Family Members' Perceptions of the Quality of Long-Term Care

Psychometric Analysis of the 2016 Ohio Long-Term Care Facilities Family Satisfaction Scale

Although the Ohio Family Satisfaction Survey (OFSS) has been around since 2002 as an important indicator of long-term care facilities' performance, the validity of this scale has not been evaluated. Using the Robust Maximum Likelihood Estimator Method in Mplus, psychometric analysis involving second-order construct validity or hierarchical construct validity was conducted using responses from 1636 facilities including nursing homes and residential care facilities (N = 32,424). The results showed that OFSS retained the 7-factor structure for the 7 domains and the factor loadings for each domain were above 0.5. It is crucial to include families' input regarding quality of long-term care facilities as some older residents, especially those with moderate to severe cognitive impairments may be unable to provide consistent and comprehensive inputs about the quality of care and services they receive. Therefore, validation of the OFSS has an important implication for quality improvement practice.

What are the shared decision-making experiences of adult children in regard to their parent/s' health care in residential aged care facilities?

AIM

This scoping literature review aimed to answer the question: What are the shared decision-making experiences of adult children in regard to their parent/s' health care in residential aged care facilities?

BACKGROUND

Shared decision-making has been an important patient-centred approach to nursing care since the 1990s, yet it is becoming increasingly evident that it is still not the reality in aged care facilities fifty years on. Currently, it is not well understood how adult children participate in shared decision-making and the types of decisions they are required to make.

DESIGN

A review of original research papers using Kable, Pich and Maslin-Prothero 12-step systematic approach to documenting a search strategy.

METHOD

The researcher screened 597 articles from four databases, published in the English language, during the period 1985-2019. The researcher used the Mixed Methods Appraisal Tool version 2011 to determine the methodological quality of the included studies. The Joanna Briggs Institute QARI data tool was used to appraise the seven selected articles and thematically analyse findings, respectively.

RESULTS

Four themes were highlighted: communication; staffing; being involved; and staff-family relationships. Despite these themes being apparent, families have limited opportunities to participate in shared health decision-making in regard to their parents' care.

CONCLUSION

The findings from this literature show how shared decision-making is affected by the RACF environment. There is a need to find out and understand what is important from a family member's point of view to optimise shared decision-making and nursing care of the family member in residential aged care settings.

RELEVANCE TO CLINICAL PRACTICE

The limited findings specific to the SDM experiences of adult children of parents in RACFs in this review could help staff and RACFs to develop strategies and staff training to encourage and facilitate the implementation of shared health decision-making with staff and families on older people's care.

Expressed emotions and experiences from relatives regarding having a family member living in a nursing home for older people

Objectives:

The purpose of this study was to describe the topics relatives with a family member in a nursing home for older persons choose to talk about and focus on when participating in a nurse-led “Family Health Conversations” intervention. Family Health Conversations consisted of a series of three nurse-led conversations with each family, with a 2-week interval between meetings.

Methods:

The Family Health Conversations meetings were tape-recorded and analyzed using qualitative content methods. The participants were relatives of family members living in a nursing home for older persons in a municipality in Sweden.

Results:

The findings showed how the relatives talked about their suffering and difficulties concerning the new situation. The relatives talked about frustration and sadness together in a new way, with a focus on how to manage the future. They also wished that they had been offered an opportunity to talk about this with nurses earlier in the illness trajectory.

Conclusion:

The relatives had a significant need to talk about their experiences together within the family and together with the nurses. Nurses have an especially important task in supporting relatives having a family member living in a nursing home.

Family Health Conversations have Positive Outcomes on Families - A Mixed Method Research Study

BACKGROUND

Having a family member living in a residential home affects the entire family and can be hard to handle. Family members require encouraging and open communication support from nurses during and after relocation to a residential home. A Family Systems Nursing intervention, "Family Health Conversations" (FamHC) was conducted in order to strengthen the health of families having relatives at residential home for older people.

OBJECTIVES

The aims of this study were to evaluate the responses to the Family Health Conversations in families with a member living at a residential home for older people and to integrate the empirical results with a theoretical assumption upon which the intervention was based.

METHODS

A mixed methods research design was used. The Swedish Health-Related Quality of Life Survey and the Family Hardiness Index were administered before and 6 months after the intervention. Qualitative data was collected by semi-structured interviews with each family 6 months post-intervention. The sample included 10 families comprising 22 family members.

RESULT

Main finding was that FamHCs helped family members process their feelings about having a member living at a residential home and made it easier for them to deal with their own situations. FamHCs helped to ease their consciences, improve their emotional well-being, and change their beliefs about their own insufficiency and guilt. Seeing problems from a different perspective facilitated the families' thinking in a new way.

CONCLUSION

These findings showed that FamHC could be an important type of intervention to improve family functioning and enhance the emotional well-being.

Beyond family satisfaction: Family-perceived involvement in residential care

AIM

To explore perceived family involvement and its relationship with satisfaction and facility impressions.

