1
|
McPherson R, Resnick B, Wallace BH. Differences in Staff-Resident Care Interactions by Nursing Home Racial Composition: a Preliminary Analysis. J Racial Ethn Health Disparities 2024; 11:2055-2063. [PMID: 37314689 DOI: 10.1007/s40615-023-01673-8] [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: 03/01/2023] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
Limited research has examined racial differences in the quality of staff-resident care interactions in long-term care settings. The quality of care interactions can significantly affect resident quality of life and psychological well-being among nursing home residents living with dementia. Limited research has assessed racial or facility differences in the quality of care interactions. The purpose of the present study was to determine if there were differences in the quality of care interactions among nursing home residents with dementia between Maryland nursing home facilities with and without Black residents. It was hypothesized that after controlling for age, cognition, comorbidities, and function, the quality of care interactions would be better in facilities with Black residents versus those in which there were only White residents. Baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) intervention study was used and included 276 residents. The results indicated that facilities in Maryland with Black residents had a 0.27 increase (b = 0.27, p < .05) in the quality of care interaction score compared to facilities without Black residents. The findings from this study will be used to inform future interventions to aid in reducing quality of care disparities in nursing home facilities with and without Black nursing home residents. Future work should continue to examine staff, resident, and facility characteristics associated with the quality of care interactions to improve quality of life among all nursing home residents regardless of race or ethnicity.
Collapse
Affiliation(s)
- Rachel McPherson
- School of Nursing, University of Maryland Baltimore, Baltimore, MD, USA.
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, Baltimore, MD, USA
| | - Brandy Harris Wallace
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, MD, USA
| |
Collapse
|
2
|
Moermans VRA, Hamers JPH, Verbeek H, de Casterlé BD, Milisen K, Bleijlevens MHC. District nurses' experiences with involuntary treatment in dementia care at home: a qualitative descriptive study. BMC Nurs 2023; 22:394. [PMID: 37853344 PMCID: PMC10585764 DOI: 10.1186/s12912-023-01553-w] [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: 01/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Research shows that half of person(s) living with dementia (PLWD) receive care which they resist and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in providing this care. Knowledge about how district nurses experience involuntary treatment is lacking. Therefore, the aim of this study was to describe the experiences of district nurses who used involuntary treatment for PLWD at home. METHODS A qualitative descriptive design using semi-structured interviews. Sixteen district nurses with experience in involuntary treatment for PLWD were recruited through purposive sampling. Data were analysed using the Qualitative Analysis Guide of Leuven. RESULTS District nurses' experiences with involuntary treatment were influenced by their involvement in the decision-making process. When they were involved, they considered involuntary treatment use to be appropriate care. However, at the moment that involuntary treatment use was started, district nurses were worried that its use was unjust since they wished to respect the wishes of the PLWD. Eventually, district nurses found, from a professional perspective, that involuntary treatment use was necessary, and that safety outweighed the autonomy of the PLWD. District nurses experienced dealing with this dilemma as stressful, due to conflicting values. If district nurses were not involved in the decision-making process regarding the use of involuntary treatment, family caregivers generally decided on its use. Often, district nurses perceived this request as inappropriate dementia care and they first tried to create a dialogue with the family caregivers to reach a compromise. However, in most cases, family caregivers stood by their request and the district nurse still provided involuntary treatment and found this difficult to tolerate. CONCLUSIONS Our results show that district nurses experience involuntary treatment use as stressful due to dealing with obverse values of safety versus autonomy. To prevent involuntary treatment use and obverse values, we need to increase their ethical awareness, communication skills, knowledge and skills with person-centred care so they can deal with situations that can evolve into involuntary treatment use in a person-centred manner.
Collapse
Affiliation(s)
- Vincent R A Moermans
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
- Department of Nursing, White Yellow Cross Limburg, Genk, Belgium.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| |
Collapse
|
3
|
Shirobe M, Edahiro A, Motokawa K, Morishita S, Ohara Y, Motohashi Y, Iwasaki M, Watanabe Y, Hirano H. Association between Dementia Severity and Oral Hygiene Management Issues in Older Adults with Alzheimer's Disease: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3841. [PMID: 36900852 PMCID: PMC10001667 DOI: 10.3390/ijerph20053841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Oral hygiene management issues vary across types and clinical stages of dementia. We aimed to clarify the issues related to oral hygiene management in older adults with Alzheimer's disease (AD) according to stages defined by the Functional Assessment Staging of Alzheimer's Disease (FAST). In all, 397 records (45 men and 352 women; average age, 86.8 years; age range, 65-106) from older adults with AD were used for the cross-sectional study. We used data from a cohort of older adults (≥65 years old) who required long-term care and lived in the Omorimachi area of Yokote City, Akita Prefecture, Japan. Multilevel logistic regression analysis was conducted to examine the associations of the FAST stage, set as the exposure variable, with oral hygiene management parameters set as outcome variables. Compared to the reference category (combined FAST stage 1-3), FAST stages 6 and 7 had significantly higher odds ratios for refusal of oral health care, dependence in performing oral health care, and rinsing and gargling disability. FAST stages 4 and 7 were associated with dental plaque accumulation. Oral health care for older adults with AD should be planned appropriately according to dementia severity.
