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Kiljunen O, Savela RM, Välimäki T, Kankkunen P. Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review. Res Nurs Health 2024; 47:397-408. [PMID: 38522016 DOI: 10.1002/nur.22382] [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: 10/19/2023] [Revised: 01/23/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Identifying ways to ensure resident safety is increasingly becoming a priority in residential settings and nursing homes. The aim of this qualitative systematic review was to identify, describe, and assess research evidence on managers' perceptions regarding the barriers and facilitators of daily resident and patient safety work in residential settings and nursing homes. A qualitative systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Published studies were sought through academic databases: Academic Search Premier, CINAHL, PubMed (MEDLINE), Scopus, SocINDEX, and Web of Science Core Collection in April 2023. Finally, 12 studies were included. The results of the included studies were synthesized using thematic synthesis after data extraction. According to the results, (1) competent staff and material resources; (2) management and culture; (3) communication, networks, optimal use of expertise; and (4) effective use of guidelines, rules, and regulations play a significant role in the success of resident and patient safety work. The findings revealed that promoting resident safety should not be seen solely as the responsibility of individual residential or nursing home personnel, as it requires multiprofessional cooperation and access to wider networks. Staff and managers must be receptive to learning, changing, and improving safety. Moreover, to ensure resident safety, it is essential to ensure that the organizations support safety work in residential and nursing home units.
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Affiliation(s)
- Outi Kiljunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Baumann A, Crea-Arsenio M, Smith V, Antonipillai V, Idriss-Wheeler D. Abuse in Canadian long-term care homes: a mixed methods study. BMJ Open Qual 2024; 13:e002639. [PMID: 38834369 PMCID: PMC11163654 DOI: 10.1136/bmjoq-2023-002639] [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: 10/06/2023] [Accepted: 05/19/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To examine reported cases of abuse in long-term care (LTC) homes in the province of Ontario, Canada, to determine the extent and nature of abuse experienced by residents between 2019 and 2022. DESIGN A qualitative mixed methods study was conducted using document analysis and descriptive statistics. Three data sources were analysed: LTC legislation, inspection reports from a publicly available provincial government administrative database and articles published by major Canadian newspapers. A data extraction tool was developed that included variables such as the date of inspection, the type of inspection, findings and the section of legislation cited. Descriptive analyses, including counts and percentages, were calculated to identify the number of incidents and the type of abuse reported. RESULTS According to legislation, LTC homes are required to protect residents from physical, sexual, emotional, verbal or financial abuse. The review of legislation revealed that inspectors are responsible for ensuring homes comply with this requirement. An analysis of their reports identified that 9% (781) of overall inspections included findings of abuse. Physical abuse was the most common type (37%). Differences between the frequency of abuse across type of ownership, location and size of the home were found. There were 385 LTC homes with at least one reported case of abuse, and 55% of these homes had repeated incidents. The analysis of newspaper articles corroborated the findings of abuse in the inspection reports and provided resident and family perspectives. CONCLUSIONS There are substantial differences between legislation intended to protect LTC residents from abuse and the abuse occurring in LTC homes. Strategies such as establishing a climate of trust, investing in staff and leadership, providing standardised education and training and implementing a quality and safety framework could improve the care and well-being of LTC residents.
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Affiliation(s)
- Andrea Baumann
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mary Crea-Arsenio
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Victoria Smith
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Valentina Antonipillai
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Caspi E. Residents' Fear of Retaliation in America's Nursing Homes: An Exploratory Study. J Appl Gerontol 2024; 43:497-514. [PMID: 37991342 DOI: 10.1177/07334648231214413] [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: 11/23/2023] Open
Abstract
The phenomenon of residents' fear of staff retaliation when voicing care concern and making mistreatment complaints in nursing homes has been shown in research to be common. Despite longstanding concerns by care advocacy organizations about this phenomenon and its impact on residents (including emotional suffering, inadequate care, and mistreatment due to fear-driven lack of reporting, investigation, and resolution), little research examined it to date. Using 100 standard survey and complaint investigation reports from state survey agencies in nursing homes in 30 states, the researcher of this qualitative study aimed to improve understanding of residents' lived experience of four aspects of this phenomenon-fear of retaliation, allegations of threats of retaliation, perceived retaliation, and actual (confirmed) retaliation-and their emotional consequences. The findings could inform practice and policy changes necessary to realize residents' federal right to speak up without fear of retaliation when advocating for dignified and safe care.
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St Clair B, Nguyen A, Jorgensen M, Georgiou A. Adverse impacts in residential aged care facilities: The resident perspective. Australas J Ageing 2024. [PMID: 38595217 DOI: 10.1111/ajag.13306] [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: 05/14/2023] [Revised: 01/21/2024] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Inclusion of consumer perspectives is a key component to person-centred health-care approaches. While current residential aged care systems focus on recording adverse events to meet the requirements of regulatory reporting, little is known about the views of residents. The aim of this research was to explore residents' responses on the types of incidents that have an adverse impact on them and how they are affected by these incidents. METHODS The study used a qualitative, inductive approach to derive themes from interviews with 20 permanent residents of aged care facilities in New South Wales and the Australian Capital Territory. RESULTS Four main themes surrounding adverse incidents emerged: (i) social relationships and the adverse impacts of lack of meaningful interactions, (ii) adjustment to life in the residential aged care facility and the loss of residents' former life and self-determination, (iii) the impact of COVID-19 lockdowns which meant that residents were not able to go out or interact with others and (iv) acceptance, resignation and resilience in coping with adverse incidents. CONCLUSIONS This research highlights the difference between health-care definition, used for incident management reporting and quality indicators, and the way residents respond when asked to describe an incident that has affected them. Resident responses discuss situations having an adverse effect on them in contrast to the way adverse events and incidents are reported and monitored. The findings suggest that within adverse event and incident management systems and resident governance systems, there is scope for incorporating periods of transitions and well-being measures that capture elements that matter to older people.
