1
|
Auclair I, Bourbonnais A. The Involvement of Caregivers in the End-of-life Care of an Older Adult Living in a Long-term Care Home: A Qualitative Case Study with Nurses and Relatives. Can J Nurs Res 2024; 56:303-316. [PMID: 38619920 PMCID: PMC11308322 DOI: 10.1177/08445621241247862] [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: 04/17/2024] Open
Abstract
BACKGROUND A key role of nurses working in long-term care homes (LTCHs) is to promote the involvement of care partners in end-of-life (EOL) care. However, studies on the involvement of care partners in EOL care in LTCHs have focused on care planning and decision-making. While care partners can participate in other ways, it's unclear how they are currently involved in EOL care by staff. PURPOSE We aimed to explore the involvement of care partners in the EOL care of an older adult living in a LTCH. METHODS A qualitative case study was conducted. Data was collected from a sample of four nurses and three care partners, using sociodemographic questionnaires, individual semi-structured interviews, documents pertaining to the LTCH's philosophy for EOL care, and a field diary. RESULTS The results of a thematic analysis showed the broad scope of care partners' possible involvement, including contributing to care, obtaining information, and being present. As there was some variation in care partners' desire to be involved, nurses seemed to rely on them to convey their wishes. To promote this involvement, some strategies aimed at health professionals and managers were suggested. CONCLUSIONS These results can guide improvement in clinical practices and raise awareness on the EOL care experiences of care partners.
Collapse
Affiliation(s)
- Isabelle Auclair
- PhD candidate, Faculty of Nursing, Université de Montréal, Montreal, Canada
- Research assistant, Research Centre of the Institut universitaire de gériatrie de Montréal, Montreal, Canda
| | - Anne Bourbonnais
- Full professor, Faculty of Nursing, Université de Montréal, Montreal, Canada
- Researcher, Research Centre of the Institut universitaire de gériatrie de Montréal, Montreal, Canada
- Chairholder of the Canada Research Chair in Care for Older People Chairholder of the Research Chair in Nursing Care for Older People and their Families, Montreal, Canada
| |
Collapse
|
2
|
Wei A, Bell J, Locke J, Roach A, Rogers A, Plys E, Zaguri-Greener D, Zisberg A, Lopez RP. Family Involvement in the Care of Nursing Home Residents With Dementia: A Scoping Review. J Appl Gerontol 2024:7334648241255534. [PMID: 39032173 DOI: 10.1177/07334648241255534] [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: 07/22/2024] Open
Abstract
Family members are involved in the lives of older adults with dementia in complex ways. This scoping review synthesizes existing research on family involvement in the care of nursing home residents with advanced dementia. Using the Arksey and O'Malley scoping review framework, electronic searches of PubMed, EBSCO's CINAHL Complete, and APA PsychInfo on the Ovid platform were conducted. Twenty-eight studies met inclusion criteria. Emergent themes and definitions of involvement were obtained through thematic analysis, including: (1) contact (through visitation, calling, or writing letters); (2) engagement in care activities (instrumental/activities of daily living); (3) planning and monitoring care (being aware of health and treatment changes, partnership with care staff, ensuring adequate care, and decision-making); and (4) supporting the resident (advocacy, socioemotional support, and financial support). Moreover, limited psychometrically sound instruments exist to measure family involvement. These limitations stall the progression of research targeting family involvement.
Collapse
Affiliation(s)
- Andrea Wei
- MGH Institute of Health Professions, Boston, MA, USA
| | - Jessica Bell
- MGH Institute of Health Professions, Boston, MA, USA
| | - Jenna Locke
- MGH Institute of Health Professions, Boston, MA, USA
| | - Ashley Roach
- School of Nursing, Oregon Health & Science University, Portland, OR USA
| | - Anita Rogers
- Department of Nursing, University of Tennessee, Martin, TN, USA
| | - Evan Plys
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Dalit Zaguri-Greener
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
- The Center of Research & Study of Aging Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
- Department of Nursing Sciences, Ruppin Academic Center, Emek- Hefer, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
- The Center of Research & Study of Aging Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
| | - Ruth P Lopez
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
- The Center of Research & Study of Aging Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
| |
Collapse
|
3
|
Swinton J, Vilapakkam Nagarajan S, Atee M, Morris T, Poulos CJ. Being Present and Meaningful Engagement for Aged Care Residents Living With Dementia: A Mixed-Methods Evaluation of Australian Care Worker's Experiences. THE GERONTOLOGIST 2024; 64:gnad131. [PMID: 37777877 PMCID: PMC10943499 DOI: 10.1093/geront/gnad131] [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: 01/23/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Meaningful engagement is essential for aged care residents living with dementia. Our knowledge pertaining to caring presence for residents living with dementia is limited. This study aims to understand care workers' experiences of providing care to residents, the challenges they face in being present with residents and support that enable them to be more present and provide person-centered care. RESEARCH DESIGN AND METHODS A mixed-methods approach using surveys and semi-structured interviews with care workers from three Australian residential aged care homes was adopted. Surveys were analyzed using descriptive statistics. Open-ended survey responses and interviews were analyzed using thematic analysis. RESULTS Twenty-six care workers completed surveys and a subset (n = 8) participated in interviews. Survey participants were largely positive about their role and reported that they loved caring for and making a difference in the lives of residents. Three themes emerged from interviews: (a) trust, connection, and the complexities of maintaining engagement; (b) time as gift and challenge; (c) organizational culture, structure and resources, and enabling carer presence. DISCUSSION AND IMPLICATIONS Care workers in our study expressed their desire to be present with residents and stated that enablers such as meaningfully engaging with residents was one of the most enjoyable aspects of their work. Barriers such as staff shortages, competing demands of the role, and time-related impediments to being present were reported. Addressing challenges to being present with residents living with dementia is key to help avoiding poor care practices and resident outcomes.