METHOD

A questionnaire was posted to residents' next of kin from four South Australian residential aged care facilities.

RESULTS

One hundred and fifty next of kin participated in the survey. Family-perceived involvement was significantly and positively correlated with satisfaction and facility impressions.

CONCLUSION

The findings of this study add to the limited body of research into family involvement in long-term residential care. Feedback from the family regarding particular aspects of involvement may also improve the experience of long-term care for both family and resident, and assist with the identification of specific issues towards which organisations may target their quality improvement efforts.

Content analysis and qualitative study of hemodialysis patients, family experience and perceived social support

Background:

Various treatments such as hemodialysis prolong the life of chronic renal failure disease patients who must tolerate many physical, emotional, social and economic difficulties. Therefore, social support is considered as a vital area of investigation for such patients.

Objectives:

In this qualitative research, a grounded theory approach was used and written as a content analysis form to study hemodialysis patients and family experience of perceived social support.

Patients and Methods:

Three nurses, 4 general practitioners, a specialist and two family members who participated were interviewed from April to September 2012 in Urmia, Iran. Interviews were guided to divulge the perception of changes in their lives, needs for social support for disease complications, and the type of treatment process. Purposive sampling continued up to data saturation. Data analysis was performed based on Strauss and Corbin Method. Constant comparison analysis was performed until data saturation.

Results:

The research results are shown in 3 steps. In the first step, 113 categories and four main themes from 993 first codes were explored. Social support was explored based on the implications of five general themes including “Perceived Threats Caused by Disease Complications”, “Searching for Social Support”, “Accessible Social Support”, “Beliefs and Values”, and “Perceived Social Support”.

Conclusions:

The core variable of our research is acceptance of the reality of the conditions caused by the disease. The research finalized our knowledge about patient problems regarding social support and revealed many problems of supporting patients by Health Team Members, family members and organizations. The findings suggest that individual aspects of patient experiences must be considered if social support is to be given and Healthcare Providers have to facilitate positive health services.

Living with and caring for patients with Alzheimer's disease in nursing homes

INTRODUCTION

Many of the patients with Alzheimer disease are taken care of in nursing homes. However the literature on the experiences of Iranian formal caregivers of older adults with Alzheimer disease is scarce. This qualitative study explored the caring experiences of formal caregivers in nursing homes that can improve the quality of care and patient's quality of life.

METHODS

This qualitative study used the principles of descriptive content analysis to analyze these data. Our participants included 11 female and 3 male caregivers aged 25 to 38 years who were selected for interviewing based on a purposive sampling method. The data were analyzed with a content analysis method.

RESULTS

Nearly 900 initial codes were extracted and categorized into 6 main themes including "managing difficult behaviors", "dependence on familial care", "continuum of different feelings", "care for a child", "living with the patients" and "not understanding the patients", which was further analyzed in the two subcategories "caring without enough information" and " a dead man moving". conclusion: The care provided by our informants was mainly influenced by attitudes, culture and religious beliefs of caregivers about family attachment and ample driven reward of helping and caring frail or old people in Islam. These cultural and religious beliefs could facilitate provision of care and confrontation with patients' child-like behaviors. It is suggested that employment of trained staff and plans for their continued education can improve the quality of care and the quality of the patient's life.

Family members' involvement in elder care provision in nursing homes and their considerations about financial compensation: a qualitative study

The aim of this study was to establish how family members are involved in elder care provision in nursing homes; this included research into their feelings about potentially extending their involvement to obtain financial benefits as compensation for high accommodation costs. Family members remain involved in the caring process after their relatives have been admitted to an institution. On average, accommodation costs in nursing homes in Slovenia have risen above the residents' retirement pension, and families must supplement the difference. Because of this, familial involvement should be linked to reduced accommodation costs. This research employed a non-experimental, descriptive study design through unstructured interviews. Participants included fifty family members (n=50) who visit their relatives in nursing homes. Data were collected in 2010 at five nursing homes in Slovenia and processed by means of conventional content analysis. The major themes that emerged from the content analysis, describing family involvement, were as follows: visiting and making oneself useful, delivery of items for personal use, hands-on care, physical therapy and organization of nursing home activities. Family members showed some interest in receiving financial compensation for their involvement. The proposed financial compensation may be a delicate and morally questionable matter but would involve fairness and transparency, while enabling easier organization of elder care provision. Eventually, nursing home residents' well-being could be improved.

Characteristics of care and caregivers of Alzheimer's patients in elderly care homes: a qualitative research

BACKGROUND

Due to the increase in the number of Alzheimer's patients in Iran and also the limitation of cultural knowledge about caring of these patients, this study was designed to explore the perceptions of Iranian caregivers about caring Alzheimer patients in the elderly care homes.

METHODS

A qualitative content analysis method was conducted on two elderly care homes of Shiraz/Iran, during 2009-2011. Fourteen key informants (10 women and 4 men, between 25-35 years of age), who had been working in elderly care homes caring for the elderly with Alzheimer disease for about 1-11 years (Mean=30 months) were selected by purposive sampling method. The caring experience and ability of transferring their experience to others were the main criteria for selection of the participants. They were participated in 2 focus groups and 4 interviews.