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Affiliation(s)
- Bella St Clair
- Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Health, Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Amy Nguyen
- Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Mikaela Jorgensen
- Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Min D, Park S, Kim S, Park HO. Patient Safety in Nursing Homes From an Ecological Perspective: An Integrated Review. J Patient Saf 2024; 20:77-84. [PMID: 38126786 DOI: 10.1097/pts.0000000000001189] [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: 12/23/2023]
Abstract
OBJECTIVES The aims of the study were to identify the systemic factors affecting the characteristics and safety of older adults living in nursing homes and the resulting resident outcomes and to explore the relationship between them through an integrated literature review. METHODS A literature search was conducted from April 22 to May 6, 2021, in the PubMed, Embase, Cochrane CENTRAL, CIHNAL, RISS, NDL, and KoreaMed databases. The following key words and MeSH terms were used for the search: "nursing home," "skilled nursing facility," "long-term care facility," and "patient safety" or "safety." RESULTS Forty-seven qualifying articles were finally selected. Three domains were derived as personal factors, 12 as facility factors, and one as a policy factor. The interrelationships between them could result in positive or negative resident outcomes. The relationship between them was also reconstructed from an ecological perspective. CONCLUSIONS The results demonstrated that the safety and quality of life of older adults living in nursing homes were affected by both individual and institutional factors.
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Affiliation(s)
- Deulle Min
- From the Department of Nursing, College of Medicine, Wonkwang University, Iksan
| | - Seungmi Park
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju
| | - Suhee Kim
- School of Nursing and Research Institute of Nursing Science, Hallym University
| | - Hye Ok Park
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
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Min D, Kim S. Development and validation of the resident safety activity questionnaire for long-term care facility staff. Geriatr Nurs 2024; 56:278-284. [PMID: 38402807 DOI: 10.1016/j.gerinurse.2024.02.019] [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: 10/21/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
This study developed and tested a questionnaire to evaluate the safety activities supporting older adult residents' quality of care among long-term care facility staff. The process included item construction, expert review and pilot testing, testing of reliability and validation with 268 staff from 12 targeted facilities in South Korea. The final questionnaire yielded 28 items across six domains: proactive activities for emergency situations, comfort management, prevention of infections, staff training and communication, sufficient goods and equipment, and adequate personnel. These factors explained 73.48 % of the total variance. The fit indices in the confirmatory factor analysis were acceptable, and the total Cronbach's ⍺ was 0.952 (sub-domains: 0.823 - .895), indicating high reliability. The findings suggest the reliability and validity of the newly-developed Resident Safety Activity Questionnaire, enabling an accurate evaluation of the safety of long-term care facility residents and serving as an indicator for improving care quality in such establishments.
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Affiliation(s)
- Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Suhee Kim
- School of Nursing and Research Institute of Nursing Science, Hallym University, Chuncheon, Republic of Korea.
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Berg K, Kjellberg I. Managing reports of trouble: designated officials' responses to reports of mistreatments initiated by service users and relatives. J Elder Abuse Negl 2024; 36:1-24. [PMID: 38126731 DOI: 10.1080/08946566.2023.2297221] [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: 12/23/2023]
Abstract
Mandatory reporting of elder abuse aims to detect and prevent mistreatment and improve services. Service users and their relatives can raise concerns, but only staff can file mandatory reports. This article examines how the concerns of service users and relatives were managed by designated officials in reports of mistreatments in care for older adults in Sweden. We lean on sociological theories of "interpersonal trouble" and organizational "disputes domains." The thematic analysis is based on 28 incident reports initiated by service users or their relatives. The analysis shows that the reports were managed in one of three ways: asymmetrically, by 1) dismissing or 2) supporting the complainant's position, or symmetrically, by 3) treating complainants' accounts as credible but minimizing their seriousness. There were differences between reports initiated by service users and relatives. Dismissing concerns about abuse, mainly those made by relatives, risks support for service users failing.
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Affiliation(s)
- Karin Berg
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Inger Kjellberg
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
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Min D, Yu SY. Long-term Care Facility Staff's Experience of Safety Activities: A Qualitative Study. West J Nurs Res 2023; 45:1008-1016. [PMID: 37737156 DOI: 10.1177/01939459231201086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Ensuring the safety and quality of care is paramount in long-term care facilities due to residents' vulnerability. OBJECTIVE We explored the experiences of long-term care facility staff (eg, registered nurses [RNs], certified nursing assistants [CNAs], care workers, social workers, and physical therapists) in safety activities, aiming to understand their meaning and nature. METHODS We conducted qualitative focus group interviews with 25 participants, specifically addressing safety issues in long-term care facilities through the use of open-ended questions. We transcribed the data and conducted thematic analysis. RESULTS Participants engaged in discussions about various challenges, including assisting residents in maintaining physical comfort, managing behavioral and psychological symptoms of dementia, ensuring medication safety, implementing infection control practices, and providing adequate training on fire prevention, evacuation, and response protocols. Themes identified were "physical comfort," "managing dementia symptoms," "drug administration," "infection control," and "fire prevention." CONCLUSIONS The staff emphasized the safety of residents as their highest priority. Considering the lack of registered nurses in long-term care facilities, ongoing training and supervision are necessary to ensure that other long-term care facility staff can perform safety activities.
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Affiliation(s)
- Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Soo-Young Yu
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
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Wang J, Yang Z, Li Y, Ma R, Zhang L, Du Y, Dou H. Status and influencing factors of elder neglect by geriatric nursing assistants in Chinese nursing homes: a cross-sectional survey. Front Med (Lausanne) 2023; 10:1273289. [PMID: 37954552 PMCID: PMC10634532 DOI: 10.3389/fmed.2023.1273289] [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: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Background In nursing homes, elder neglect has come to the forefront. Currently, few studies have examined the impact of personal and organizational factors of geriatric nursing assistants on elder neglect. From the perspective of geriatric nursing assistants, this study aims to explore the current situation and influencing factors of elder neglect in Chinese nursing homes. Methods A convenience sampling method was used to recruit 412 geriatric nursing assistants from 50 nursing homes in China. Participants were surveyed using a demographic questionnaire, the Elder Neglect Scale for Geriatric Nursing Assistants, the General Self-Efficacy Scale (GSES), and the Proactive Personality Scale (PPS). Spearman correlation analysis and multiple linear regression were used to analyze the factors influencing elder neglect. Results Geriatric nursing assistants scored a median of 74 out of 85 on the Elder Neglect Scale. Multiple linear regression analyses showed that the main personal factors influencing geriatric nursing assistants' elder neglect were general self-efficacy (β = 0.312), proactive personality (β = 0.180), and advanced qualification (β = 0.084), while the main organizational factors included monthly salary ≤ 1,900 RMB (β = -0.256), no regular training after induction (β = -0.253), and the number of days off per month (3-4 days off β = 0.192, ≥ 5 days off β = 0.101). Conclusion Although geriatric nursing assistants are at low levels of elder neglect, it remains a cause for concern. Among the personal factors, geriatric nursing assistants who possessed proactive personalities, high self-efficacy and advanced qualifications, exhibited low levels of elder neglect. Among the organizational factors, those who possessed a high number of days off per month portrayed low levels of elder neglect. Conversely, those who received low monthly salaries and no regular training after induction portrayed high levels of elder neglect. To reduce the risk of elder neglect, nursing homes should give due consideration to candidates' self-efficacy and proactive personality traits when recruiting, and focus on fostering these personality traits in their employees during their work. In addition, strengthening regular training for geriatric nursing assistants, optimizing the salary structure, and arranging rest days in a reasonable manner are also necessary measures.
