From risky to safer home care: health care assistants striving to overcome a lack of training, supervision, and support

Explanations for sickness absence due to common mental disorders: A narrative study of young health and social care workers

Over recent decades, sickness absence due to common mental disorders has increased among young workers. The phenomenon is mostly understood on the basis of epidemiological research, and knowledge regarding the viewpoints of young workers themselves is lacking. Our study explored the explanations for mental health-related sickness absence in the narrative accounts of young workers in high-risk health and social care occupations. Semi-structured narrative interviews were conducted with 23 Finnish young workers (aged 21-34), with self-reported sickness absence related to common mental disorders over the previous year. Our analysis identified three narrative explanations for the onset of mental health problems leading to sick leave: work as the sole cause, work as an additional cause and work as a trigger. These findings indicate that mental health-related sickness absences form a complex phenomenon related to various life and work-related circumstances. More comprehensive preventive measures are needed in the health and social care sector to help tackle mental health problems among young workers.

Home-based supportive and health care services based on functional ability in older adults in Iran

BACKGROUND

Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults.

MATERIALS AND METHODS

In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022.

RESULTS

A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05).

CONCLUSION

Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

Lifelong learning in community healthcare: Testing competence after learning activities in a blended learning space

AIMS AND OBJECTIVES

This study reports from a municipality in Norway that implemented a competence enhancement programme for all its institutional nursing staff during the COVID-19 pandemic to fill identified competence gaps.

BACKGROUND

Many Norwegian municipalities are experiencing a demand for expanded community healthcare services due to an increase in elderly patients and patients with extensive and complex needs. At the same time, most municipalities are striving to recruit and keep competent health personnel. New ways of organising and increasing the competence of the workforce may help ensure that the healthcare delivered corresponds to patients' changing needs.

DESIGN AND METHODS

Nursing staff were encouraged to complete targeted competence enhancing activities with the aim of enhancing their competence in identified areas. The learning activities were blended and consisted of e-learning courses, lectures, supervision, vocational training and meetings with a superior. Competence was measured before and after the competence enhancing activities (n = 96). The STROBE checklist was applied.

RESULTS

The results provide insight into the competence development of registered nurses and assistant nurses in institutional community health services. They show that the implementation of a workplace-based blended learning programme improved competence significantly, especially for assistant nurses.

CONCLUSIONS

Offering workplace-based competence enhancing activities seems to be a sustainable way of facilitating lifelong learning among nursing staff. Facilitation of learning activities in a blended learning space may enhance accessibility and increase the potential for participation. A combination of reorganisation of roles and simultaneous competence enhancing activities can ensure that both managers and nursing staff prioritise filling competence gaps.

How does the distribution of work tasks among home care personnel relate to workload and health-related quality of life?

BACKGROUND

The work for Swedish home care workers is challenging with a variety of support and healthcare tasks for home care recipients. The aim of our study is to investigate how these tasks relate to workload and health-related quality of life among home care workers in Sweden. We also explore staff preferences concerning work distribution.

METHODS

A cross-sectional study was conducted in 16 municipalities in Northern Sweden. Questionnaires with validated instruments to measure workload (QPSNordic) and health-related quality of life (EQ-5D), were responded by 1154 (~ 58%) of approximately 2000 invited home care workers. EQ-5D responses were translated to a Quality-adjusted life-year (QALY) score. For 15 different work task areas, personnel provided their present and preferred allocation. Absolute risk differences were calculated with propensity score weighting.

RESULTS

Statistically significantly more or fewer problems differences were observed for: higher workloads were higher among those whose daily work included responding to personal alarms (8.4%), running errands outside the home (14%), rehabilitation (13%) and help with bathing (11%). Apart from rehabilitation, there were statistically significantly more (8-10%) problems with anxiety/depression for these tasks. QALY scores were lower among those whose daily work included food distribution (0.034) and higher for daily meal preparation (0.031), both explained by pain/discomfort dimension. Personnel preferred to, amongst other, spend less time responding to personal alarms, and more time providing social support.

CONCLUSION

The redistribution of work tasks is likely to reduce workload and improve the health of personnel. Our study provides an understanding of how such redistribution could be undertaken.

Developing a comprehensive model of home-based formal care for elderly adults in Iran: A study protocol

BACKGROUND

Due to the increasing Iran's aging population, designing a home care model is necessary. However, the data on designing the home care model for elderly adults among developing countries are limited. This study will be carried out to develop a formal home-based care model for elderly adults in Iran.

