nursing home. BACKGROUND Many older people living in nursing homes need assisted bodily care, provided by assistant nurses. This means exposedness, as the assistance is often provided under stress, but also brings pleasure. Family members, who may wish to and often benefit from continuing to provide assisted bodily care, are perceived as visitors and are expected to relinquish the assisted bodily care to the assistant nurses. DESIGN This study has a qualitative design with a phenomenographic approach. METHODS Data were collected through semi-structured interviews (n = 13) with family members of older people who were aged > 80, permanently living in a nursing home, suffering from multimorbidity, and in daily need of assisted bodily care. The data were analysed using a phenomenographic method. RESULTS Three categories of description presenting an increasing complexity were identified. The family members perceived that assisted bodily care is built upon a respect for the older person's self-determination, practically supported by assistant nurses, and complemented by family members. CONCLUSIONS In the family members' perceptions, assisted bodily care signifies ambiguity, as they find themselves balancing between the older persons' need for self-determination and need for help, and, further, between their trust in the assistant nurses' skills and their own perceived inadequacies in intimate assisted bodily care. IMPLICATIONS FOR PRACTICE Policies that address the family members' role in nursing homes are needed. Furthermore, time for collaboration is needed for assistant nurses to inform and explain care decisions, become aware of the family members' perceptions of their situation and learn from them.
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Affiliation(s)
- Bodil Holmberg
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ingrid Hellström
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Jane Österlind
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
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Holmberg B, Hellström I, Norberg A, Österlind J. Assenting to exposedness – meanings of receiving assisted bodily care in a nursing home as narrated by older persons. Scand J Caring Sci 2019; 33:868-877. [DOI: 10.1111/scs.12683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Bodil Holmberg
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
| | - Ingrid Hellström
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Social and Welfare Studies Linköping University Norrköping Sweden
| | - Astrid Norberg
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Nursing Umeå University Umeå Sweden
| | - Jane Österlind
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
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