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Affiliation(s)
- Jing Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhihua Yang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ya Li
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Ruijuan Ma
- School of Media and Communications, Urumqi Vocational University, Urumqi, China
| | - Liping Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yage Du
- School of Nursing, Peking University, Beijing, China
| | - Haoying Dou
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Ribeiro D, Carreira L, Salci MA, Marques FRDM, Gallo A, Baccon W, Baldissera V, Laranjeira C. The Institutionalisation of Brazilian Older Abused Adults: A Qualitative Study among Victims and Formal Carers. Geriatrics (Basel) 2023; 8:65. [PMID: 37367097 DOI: 10.3390/geriatrics8030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Abuse against elders is acknowledged as a severe and pervasive problem in society. If support services are not tailored to the victims' knowledge or perceived needs, the intervention is likely to be unsuccessful. This study aimed to explore the experience of institutionalisation of abused older people from the perspective of the victims and their formal carers in a Brazilian social shelter. A qualitative descriptive study was performed with 18 participants, including formal carers and older abused persons admitted to a long-term care institution in the south of Brazil. Qualitative thematic analysis was used to analyse the transcripts of semi-structured qualitative interviews. Three themes were identified: (1) personal, relational, and social bonds: broken or weakened; (2) denial of the violence suffered; and (3) from imposed protection to compassionate care. Our findings provide insights for effective prevention and intervention measures in elder abuse. From a socio-ecological standpoint, vulnerability and abuse might be averted at the community and societal levels (e.g., education and awareness of elder abuse) by creating a minimum standard for the care of older individuals (e.g., law or economic incentives). Further study is needed to facilitate recognition and raise awareness among individuals in need and those offering assistance and support.
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Affiliation(s)
- Dayane Ribeiro
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Lígia Carreira
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Maria Aparecida Salci
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | | | - Adriana Gallo
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Wanessa Baccon
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Vanessa Baldissera
- Postgraduate Nursing Department, State University of Maringá, Avenida Colombo, 5790-Campus Universitário, Maringá 87020-900, PR, Brazil
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Campus 5, Rua de Santo André-66-68, 2410-541 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
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Lund SB, Skolbekken JA, Mosqueda L, Malmedal W. Making Neglect Invisible: A Qualitative Study among Nursing Home Staff in Norway. Healthcare (Basel) 2023; 11:healthcare11101415. [PMID: 37239698 DOI: 10.3390/healthcare11101415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Research shows that nursing home residents' basic care needs are often neglected, potentially resulting in incidents that threaten patients' safety and quality of care. Nursing staff are at the frontline for identifying such care practices but may also be at the root of the problem. The aim of this study was to generate new knowledge on reporting instances of neglect in nursing homes based on the research question "How is neglect reported and communicated by nursing home staff?" METHODS A qualitative design guided by the principles of constructivist grounded theory was used. The study was based on five focus-group discussions (20 participants) and 10 individual interviews with nursing staff from 17 nursing homes in Norway. RESULTS Neglect in nursing homes is sometimes invisible due to a combination of personal and organizational factors. Staff may minimize "missed care" and not consider it neglect, so it is not reported. In addition, they may be reluctant to acknowledge or reveal their own or colleagues' neglectful practices. CONCLUSION Neglect of residents in nursing homes may continue to occur if nursing staff's reporting practices are making neglect invisible, thus proceeding to compromise a resident's safety and quality of care for the foreseeable future.
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Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Laura Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
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Lund SB, Skolbekken JA, Mosqueda L, Malmedal WK. Legitimizing neglect - a qualitative study among nursing home staff in Norway. BMC Health Serv Res 2023; 23:212. [PMID: 36879261 PMCID: PMC9990246 DOI: 10.1186/s12913-023-09185-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Residents in nursing homes do not always get qualitatively good nursing care, and research shows that residents' basic care needs are sometimes neglected. Neglect in nursing homes is a challenging and complex issue, yet a preventable one. Nursing home staff are at the frontline of detecting and preventing neglect but may also be the ones causing it. It is essential to understand why and how neglect happens in order to recognize, expose, and prevent its occurrence. Our aim was to generate new knowledge on the processes leading to and allowing neglect to continue in Norwegian nursing homes, by studying how nursing home staff perceive and reflect on when nursing home residents are neglected in their daily practice. METHODS A qualitative exploratory design was used. The study was based on five focus group discussions (20 participants, total) and ten individual interviews with nursing home staff from 17 different nursing homes in Norway. The interviews were analysed according to Charmaz constructivist grounded theory. RESULTS In order to make neglect an acceptable practice, nursing home staff apply different strategies. These strategies were identified as when the staff legitimize neglect by neglecting neglect, when the staff are not recognizing their own behaviour as neglectful, as expressed in their actions and language, and normalizing missed care when resources are lacking and nursing staff are rationing care. CONCLUSIONS The gradual shift between judging actions as neglectful or not are made possible when nursing home staff legitimize neglect by not recognizing their practice as neglective, thus neglecting neglect or when they are normalizing missed care. Increased awareness and reflections on these processes may be a way of reducing the risk of and preventing neglect in nursing homes.
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Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway.