Collapse
Affiliation(s)
- Maki Shirobe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shiho Morishita
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- School of Health Sciences, Meikai University, 1 Meikai, Urayasu-shi, Chiba 279-8550, Japan
| | - Yuki Ohara
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yoshiko Motohashi
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Gerodontology, Department of Oral Health Science, Hokkaido University, Kita 13-jo Nishi 7-chome, Kita-ku, Sapporo-shi, Hokkaido 060-8586, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Dentistry and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| |
Collapse
|
4
|
Backhouse T, Jeon YH, Killett A, Mioshi E. How do family carers and care-home staff manage refusals when assisting a person with advanced dementia with their personal care? DEMENTIA 2022; 21:2458-2475. [PMID: 36053711 PMCID: PMC9583289 DOI: 10.1177/14713012221123578] [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: 11/22/2022]
Abstract
Background and objectives Caregivers may encounter, or inadvertently cause, refusals of care by a care
recipient. Managing refusals of care can be challenging and have potential
negative consequences. We aimed to examine caregivers’ (care-home staff and
family carers) experiences of managing refusals of personal care in advanced
dementia. Research design and methods One-to-one semi-structured interviews with 12 care assistants from six care
homes and 20 family carers who were physically assisting a person with
advanced dementia with their personal care in the UK. Interviews were audio
recorded and transcribed verbatim, with data analysed using qualitative
content analysis. Findings Core to the caregiver experience of refusals of care was
knowing the person. This underpinned
five key themes identified as caregivers’ strategies used in preventing or
managing refusals of care: (1) finding the right moment to care; (2) using
specific communication strategies; (3) being tactful: simplifying, leaving,
or adapting care; (4) having confidence in care; and (5) seeking support
from others when safety is at risk. Discussion and implications Different caregiver relationships with the person with dementia influenced
how they managed refusals of care. Refusals of care can place caregivers in
tough situations with tensions between providing care when it is seemingly
not wanted and leaving care incomplete. Both caregiver groups require
support such as coaching, mentoring and/or advice from other health and
social care practitioners to manage difficult personal care interactions
before crisis points occur.
Collapse
Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
| | - Yun-Hee Jeon
- Sydney Nursing School, 4334The University of Sydney, Sydney, NSW, Australia
| | - Anne Killett
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
| | - Eneida Mioshi
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
| |
Collapse
|
5
|
Resnick B, Boltz M, Galik E, Zhu S. The Impact of Cognitive impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings. Clin Nurs Res 2021; 31:310-319. [PMID: 34472369 DOI: 10.1177/10547738211040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to describe differences in pain, behavioral symptoms, quality of staff-resident interactions, participation in function focused care and physical activity among residents with and without cognitive impairment in assisted living. This was a secondary data analysis using baseline data from an ongoing trial testing Function Focused Care for Assisted Living using the Evidence Integration Triangle (FFC-AL-EIT). A total of 550 residents were recruited from 59 communities. The average age of participants was 89.30 (SD = 7.63), the majority were white (98%), female (69%), had evidence of cognitive impairment (75%), and 5.16 (SD = 1.86) comorbidities. Those with cognitive impairment had more pain, were more sedentary and less likely to engage in function focused care activities. Addressing pain and implementing interventions for those with cognitive impairment to participate in function focused care may help optimize function and physical activity in assisted living residents.
