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Iwasaki Y, Fukahori H, Okumura-Hiroshige A, Sakai I, Inoue S, Sugiyama T, Nasu K, Ogawara H. Family Caregivers' Needs in Long-Term Care Facilities: A Descriptive Qualitative Study. Res Gerontol Nurs 2024; 17:177-187. [PMID: 38916473 DOI: 10.3928/19404921-20240614-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
PURPOSE To explore the needs of family caregivers (FCs) and how these are addressed in long-term care facilities (LTCFs). METHOD A descriptive qualitative study was performed, using semi-structured interviews with 23 FCs from seven LTCFs in Japan. RESULTS Inductive content analysis revealed three main themes: Coexistent Needs Related to Residents' and FCs' Own Well-Being, Means by Which FCs Promote Residents' and Their Own Well-Being, and Managing Conflicting Needs by Prioritizing and Compromising. FCs recognized that their needs relate to the well-being of residents and themselves, and both needs coexist. To address these multifaceted needs, FCs engaged in various activities while seeking support. However, limited availability of means often made it challenging to meet multiple needs simultaneously, leading FCs to manage these conflicting needs by prioritizing or compromising. CONCLUSION The current study underscores the significance of comprehensive support that simultaneously addresses FCs' conflicting needs, rather than approaching each need separately. [Research in Gerontological Nursing, 17(4), 177-187.].
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van Muijden T, Gräler L, van Exel J, van de Bovenkamp H, Petit‐Steeghs V. Different views on collaboration between older persons, informal caregivers and care professionals. Health Expect 2024; 27:e14091. [PMID: 38924218 PMCID: PMC11196834 DOI: 10.1111/hex.14091] [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: 01/23/2024] [Revised: 04/12/2024] [Accepted: 05/11/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Informal care features high on the policy agenda of many countries to deal with workforce shortages. As a consequence, care provision increasingly takes place in the care triad of care recipients, informal caregivers and care professionals. How collaboration between care partners takes shape depends on how the different partners perceive this collaboration. This paper aims to investigate the relative importance of the different aspects of collaboration from the perspectives of care recipients, informal caregivers and care professionals in the context of the care for older persons in The Netherlands. METHODS Using Q-methodology, 32 participants ranked 28 statements that reflect different aspects of collaboration in the care triad and explained their ranking during a follow-up interview. Participants comprised 9 older persons, 10 informal caregivers and 13 care professionals. Data were analysed using by-person factor analysis to identify common patterns in the rankings of the statements. Emerging patterns were interpreted and described as views on collaboration using aggregated rankings and qualitative data from the interviews. RESULTS Five distinct views on collaboration were found: (1) Emphasizing warm collaboration, (2) trusting care professional's expertise, (3) open and compassionate care professionals, (4) responsive decision-making by autonomous care professionals and (5) prioritizing care recipient's and informal caregiver's interests. Care recipients and/or informal caregivers were associated with views 1, 3 and, 5, whereas care professionals were associated with all five views. CONCLUSIONS Our study highlights the importance of recognizing the potential diversity of views between and within different partner groups in care triads. Governmental and organizational policy makers, as well as healthcare professionals who aim to increase or support the involvement of informal caregivers, should take this heterogeneity into consideration. PATIENT OR PUBLIC CONTRIBUTION An advisory board of older persons (care recipients and informal caregivers) was involved in the recruitment of the participants, the formulation of the statements and the reflection on the findings of the study and potential implications.
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Affiliation(s)
- Teyler van Muijden
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
| | - Leonoor Gräler
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
| | - Job van Exel
- Department of Health EconomicsErasmus School of Health Policy & ManagementRotterdamNetherlands
| | | | - Violet Petit‐Steeghs
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
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Conklin J, Dehcheshmeh MM, Archibald D, Elliott J, Hsu A, Kothari A, Stolee P, Sveistrup H. From Compliance to Care: Qualitative Findings from a Survey of Essential Caregivers in Ontario Long-Term Care Homes. Can J Aging 2024:1-10. [PMID: 38561989 DOI: 10.1017/s071498082400014x] [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: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic highlighted the importance of the care provided by family members and close friends to older people living in long-term care (LTC) homes. Our implementation science team helped three Ontario LTC homes to implement an intervention to allow family members to enter the homes during pandemic lockdowns. OBJECTIVE We used a variety of methods to support the implementation, and this paper reports results from an Ontario-wide survey intended to help us understand the nature of the care provided by family caregivers. METHODS We administered a survey of essential caregivers in Ontario, and a single open-ended question yielded a substantial qualitative data set that we analysed with a coding and theming procedure that yielded 13 themes. FINDINGS The 13 themes reveal deficiencies in Ontario's LTC sector, attempts to cope with the deficiencies, and efforts to influence change and improvement. DISCUSSION Our findings indicate that essential caregivers find it necessary to take on vital roles in order to shore up two significant gaps in the current system: they provide psychosocial and emotional (and sometimes even basic) care to residents, and they play a monitoring and advocacy role to compensate for the failings of the current regulatory compliance regime.