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway
| | - Laura Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Wenche K Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway
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Fredriksen-Goldsen K. Blueprint for Future Research Advancing the Study of Sexuality, Gender, and Equity in Later Life: Lessons Learned From Aging With Pride, The National Health, Aging, and Sexuality/Gender Study (NHAS). THE GERONTOLOGIST 2023; 63:373-381. [PMID: 36254775 PMCID: PMC9960017 DOI: 10.1093/geront/gnac146] [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: 05/03/2022] [Indexed: 11/12/2022] Open
Abstract
While interest in sexuality\research is growing, in the past, it has been largely invisible in gerontology. By exploring the full range and dimensions of sexuality and their interrelationships with multiple factors, this article presents conceptual, substantive, and methodological advances for the field of sexuality in later life. Based on the Sexual Equity Framework, an extension of the Health Equity Promotion Model, this article highlights the heterogeneity and intersectionality of sexuality across the life course, examining how historical and contemporary contexts frame key dimensions of sexuality at multiple levels (intrapersonal, interpersonal, sociocultural, and structural) and their relationship with sexual quality of life. Utilizing findings from Aging with Pride: National Health, Aging and Sexuality/Gender Study, the heterogeneity and intersectionality of age, gender, race, and ethnicity are critical to understanding sexuality and its dimensions in later life. Many adults experience changes in sexual and gender identities over time. Affirming sexual and gender identities, social connections, and health-promoting behaviors are positively associated with sexual quality of life, while sexual stigma and marginalization have adverse consequences. The study of sexuality needs to be fully integrated into gerontology. The Sexual Equity Framework explicates the potential deleterious effect of historical and contemporary structures on sexuality as well the important roles of affirmation, agency, and resilience among older adults, and recognizes the important role of human rights to advance sexual quality of life. Important directions for future research, practices, and policies are outlined.
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D’Anna T, Argo A, Albano GD, Puntarello M, Rizzo C, Guadagnino D, Zerbo S. Focus on Liability of Residences for Elderly and Sick People: A Case Series and Medico-Legal Issues. Healthcare (Basel) 2023; 11:healthcare11040539. [PMID: 36833073 PMCID: PMC9956670 DOI: 10.3390/healthcare11040539] [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: 12/30/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Residences for elderly and sick people, self-sufficient or dependent, are varied. To date, the liability profiles of these structures are not clearly delineated, and increasingly often, their operating and organization criteria are entrusted to subnational, regional, or local regulations. Among the various deficits, there is the keeping of a complete and detailed documentation/diary of the patient, the lack of which can generate medico-legal problems. In this paper, we present three cases of guests in residences for a dependent person brought to the attention of the Institute of Forensic Medicine of the University Hospital of Palermo due to criminal proceedings, where the lack of existing documentation in the structure and, in some cases, the behavior of the professionals working there, led the evaluator to deduce the organization's culpability.
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Affiliation(s)
- Tommaso D’Anna
- Policlinic Hospital, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
- Correspondence: (T.D.); (A.A.); Tel.: +39-39-3771-4629 (T.D.); +39-09-1238-6301 (A.A.)
| | - Antonina Argo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
- Correspondence: (T.D.); (A.A.); Tel.: +39-39-3771-4629 (T.D.); +39-09-1238-6301 (A.A.)
| | - Giuseppe Davide Albano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Maria Puntarello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Chiara Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Daniela Guadagnino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Stefania Zerbo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
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15
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Yan E, To L, Wan D, Xie X, Wong F, Shum D. Strategies to build more effective interventions for elder abuse: a focus group study of nursing and social work professionals in Hong Kong. BMC Geriatr 2022; 22:978. [PMID: 36536315 PMCID: PMC9762662 DOI: 10.1186/s12877-022-03682-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND One in six older adults living in communities experience abuse and neglect. Elder abuse has serious consequences for individuals, families, and society, including mortality, physical and psychological morbidities, and increased care requirements. Timely and effective interventions for elder abuse should therefore be a priority. This study used a qualitative focus group approach to address the following questions: What are the essential elements of elder abuse interventions? What can be done to improve current interventions? METHOD The 32 participants in this focus group study included social workers, medical social workers, and nurses from seven organizations who shared their knowledge and insights. All sessions were conducted online, audio-recorded, and transcribed verbatim. Three researchers with backgrounds in social work and psychology independently coded the transcripts and agreed on the themes emerging from the focus groups. RESULTS Based on the experiences of frontline helping professionals in Hong Kong, we highlighted the key factors for effective elder abuse intervention: 1) identification and assessment; 2) essential skills and attitudes; 3) elements of effective interventions; 4) collaborative efforts across disciplines and agencies; and 5) raising awareness among professionals and the public. CONCLUSIONS Training can equip frontline professionals with the necessary skills to identify elder abuse cases and to assess the risk of abuse. Effective interventions should not only address clients' safety and need for tangible support but also respect their autonomy and privacy. A client-centered, strength-based approach that involves supportive peers and addresses the complex family relationships involved can be useful. Interventions should also involve cross-discipline and cross-agency collaboration.
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Affiliation(s)
- Elsie Yan
- grid.16890.360000 0004 1764 6123Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Louis To
- grid.16890.360000 0004 1764 6123Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Debby Wan
- grid.16890.360000 0004 1764 6123Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xiaojing Xie
- grid.16890.360000 0004 1764 6123Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Frances Wong
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - David Shum
- grid.16890.360000 0004 1764 6123Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Lev S, Dolberg P, Lang B. "They just did what they usually do": Mistreatment, abuse, and neglect in nursing homes from the perspective of Ministry of Health auditing teams. Geriatr Nurs 2022; 48:24-31. [PMID: 36099776 DOI: 10.1016/j.gerinurse.2022.08.005] [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: 05/22/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
The aim of this article was to examine how Ministry of Health auditing teams experience quality of care, mistreatment, abuse, and neglect in nursing homes in Israel. The research included four in-depth focus groups consisting of 19 multidisciplinary auditors. The qualitative analysis was encoded in stages with repeated comparisons between individual participants and within groups and led to three main themes: (1) Failure in addressing basic, personal, and social needs of residents in nursing homes; (2) Mistreatment manifested in violation of residents' privacy and human dignity, neglect, and physical harm; (3) Abuse, including psychological, financial, and physical abuse. The findings can be explained by the characteristics of nursing homes as total institutions, as well as perceptions of ageism and de-humanization of the residents. In addition, the findings highlight the importance of the auditing role in monitoring the nursing homes' quality of care and the safety of the residents.