Collapse
Affiliation(s)
- John Swinton
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
- School of Divinity, History and Philosophy and Art History, University of Aberdeen, Aberdeen, United Kingdom
| | - Srivalli Vilapakkam Nagarajan
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mustafa Atee
- The Dementia Centre, HammondCare, Osborne Park, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Serbser-Koal J, Dreyer J, Roes M. Autonomy and its relevance for the construction of personhood in dementia- a thematic synthesis. BMC Geriatr 2024; 24:255. [PMID: 38486169 PMCID: PMC10941450 DOI: 10.1186/s12877-024-04808-6] [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: 01/30/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND This article examines the concept of autonomy in the context of person-centred dementia research and care, which is frequently being used but not clearly defined. Also, there is no clear conceptual relation between autonomy and personhood in this context. METHODS Therefore, literature on person-centred dementia research and care was examined to answer the following question: How is the concept of autonomy discussed in person-centred dementia research and care literature? RESULTS This analysis revealed heterogeneous perspectives on autonomy within the context of dementia. These were assigned to two different perspectives on personhood: one that links personhood to the existing cognitive abilities and the other one, that understands personhood relationally as the result of a socially constructed process. These results are discussed with regard to a nursing and care practice that could be considered as being deficit-oriented, but also with regard to the concept of social health in dementia. CONCLUSIONS Derived from this analysis, there is a clear need for general conceptual sensitivity in this field. Also, an in-depth examination of the social constructionist approach to personhood in the context of dementia is warranted.
Collapse
Affiliation(s)
- Jonathan Serbser-Koal
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany.
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.
| | - Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| |
Collapse
|
5
|
Arjama AL. Ethical issues in long-term care settings: Care workers' lived experiences. Nurs Ethics 2024; 31:213-226. [PMID: 37541651 PMCID: PMC11181730 DOI: 10.1177/09697330231191277] [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: 08/06/2023]
Abstract
BACKGROUND Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work. RESEARCH AIM Our aim was to describe the care workers' lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, occupational well-being and nursing education. RESEARCH DESIGN Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding. PARTICIPANTS AND RESEARCH CONTEXT We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021. ETHICAL CONSIDERATIONS This was a sensitive study, which was connected to the participants' individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed. FINDINGS Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS. CONCLUSIONS Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society.
Collapse
|
6
|
Mamun MR, Hirakawa Y, Saif-Ur-Rahman KM, Hong YJ, Song Z, Yoshida Y, Yatsuya H. Good death for people living with dementia: a qualitative study. BMC Geriatr 2023; 23:665. [PMID: 37845634 PMCID: PMC10580641 DOI: 10.1186/s12877-023-04395-y] [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: 12/19/2022] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Ensuring a good death is one of the primary objectives of palliative care and end-of-life care. There is insufficient evidence regarding what defines a good death for people living with dementia. Obtaining an understanding of what constitutes a good death could help improve dementia care. This study aimed to explore how multiple stakeholders perceive a good death for people living with dementia. METHODS This qualitative study was carried out across six prefectures in Japan. Enrollment of participants took place within dementia outpatient clinics, hospitals, daycare centers, and community centers. A total of thirty-three in-depth interviews with people living with dementia, physicians, and nurses were conducted. Six focus group discussions were performed with family caregivers and care workers. Verbatim transcripts of the interviews were prepared, and inductive content analysis was used to examine the data. FINDINGS Regarding the perception of a good death, the following themes were derived: (1) painless death; (2) dying in a preferred environment; (3) family's coping with loss; (4) maintaining regular life; (5) living with respect; and (6) preparation for death. All these themes are interrelated. Participants viewed a good death as a process rather than a single event. CONCLUSION This study identifies crucial components of a good death for people living with dementia. The findings could be used to improve dementia care.
