A realist evaluation of the feasibility of a randomised controlled trial of a digital music and movement intervention for older people living in care homes

BACKGROUND

Low physical activity in care home residents brings about negative mental health consequences, such as higher levels of depression and loneliness. With advancements in communication technology, particularly during the COVID-19 pandemic, the feasibility and effectiveness of a randomised controlled trial (RCT) of a digital Physical Activity (PA) resource in care homes deserve more research attention. A realist evaluation was used to uncover influencing factors of a feasibility study implementation to inform how a digital music and movement programme would work and under what circumstances this would be most effective.

METHODS

Participants were 49 older adults (aged 65 years +) recruited across ten care homes in Scotland. Surveys were administered at baseline and post-intervention comprising psychometric questionnaires on multidimensional health markers validated in older adults with possible cognitive impairment. The intervention comprised 12 weeks of four prescribed digitally delivered movement (n = 3) and music-only (n = 1) sessions per week. An activity coordinator delivered these online resources in the care home. Post-intervention focus groups with staff and interviews with a sub-sample of participants were conducted to gain qualitative data on the acceptability of the intervention.

RESULTS

Thirty three care home residents started the intervention, but only 18 residents (84% female) completed both pre- and post-intervention assessments. Activity coordinators (AC) offered 57% of the prescribed sessions, with an average residents' adherence of 60%. Delivery of the intervention did not go as planned due to Covid restrictions in care homes and delivery challenges, including (1) motivation and engagement, (2) changes in cognitive impairment and disabilities of the participants, (3) death or hospitalisation of the participants and (4) limited staffing and technology resources to deliver the programme as intended. Despite this, group participation and encouragement of residents supported the delivery and acceptance of the intervention, with ACs and residents reporting improved mood, physical health, job satisfaction and social support. Improvements with large effect sizes were found for anxiety, depression, loneliness, perceived stress and sleep satisfaction, but no changes in fear of falling, domains of general health or appetite.

CONCLUSION

This realist evaluation suggested that this digitally delivered movement and music intervention is feasible. From the findings, the initial programme theory was refined for future implementation of an RCT in other care homes but future research exploring how to tailor the intervention to those with cognitive impairment and/or lacking capacity to consent is needed.

TRIAL REGISTRATION

Retrospectively registered at ClinicalTrials.gov NCT05559203.

The development and validation of the Japanese version of job satisfaction scale: a cross-sectional study on home healthcare nurses

Objective

A reliable and valid tool is required to assess home healthcare nurses’ job satisfaction for evaluating and improving the work environment and clinical practice of home healthcare. This study aimed to develop and examine the Japanese version of the Home Healthcare Nurses’ Job Satisfaction Scale (HHNJS-J). The Home Healthcare Nurses’ Job Satisfaction Scale (HHNJS) was translated into Japanese; a backward translation was performed until equivalence between the original and the backward-translated HHNJS was confirmed. Subsequently, a mail survey was conducted among 409 home healthcare nurses from 154 home healthcare agencies in Japan. We evaluated construct validity through Confirmatory Factor Analysis (CFA), and criterion-related validity and internal consistency were also tested.

Results

The CFA revealed a second-order seven-factor structure and adequate internal consistency, although, the fit of the data to the factor structure was moderate. As per the goodness-of-fit indices of the final model of the CFA, the comparative fit index was 0.89 and root mean square error of approximation was 0.06. This newly translated scale can be used to assess the job satisfaction of home healthcare nurses within Japan. The HHNJS-J evaluated acceptable reliability and validity among Japanese home healthcare nurses and had application in clinical practice in Japan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-06092-2.

Tips for Managing Ethical Challenges in Advance Care Planning: A Qualitative Analysis of Japanese Practical Textbooks for Clinicians

(1) Background: While advance care planning (ACP) provides healthcare professionals with valuable tools to meet patients’ needs in a person-centered manner, several potential ethical challenges are inherent to the process. However, recent studies have largely focused on ACP practicalities such as implementation, execution, and completion rather than on the ethical challenges that clinicians routinely encounter in ACP practices. (2) Research question/aim/objectives: This study aimed to identify tips for clinicians managing ethical challenges in ACP practices. (3) Methods: It performed a brief search for all Japanese published books pertaining to ACP practice available as of January 2021 using the keywords “advance care planning (ACP)” and “autonomy” and analyze the content of nine practical ACP textbooks for clinicians. (4) Results: Two major themes capturing the essential recommendations for managing ethical challenges in ACP were ultimately identified, namely interprofessional ethics and informed consent. (5) Conclusion: The findings suggested tips for managing ethical challenges in ACP: refer to ethical frameworks for interprofessional collaboration and ethical decision making, assess decision-making capacity of family substitute decision makers and one’s eligibility for the role, understand the standard process of informed consent and how to handle situations when the patient are not well informed about the diagnosis and prognosis of non-cancer illness.

Job satisfaction among physicians providing health care to the elderly in Japan: a qualitative study

BACKGROUND

Physicians' job satisfaction plays an important role in service delivery. Japan is a country with a higher number of elderly people and their medical care is a crucial issue. To date, no study has been conducted on the job satisfaction of geriatricians serving the elderly in Japan. This study aims to explore the job satisfaction and motivation of physicians providing health care to the elderly working at different hospitals in Japan.

METHODS

In-depth interview of 23 geriatric physicians was conducted and data were coded and analysed. Qualitative content analysis was conducted to identify the response themes.

RESULTS

Three major themes emerged from the analysis and they are: satisfaction as a primary care provider, career development, and suitable communication with patients. Geriatric physicians enjoy their work with inter-professional collaboration and are satisfied to provide primary health care to elderly people. Geriatrics is a very promising career to them and they enjoy the communication and empathetic doctor-patient relationship in their service.

CONCLUSIONS

Japanese physicians providing health care to the elderly are enjoying their work due to a suitable environment, multi-professional collaboration, work-life balance, and patient-doctor relationship.