Collapse
Affiliation(s)
| | - Marie Boltz
- Pennsylvania State University, University Park, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
| |
Collapse
|
6
|
Suwa S, Yumoto A, Ueno M, Yamabe T, Hoshishiba Y, Sato M. Practitioners' identification of informal caregivers' difficulties with activities of daily living interventions for older people with dementia in Japan. Psychogeriatrics 2021; 21:466-477. [PMID: 33847046 DOI: 10.1111/psyg.12689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older people with dementia who cannot perform daily activities independently due to cognitive impairment need support at home and in the community. This study identified aspects of activities of daily living (ADL) interventions that advanced dementia care practitioners recognise as challenging for informal caregivers to perform. METHODS We conducted a self-administered cross-sectional survey on advanced dementia care practitioners, including certified nurses, specialising in gerontological, community health, home care, and visiting nursing, nurses specialising in dementia certified by the Japanese Nursing Association, and dementia care leaders certified by prefectural governors. The participants rated a caregivers' extent of difficulty in aspects of ADL interventions on a four-point Likert scale. Factor analysis was performed to determine ADL intervention aspects that are recognised by advanced dementia care practitioners as challenging for informal caregivers. RESULTS The highest loaded factors for mild, moderate, and severe cognitive impairment stages were 'right time to draw attention,' 'opportunities to perform ADL,' and 'communicating how to perform ADL without giving up,' respectively. Therefore, it is imperative to educate informal caregivers about the effects of cognitive impairment on ADL performance in people with dementia and enable them to provide concrete ADL interventions and tips to support the persons' autonomy and independence. The Cronbach's alpha values of the highest loaded factors for mild, moderate, and severe cognitive impairment stages were 0.851, 0.925, and 0.946, respectively. Moreover, the cumulative contribution ratios of each stage were 46.04%, 50.52%, and 47.36%, respectively. CONCLUSION This study dealt with identifying informal caregivers' difficulties with ADL interventions across the stages of dementia. Informal caregivers should be supported on aspects of ADL interventions that are potentially difficult for them to perform. Useful educational content and approaches in training programs for informal caregivers should be developed to enable them to help people with Alzheimer's disease maintain ADL performance toward 'ageing in place' even as the disease progresses.
Collapse
Affiliation(s)
- Sayuri Suwa
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Akiyo Yumoto
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Mari Ueno
- School of Nursing, Jichi Medical University, Tochigi, Japan
| | - Tomoko Yamabe
- Department of Business, Japan Visiting Nursing Foundation, Tokyo, Japan
| | - Yumiko Hoshishiba
- Department of Social Policy, Mitsubishi UFJ Research and Consulting Co., Ltd., Tokyo, Japan
| | - Mihoko Sato
- Department of Management, Japan Visiting Nursing Foundation, Tokyo, Japan
| |
Collapse
|
7
|
Gjellestad Å, Oksholm T, Bruvik F. Forced treatment and care in home-dwelling persons with dementia. Nurs Ethics 2020; 28:372-386. [PMID: 33054528 DOI: 10.1177/0969733020948107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of forced treatment and care of home-dwelling persons with dementia is a universally important topic. These patients are completely dependent on care from others to continue living at home. AIM This study aimed to gain insights into formal decisions related to the forced treatment and care of home-dwelling persons with dementia. DESIGN AND SAMPLE This is a cross-sectional study, based on formal decisions of forced treatment and care of home-dwelling persons with dementia in Norway between 1 January 2015 and 31 December 2016. METHODS Descriptive statistical analysis. Statistically significant associations suitable for binary logistic regression were presented as odds ratios with 95% confidence intervals. ETHICAL CONSIDERATIONS Approved by The Regional Committee for Medical and Health Research Ethics, and by the Norwegian Center for Research. RESULTS We found 108 formal decisions of forced treatment and care of persons with dementia. Decisions of admission represented 57% of the data, other medical and safety decisions 27%, and assistance with activities of daily living 16%. In most cases, physicians were responsible for the decisions (77%), but nurses and family members were often involved. DISCUSSION AND CONCLUSION This study demonstrated a prevalence rate of formally documented decisions of forced treatment and care much lower than findings in previous studies. Poor documentation may constitute a risk for the safety and wellbeing of persons with dementia. Although physicians were usually responsible for the decisions, nurses and family members were often involved in the process. Family participation in forced treatment and care raises ethical dilemmas. More research on the experiences of nurses, persons with dementia and family members with forced treatment and care is needed to aid ethical, legal, and clinically challenging decision-making processes.
Collapse
|
8
|
Beecher C, Devane D, White M, Greene R, Dowling M. Concept development in Nursing and Midwifery: An overview of methodological approaches. Int J Nurs Pract 2018; 25:e12702. [DOI: 10.1111/ijn.12702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 08/02/2018] [Accepted: 09/08/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Claire Beecher
- School of Nursing and Midwifery; National University of Ireland; Galway Ireland
| | - Declan Devane
- School of Nursing and Midwifery; National University of Ireland; Galway Ireland
| | - Mark White
- Programme for Health Service Improvement, Health Service Executive; Dublin Ireland
| | - Richard Greene
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; Cork Ireland
| | - Maura Dowling
- School of Nursing and Midwifery; National University of Ireland; Galway Ireland
| |
Collapse
|