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Affiliation(s)
- James Conklin
- Department of Applied Human Sciences, Concordia University, Montreal, QC, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Douglas Archibald
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jacobi Elliott
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Amy Hsu
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anita Kothari
- School of Health Studies, Western University, London, ON, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Heidi Sveistrup
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Paulis SJC, Everink IHJ, Huppertz VAL, Lohrmann C, Schols JMGA. Roles, mutual expectations and needs for improvement in the care of residents with (a risk of) dehydration: A qualitative study. J Adv Nurs 2024; 80:150-160. [PMID: 37424109 DOI: 10.1111/jan.15777] [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: 11/30/2022] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
AIM Examining the perspectives of formal and informal caregivers and residents on roles, mutual expectations and needs for improvement in the care for residents with (a risk of) dehydration. DESIGN Qualitative study. METHODS Semi-structured interviews with 16 care professionals, three residents and three informal caregivers were conducted between October and November 2021. A thematic analysis was performed on the interviews. RESULTS Three topic summaries contributed to a comprehensive view on the care for residents with (a risk of) dehydration: role content, mutual expectations and needs for improvement. Many overlapping activities were found among care professionals, informal caregivers and allied care staff. While nursing staff and informal caregivers are essential in observing changes in the health status of residents, and medical staff in diagnosing and treating dehydration, the role of residents remains limited. Conflicting expectations emerged regarding, for example, the level of involvement of the resident and communication. Barriers to multidisciplinary collaboration were highlighted, including little structural involvement of allied care staff, limited insight into each other's expertise and poor communication between formal and informal caregivers. Seven areas for improvement emerged: awareness, resident profile, knowledge and expertise, treatment, monitoring and tools, working conditions and multidisciplinary working. CONCLUSION In general, many formal and informal caregivers are involved in the care of residents with (a risk of) dehydration. They depend on each other's observations, information and expertise which requires an interprofessional approach with specific attention to adequate prevention. For this, educational interventions focused on hydration care should be a core element in professional development programs of nursing homes and vocational training of future care professionals. IMPACT The care for residents with (a risk of) dehydration has multiple points for improvement. To be able to adequately address dehydration, it is essential for formal and informal caregivers and residents to address these barriers in clinical practice. REPORTING METHOD In writing this manuscript, the EQUATOR guidelines (reporting method SRQR) have been adhered to. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Simone J C Paulis
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Irma H J Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Vivienne A L Huppertz
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Nijsten JMH, Plouvier AOA, Smalbrugge M, Koopmans RTCM, Leontjevas R, Gerritsen DL. The development and feasibility evaluation of a program to identify and manage apathy in people with dementia: the SABA program. Aging Ment Health 2024; 28:227-237. [PMID: 37382202 DOI: 10.1080/13607863.2023.2228252] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To develop and evaluate feasibility of a program for family and professional caregivers to identify and manage apathy in people with dementia: the Shared Action for Breaking through Apathy program (SABA). METHODS A theory- and practice-based intervention was developed and tested among ten persons with apathy and dementia in two Dutch nursing homes from 2019 to 2021. Feasibility was evaluated with interviews with family caregivers (n = 7) and professional caregivers (n = 4) and two multidisciplinary focus groups with professional caregivers (n = 5 and n = 6). RESULTS SABA was found feasible for identifying and managing apathy. Caregivers mentioned increased knowledge and awareness regarding recognizing apathy and its impact on their relationship with the person with apathy. They experienced increased skills to manage apathy, a greater focus on small-scale activities and increased appreciation of small moments of success. The content, form and accessibility of the program's materials were considered facilitating by all stakeholders, as was the compatibility of the procedures with the usual way of working. The expertise and involvement of stakeholders, staff stability and the support of an ambassador and/or manager were facilitating, while insufficient collaboration was a barrier. Organizational and external aspects like not prioritizing apathy, staff discontinuity, and the Covid-19 pandemic were perceived as barriers. A stimulating physical environment with small-scale living rooms, and access to supplies for activities were considered facilitating. CONCLUSIONS SABA empowers family and professional caregivers to successfully identify and manage apathy. For implementation, it is important to take into account the facilitators and barriers resulting from our study.