Collapse
Affiliation(s)
- Md Razib Mamun
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
| | - K M Saif-Ur-Rahman
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
- College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Young Jae Hong
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Zean Song
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuko Yoshida
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| |
Collapse
|
7
|
McGhan G, McCaughey D, Flemons K. Examining the Needs of Family Caregivers of People Living with Dementia in the Community during the COVID-19 Pandemic. Can J Aging 2023; 42:485-494. [PMID: 37272524 DOI: 10.1017/s0714980823000119] [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] [Indexed: 06/06/2023] Open
Abstract
The COVID-19 pandemic has had a disproportionate effect on older adults and their family caregivers (FCGs). For FCGs, the pandemic has impacted almost every dimension of their lives and caregiving routines, from their own risk of becoming ill to their access to resources that support caregiving. The purpose of this mixed-methods study was to examine the impact of COVID-19 on FCGs' ability to provide care for their family member with dementia. A total of 115 FCGs who identified as having their family member living with dementia residing in the community completed the survey. Ten family caregivers participated in the follow-up focus groups. Recommendations to address the needs of FCGs now and in the future include: (1) making resources for care provision consistently available and tailored, (2) providing support for navigating the health care system, and (3) supplying concise information on how to provide care during public health emergencies.
Collapse
Affiliation(s)
- Gwen McGhan
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Deirdre McCaughey
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kristin Flemons
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
8
|
Vilaplana-Prieto C, Gómez Martínez CS, Echevarría Pérez P, Legaz I. Sociosanitary Legal and Economic Aspects in Nursing Homes for the Elderly in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4928. [PMID: 36981839 PMCID: PMC10048867 DOI: 10.3390/ijerph20064928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
AIM The study aimed to identify and compare aspects of the different Spanish regulations on the minimum conditions that nursing homes must meet and to compare whether these requirements significantly affect the price of a nursing home place in each region. METHODS We analyzed and compared the 17 regional regulations that must be met by nursing homes in terms of equipment and social and healthcare staff and combined this information with regional information concerning the price and coverage of public and subsidized places in nursing homes. RESULTS The study revealed significant regional inequality in physical facilities and human resources. However, the number of regulatory measures referring to the mandatory availability of physical space or specific material resources was not positively correlated with an increase in the price of a place in a public or subsidized nursing home. CONCLUSIONS No unified regulations throughout Spain regulate the aspects that residential centers must comply with. There is a need to move towards a person-centered approach, providing an environment as close to home as possible. The regulation of minimum standards to be met by all nursing homes at the national level should not significantly impact prices.
Collapse
Affiliation(s)
- Cristina Vilaplana-Prieto
- Department of Fundamentals of Economic Analysis, Faculty of Economics and Business, University of Murcia, 30120 Murcia, Spain
| | | | | | - Isabel Legaz
- Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, 30100 Murcia, Spain
| |
Collapse
|
9
|
Gonella S, Cornally N, Antal A, Tambone S, Martin P, Dimonte V, Di Giulio P. Family caregivers' experience of communication with nursing home staff from admission to end of life during the COVID-19 pandemic: A qualitative study employing a transitional perspective. Palliat Support Care 2023:1-12. [PMID: 36847131 DOI: 10.1017/s1478951523000019] [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: 03/01/2023]
Abstract
OBJECTIVES Family caregivers' (FCs) caregiving in nursing home (NH) moves across 3 main phases: transitioning relatives to long-term care, worsening of a relative's conditions, and end of life; each phase brings specific challenges that FCs must confront. Moreover, during the COVID-19 pandemic, strict mandatory visitor restrictions affected communication modalities. This study explored FCs' experience of communication with NH staff during the COVID-19 pandemic from admission to end of life. METHODS A descriptive qualitative study with inductive content analysis was performed in 7 Italian NHs from May to June 2021. NH managers purposively identified 25 FCs at different phases of their caregiving trajectory: transitional (i.e., admission in the previous 8 weeks, n = 8), deterioration-in-condition (i.e., acknowledged changes in care needs of their relative after trigger events, n = 10), and end-of-life phase (i.e., death expected in the next weeks or a few months, n = 7), who were interviewed. RESULTS Regardless the phase of caregiving trajectory, what mattered most to FCs was the opportunity to have regular and sensitive discussions with health-care professionals. The need of in-person communication increased nearing death. The COVID-19 pandemic enhanced FCs' need to interact with health-care professionals they trusted. Knowledge of residents' preferences mitigated FCs' turbulent emotions throughout the overall caregiving trajectory. SIGNIFICANCE OF RESULTS Findings suggest that in-person contacts should be prioritized and facilitated when possible, particularly at the end of life; nonetheless, meaningful communication can occur also through remote modalities. Investments in training health-care professionals about effective long-distance communication and supportive skills can help trusting relationships to be established. Open discussions about residents' care preferences should be encouraged.