RESULTS

Nearly, 800 initial codes were extracted and categorized into 3 groups of "multidimensional care", "going along with the patients" and "need to be professional" and 12 subcategories. Although several aspects of care were mentioned by the participants but the main aspect was physical care. Infantilizing the patients was the main feature of care and caring personality was an important characteristic of caregivers.

CONCLUSION

An appropriate schedule of care considering main categories and subcategories of this research based on cultural context should be prepared. Moreover, consistent promotion of the schedule, employment of trained staff and plans for continued education for them can improve the quality of care and patient's life in elderly care homes.

Visiting a nursing home: relatives' experiences of encounters with nurses

The purpose of this study was to explore and interpret the meaning of relatives' experiences of encounters with nurses when visiting residents in nursing homes. Thirteen relatives of residents in three nursing homes in Sweden were interviewed. The interviews were tape-recorded and transcribed verbatim. The method used was hermeneutical text analysis. Four themes emerged in the analysis and interpretation of the whole text: 'being paid attention to', 'being ignored', 'being involved' and 'being safe and secure'. A further interpretation of the findings shows a deeper understanding of the meaning of relatives. This meaning was revealed as being invited into an encounter with nurses and gave a sense of community but the opposite was being ignored and left outside. This study gives a deeper understanding of the meaning of encounters between relatives and nurses in nursing homes; it also illuminates how these encounters also can affect the care of the residents. This new understanding can hopefully offer support for nurses during their encounters with relatives and optimise the ability to provide a positive outcome for residents in nursing homes.

Survival disparities in patients with lymphoma according to place of residence and treatment provider: a population-based study

PURPOSE

Health disparities exist according to an individual's place of residence. We evaluated the association between primary area of residence (urban v rural) according to treatment provider (university based v community based) and overall survival in patients with lymphoma and determined whether there are patient groups that could benefit from better coordination of care.

PATIENTS AND METHODS

Population-based, retrospective cohort study of 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states and treated by university-based or community-based oncologists from 1982 to 2006.

RESULTS

Among urban residents, 321 (14%) were treated by university-based providers (UUB) and 816 (35%) were treated by community-based providers (UCB). Among rural residents, 332 (14%) were treated by university-based providers (RUB), and 861 (37%) were treated by community-based providers (RCB). The relative risk (RR) of death among UUB, UCB, and RUB were not statistically different. However, RCB had a higher risk of death (RR, 1.37; 95% CI, 1.14 to 1.65; P = .01; and RR, 1.26; 95% CI, 1.06 to 1.49; P = .01) when compared with UUB and RUB, respectively. This association was true in both low- and intermediate-risk patients. Among high-risk patients, UCB, RUB, and RCB were all at higher risk of death when compared with UUB.

CONCLUSION

Survival outcomes of patients with lymphoma may be associated with place of residence and treatment provider. High-risk patients from rural areas may benefit from better coordination of care.

Facilitating best practice in aged care: exploring influential factors through critical incident technique

Aim.  The focus of this study is on the perspective of facilitators of evidence-based aged care in long-term care (LTC) homes about the factors that influence the outcome of their efforts to encourage nursing staff use of best practice knowledge. Design.  Critical incident technique was used to examine facilitators' experiences. Methods.  Thirty-four participants submitted critical incident stories about their facilitation experiences through face-to-face interviews, telephone interviews, and/or a web-based written questionnaire. The resultant 123 stories were analysed using an inductive qualitative approach. Results.  Factors at individual and contextual levels impacted the success of facilitators' work. The approaches and traits of facilitators as well as the emotionality and intellectual capacity of nursing staff were the individual factors of influence. On a contextual level, the inherent leadership, culture, and workload demands within LTC homes, as well as externally imposed standards were influential. Conclusions.  Primary factors influencing the facilitation of best aged care in LTC homes appear to be largely relational in nature and intimately connected to the emotionality of those who work within these settings. Enhancing the interactional patterns amongst staff and leaders as well as promoting a positive emotional climate may be particularly effective in promoting better aged care nursing practice.

Maintenance of Patients' Integrity in Long-Term Institutional Care

This study aimed to describe and compare the views of nurses and older patients' relatives on factors restricting the maintenance of patient integrity in long-term care. The purposive sample comprised 222 nurses and 213 relatives of older patients in four Finnish long-term care institutions. The data were collected using a self-developed questionnaire addressing five sets of factors relating to patients, relatives, nurses, the organization and society. The maintenance of patient integrity was restricted by: (1) social factors, including lack of respect for long-term geriatric care and lack of adequate resources; (2) patient factors relating to forgetfulness; and (3) factors relating to nurses and relatives in maintaining patient integrity. Better maintenance of patient integrity requires that more consideration is paid to issues of social respect and to the availability of adequate resources. Closer attention must be given to patients who are forgetful and unable to take part in decision making.