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Affiliation(s)
- Johanna M H Nijsten
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Archipel Landrijt, Expertise Center for Specialized Care, Eindhoven, The Netherlands
| | - Annette O A Plouvier
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond T C M Koopmans
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Waalboog, location Joachim and Anna, Center for Specialised Geriatric Care, Nijmegen, The Netherlands
| | - Ruslan Leontjevas
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Debby L Gerritsen
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
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Tasseron-Dries PEM, Smaling HJA, Nakanishi M, Achterberg WP, van der Steen JT. What are best practices for involving family caregivers in interventions aimed at responsive behaviour stemming from unmet needs of people with dementia in nursing homes: a scoping review. BMJ Open 2023; 13:e071804. [PMID: 38149428 PMCID: PMC10711828 DOI: 10.1136/bmjopen-2023-071804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/03/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES This study aimed to determine best practices for involving family caregivers in interventions aimed at preventing and reducing responsive behaviour stemming from unmet needs, including pain. DESIGN Scoping review, reported according to the Preferred Reporting Items for Systematic Reviews, Meta-Analyses extension for Scoping Reviews reporting guideline. DATA SOURCES PubMed, Embase, Emcare, Web of Science, COCHRANE Library, PsycINFO, Academic Search Premier and Cinahl searched up to 23 July 2023. ELIGIBILITY CRITERIA Studies reporting on family involvement in interventions for nursing home residents with dementia were included. DATA EXTRACTION AND SYNTHESIS Two researchers independently extracted the data, followed by a content analysis. RESULTS Of the 1486 records screened, 20 studies were included. Family caregivers were involved in interventions aimed at planning care, life review (eg, documentation of life experiences of their relative), and selecting activities for their relative. Family caregivers preferred an active role in developing optimal care for their relative. Drivers of success and barriers to family involvement centred around three themes: (1) communication between all involved; (2) prerequisites (organisational and other conditions) and (3) personal circumstances (family's coping and skills). CONCLUSION Best practices for involving family caregivers in interventions aimed at addressing responsive behaviour in residents with dementia concerned those interventions in which family caregivers were given an important role in managing responsive behaviour. This means that, in order to achieve an active role of family caregivers in the whole care process, their needs must be taken into account. TRIAL REGISTRATION NUMBER The protocol of the review was regisered at OSF; https://osf.io/twcfq.
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Affiliation(s)
- Petra E M Tasseron-Dries
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Warande (Nursing Home Organization), Zeist, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Primary and Community Care, and Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
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Thompson GN, Hack TF, Chochinov HM, Roger K, St John PD, McClement SE. Developing a question prompt list for family caregivers concerning the progression and palliative care needs of nursing home residents living with dementia. PEC INNOVATION 2023; 2:100160. [PMID: 37384156 PMCID: PMC10294106 DOI: 10.1016/j.pecinn.2023.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 06/30/2023]
Abstract
Objective Communication around a palliative approach to dementia care often is problematic or occurs infrequently in nursing homes (NH). Question prompt lists (QPLs), are evidence-based lists designed to improve communication by facilitating discussions within a specific population. This study aimed to develop a QPL concerning the progression and palliative care needs of residents living with dementia. Methods A mixed-methods design in 2 phases. In phase 1, potential questions for inclusion in the QPL were identified using interviews with NH care providers, palliative care clinicians and family caregivers. An international group of experts reviewed the QPL. In phase 2, NH care providers and family caregivers reviewed the QPL assessing the clarity, sensitivity, importance, and relevance of each item. Results From 127 initial questions, 30 questions were included in the first draft of the QPL. After review by experts, including family caregivers, the QPL was finalized with 38 questions covering eight content areas. Conclusion Our study has developed a QPL for persons living with dementia in NHs and their caregivers to initiate conversations to clarify questions they may have regarding the progression of dementia, end of life care, and the NH environment. Further work is needed to evaluate its effectiveness and determine optimal use in clinical practice. Innovation This unique QPL is anticipated to facilitate discussions around dementia care, including self-care for family caregivers.
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Affiliation(s)
- Genevieve N. Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada
| | - Thomas F. Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada
| | - Harvey Max Chochinov
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, PZ433-771 Bannatyne Avenue, Winnipeg, Manitoba R3E 3N4, Canada
- CancerCare Manitoba Research Institute, 4005-675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9, Canada
| | - Kerstin Roger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 35-220 Chancellor Circle, Winnipeg, Manitoba R3T 2N2, Canada
| | - Philip D. St John
- Section of Geriatric Medicine, Max Rady College of Medicine, University of Manitoba, GE 547 Health Sciences Centre, 820 Sherbrook St, Winnipeg, MB R2A 1R9, Canada
- Research Affiliate, Centre on Aging, University of Manitoba, 338 Isbister Building, 183 Dafoe Rd, Winnipeg, Manitoba R3T 2N2, Canada
| | - Susan E. McClement
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada
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Khemai C, Meijers JM, Bolt SR, Pieters S, Janssen DJA, Schols JMGA. I want to be seen as myself: needs and perspectives of persons with dementia concerning collaboration and a possible future move to the nursing home in palliative dementia care. Aging Ment Health 2023; 27:2410-2419. [PMID: 37354050 DOI: 10.1080/13607863.2023.2226079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/11/2023] [Indexed: 06/26/2023]
Abstract
Introduction: Interprofessional collaboration (IPC) within and during movements between care settings is crucial for optimal palliative dementia care. The objective of this study was to explore the experiences of persons with dementia regarding collaboration with and between healthcare professionals (HCPs) and their perceptions of a possible future move to the nursing home (NH) in palliative dementia care. Method: We conducted a cross-sectional qualitative study and performed semi-structured interviews with a purposive sample of persons with dementia living at home (N = 18). Data analysis involved content analysis. Results: Our study demonstrated that even though most persons with dementia find it difficult to perceive the collaboration amongst HCPs, they could describe their perceived continuity of care (Theme 1. My perception of collaboration among HCPs). Their core needs in collaboration with HCPs were receiving information, support from informal caregivers, personal attention and tailored care (Theme 2. My needs in IPC). Regarding a possible future move to the NH, persons with dementia cope with their current decline, future decline and a possible future move to the NH (Theme 3. My coping strategies for a possible future move to the NH). They also prefer to choose the NH, and continue social life and activities in their future NH (Theme 4. My preferences when a NH becomes my possible future home). Conclusion: Persons with dementia are collaborative partners who could express their needs and preferences, if they are willing and able to communicate, in the collaboration with HCPs and a possible future move to the NH.