Collapse
Affiliation(s)
- Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Direction of Health Professions, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Alexandra Antal
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Sara Tambone
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Peter Martin
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Direction of Health Professions, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| |
Collapse
|
10
|
Gonella S, Conti A, Albanesi B, Antal A, Dimonte V, Di Giulio P. Lived experiences of end-of-life communication among nursing home staff: An interpretive phenomenological study. J Adv Nurs 2023; 79:698-710. [PMID: 36447384 DOI: 10.1111/jan.15489] [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: 05/02/2022] [Revised: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 12/02/2022]
Abstract
AIMS To explore and understand lived experiences of end-of-life communication among nursing home staff. DESIGN Interpretive phenomenological study. METHODS In-person, semi-structured, in-depth interviews were conducted from May to August 2021 with 21 nursing home staff members involved in end-of-life communication (four managers, four chief nurses, three chief medical officers, three nurses, three psychologists, two occupational therapists, one chief nurse aide and one nurse aide). Data were analysed by van Manen's hermeneutic approach, which uses the lifeworld existentials of spatiality, corporeality, temporality and relationality to guide reflection on the human experience. Data were reported according to the Consolidated Criteria for Reporting Qualitative Research. RESULTS Thirteen categories were identified and framed within the four existentials. Regarding spatiality, end-of-life communication took place in a physical, mental, socio-cultural and professional competence space. With regard to corporeality, interviewees reported difficulties in managing their own feelings and those of family caregivers. For temporality, interviewees reported delays in end-of-life communication due to staffing issues and an increase in urgent and temporary relief admissions to nursing homes. To compensate, they tried to assure that all interactions that did take place were of high quality. Finally, with regard to relationality, interviewees lived end-of-life communication through their relationships with family caregivers and colleagues. The supportive role of colleagues was expressed as teamwork, which helped promote reflexivity about how to tailor communication, manage challenging emotions and situations, set aside time for communication, and prepare family caregivers for death. CONCLUSION End-of-life communication was an all-encompassing experience for nursing home staff. The supportive role of colleagues was stressed across all existentials, suggesting that teamwork is essential in delivering effective communication at the end-of-life. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution to this study, which addresses the experiences of nursing home staff only.
Collapse
Affiliation(s)
- Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Beatrice Albanesi
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Alexandra Antal
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| |
Collapse
|
11
|
Nursing Leadership and Palliative Care in Long-Term Care for Residents with Advanced Dementia. Nurs Clin North Am 2022; 57:259-271. [DOI: 10.1016/j.cnur.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
12
|
Gonella S, Mitchell G, Bavelaar L, Conti A, Vanalli M, Basso I, Cornally N. Interventions to support family caregivers of people with advanced dementia at the end of life in nursing homes: A mixed-methods systematic review. Palliat Med 2022; 36:268-291. [PMID: 34965759 DOI: 10.1177/02692163211066733] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most people with dementia transition into nursing homes as their disease progresses. Their family caregivers often continue to be involved in their relative's care and experience high level of strain at the end of life. AIM To gather and synthesize information on interventions to support family caregivers of people with advanced dementia at the end of life in nursing homes and provide a set of recommendations for practice. DESIGN Mixed-Methods Systematic Review (PROSPERO no. CRD42020217854) with convergent integrated approach. DATA SOURCES Five electronic databases were searched from inception in November 2020. Published qualitative, quantitative, and mixed-method studies of interventions to support family caregivers of people with advanced dementia at the end of life in nursing home were included. No language or temporal limits were applied. RESULTS In all, 11 studies met the inclusion criteria. Data synthesis resulted in three integrated findings: (i) healthcare professionals should engage family caregivers in ongoing dialog and provide adequate time and space for sensitive discussions; (ii) end-of-life discussions should be face-to-face and supported by written information whose timing of supply may vary according to family caregivers' preferences and the organizational policies and cultural context; and (iii) family caregivers should be provided structured psychoeducational programs tailored to their specific needs and/or regular family meetings about dementia care at the end of life. CONCLUSION The findings provide useful information on which interventions may benefit family caregivers of people with advanced dementia at the end of life and where, when, and how they should be provided.
Collapse
Affiliation(s)
- Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gary Mitchell
- School of Nursing & Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, Northern Ireland
| | - Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Mariangela Vanalli
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, Roma, Italy
| | - Ines Basso
- School of Nursing, Azienda Ospedaliera "SS Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
13
|
Takahashi Z, Yamakawa M, Nakanishi M, Fukahori H, Igarashi N, Aoyama M, Sato K, Sakai S, Nagae H, Miyashita M. Defining a good death for people with dementia: A scoping review. Jpn J Nurs Sci 2021; 18:e12402. [PMID: 33442939 DOI: 10.1111/jjns.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/01/2022]
Abstract
AIM End-of-life care for people with dementia is becoming increasingly important as the global population ages. However, there is no agreed definition of a good death for people with dementia. The current review examined previous literature to establish the current state of knowledge on this issue. METHODS We conducted a scoping review using a standard methodological framework. Relevant studies were identified from four databases. Studies were included if they were in English, discussed palliative or end-of-life care for dementia, and defined or explained a good death. The definitions or explanations of a good death were categorized into subthemes, and grouped into broader themes. RESULTS We identified 11 articles discussing or explaining a good death in dementia, which were published between 2009 and 2017. Most of these studies drew on the views of healthcare professionals and/or family members of people with dementia, and only one considered the views of people with dementia themselves. Ten themes were identified, including pain-free status, peaceful/comfort, dignity, family presence, surrounded by familiar things and people, person-centered communication, spirituality, life completion, treatment preferences, and other. CONCLUSIONS The characteristics of a good death in dementia showed similarities with those identified more generally. However, there were some themes that were specific to end-of-life care in dementia, notably "surrounded by familiar things and people" and "person-centered communication". To obtain a fuller picture of the nature of a good death in dementia, researchers need to examine the views of people living with dementia.