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Affiliation(s)
- Sagit Lev
- School of Social Work, Bar-Ilan University, Israel.
| | - Pnina Dolberg
- Department of Social Work, Ruppin Academic Center, Israel
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17
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Ranabhat P, Nikitara M, Latzourakis E, Constantinou CS. Effectiveness of Nurses' Training in Identifying, Reporting and Handling Elderly Abuse: A Systematic Literature Review. Geriatrics (Basel) 2022; 7:geriatrics7050108. [PMID: 36286211 PMCID: PMC9602163 DOI: 10.3390/geriatrics7050108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
The elderly population globally is estimated to grow by one-third of the world’s population by the year 2050. At the same time, elder abuse and neglect have been acknowledged as major growing concerns. With the growing elderly population and increasing concerns about elder abuse, understanding the ways to deal with elder abuse is important. The healthcare professionals, especially nurses, are among the first groups who come in contact with the elderly population and can identify and assess cases of elder abuse. There is evidence to suggest that nurses lack knowledge in the assessment, identification, management, and reporting of an elder abuse case. This study aims to explore the available literature in the effectiveness of training programs for nurses in elder abuse management. The search strategy included the electronic databases CINHAL, Medline, and Health Source. A total of 646 research articles published between 2010 and 2021 were screened against inclusion and exclusion criteria. After reviewing and removing duplicates and irrelevant studies, 14 articles were included in this review. The findings of this literature review revealed that providing education and training for nurses in elder abuse can enhance their knowledge and increase identification and reporting of elder abuse cases. It also indicated that mixed teaching methods, such as face-to-face lectures, simulation, or case scenarios and debriefings or feedback can strengthen the learning process of nurses. In conclusion, educational programs for nurses can significantly improve the identification, reporting, and handling skills of elder abuse incidents. This finding can help in developing accurate strategies for minimizing and preventing elder abuse cases. From the results of this systematic review, we propose the ECLiPSE pathway for the effective training of nurses and handling of elder abuse cases, eventually contributing to decreasing the incidents.
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Affiliation(s)
- Pratibha Ranabhat
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia 1700, Cyprus
| | - Monica Nikitara
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia 1700, Cyprus
| | - Evangelos Latzourakis
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia 1700, Cyprus
| | - Costas S. Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2408, Cyprus
- Correspondence:
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18
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Mussie KM, Setchell J, Elger BS, Kaba M, Memirie ST, Wangmo T. Care of Older Persons in Eastern Africa: A Scoping Review of Ethical Issues. Front Public Health 2022; 10:923097. [PMID: 35874990 PMCID: PMC9298985 DOI: 10.3389/fpubh.2022.923097] [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: 04/18/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The aging population is rapidly increasing globally, with 80% of the older population living in low- and middle-income countries. In Eastern African countries, there exists an incongruence between readiness-economically, structurally, politically, and culturally-to create a conducive environment for healthy aging, which implies public health as well as ethical concerns. The aim of this scoping review was to explore existing evidence addressing the various ethical issues in connection with elder care in the region of Eastern Africa. Methods We searched six databases (Africa-Wide Information, AgeLine, CINHAL, MEDLINE, APA PsycInfo, and SocINDEX) to identify peer-reviewed journal articles that could meet some eligibility criteria such as being a peer-reviewed journal article written in English, having been published in any year until July 2020, and focusing on ethical issues in the care of older people aged 60 years and older from Eastern Africa. We also searched for additional evidence in the references of included papers and web-based platforms. We included 24 journal articles and analyzed them using the inductive content analysis approach. Results The included articles represent seven (38.9%) of the 18 countries in the Eastern African region. The articles covered six ethical concerns: lack of government attention to older persons (n = 14, 58.3%), inaccessibility of health care services (n = 13, 54.2%), loneliness and isolation (n = 11, 45.8%), gender inequalities in old age (n = 9, 37.5%), mistreatment and victimization (n = 8, 33.3%), and medical errors (n = 2, 8.3%). Conclusion This scoping review summarized ethical issues arising in relation to providing care for older persons in the Eastern African context. In light of the rapid increase in the number of older persons in this region, it is critical for governments and responsible bodies to implement and accelerate efforts promptly to generate more evidence to inform programs and policies that improve the health and wellbeing of older persons. Further research is needed to inform global health efforts that aim at improving the lives of older persons, particularly in low- and middle-income countries. Clinical Trial Registration https://osf.io/sb8gw, identifier: 10.17605/OSF.IO/SB8GW.
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Affiliation(s)
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Tessema Memirie
- Addis Centre for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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19
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Hirt J, Adlbrecht L, Heinrich S, Zeller A. Staff-to-resident abuse in nursing homes: a scoping review. BMC Geriatr 2022; 22:563. [PMID: 35794542 PMCID: PMC9261065 DOI: 10.1186/s12877-022-03243-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elder abuse in long-term care is an important public health concern with social, health-related, and economic implications. Staff-to-resident abuse is of particular interest since institutions should protect residents' rights and prevent harm. To provide an up-to date comprehensive overview of staff-to-resident abuse in nursing homes, we performed a scoping review considering types of abuse, their prevalence and associated factors, descriptions, experiences, and preventive interventions. METHODS We performed a scoping review following the framework provided by Arksey and O'Malley. We searched MEDLINE (via PubMed), CINAHL, PsycINFO via Ovid, and Cochrane Library. Additionally, we performed free web searching using Google Scholar and checked relevant reviews. Two reviewers independently selected studies. We narratively synthesised the results. RESULTS Out of 3876 references retrieved by our search, we included 46 studies in 47 reports. The prevalence rates of abuse varied widely, ranging from 0 to 93% depending on the type of abuse. Associated factors of abuse at the staff, resident, and nursing home level were evaluated inconsistently. Abuse was perceived ambiguous: even though it was considered unacceptable, it was underreported. We found only four studies addressing preventive interventions. Of these, four made recommendations for intervention development. Only one study with an experimental design examined a multi-component intervention including education and mutual support. CONCLUSIONS The review yielded heterogenous evidence not allowing a concrete conclusion on prevalence and associated factors. However, the results show the significance of the problem and indicate that there are associate factors of abuse that can be influenced by appropriate interventions. These are amongst other staff education, organisational culture, and conditions. Further research should investigate the composition and content of preventive interventions and their potential to reduce abusive behaviours.