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Affiliation(s)
- Chandni Khemai
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Judith M Meijers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Zuyderland Care, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Sascha R Bolt
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Sabine Pieters
- Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Research and Education, CIRO, Horn, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Paananen J. Discussing physical restrictions in care plan meetings between family members of residents with dementia and nursing home staff. DEMENTIA 2023; 22:1530-1547. [PMID: 37387268 PMCID: PMC10521163 DOI: 10.1177/14713012231186346] [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] [Indexed: 07/01/2023]
Abstract
In long-term dementia care, caregivers face a dilemma. On the one hand, they need to respect the residents' right to self-determination, but on the other hand, they sometimes rely on physical restraints to deal with potential violence and self-destructive behavior. The issue of self determination is further complicated by residents often depending on family members as advocates in decision-making. In this article, we examine 15 care plan meetings to identify the professional practices of discussing the physical restrictions posed to residents with severe dementia. Our method is conversation analysis. Our analysis demonstrates that staff members' practices involve informing, accounting, and agreeing on the goals rather than on the methods of physical restraining. Staff members tend to first inform family members about the principles of restraining and then account for the use of restraints. Accounts highlight the problems that can be avoided and the benefits that can be achieved by limiting residents' actions. Consequently, the family members' role in the discussion is to accept the decision that has already been approved by authorities. As the staff members highlight the aim of protecting the well-being of the resident, the family members tend to respond with overt agreement and even promote the use of restraints. Current negotiation practices provide insufficient opportunities for family members to advocate for residents. Therefore, we recommend involving family members in decision-making about restraining at an earlier stage, adjusting the protocol in care plan meetings, and engaging the family in minimizing and preventing restraints. In general, staff members should pay more attention to the residents' experiences and the family members' lifeworld knowledge of the residents.
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Affiliation(s)
- Jenny Paananen
- Department of Nursing Science, University of Turku, Finland
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de Graaf L, Janssen M, Roelofs T, Luijkx K. Who's Involved? Case Reports on Older Adults' Alcohol and Tobacco Use in Dutch Residential Care Facilities. QUALITATIVE HEALTH RESEARCH 2023; 33:945-955. [PMID: 37429034 PMCID: PMC10494475 DOI: 10.1177/10497323231186879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities and aim to provide person-centered care (PCC). Maintaining residents' autonomy is important to provide PCC, for example, with shared decision-making (SDM). Residents are largely dependent on multiple stakeholders, which could jeopardize their autonomy, especially regarding unhealthy behaviors, such as smoking tobacco or drinking alcohol. This case study explores the dynamics of multiple stakeholders around four RCF residents regarding their alcohol and/or tobacco use. Four RCF residents who smoke tobacco and/or drink alcohol were selected from a previous study, and their (in)formal caregivers were additionally invited to participate. A qualitative research design was chosen, and semi-structured interviews were conducted. The Ethics Review Board from the Tilburg University School of Social and Behavioral Sciences (Reference: RP39) and the executive boards of the two participating organizations granted approval. Narrative portraiture resulted in four case descriptions. Two cases focused mostly on tobacco use, and two cases focused mostly on alcohol use. Multiple stakeholders were involved on different levels: family bought alcohol or cigarettes, and team managers supported care professionals. However, little interaction was found between stakeholders. In these cases, limited interaction between the stakeholders, including the resident, jeopardizes SDM and, in this way, PCC regarding residents' alcohol and/or tobacco use. SDM on this topic could enhance interaction between all stakeholders involved, which could increase PCC. Finally, the cases indicate a constant struggle between protecting residents from adverse outcomes of alcohol and tobacco use and enhancing their autonomy.
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Affiliation(s)
- Lisette de Graaf
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Mijzo, Waalwijk, The Netherlands
| | - Meriam Janssen
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Tineke Roelofs
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Archipel Zorggroep, The Netherlands
| | - Katrien Luijkx
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Mitchell LL, Horn B, Stabler H, Birkeland RW, Peterson CM, Albers EA, Gaugler JE. Caring for a Relative With Dementia in Long-Term Care During the COVID-19 Pandemic: A Prospective Longitudinal Study. Innov Aging 2023; 7:igad034. [PMID: 37213326 PMCID: PMC10195573 DOI: 10.1093/geroni/igad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Indexed: 05/23/2023] Open
Abstract
Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic introduced unprecedented threats and disruptions for caregivers of people with dementia living in residential long-term care (LTC) facilities. Qualitative and cross-sectional studies have reported substantial negative effects of the pandemic on dementia caregivers' well-being, but little to no prospective research has examined the impact of COVID-19 on caregiver well-being using pre-pandemic assessments. The present study used longitudinal data from an ongoing randomized controlled trial of a psychosocial intervention to support family caregivers whose relatives had entered LTC. Research Design and Methods Data collection began in 2016 and continued through 2021. Caregivers (N = 132) completed up to 7 assessments measuring their depressive symptoms, self-efficacy, and burden. Results Latent growth curve models testing preregistered hypotheses revealed no significant effects of the pandemic on caregiver outcomes on average, though caregivers varied in terms of individual intercepts and slopes. Furthermore, factors such as caregiver-care recipient relationship closeness, care recipient's COVID-19 infection status, and caregivers' ratings of LTC facilities' COVID-19 policies did not significantly moderate trajectories of well-being. Discussion and Implications Findings highlight the heterogeneity of caregivers' experiences during the pandemic, and suggest caution when interpreting cross-sectional findings on the impacts of the COVID-19 pandemic on caregiver well-being and distress.