Collapse
Affiliation(s)
- Zaiya Takahashi
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyae Yamakawa
- Division of Health Sciences, Department of Evidence-Based Clinical Nursing, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Miharu Nakanishi
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Minato-ku, Japan
| | - Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kazuki Sato
- Nursing for Advanced Practice, Division of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shima Sakai
- Faculty of Health Sciences, Kyorin University, Hachioji, Japan
| | - Hiroko Nagae
- Gerontological Nursing/End of Life Care in Nursing, School of Nursing, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
| |
Collapse
|
14
|
Angheluta AA, Gonella S, Sgubin C, Dimonte V, Bin A, Palese A. When and how clinical nurses adjust nursing care at the end-of-life among patients with cancer: Findings from multiple focus groups. Eur J Oncol Nurs 2020; 49:101856. [PMID: 33120222 DOI: 10.1016/j.ejon.2020.101856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/04/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Defining patients as 'terminally-ill' may be difficult. Therefore, determining when to shift the goal of care from curative to comfort care may be extremely challenging. The aim of this study was to merge when and how Registered Nurses (RNs) and Nurses' Assistants (NAs) adjust end-of-life care to pursue patient comfort at the end of their lives. METHODS A descriptive qualitative study based on multiple focus groups was performed in 2017 according to the COnsolidated criteria for REporting Qualitative research guidelines. In all, 25 RNs and 16 NAs across seven north-east Italian facilities that provide end-of-life care, voluntarily participated in the study. Each focus group was conducted following the same interview guide with open-ended questions, and was audiotaped. A thematic analysis was applied to interview transcripts. RESULTS The process of nursing care plan adjustment is based upon two main themes, around 'when' and 'how' to adjust it. Regarding when, 'Detecting the turning point', and 'Being ready to change continuously until the end' emerged as the main sub-themes. Regarding how, 'Weighing harms and benefits of nursing care interventions'; 'Advocating for patients' wishes', 'Sharing the adjustments inside the team at different levels', 'Involving family in the adjustments of nursing care'; and 'Allowing care to move away from evidence-based practice' were the sub-themes emerged. CONCLUSIONS Shedding light on the implicit decisional processes that inform care adjustments and the implementation of related strategies is essential to improve the quality of end-of-life care given that an early detection of the terminal phase has been reported to result in changes of care improving outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Alessandra Bin
- Azienda Sanitaria Universitaria Integrata di Udine, Oncological Department, Udine, Italy
| | | |
Collapse
|
15
|
Social Participation in Long-term Residential Care: Case Studies from Canada, Norway, and Germany. Can J Aging 2020; 40:138-155. [PMID: 32985390 DOI: 10.1017/s0714980820000318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents' social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.
Collapse
|
16
|
Lood Q, Sjögren K, Bergland Å, Lindkvist M, Kirkevold M, Sandman PO, Edvardsson D. Effects of a staff education programme about person-centred care and promotion of thriving on relatives' satisfaction with quality of care in nursing homes: a multi-centre, non-equivalent controlled before-after trial. BMC Geriatr 2020; 20:268. [PMID: 32738880 PMCID: PMC7395407 DOI: 10.1186/s12877-020-01677-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As part of a nursing home intervention study, the aim of this paper was 1) to evaluate the effects of a staff education programme about person-centred care and promotion of thriving on relatives' satisfaction with quality of care and their perceptions of the person-centredness of the environment, and 2) to outline factors of importance to explain the variance in relatives' satisfaction with quality of care. Relatives are often referred to as vital for the operationalisation of person-centredness in nursing homes, representing an important source of information for care planning and quality of care assessments. However, the evidence for effects of person-centredness in nursing homes on relatives' experiences is sparse and little is known on what could explain their satisfaction with the quality of care. METHODS A multi-centre, non-equivalent controlled group before-after design with study sites in Australia, Norway and Sweden. Staff in the intervention group participated in a 14-month education on person-centredness, person-centred care, thriving and caring environment. Staff in the control group received a one-hour lecture before the intervention period. Data were collected at baseline, after the intervention and six months after the end of the intervention, and analysed using descriptive statistics, a generalised linear model and hierarchical multiple regression. RESULTS In general, relatives from both the intervention and control nursing homes were satisfied with the quality of care, and no statistically significant overall between-group-effects of the intervention were revealed on satisfaction with quality of care or perceptions of the person-centredness of environment. A person-centred environment in terms of safety and hospitality were identified as factors of prominent importance for the relatives' satisfaction with the quality of care. CONCLUSION The findings of this paper provide a foundation for future research in terms of intervention design in nursing home contexts. Staff availability, approachability, competence and communication with relatives may be important factors to consider to improve quality of care from the perspective of relatives, but more research both with and for relatives to people living in nursing homes is necessary to identify the keys to success. TRIAL REGISTRATION ClinicalTrials.gov- NCT02714452 . Registered on March 19, 2016.