METHODS

This multi-method study will include three phases: First, Mixed-methods sequential explanatory study including two steps: One, survey to determine the prevalence of dependence on formal and informal caregivers among people aged ≥ 60 years living in Tabriz metropolis; and two, content analysis approach includes face-to-face, semi-structured interviews with the older adults receiving formal care at home, their caregivers and relevant key informants on the characteristics of care and caregiver, challenges and expectations of standard care. In phase 2, a scoping review will be used to find out the components of home care in other countries, such as care provider organization, caregivers training, and financing. PubMed, Scopus, Web of Science, EMBASE, Google scholar databases and grey literature will be run to retrieve relevant evidence using proper MeSH terms. In phase3, the triangulation method (using the results of the previous phases, reviewing national upstream documents and the focus group discussion) will be done to reach consensus and design the initial model for the Iranian context. In the following, a Delphi study will be conducted on the validation and feasibility of the developed model.

DISCUSSION

The current health infrastructure in Iran is focused on caring for younger people, despite the near future population aging. Most studies have addressed the challenges of geriatric care, but no study has addressed the various dimensions of home care in Iran and how to provide this service to elderly adults. Providing a comprehensive model of home care for the elderly can improve the quality of life and satisfaction of the elderly and their caregivers.

Exploring barriers to and facilitators of the implementation of home rehabilitation care for older adults with disabilities using the Consolidated Framework for Implementation Research (CFIR)

BACKGROUND

With global aging on the rise, the number of older adults with disabilities was also increasing exponentially. There has been growing international interest in home rehabilitation care as a new method for older adults with disabilities.

METHOD

The current study is a descriptive qualitative study. Guided by the Consolidated Framework for Implementation Research (CFIR), semistructured face-to-face interviews were performed to collect data. The interview data were analyzed using a qualitative content analysis method.

RESULT

Sixteen nurses with different characteristics from 16 cities participated in the interviews. The findings highlighted 29 implementation determinants of home-based rehabilitation care for older adults with disabilities, including 16 barriers, and 13 facilitators. These influencing factors aligned with all four CFIR domains that were used to guide the analysis and 15 of the 26 CFIR constructs. More barriers were identified in the CFIR domain of characteristics of individuals, intervention characteristics, and the outer setting, while fewer barriers were identified in the inner setting.

CONCLUSION

Nurses from the rehabilitation department reported many barriers related to the implementation of home rehabilitation care. They reported facilitators to the implementation of home rehabilitation care despite the barriers, which provided practical recommendations for directions to be explored by researchers in China and elsewhere.

Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool

BACKGROUND

The provision of home healthcare is increasing in response to the growing aging population with the need for chronic disease management in their homes. Safety work differs from hospital care. The incidence of adverse events in home healthcare is sparsely studied but is estimated to occur in-one third of patients, and most are deemed preventable. Although nursing care is crucial for risk assessment and preventive work in the home environment, the role of registered nurses in the prevention of no-harm incidents and adverse events has not received sufficient scientific attention.

OBJECTIVES

To explore nursing-sensitive events in patients receiving home healthcare.

DESIGN, SETTING AND PARTICIPANTS

A Swedish national multicenter study based on a structured record review of 600 randomly chosen healthcare records from 10 organizations in different regions of the country.

METHODS

Ten trained teams, each including physician(s) and registered nurses, undertook a review based on the Global Trigger Tool method. The review covered a maximum of 90 days from admission to home healthcare. First, each record was screened for the presence of 38 predefined triggers. In the second step, every potential event was assessed according to preventability, types of events, severity, time of occurrence, consequences of the event, and potential contributing causes.

RESULTS

In total, 699 events were identified in the study. Of these, 495 (74.0%) were classified as nursing-sensitive (227 no-harm incidents and 268 adverse events) and affected 267 (44.5%) patients, with a mean of 1.9 events per patient. The majority (n = 367, 73.1%) were considered preventable. The most prominent types of nursing-sensitive event were falls (n = 138, 27.9%), pressure ulcers (n = 62, 12.5%), healthcare-associated infections (n = 58, 11.7%) and medication management (n = 50, 10.1%). Concerning severity, 45.9% were classified as no-harm incidents and another 36.6% resulted in temporary harm that required extra healthcare resources: 226 hospital days, 66 physician visits in outpatient care, and 99 in home healthcare. All severity types occurred from day 1, except death, which included only one patient. The most frequent contributing factors were deficiencies in nursing care, treatment & diagnosis, with the subgroups nursing care, observation, treatment & follow-up, followed by deficiencies in the organization.