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Affiliation(s)
- Lauren L Mitchell
- Department of Psychology & Neuroscience, Emmanuel College, Boston, Massachusetts, USA
| | - Brenna Horn
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Henry Stabler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robyn W Birkeland
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Colleen M Peterson
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Elle A Albers
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Falzarano FB, Cimarolli V, Siedlecki KL. Staying in the loop: Quality of family-paid caregiver communication and influences on resident mental health in long-term care. J Am Geriatr Soc 2023; 71:1209-1219. [PMID: 36514200 PMCID: PMC10089968 DOI: 10.1111/jgs.18184] [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: 04/13/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Considerable research has examined communication dynamics among family members and staff in nursing homes (NHs) and has demonstrated that better communication is associated with more optimal mental health outcomes in both family caregivers and paid caregivers. However, the literature on how communication dynamics influence mental health in long-term care residents is limited and it has yet to be determined how communication impacts residents across care contexts, such as assisted living facilities (ALFs). The purpose of this study is to examine family caregivers' perceptions of communication with paid caregivers and its influence on long-term care resident outcomes and to compare how results differ across care settings (NHs vs. ALFs). METHODS Data were drawn from a subsample of the National Health and Aging Trends Study (NHATS) and the National Study on Caregiving (NSOC). The sample consisted of 142 NHATS participants residing in long-term care (n = 93 ALF residents; n = 49 NH residents) with an eligible family caregiver who participated in the NSOC. Family caregivers' perceived quality of communication was assessed via questions regarding the frequency, availability, and helpfulness of communication with paid caregivers. Resident mental health was assessed via measures of positive and negative affect, depressive symptoms, and anxiety. RESULTS Across the total sample, greater availability of communication between paid and family caregivers was associated with lower depressive symptoms and negative affect in residents. When examining how these relationships varied across care settings, communication was a stronger predictor of fewer depressive symptoms among residents in ALF settings. CONCLUSIONS Study findings provide insights into how interpersonal dynamics between family and paid caregivers influence resident mental health and underscore the importance of enhanced communication among all members of the primary care team, that is, paid caregivers, residents, and their family members.
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Affiliation(s)
- Francesca B Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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13
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Dolberg P, Lev S, Even-Zahav R. "Let me touch him": Perceptions and experiences of family caregivers of nursing home residents during the COVID-19 outbreak in Israel. J Aging Stud 2023; 64:101115. [PMID: 36868607 PMCID: PMC9902284 DOI: 10.1016/j.jaging.2023.101115] [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: 12/09/2021] [Revised: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
Older adults in nursing homes were particularly vulnerable to COVID-19 morbidity and mortality worldwide. Due to the COVID-19 pandemic, visitations in nursing homes were restricted. The present study examined the perceptions and experiences of family caregivers of nursing home residents during the COVID-19 crisis in Israel and their coping strategies. Online focus group interviews were held with 16 family caregivers of nursing home residents. Three main categories were identified through Grounded Theory techniques: (a) Anger and decreased trust in nursing homes; (b) Perception of the residents as victims of the nursing home policy; (c) Coping strategies at different levels. The outbreak redefined family caregivers' understanding of their role. Practical implications include making the voice of the family caregivers heard, identifying effective coping strategies, and creating a dialogue between family caregivers, nursing home managements, and staff.
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Affiliation(s)
- Pnina Dolberg
- Department of Social Work, Ruppin Academic Center, Israel.
| | - Sagit Lev
- School of Social Work, Bar-Ilan University, Israel
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14
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Cooke HA, Wu SA, Bourbonnais A, Baumbusch J. Disruptions in Relational Continuity: The Impact of Pandemic Public Health Measures on Families in Long-Term Care. JOURNAL OF FAMILY NURSING 2023; 29:6-17. [PMID: 35674340 PMCID: PMC9850387 DOI: 10.1177/10748407221102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although the value of family caregivers' involvement with relatives in long-term care (LTC) is well recognized, tensions remain regarding their role. Such tensions were exacerbated during the COVID-19 pandemic as strict public health measures restricted family access to LTC homes. Using interpretive description, we examined the impact of visitation restrictions on family caregivers' experiences caring for a relative in LTC between March 2020 and June 2021. In-depth interviews were conducted with 14 family caregivers (five spouses and nine adult daughters) and two key themes were identified. The first theme, "seeking to maintain relational continuity," illustrates how caregivers sought to sustain connections with residents prior to and during the pandemic. The second theme, "disrupted relational continuity," highlights the impact of severed relational connections on caregivers' sense of self and ongoing feelings of loss and anger. Findings call for a trauma-informed approach that recognizes the pervasiveness of trauma for family caregivers and the avoidance of re-traumatization.