Collapse
Affiliation(s)
- Qarin Lood
- The Medical Faculty, Department of nursing, Umeå University, Vårdvetarhuset, Hus A, plan 5, 90187, Umeå, Sweden. .,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Box 455, 40530, Gothenburg, Sweden. .,College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Level 4 Austin Tower, PO Box 5555, Heidelberg, VIC, 3084, Australia.
| | - Karin Sjögren
- The Medical Faculty, Department of nursing, Umeå University, Vårdvetarhuset, Hus A, plan 5, 90187, Umeå, Sweden
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Lovisenberggaten 15b, 0456, Oslo, Norway
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Försörjningsvägen 7D, 907 37, Umeå, Sweden
| | - Marit Kirkevold
- Faculty of Medicine, Institute of Health and Society, Oslo University, Nedre Ullevål 9, 0850, Oslo, Norway.,Institute of Nursing and health promotion, Oslo Metropolitan University, Pilestredet 32, 0130, Oslo, Norway
| | - Per-Olof Sandman
- The Medical Faculty, Department of nursing, Umeå University, Vårdvetarhuset, Hus A, plan 5, 90187, Umeå, Sweden.,NVS, Department of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - David Edvardsson
- The Medical Faculty, Department of nursing, Umeå University, Vårdvetarhuset, Hus A, plan 5, 90187, Umeå, Sweden.,College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Level 4 Austin Tower, PO Box 5555, Heidelberg, VIC, 3084, Australia
| |
Collapse
|
17
|
Siu HY, Elston D, Arora N, Vahrmeyer A, Kaasalainen S, Chidwick P, Borhan S, Howard M, Heyland DK. The Impact of Prior Advance Care Planning Documentation on End-of-Life Care Provision in Long-Term Care. Can Geriatr J 2020; 23:172-183. [PMID: 32494333 PMCID: PMC7259921 DOI: 10.5770/cgj.23.386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The impact of prior advance care planning (ACP) documentation on substitute decision-makers' (SDMs) knowledge of values for end-of-life (EOL) care, and its correlation with SDM satisfaction with EOL care provision, have not been assessed in long-term care (LTC). METHODS A cross-sectional survey of 2,595 SDMs from 27 LTC homes assessed: 1) knowledge of pre-existing ACP documentation and values for EOL care, and 2) the importance and satisfaction of EOL care provision in LTC. Knowledge of values for EOL care was compared to administrative documentation. Importance and satisfaction were plotted on a performance-importance grid. Multiple linear regression assessed whether knowledge of pre-existing ACP documentation correlated with satisfaction. RESULTS The response rate was 25% (658/2,595); 69% of LTC residents had pre-existing ACP documentation. Discordance was noted between SDMs' knowledge of values for EOL care and administrative documentation. Pre-existing knowledge of ACP documentation was not correlated with EOL care provision satisfaction. Priority areas for increasing satisfaction include illness management, SDM communication, and relationships with LTC clinicians. CONCLUSIONS The discordance between SDMs' knowledge of values for EOL care and formal documentation needs to be addressed. Although pre-existing ACP documentation does not impact satisfaction, EOL care provision could be improved by targeting illness management, SDM communication, and relationships with LTC clinicians.
Collapse
Affiliation(s)
- Henry Y.H. Siu
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Dawn Elston
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Neha Arora
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Amie Vahrmeyer
- Extendicare Assist, (a division of Extendicare), Markham, ON, Canada
| | | | | | - Sayem Borhan
- Department of Health Research Methods, Evidence, and Impact, McMaster University Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Daren K. Heyland
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada
| |
Collapse
|
18
|
Midtbust MH, Alnes RE, Gjengedal E, Lykkeslet E. Separation characterized by responsibility and guilt: Family caregivers' experiences with palliative care for a close family member with severe dementia in long-term care facilities. DEMENTIA 2020; 20:518-533. [PMID: 31918569 DOI: 10.1177/1471301219898341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM AND OBJECTIVES The aim of this study was to explore family caregivers' experiences with palliative care for a close family member with severe dementia in long-term care facilities. BACKGROUND Dementia not only affects individuals but also affects and changes the lives of close family members. An increasing number of dementia-related deaths occur in long-term care facilities; therefore, it is critical to understand how healthcare professionals support and care for residents with dementia and their families at the end of life. DESIGN A qualitative design with a phenomenological approach was adopted. METHODS In-depth interviews were performed with 10 family caregivers of residents in 3 Norwegian long-term care facilities. RESULTS The family caregivers' experiences with palliative care for a close family member with severe dementia in long-term care facilities were characterized by responsibility and guilt. Admission to a long-term care facility became a painful relief for the family caregivers due to their experiences with the poor quality of palliative care provided. The lack of meaningful activities and unsatisfactory pain relief enhanced the feelings of responsibility and guilt among the family caregivers. Despite the feelings of insecurity regarding the treatment and care given during the early phase of the stay, the family caregivers observed that their close family member received high-quality palliative care during the terminal phase. The family caregivers wanted to be involved in the care and treatment, but some felt that it became a heavy responsibility to participate in ethical decision-making concerning life-prolonging treatment. CONCLUSIONS The family caregivers experienced ongoing responsibility for their close family members due to painful experiences with the poor quality of the palliative care provided. When their expectations regarding the quality of care were not met, the palliative care that was offered increased their feeling of guilt in an already high-pressure situation characterized by mistrust.