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Affiliation(s)
- Julian Hirt
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
- International Graduate Academy, Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle (Saale), Germany
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Adlbrecht
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Steffen Heinrich
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Adelheid Zeller
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
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20
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Jester DJ, Molinari V, Bowblis JR, Dobbs D, Zgibor JC, Andel R. Abuse and Neglect in Nursing Homes: The Role of Serious Mental Illness. THE GERONTOLOGIST 2022; 62:1038-1049. [PMID: 35022710 DOI: 10.1093/geront/gnab183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing homes (NH) are serving a large number of residents with serious mental illness (SMI). We analyze the highest ("High-SMI") quartile of NHs based on the proportion of residents with SMI and compare NHs on health deficiencies and the incidence of deficiencies given for resident abuse, neglect, and involuntary seclusion. RESEARCH DESIGN AND METHODS We used national Certification and Survey Provider Enhanced Reports (CASPER) data for all freestanding certified NHs in the continental United States from 2014 to 2017 (14,698 NHs; 41,717 recertification inspections; 246,528 deficiencies). Differences in the number of deficiencies, a weighted deficiency score, the deficiency grade, and the facility characteristics associated with deficiencies for abuse, neglect, and involuntary seclusion were examined in High-SMI. Incidence rate ratios (IRR) and odds ratios (OR) were reported with 95% confidence intervals. RESULTS High-SMI NHs did not receive more deficiencies or a greater weighted deficiency score per recertification inspection. Deficiencies given to High-SMI NHs were associated with a wider scope, especially Pattern (IRR:1.03;[1.00, 1.07]) and Widespread (IRR:1.07;[1.02, 1.11]). High-SMI NHs were more likely to be cited for resident abuse and neglect (OR:1.49;[1.23, 1.81]) and the policies to prohibit and monitor for abuse and neglect (OR:1.18;[1.08, 1.30]) in comparison to all other NHs. DISCUSSION AND IMPLICATIONS Although resident abuse, neglect, and involuntary seclusion are rarely cited, these deficiencies are disproportionately found in High-SMI NHs. Further work is needed to disentangle the antecedents to potential resident abuse and neglect in those with mental healthcare needs.
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Affiliation(s)
- Dylan J Jester
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Victor Molinari
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - John R Bowblis
- Department of Economics and Scripps Gerontology Center, Miami University, Oxford, OH
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Janice C Zgibor
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Ross Andel
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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21
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Howe MJK, Choi KW, Piedra LM, Zhong S, Pierce G, Cook SC, Ramirez R. Detecting Risk of Neglect in NSHAP Round 3 Using New Follow-Up Questions to Activities of Daily Living Measures. J Gerontol B Psychol Sci Soc Sci 2021; 76:S348-S362. [PMID: 34918149 PMCID: PMC8678447 DOI: 10.1093/geronb/gbab186] [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: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Elder neglect is a type of elder abuse wherein an older adult's basic needs remain unmet through negligence. The risk of neglect and its harmful consequences coincides with the need for care that arises with difficulties completing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). In this paper, we describe how new questions included in Round 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP-R3) can help detect the risk of elder neglect. METHODS Based on the 2,340 respondents who indicated problems with at least one ADL or IADL, we categorized respondents as at a higher risk of neglect if they were either: (a) not getting wanted help (WANTHELP) or (b) getting help from an undependable caregiver (UNRELIABLE). We tested the external validity of these indicators by examining their association with NSHAP-R3 measures of physical and mental health, personal hygiene, home tidiness, social support, and elder mistreatment, using t tests and chi-square tests. RESULTS Those labeled higher neglect risk based on the WANTHELP variable showed significantly worse self-rated physical health, personal hygiene, room tidiness, mental health, partner support, family support, and elder mistreatment. The same correlates were significantly associated with higher neglect risk based on the UNRELIABLE variable, except for self-rated physical health, personal hygiene, and room tidiness. DISCUSSION Findings suggest that these new measures can be useful for identifying NSHAP respondents who are at risk of types of neglect that can be associated with having I/ADL limitations.
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Affiliation(s)
- Melissa J K Howe
- Academic Research Centers, NORC at the University of Chicago, Chicago, Illinois, USA
| | - Kyung Won Choi
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
| | - Lissette M Piedra
- School of Social Work, University of Illinois Urbana-Champaign, Urbana-Champaign, Illinois, USA
| | - Selena Zhong
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
| | - Grey Pierce
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
| | - Soren C Cook
- Academic Research Centers, NORC at the University of Chicago, Chicago, Illinois, USA
| | - Randy Ramirez
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
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22
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Fadayevatan R, Rahimi M, Abedi H. Care Process in Iranian Nursing Homes: A Grounded Theory Study. J Caring Sci 2021; 10:160-168. [PMID: 34849360 PMCID: PMC8609117 DOI: 10.34172/jcs.2021.024] [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: 12/13/2019] [Accepted: 04/02/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: The need and use of long-term care services for older people has increased with their rising population and there is little information about the state of serving in nursing homes. This study aimed to identify the caring process in Iranian nursing homes.
Methods: This qualitative study was conducted in three Iranian nursing homes using grounded theory approach. The participants included 28 individuals (14 older people and 14 caregivers). The data were collected using unstructured interviews up to data saturation, and analyzed by constant comparative method.
Results: Fragmented care emerged as the core variable. The main factor for developing the core variable was ‘experience-based caring’. Other factors included ‘inappropriate structure for care’ as contextual factors in the nursing homes environment and ‘keeping instead of caring’, ‘dismal life’, and ‘up and down of the path’ as strategies and consequences.
Conclusions: The most common type of care was the routine and unplanned one with focusing on physical aspects. To improve a delivery care system for older people in nursing homes, proposing a care plan with focus on an integrated model of care in nursing homes, provision of instructions for treatment, as well as supervision and training caregivers to provide better care are necessary
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Affiliation(s)
- Reza Fadayevatan
- Department of Gerontology, Iranian Research Center of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Majid Rahimi
- Department of Health Education and Promotion, Health Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Heidarali Abedi
- Department of Nursing, Isfahan Branch, Islamic Azad University, Khorasghan, Iran
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23
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Su Z. Rigorous Policy-Making Amid COVID-19 and Beyond: Literature Review and Critical Insights. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12447. [PMID: 34886171 PMCID: PMC8657108 DOI: 10.3390/ijerph182312447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/23/2022]
Abstract
Policies shape society. Public health policies are of particular importance, as they often dictate matters in life and death. Accumulating evidence indicates that good-intentioned COVID-19 policies, such as shelter-in-place measures, can often result in unintended consequences among vulnerable populations such as nursing home residents and domestic violence victims. Thus, to shed light on the issue, this study aimed to identify policy-making processes that have the potential of developing policies that could induce optimal desirable outcomes with limited to no unintended consequences amid the pandemic and beyond. Methods: A literature review was conducted in PubMed, PsycINFO, and Scopus to answer the research question. To better structure the review and the subsequent analysis, theoretical frameworks such as the social ecological model were adopted to guide the process. Results: The findings suggested that: (1) people-centered; (2) artificial intelligence (AI)-powered; (3) data-driven, and (4) supervision-enhanced policy-making processes could help society develop policies that have the potential to yield desirable outcomes with limited unintended consequences. To leverage these strategies' interconnectedness, the people-centered, AI-powered, data-driven, and supervision-enhanced (PADS) model of policy making was subsequently developed. Conclusions: The PADS model can develop policies that have the potential to induce optimal outcomes and limit or eliminate unintended consequences amid COVID-19 and beyond. Rather than serving as a definitive answer to problematic COVID-19 policy-making practices, the PADS model could be best understood as one of many promising frameworks that could bring the pandemic policy-making process more in line with the interests of societies at large; in other words, more cost-effectively, and consistently anti-COVID and pro-human.