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Affiliation(s)
| | - Sarah A. Wu
- The University of British Columbia, Vancouver, Canada
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15
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Rosteius K, de Boer B, Staudacher S, Schols J, Verbeek H. How the interrelated physical, social and organizational environment impacts daily life of residents with dementia on a Green Care Farm. Front Public Health 2022; 10:946962. [PMID: 36106159 PMCID: PMC9467523 DOI: 10.3389/fpubh.2022.946962] [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] [Received: 05/18/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023] Open
Abstract
Green Care Farms (GCF) are innovative long-term care environments and an alternative to regular nursing homes in the Netherlands. Following a culture change movement, GCFs have radically altered the care environment. Research suggests positive effects on residents. However, knowledge is limited regarding their physical, social and organizational environment. This article explores the care environment of 24-h GCFs for people with dementia and its impact on residents and their daily life. An ethnographic study using mixed methods was carried out at a GCF in the Netherlands between June and October 2021. Researchers lived on the GCF and completed 28 days of participatory observations in three groups. During the day, informal conversations were held with residents (n = 48), staff and family members. Twenty four semi-structured interviews were conducted with residents, their family members, staff and the managers, complemented by a focus group with staff. The physical environment was additionally assessed with the OAZIS-dementia tool. Data collection methods informed each other. Qualitative data was thematically analyzed, quantitative data descriptively. Four themes were identified as crucial during daily life on the GCF: stimulating the senses, engaging in purposeful activities, sharing responsibilities and creating a community in a new home. Realizing these topics in practice, physical, social and organizational environmental components were highly interrelated. The physical environment encouraged and facilitated meaningful in-/outdoor activities and social encounters. The organizational environment supported the use of the physical environment by aligning processes and transporting the vision. The social environment focused on collaboration and creating a home-like atmosphere by including residents in household- and farm chores. This community-building led to more meaningful activities and social interaction. In conclusion, this study revealed the central influence of the management in paving the way for a new form of care delivery. As leaders shape the three environments, the organization influences the design of the physical environment and the actions taking place within it. By creating a community, the care home benefits residents, their families and staff equally. The conscious interrelation and harmonization of the physical, social and organizational components of a long-term care environment has the potential to improve the daily life of residents.
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Affiliation(s)
- Katharina Rosteius
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands,Living Lab in Ageing and Long Term Care, Maastricht, Netherlands,*Correspondence: Katharina Rosteius
| | - Bram de Boer
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands,Living Lab in Ageing and Long Term Care, Maastricht, Netherlands
| | - Sandra Staudacher
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands,Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Jos Schols
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands,Living Lab in Ageing and Long Term Care, Maastricht, Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands,Living Lab in Ageing and Long Term Care, Maastricht, Netherlands
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16
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Duggleby W, O'Rourke HM, Baxter P, Nekolaichuk C, Thompson G, Peacock S, Ghosh S, Holroyd-Leduc J, McAiney C, Dubé V, Swindle J, Pagnucco-Renaud M, Sana S. Building a new life: a qualitative study of how family carers deal with significant changes. BMC Geriatr 2022; 22:551. [PMID: 35778694 PMCID: PMC9248114 DOI: 10.1186/s12877-022-03236-8] [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] [Received: 03/30/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Family carers of persons living with dementia who are residing in long term care (LTC), often experience significant changes in their roles and relationships which affects mental and physical health. Research has focused on describing the carers’ experience, but not on how they deal with these changes or their perceptions of support needs. The purpose of this study was to explore how family carers of persons living with dementia residing in LTC deal with significant changes and to understand how best to support these carers. Methods Eight face-to-face audio-recorded focus group interviews were conducted with 45 participants from September 2019 to January 2020, as part of a larger study aimed at guiding the adaptation of an online toolkit to support family carers of persons living with dementia residing in LTC. Applied thematic analysis was used to analyze the focus group data. Findings/results Carers dealt with the significant changes they experienced through the process of “building a new life” consisting of two sub-processes: a) building new relationships (with their family member, LTC staff and others outside of LTC), and b) finding space for themselves (sharing of care and finding balance). Understanding dementia, support from others (staff, family and friends), connecting with resources, and being included in care decisions helped carers build a new life. Conclusion The process of building a new life describes the ways that family carers deal with the life-altering changes they experienced when a family member is admitted to LTC. Carers may be supported in building their new life, by providing them with information about dementia and how to relate to staff and their family member living with dementia. The quality of care being provided and the LTC environment may also play an important role in how carers deal with the significant changes they experience.