Collapse
Affiliation(s)
| | - Rigmor E Alnes
- Department for Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway
| | - Eva Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Else Lykkeslet
- Faculty of Health Sciences and Social Care, Molde University College, Norway
| |
Collapse
|
19
|
Gonella S, Basso I, De Marinis MG, Campagna S, Di Giulio P. Good end-of-life care in nursing home according to the family carers' perspective: A systematic review of qualitative findings. Palliat Med 2019; 33:589-606. [PMID: 30969160 DOI: 10.1177/0269216319840275] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Nursing homes are becoming a common site where delivering end-of-life care for older adults. They often represent the junction between the curative and the palliative phase. AIM To identify the elements that nursing home residents' family carers perceive as good end-of-life care and develop a conceptual model of good end-of-life care according to the family perspective. DESIGN Systematic review (PROSPERO no. 95581) with meta-aggregation method. DATA SOURCES Five electronic databases were searched from inception between April and May 2018. Published qualitative studies (and mixed-method designs) of end-of-life care experience of nursing home family carers whose relative was dead or at the end-of-life were included. No language or temporal limits were applied. RESULTS In all, 18 studies met inclusion criteria. A 'life crisis' often resulted in a changed need of care, and the transition towards palliative care was sustained by a 'patient-centered environment'. Family carers described good end-of-life care as providing resident basic care and spiritual support; recognizing and treating symptoms; assuring continuity in care; respecting resident's end-of-life wishes; offering environmental, emotional and psychosocial support; keeping family informed; promoting family understanding; and establishing a partnership with family carers by involving and guiding them in a shared decision-making. These elements improved the quality of end-of-life of both residents and their family, thus suggesting a common ground between good end-of-life care and palliative care. CONCLUSION The findings provide a family-driven framework to guide a sensitive and compassionate transition towards palliative care in nursing home.
Collapse
Affiliation(s)
- Silvia Gonella
- 1 Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.,2 Azienda Ospedaliero Universitaria Città della Salute e della Scienza of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Ines Basso
- 3 Department of Public Health and Pediatrics, University of Turin, via Santena 5 bis, 10126 Turin, Italy
| | - Maria Grazia De Marinis
- 4 Nursing Research Unit. University Campus Bio Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Sara Campagna
- 3 Department of Public Health and Pediatrics, University of Turin, via Santena 5 bis, 10126 Turin, Italy
| | - Paola Di Giulio
- 3 Department of Public Health and Pediatrics, University of Turin, via Santena 5 bis, 10126 Turin, Italy
| |
Collapse
|
20
|
Convey H, Holt J, Summers B. Proxy decision making and dementia: Using Construal Level Theory to analyse the thoughts of decision makers. J Adv Nurs 2018. [DOI: 10.1111/jan.13563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Helen Convey
- School of Healthcare; University of Leeds; Leeds UK
| | - Janet Holt
- School of Healthcare; University of Leeds; Leeds UK
| | - Barbara Summers
- Centre for Decision Research; Leeds University Business School; University of Leeds; Leeds UK
| |
Collapse
|
21
|
Molony SL, Kolanowski A, Van Haitsma K, Rooney KE. Person-Centered Assessment and Care Planning. THE GERONTOLOGIST 2018; 58:S32-S47. [DOI: 10.1093/geront/gnx173] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 11/13/2022] Open
|
22
|
Kiljunen O, Kankkunen P, Partanen P, Välimäki T. Family members’ expectations regarding nurses’ competence in care homes: a qualitative interview study. Scand J Caring Sci 2017; 32:1018-1026. [DOI: 10.1111/scs.12544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Outi Kiljunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | - Päivi Kankkunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | - Pirjo Partanen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | - Tarja Välimäki
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| |
Collapse
|
23
|
De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick SJ, Morgan SM, Watson M, Parsons C. 'There's a Catch-22' - The complexities of pain management for people with advanced dementia nearing the end of life: A qualitative exploration of physicians' perspectives. Palliat Med 2017; 31:734-742. [PMID: 28659013 DOI: 10.1177/0269216316673549] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. AIM To explore physicians' experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. DESIGN Qualitative, semi-structured interview study exploring barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. SETTING/PARTICIPANTS A total of 23 physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care ( n = 9), psychiatry ( n = 7) and hospice care ( n = 7). RESULTS Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialities. Cross-speciality mentoring and the creation of knowledge networks were believed to improve pain management in this patient population. CONCLUSION Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients' families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.