CONCLUSIONS

Nursing-sensitive events in home healthcare are common, often preventable, and occur from the start of the care period. This study contributes to increased knowledge of patient safety shortcomings and points to the important role that registered nurses play in patient safety work.

Comparing the quality of care for long-term ventilated individuals at home versus in shared living communities: a convergent parallel mixed-methods study

BACKGROUND

People on home mechanical ventilation (HMV) belong to a heterogeneous population with complex care needs. In Germany, outpatient intensive care is provided in people's private home (PH) or in shared living communities (SLC). Increasing patient numbers have led to criticism of the quality of care in recent years. Since quality deficits from the perspective of those affected are largely unclear, the following research question emerged: How do interviews with ventilated individuals and family caregivers explain any differences or similarities in the quality of care between PH and SLC?

METHODS

This study used a mixed-methods convergent parallel design, where quantitative and qualitative components were separately collected and analysed. The quantitative component (structured interviews and online survey) included ventilation characteristics, health-related resource use, health-related quality of life (HRQL) measured with the Severe Respiratory Insufficiency Questionnaire (SRI; range 0-100; higher scores indicated higher HRQL) and the Burden Scale of the Family Caregivers short version (BSFC-s; range 0-30; higher scores indicated higher burden). The qualitative component (semi-structured interviews) focused on people's experience of person-centred care. Data were merged using a weaving method and the Picker framework of Person-Centred Care.

RESULTS

The quantitative component revealed that ventilated individuals living in PHs were on average 20 years younger than participants living in SLCs (n = 46; PH: 46.86 ±15.40 years vs. SLC: 65.07 ±11.78 years; p = .001). HRQL (n = 27; PH: 56.62 ±16.40 vs. SLC: 55.35 ±12.72; p > .999) and the burden of family caregivers (n = 16; PH: 13.20 ±10.18 vs. SLC: 12.64 ±8.55; p > .999) were not significantly different between living situation. The qualitative component revealed that person-centred care is possible in both care settings (ventilated individuals: n = 13; family caregivers: n = 18).

CONCLUSION

This study describes a care situation that is as heterogeneous as the population of people with HMV. HRQL and the burden of family caregivers are highly individual and, like person-centred care, independent of the living situation. Policy decisions that facilitate person-centred care need to recognise that quality of care is highly individual and starts with the free choice of the care setting.

Community-based personal support workers' satisfaction with job-related training at the organization in Ontario, Canada: Implications for future training

BACKGROUND AND AIMS

Complexity of community-based homecare for older adults has increased significantly in the past decade in Ontario, Canada. Personal support workers (PSWs), who are unregulated and vary in formal education, provide the majority of community homecare work for increasingly complex clients. This paper seeks to understand community-based PSWs' satisfaction with opportunities for job-related training at their employing organization to provide the skills and knowledge to meet the demands of their evolving role.

METHODS

Data for this paper are from a cross-sectional survey of 1746 community-based PSWs in Ontario, Canada entitled, "The PSW Health and Safety Matters Survey" www.pswshaveasay.ca. This survey was part of a research project "Keeping Community Based PSWs Safe in a Changing World of Work," funded by the Ontario Ministry of Labour. The data were analyzed using descriptive statistics, correlations, multivariate regression, and thematic analysis.

RESULTS

Quantitative analysis revealed most community homecare organizations offer PSWs job-related training to help them retain and update their skills and that PSWs have a moderate level of satisfaction with their job-related training. The analysis revealed that PSWs' satisfaction with organizational training is greater when the organization provides work-related training on challenging tasks, lifting and transferring tasks, and tasks delegated by nurses and supervisors. Data from the open-ended question highlighted seven key themes for desired training by PSWs: safe body mechanics for moving/lifting clients, managing aggression primarily with clients, infection control, CPR/first aid, mental illness, equipment training, and basic health and safety.

CONCLUSION

Implications for factors associated with PSWs' satisfaction with opportunities for job-related training are discussed along with recommendations for mitigating variability in education and training to meet the demands of their evolving role.