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Affiliation(s)
- Wendy Duggleby
- Faculty of Nursing University of Alberta, 4-141 ECHA, 11405 87th Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Hannah M O'Rourke
- Faculty of Nursing University of Alberta, 4-141 ECHA, 11405 87th Ave, Edmonton, AB, T6G 1C9, Canada
| | - Pamela Baxter
- Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, L8S4K1, Canada
| | - Cheryl Nekolaichuk
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6L 0A3, Canada
| | - Genevieve Thompson
- College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Sunita Ghosh
- Alberta Health Services-Cancer Control Alberta, Department of Medical Oncology, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 4W4, Canada
| | - Carrie McAiney
- Schlegel Research Chair in Dementia, Schlegel-UW Research Institute for Aging, Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo, 200 University Ave, W, Waterloo, ON, N2L 3G1, Canada
| | - Véronique Dubé
- Chairholder Marguerite-d'Youville Research Chair, Faculty of Nursing, University of Montreal, P.O. Box 6128, Centre-ville Station, Montreal, QC, H3C 3J7, Canada
| | - Jennifer Swindle
- Faculty of Nursing, University of Alberta, Level 3 ECHA, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Madeleine Pagnucco-Renaud
- Faculty of Nursing University of Alberta, 4-005A, ECHA, 11405 87th Ave, Edmonton, AB, T6G 1C9, Canada
| | - Samina Sana
- Faculty of Nursing, School of Public Health, University of Alberta, Edmonton, Canada
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17
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Vandenbogaerde I, De Vleminck A, van der Heide A, Deliens L, Van den Block L, Smets T. Quality of end-of-life nursing home care in dementia: relatives' perceptions. BMJ Support Palliat Care 2022:bmjspcare-2021-003497. [PMID: 35710707 DOI: 10.1136/bmjspcare-2021-003497] [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: 12/03/2021] [Accepted: 05/30/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Only a few studies have investigated the quality of end-of-life care provided to nursing home residents with dementia as perceived by their relatives. We aim to investigate the quality of end-of-life care as perceived by relatives and to investigate which characteristics of nursing home residents with dementia, their relatives and the care they received are associated with the evaluation the quality of end-of-life care as perceived by the relatives. METHODS Data used were from two cross-sectional studies performed in Flanders in 2010 and 2015. Questionnaires were sent to bereaved relatives of nursing home residents with dementia and 208 questionnaires were returned. The quality of end-of-life care as perceived by the relatives was measured with the End-of-Life with Dementia-Satisfaction With Care scale (scores ranging 10-40). RESULTS In total, 208 (response rate2010: 51.05%, response rate2015=60.65%) bereaved relatives responded to the questionnaire. The quality of end-of-life care as perceived by them was positively associated with the nursing home resident being male (b=1.78, p<0.05), relatives receiving information on palliative care (b=2.92, p<0.01) and relatives receiving information about medical care from care providers (b=2.22, p<0.01). CONCLUSION This study suggests that relatives need to be well informed about palliative and medical care. Future end-of-life care interventions in nursing homes should focus on how to increase the information exchange and communication between nursing home staff and relatives.
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Affiliation(s)
- Isabel Vandenbogaerde
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Aline De Vleminck
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Luc Deliens
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lieve Van den Block
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Tinne Smets
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
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18
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The perceptions, needs and preferences of informal caregivers of nursing home residents with dementia regarding physical therapy: A qualitative study. Geriatr Nurs 2022; 44:167-175. [PMID: 35182805 DOI: 10.1016/j.gerinurse.2022.01.014] [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: 12/17/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Informal caregivers often support nursing home residents with dementia in making therapeutic decisions. We explored the perceptions, needs and preferences of informal caregivers of nursing home residents with dementia regarding physical therapy. METHOD We conducted eleven semi-structured interviews. Thematic analysis was used. RESULTS Five themes emerged: 1) visibility and familiarity; 2) communication; 3) aim and content; 4) dosage and location; 5) level of expertise and the role of the physical therapist within the interdisciplinary team. Informal caregivers' perceptions of physical therapy included a lack of visibility and familiarity. They needed more communication, and empathic communication skills of the physical therapists. Preferences included physical therapy to be enjoyable, accessible and tailored to the needs of the resident. CONCLUSION Physical therapists need to involve informal caregivers in physical therapy care. Implementing shared decision-making will help to get informal caregivers more involved, but has yet to be studied in this setting.
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19
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Jiang L, Sun F, Bonifas RP, Hodge DR. Leadership challenges and strategies to dementia care in Chinese faith-based nursing homes: A qualitative study. J Nurs Manag 2022; 30:777-784. [PMID: 35174564 DOI: 10.1111/jonm.13564] [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: 09/25/2021] [Revised: 01/19/2022] [Accepted: 02/14/2022] [Indexed: 12/01/2022]
Abstract
AIM To address the need and fill a knowledge gap in understanding challenges and coping strategies from the perspectives of nursing home leadership. BACKGROUND The rapid increase of older adults with dementia in China highlights the need for research on dementia care in long-term care facilities. METHODS Semi-structured interviews were conducted among 20 facility directors employed by faith-based nursing homes across 12 provinces in China via phone or in-person in their native language. Two researchers fluent in Mandarin Chinese and English coded interview transcripts; thematic analysis was conducted to identify patterns. RESULTS Four primary challenges were identified, including recruiting and retaining nursing staff, funding, lacking governmental support, and discord with family members. The coping strategies included using external resources, incorporating religious beliefs, teamwork, rewarding performance, and improving staff skills and empathy. CONCLUSIONS This study contributes to nursing home practice knowledge by disseminating insights of administrators regarding culturally relevant dementia management strategies in China. IMPLICATIONS FOR NURSING MANAGEMENT Teamwork and staff encouragement Advocate for a sustainable governmental financial support Staff training and staff-resident ratio regulations and policy Seeking external resources Integrate faith-based means for problem management and service quality improvement.