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Affiliation(s)
- Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX 78229, USA
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24
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Papinaho O, Häggman-Laitila A, Kangasniemi M. Unprofessional conduct by nurses: A document analysis of disciplinary decisions. Nurs Ethics 2021; 29:131-144. [PMID: 34583555 PMCID: PMC8866744 DOI: 10.1177/09697330211015289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: A small minority of nurses are investigated when they fail to meet the
required professional standards. Unprofessional conduct does not just affect
the nurse but also patients, colleagues and managers. However, it has not
been clearly defined. Objective: The objective was to identify unprofessional conduct by registered nurses by
examining disciplinary decisions by a national regulator. Design: A retrospective document analysis. Data and research context: Disciplinary decisions delivered to 204 registered nurses by the Finnish
national regulatory authority from 2007 to 2016. The data were analysed with
quantitative statistics. Ethical consideration: The study received permission from the Finnish National Supervisory Authority
for Welfare and Health and used confidential documents that were supplied on
the basis of complete anonymity and confidentiality. Findings: The mean age of the registered nurses who were disciplined was 44 years and
81% were female. Two-thirds had worked for their employer for 5 years or
less, 53% had two or more employers and 18% had a criminal history. All the
decisions included a primary reason for why the nurses were investigated,
but there were also 479 coexisting reasons. In most cases, unprofessional
conduct was connected to substance abuse (96%). In addition, stealing of
medicine, a decreased ability to work and neglect of nursing guidelines were
reported. Discussion: We found that the nurses were investigated for unprofessional conduct for
complex combinations of primary and coexisting reasons. Our study
highlighted that more attention needs to be paid to the key markers for
unprofessional conduct. Conclusion: Unprofessional conduct is a complex phenomenon that is connected to nurses’
individual and working backgrounds and has an impact on their work
performance. More research is needed to identify how nursing communities can
detect, manage and limit the serious effects and consequences of
unprofessional conduct.
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Affiliation(s)
- Oili Papinaho
- Oili Papinaho, Department of Nursing
Science, University of Turku, Joukahaisenkatu 3-5, 20520 Turku, Finland.
| | - Arja Häggman-Laitila
- University of Eastern Finland, Finland;
Department of Social Services and Health Care, Finland
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25
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Saga S, Blekken LE, Nakrem S, Sandmoe A. Relatives' experiences with abuse and neglect in Norwegian nursing homes. A qualitative study. BMC Health Serv Res 2021; 21:684. [PMID: 34247595 PMCID: PMC8272837 DOI: 10.1186/s12913-021-06713-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background Elder abuse in nursing homes (NH) is a widespread and complex problem. Residents’ ability to share their experiences are impeded, due to a high degree of cognitive problems and frailty, and previous studies are thus mainly based on reports from staff. Therefore, we aimed to give voice to the residents by investigating their relatives’ experiences with elder abuse in NH. Methods Qualitative individual interviews were conducted with 16 relatives of residents with experience of abuse and/or neglect in NH. Content analysis was used to analyse the data. Results Relatives perceived neglect as most pervasive and staff-to-resident psychological abuse as a key problem. Physical abuse was mostly related to resident-to-resident aggression. Relatives perceived elder abuse in NH to be related to low competence among staff, low staffing, poor NH leadership, working cultures characterized by fear and loyalty to employer or co-workers, and a lack of individualized care for the residents. Furthermore, relatives themselves experienced maltreatment from NH, which caused them to suffer stress, anxiety and distrust. Relatives also expressed a need to compensate for lack of care. Conclusions Relatives of NH residents who had experienced abuse reported that neglect of basic care and individual rights was predominant and viewed organizational explanations as most important. Relatives perceive themselves as collaborators in care and are emotionally attached to their family member. Therefore, if relatives experience resident abuse or neglect, it inflicts a feeling of being mistreated themselves, particularly if they are not listened to or their notice of abuse on the part of the resident is ignored or trivialized. Including relatives in a committed partnership with NH in care practices is not only a valuable path to reduce the risk of abuse, but it also leads to a more sustainable healthcare with high standards of quality and safety.
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Affiliation(s)
- Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lene Elisabeth Blekken
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Astrid Sandmoe
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Simmons J, Wenemark M, Ludvigsson M. Development and validation of REAGERA-P, a new questionnaire to evaluate health care provider preparedness to identify and manage elder abuse. BMC Health Serv Res 2021; 21:473. [PMID: 34006271 PMCID: PMC8131191 DOI: 10.1186/s12913-021-06469-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Elder abuse is prevalent and associated with morbidity but often goes unnoticed in health care. Research on the health care response to victims calls for valid measurements. This article describes the development and validation of a questionnaire to evaluate health care provider preparedness to care for older adults subjected to abuse, the REAGERA-P (Responding to Elder Abuse in GERiAtric Care - Provider questionnaire). METHOD REAGERA-P was developed in phase I. The questionnaire includes a case vignette, self-efficacy scales for identifying and managing elder abuse cases and cause for concern as well as organizational barriers when talking with older patients about abuse. Content validity was ensured by a review committee, and cognitive interviews were conducted to ensure face validity and to examine cognitive processes to ensure comprehension. REAGERA-P was then administered to health care providers (n = 154, response rate 99 %) to test for construct validity. Factor analysis was performed, and internal consistency was tested for the self-efficacy scales. Convergent validity was tested by investigating associations between relevant variables. Some items were revised in phase II, and new cognitive interviews were performed. Parts of the questionnaire were tested for responsiveness by administering it to medical interns (n = 31, response rate 80 %) before and after an educational intervention. RESULTS REAGERA-P showed good content and face validity. The factor analysis revealed two factors: one for asking questions about abuse (Cronbach's α = 0.75) and one for managing the response to the questions (Cronbach's α = 0.87). Results suggest good convergent validity for the self-efficacy scales and for questions about cause for concern and organizational barriers. The responsiveness of the self-efficacy scales was good: the mean on the scale for asking questions (range 0-30) was 15.0 before the intervention and 21.5 afterwards, the mean on the scale for managing the response (range 0-50) was 22.4 before the intervention and 32.5 afterwards. CONCLUSION REAGERA-P is a new questionnaire that can be used to evaluate health care provider preparedness to identify and manage cases of elder abuse, including educational interventions conducted among staff to improve health care responses to victims of elder abuse. This initial testing of the questionnaire indicates that the REAGERA-P has good validity.