Collapse
Affiliation(s)
| | - Kevin Brazil
- 2 School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Peter Passmore
- 3 Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Hilary Buchanan
- 4 Patient and Public Involvement Representative, Carer for a person living with dementia, Belfast, UK
| | | | - Sonja J McIlfatrick
- 6 Institute of Nursing and Health Research, Ulster University, Coleraine, UK.,7 All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Dublin, Ireland
| | | | | | - Carole Parsons
- 1 School of Pharmacy, Queen's University Belfast, Belfast, UK
| |
Collapse
|
24
|
Abstract
ABSTRACTThe benefits of meaningful activity in later life are well documented. Studies show that being occupied contributes to both physical and mental health as well as quality of life. Research also suggests that activity may be beneficial to people residing in care homes, including people living with dementia. This paper presents findings from a study which used the Adult Social Care Outcomes Toolkit (ASCOT) to measure quality of life in six care homes located in the south-east of England. The study found, like previous ones, that care home residents’ days were characterised by a lack of activity. Drawing on observations, interviews and focus groups with residents and staff from these homes, this paper attempts to understand why care home residents do not engage in meaningful activities. We reject the idea that these low levels of activity are a natural part of the ageing process or that they can be explained by notions of resident choice. Instead, the findings point to both insufficient funding and working practices within care homes as more substantive explanations. These explanations inform a discussion of how the low levels of engagement in meaningful activity could be addressed and residents’ quality of life improved.
Collapse
|
25
|
Anderson JG, Hundt E, Dean M, Keim-Malpass J, Lopez RP. "The Church of Online Support": Examining the Use of Blogs Among Family Caregivers of Persons With Dementia. JOURNAL OF FAMILY NURSING 2017; 23:34-54. [PMID: 27920340 DOI: 10.1177/1074840716681289] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Many individuals, including dementia caregivers, use blogs to share their experiences. These blogs contain rich narratives representing an untapped resource for understanding the psychosocial impact of caring for a person with dementia at the family level. The present study used blogs written by caregivers of persons with dementia to explore how these individuals leveraged this medium as part of the caregiving experience. Blogs written by self-identified informal caregivers of persons with dementia were identified using a systematic search method, and data were analyzed using a qualitative thematic analysis. Four themes emerged from the narratives: social support through communication and engagement, information gathering and seeking, reminiscing and legacy building, and altruism. By understanding the ways in which individuals providing care for persons with dementia use social media as part of the caregiving experience, family nurses can develop interventions and services aimed at improving caregiver burden and quality of life.
Collapse
Affiliation(s)
| | | | - Morgan Dean
- 2 University of Virginia, Charlottesville, USA
| | | | - Ruth Palan Lopez
- 3 Massachusetts General Hospital Institute of Health Professions, Charlestown, USA
| |
Collapse
|
26
|
Lethin C, Hallberg IR, Karlsson S, Janlöv AC. Family caregivers experiences of formal care when caring for persons with dementia through the process of the disease. Scand J Caring Sci 2015; 30:526-34. [DOI: 10.1111/scs.12275] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/03/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Connie Lethin
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | | | - Staffan Karlsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | | |
Collapse
|
27
|
Perceived value of support for older adults coping with multi-morbidity: patient, informal care-giver and family physician perspectives. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15000768] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThis study investigated the perceived value of informal and formal supports for older adults with multi-morbidity from the perspectives of patients, care-givers and family physicians. Semi-structured interviews were conducted with 27 patients, their informal care-givers and their family physicians in an urban academic family health team in Ontario. Analysis was conducted using a General Inductive Approach to facilitate identification of main themes and build a framework of perceived value of supports. Participant views converged on supports that facilitate patient independence and ease care-giver burden. However, important differences in participant perceptions arose regarding these priorities. Physicians and care-givers valued supports that facilitate health and safety while patients prioritised supports that enable self-efficacy and independence. While formal supports which eased care-giver burden were viewed positively by all members of the triad, many patients also rejected formal supports, citing that informal support from their care-giver was available. Such conflicts between patient, care-giver and physician-perceived value of supports may have important implications for consumer and care-giver willingness to accept formal supports when supports are available. These findings contribute to the broader literature on community-based care by incorporating the perspectives of patients, informal care-givers and family physicians to understand better the barriers and facilitators of uptake of supportive services that contribute to successful ageing at home.
Collapse
|
28
|
Siu HYH. The PAUSE approach to practising in long-term care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2015; 61:211-221. [PMID: 25767161 PMCID: PMC4369609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Henry Yu-Hin Siu
- Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
| |
Collapse
|
29
|
Hamilton G, Corlett J, Dowling M. Adult-trained perioperative nurses' practice of family-centered care. ACTA ACUST UNITED AC 2014; 23:477-82. [DOI: 10.12968/bjon.2014.23.9.477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Grainne Hamilton
- Senior Staff Nurse, Trauma and Orthopaedic Theatres, Sligo Regional Hospital, Ireland
| | - Jo Corlett
- Deputy Dean and Head of Learning and Teaching, School of Nursing and Midwifery, University of Dundee, Scotland
| | - Maura Dowling
- Lecturer at the School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| |
Collapse
|