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Affiliation(s)
- Lin Jiang
- School of Social Work, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, MI, USA
| | - Robin P Bonifas
- Department of Social Work, Indiana State University, Terre Haute, IN, USA
| | - David R Hodge
- School of Social Work, Arizona State University, Phoenix, AZ, USA.,Program for Research on Religion and Urban Civil Society, University of Pennsylvania
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20
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Gaugler JE, Mitchell LL. Reimagining Family Involvement in Residential Long-Term Care. J Am Med Dir Assoc 2022; 23:235-240. [PMID: 34973167 PMCID: PMC8821144 DOI: 10.1016/j.jamda.2021.12.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
Although descriptions of family involvement in residential long-term care (RLTC) are available in the scientific literature, how family involvement is optimized in nursing homes or assisted living settings remains underexplored. During the facility lockdowns and visitor restrictions of the COVID-19 pandemic, residents experienced social deprivation that may have resulted in significant and adverse health outcomes. As with so many other critical issues in RLTC, the COVID-19 pandemic has magnified the need to determine how families can remain most effectively involved in the lives of residents. This article seeks to better understand the state of the science of family involvement in RTLC and how the COVID-19 pandemic has expedited the need to revisit, and reimagine, family involvement in RLTC.
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Affiliation(s)
- Joseph E. Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
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21
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Kang Y, Hur Y. Nurses' Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10448. [PMID: 34639748 PMCID: PMC8508301 DOI: 10.3390/ijerph181910448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
The behavioral and psychological symptoms of dementia (BPSD), which appear in all dementia patients, demand sizable commitments of time and effort from nurses. This study aims to identify issues related to the workloads of nurses who provide care for dementia patients via qualitative meta-synthesis. Eleven articles were selected using a systematic review flowchart, which were then evaluated for their quality using the Critical Appraisal Skills Program checklist. Collected data were analyzed using a line-of-argument method. Theme clusters were "increased workload due to characteristics of dementia", "increased mental stress", "difficulty associated with playing a mediator role in addition to nursing duties", and "lacking systematic support for dementia patient care". To reduce the workload and mental stress of nurses in dementia care, supportive measures appropriate for their occupational characteristics should be developed, based on workload estimates that account for the attributes of dementia patients.
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Affiliation(s)
- Younhee Kang
- Division of Nursing, College of Nursing, Ewha Womans University, Seoul 03760, Korea;
- Graduate Program in System Health and Engineering, Ewha Womans University, Seoul 03760, Korea
| | - Yujin Hur
- Division of Nursing, College of Nursing, Ewha Womans University, Seoul 03760, Korea;
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22
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Hirt J, Karrer M, Adlbrecht L, Saxer S, Zeller A. Facilitators and barriers to implement nurse-led interventions in long-term dementia care: a qualitative interview study with Swiss nursing experts and managers. BMC Geriatr 2021; 21:159. [PMID: 33663417 PMCID: PMC7932832 DOI: 10.1186/s12877-021-02120-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background To support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in long-term dementia care. Methods We conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples’ perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant’s choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants’ perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript. Results Six dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n = 12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in long-term dementia care: «A common attitude and cohesion within the organization», «Commitment on several levels», «A needs-oriented implementation», «The effect and the public perception of the intervention», «A structured and guided implementation process», «Supporting knowledge and competencies», as well as «Resources for implementing the intervention». Conclusions To support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is necessary that the value of the intervention is perceptible.Commitment-building is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents and relatives. Furthermore, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia, thus. Therefore, it is important to support dementia-specific competencies in long-term care. Findings indicate that the barrier is determined by the intervention and its implementation – and not by the behaviour of the person with dementia. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02120-1.
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Affiliation(s)
- Julian Hirt
- Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences (formerly FHS St.Gallen), Rosenbergstrasse 59, 9000, St.Gallen, Switzerland.,International Graduate Academy, Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Melanie Karrer
- Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences (formerly FHS St.Gallen), Rosenbergstrasse 59, 9000, St.Gallen, Switzerland
| | - Laura Adlbrecht
- Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences (formerly FHS St.Gallen), Rosenbergstrasse 59, 9000, St.Gallen, Switzerland
| | - Susi Saxer
- Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences (formerly FHS St.Gallen), Rosenbergstrasse 59, 9000, St.Gallen, Switzerland
| | - Adelheid Zeller
- Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences (formerly FHS St.Gallen), Rosenbergstrasse 59, 9000, St.Gallen, Switzerland.
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