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Affiliation(s)
- Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Marika Wenemark
- Unit of Public Health and Statistics in Region Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mikael Ludvigsson
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Botngård A, Eide AH, Mosqueda L, Blekken L, Malmedal W. Factors associated with staff-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study. BMC Health Serv Res 2021; 21:244. [PMID: 33740965 PMCID: PMC7977325 DOI: 10.1186/s12913-021-06227-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Elder abuse is a public health problem that is gaining attention due to its serious impacts on people's health and well-being, and it is predicted to increase along with the world's rapidly ageing population. Staff-to-resident abuse in nursing homes is a complex and multifaceted phenomenon associated with multiple factors on different levels of the ecological model. This study aimed to explore individual, relational, and institutional characteristics associated with perpetrated staff-to-resident abuse in nursing homes, using a multilevel hierarchical approach. METHODS This was a cross-sectional exploratory study of 3693 nursing staff (response rate 60.1%) in 100 randomly selected nursing homes in Norway. We explored the characteristics of nursing staff, their relationship with residents, and institutional features associated with three types of abuse: psychological abuse, physical abuse, and neglect. These were modelled using multilevel mixed-effects logistic regression analyses. RESULTS Individual staff factors found to be associated with all three types of abuse were 1) being a registered nurse/social educator (OR 1.77-2.49) or licensed practical nurse (OR 1.64-1.92), 2) reporting symptoms of psychological distress (OR 1.44-1.46), 3) intention to leave the job (OR 1.35-1.40), and 4) reporting poor attitudes towards people with dementia (OR 1.02-1.15). Also, staff who reported poorer quality of childhood were more likely to perpetrate neglect (OR 1.14). Relational factors such as care-related conflicts (OR 1.97-2.33) and resident aggression (OR 1.36-2.09) were associated with all three types of abuse. Of institutional factors, lack of support from a manager was associated with perpetrating psychological abuse (OR 1.56). CONCLUSIONS We found several predictors of staff-to-resident abuse on different levels of the ecological model, which underlines the importance of using a multifaceted approach to identify risk factors of elder abuse in nursing homes. However, future studies should explore the underlying mechanism and causes with a prospective or qualitative design and target the multifaceted nature of risk factors when designing preventive interventions.
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Affiliation(s)
- Anja Botngård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Henning Eide
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Research, SINTEF Digital, Oslo, Norway
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Lene Blekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Lee SK, Shin JH, Ahn J, Lee JY, Jang DE. Identifying the Risk Factors Associated with Nursing Home Residents' Pressure Ulcers Using Machine Learning Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062954. [PMID: 33805798 PMCID: PMC8001016 DOI: 10.3390/ijerph18062954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Machine learning (ML) can keep improving predictions and generating automated knowledge via data-driven predictors or decisions. OBJECTIVE The purpose of this study was to compare different ML methods including random forest, logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM in terms of their accuracy, sensitivity, specificity, negative predictor values, and positive predictive values by validating real datasets to predict factors for pressure ulcers (PUs). METHODS We applied representative ML algorithms (random forest, logistic regression, linear SVM, polynomial SVM, radial SVM, and sigmoid SVM) to develop a prediction model (N = 60). RESULTS The random forest model showed the greatest accuracy (0.814), followed by logistic regression (0.782), polynomial SVM (0.779), radial SVM (0.770), linear SVM (0.767), and sigmoid SVM (0.674). CONCLUSIONS The random forest model showed the greatest accuracy for predicting PUs in nursing homes (NHs). Diverse factors that predict PUs in NHs including NH characteristics and residents' characteristics were identified according to diverse ML methods. These factors should be considered to decrease PUs in NH residents.
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Affiliation(s)
- Soo-Kyoung Lee
- College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea;
| | - Juh Hyun Shin
- College of Nursing, Ewha Womans University, Science & Ewha Research Institute of Nursing Science, Seoul 120750, Korea
- Correspondence:
| | - Jinhyun Ahn
- Department of Management Information Systems, Jeju National University, Jeju 63243, Korea;
| | - Ji Yeon Lee
- College of Nursing, Catholic University of Pusan, Busan 46252, Korea;
| | - Dong Eun Jang
- School of Nursing, University of Texas at Austin, Austin, TX 78712, USA;
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Čartolovni A, Stolt M, Scott PA, Suhonen R. Moral injury in healthcare professionals: A scoping review and discussion. Nurs Ethics 2021; 28:590-602. [PMID: 33427020 PMCID: PMC8366182 DOI: 10.1177/0969733020966776] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.
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Affiliation(s)
- Anto Čartolovni
- 324714Catholic University of Croatia, Croatia; University of Hull, UK
| | | | - P Anne Scott
- 8799National University of Ireland Galway, Ireland
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Myhre J, Saga S, Malmedal W, Ostaszkiewicz J, Nakrem S. React and act: a qualitative study of how nursing home leaders follow up on staff-to-resident abuse. BMC Health Serv Res 2020; 20:1111. [PMID: 33261610 PMCID: PMC7709220 DOI: 10.1186/s12913-020-05969-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Elder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse. METHODS A qualitative explorative design was used. The sample comprised 43 participants from two levels of nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews were conducted with 28 care managers, and individual interviews took place with 15 nursing home directors. The constant comparative method was used for the analyses. RESULTS Nursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows: 1) on an individual level, leaders performed investigations and meetings, guidance, supervision, and occasionally relocated staff members; 2) on a group level, feedback, openness, and reflection for shared understanding were strategies leaders used; and 3) on an organisational level, the main solutions were to adjust to available resources, training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that were taken. CONCLUSIONS Nursing home leaders need to be clear about how they should follow up incidents of elder abuse on different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that acknowledge that incidents of elder abuse in patient care arise not only from the actions of individuals but also from the complex everyday life of which they are a part and in which they operate.
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Affiliation(s)
- Janne Myhre
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, Australia
- National Ageing Research Institute, Parkville, VIC, 3052, Australia
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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