Changes in habits related to self-care in dementia: the nursing home versus adult day care

[Preferences for everyday living written in the nursing record - An explorative document analysis in various nursing settings]

Preferences for everyday living written in the nursing record - An explorative document analysis in various nursing settings Abstract. Background: In Germany, there was previously no instrument for the systematic recording of preferences for the everyday living of older and people in need of care. Subsequently, in a pilot study, an instrument was translated in a culturally sensitive way (PELI-D), piloted and tested psychometrically. In terms of documentation quality, it is important that the preferences recorded by nursing staff are written down in the nursing record using PELI-D, plausibly based on the nursing process.

AIM

To find out which preferences, assessed by the nursing staff in the pilot study with the PELI-D, were written down in the nursing record.

METHODS

An exploratory document analysis was carried out. Included were 13 nursing records and five discussion participants from five institutions in three nursing settings. The data were evaluated descriptively and by a structuring content analysis.

RESULTS

A total of 2% of the preferences, which were assessed with the PELI-D, were found in the nursing records and may be due to the use of PELI-D. Preferences mainly from the categories "interventions" and "biography" were found in the nursing record.

CONCLUSIONS

98% of the preferences assessed with the PELI-D were not written down. This can probably be attributed to the fact that the PELI-D was an "innovation" for the nursing staff. Therefore, the execution of an implementation study seems to be reasonable to improve the plausibility of the captured PELI-D data in the nursing documentation. In the context of this, it is also recommended to analyze how the PELI-D influences nursing processes and contents of the nursing record.

Präferenzen von Menschen mit Pflegebedarf

Hintergrund

Die Beachtung von Präferenzen des alltäglichen Lebens wird in der pflegerischen Versorgung mit einer Vielzahl von positiven Versorgungsergebnissen assoziiert. Derzeit ist unbekannt, ob in bundesdeutschen Pflegeeinrichtungen Präferenzen von Menschen mit Pflegebedarf systematisch erhoben werden, und inwiefern diese in der Pflegedokumentation auffindbar sind.

Ziel

Das Ziel der Studie bestand darin zu untersuchen, welche und wie viele Präferenzen von Menschen mit Pflegebedarf in der Pflegedokumentation in verschiedenen pflegerischen Settings dokumentiert werden.

Methode

Eine explorative Analyse von Pflegedokumentationen (n = 24) wurde in 4 Settings der pflegerischen Versorgung durchgeführt. Die erhobenen Daten wurden inhaltsanalytisch induktiv sowie quantitativ ausgewertet.

Ergebnis

Es konnten 20 verschiedene Präferenzen identifiziert werden, die sich 5 Oberkategorien zuordnen ließen. Die Analyse zeigte in allen einbezogenen Settings, dass am häufigsten Präferenzen zu den Themen Pflege und Alltag in der Pflegedokumentation dokumentiert waren.

Schlussfolgerung

Die Verschriftlichung von Präferenzen in der Pflegedokumentation ist in allen Settings unsystematisch, zugleich wird die Beachtung von Präferenzen des alltäglichen Lebens als relevant für die Pflege erachtet. Hier bietet die Verwendung eines Instruments zur systematischen Erfassung von Präferenzen die Möglichkeiten, einerseits die Sensibilisierung für dieses Thema zu stärken und andererseits die Zufriedenheit der Menschen mit Pflegebedarf zu steigern.

Cognitive Interviewing: Revising the Preferences for Everyday Living Inventory for Use In the Nursing Home

A valid tool is needed to assess preferences that are relevant and important to nursing home (NH) residents. Originally developed for older adults receiving home care services, the authors adapted the Preferences for Everyday Living Inventory (PELI) for use with NH residents. Content validity was initially established using a panel of experts in long-term care. PELI items were cognitively interviewed with 31 Veteran and 39 non-Veteran participants (N = 70). Responses from cognitive interviewing guided substantial revisions of the PELI (>25% of items) to include language that NH residents use and understand, reducing potential measurement error and ensuring the preferences assessed are relevant to NH residents. Future work will further adapt the PELI for use with more diverse groups and health care settings, and assess its psychometric properties. Using the PELI will help move clinical teams closer to the goal of providing person-centered care informed by individual preferences.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The meanings of delusions in dementia: a preliminary study

One of the common symptoms of dementia is delusions. Due to a biological conceptualization of the behaviors represented as delusions, these are classified as psychotic symptoms. This is a qualitative and quantitative study aiming to describe the delusions experienced by older persons with dementia and the context of occurrence, and to elucidate their etiology. Participants were 74 nursing home residents aged 65 and over, diagnosed with dementia, from nine nursing homes in Israel. Participants with delusions were found to have significantly more difficulties in performing ADLs, and poorer vision and hearing. Based on assessment using the BEHAVE-AD, six categories of delusions were examined: 1. One's house is not one's home, 2. Theft, 3. Danger, 4. Abandonment, 5. Misidentification, and 6. Other non-paranoid. Common themes appeared across delusions including reality, disorientation, re-experience of past events, loneliness and insecurity, boredom, and trigger. Current results suggest that delusions may not represent psychotic symptoms for most participants, because they sometimes represented reality, or were neither firm nor incontrovertible. Thus, utilizing the term delusion relegates the person's behavior to the domain of severe psychiatric phenomena and precludes understanding its true meaning.

A comparison of eating practices of independently living older adults in private residences and in senior retirement housing: a pilot study

This study investigated eating-related habits and their importance in older people and compared those living in private residences with those in senior retirement community housing. A convenience sample of 58 seniors answered eating-related items from the Self-maintenance Habits and Preferences in Elderly questionnaire (SHAPE). Meal location, companions, concurrent activities, portion size, and food variety differed between private and retirement housing for some meals, but the overall importance assigned to eating practices was similar. The meals themselves appeared to be more important than any specific socio-environmental element. Eating practices associated with dinner were more important than those for the other meals.