Which factors are related to Finnish home care workers' job satisfaction, stress, psychological distress and perceived quality of care? - a mixed method study

BACKGROUND

The desire to increase the role of home care in Finland has created problems in home care work. Working conditions have deteriorated, the quality of care experienced is low, and staff members suffer from time pressure and stress, amongst other things. The aim of this article is to explore the challenges, stressors, teamwork and management factors that are associated with home care staff members' well-being, job satisfaction and experienced care quality, and further, how staff members experience their work.

METHODS

A survey was sent to home care workers in two case organizations that participated in the study. In addition, semi-structured theme interviews with home care workers were conducted. The data from the survey was analysed using analysis of covariance, and interview data was analysed using the Grounded Theory-based method from Gioia et al. RESULTS: Respondents of the survey and the interview participants were mainly female practical nurses. The results from the survey showed, for example, that time pressure was associated with higher stress and psychological distress, and interruptions were associated with lower job satisfaction and higher stress. In addition, variables related to teamwork, such as participative safety, were shown to explain the variation in quality of care. The analysis of the interview data further brought up dissatisfaction with management practices, which seems to have led to a decrease in job satisfaction. Exhaustion and strain were present among staff members, which originated from an insufficient number of carers.

CONCLUSIONS

Current working conditions and work practices in Finnish home care are experienced stressful. The results from this study indicate that having more autonomy at work was associated with job satisfaction, according to both analyses. Team climate and idea implementation were related to quality of care. Therefore, increasing self-organizing team practices might be a possible development method for improving working conditions and staff members' well-being. Implementing self-organizing team practices could possibly also attract employees to work in home care and prevent turnover.

Perceptions of Professional Responsibility When Caring for Older People in Home Care in Sweden

Older people in Sweden are increasingly being cared for in the own home, where professional caregivers play an important role. This study aimed to describe perceptions of caring responsibility in the context of older people's homes from the perspective of professional caregivers from caring professions. Fourteen interviews were conducted with professional caregivers from different professions. The result show how professional caregivers perceive responsibility as limitless, constrained by time, moral, overseeing, meaningful and lonesome. Responsibility seems to affect caregivers to a large extent when the burden is high. Professional caregivers' perceptions of responsibility, and the potential consequences of a perceived strained work situation therefore need to be addressed. The findings also indicate a need for professional support and guidance when it is difficult to distinguish between professional and personal responsibility.

A systematic review of observational studies of adult home care

The home-care workforce is in high demand globally. Home-care workers provide care for people at home, including practical and personal care, as well as other tasks such as medication management. We conducted a systematic review with the aims of understanding methods of observation that have been employed to study home care and to explore how these methods have enabled researchers to understand the quality of home care. We searched the literature using PubMed and CINAHL databases in May 2018, with no limits applied to date of publication. We searched for MeSH terms of 'Home Care Services', 'Home Health Care', 'Home Nursing' and 'Observation*'. Across 15 eligible studies, the types of observation methods employed were categorised as structured, guided and unstructured. The characteristics of these methods, such as the level of participation adopted by the observer, varied across the studies. Three themes were developed through a narrative synthesis of the included studies' findings: 'The impact of care delivery and organisational factors', 'Observing relationships and communications', and 'People and places behind closed doors'. We conclude that methods of observation are a fairly novel, yet rich and meaningful way of exploring home-care practice. Researchers undertaking observations should consider elements such as the number of researchers observing and the potential for variations, how and when to record the observations, possible triangulation of data, the researcher's reflective stance as an observer, as well as ethical considerations.

Constituents of effective support for homecare workers providing care to people with dementia at end of life

OBJECTIVE

The aim of this study was to enhance understanding about homecare workers providing care to people with dementia at end of life by exploring homecare workers' perceptions of challenges and the support they needed and sometimes received.

METHODS

Qualitative semi-structured interviews were conducted with 29 homecare workers and 13 homecare managers in England. Framework analysis was used to analyse the data.

FINDINGS

Four overarching challenges were identified: working with clients with dementia, including clients' sometimes unpredictable responses, communication difficulties, and mood changes; caring for the dying; conflict with family members; and working alone, which often left homecare workers at risk of exhaustion, fatigue, and a sense of isolation. When their work entailed high levels of emotion, such as a client's death or getting embroiled in a client's family conflict, they felt emotionally drained, under-prepared, and overwhelmed. Supportive elements include receiving encouragement and learning from experienced peers and their feelings being acknowledged by managers at their employing homecare agency. Some workers were offered time off or encouraged to attend the client's funeral as a means of supporting the process of bereavement.

CONCLUSIONS

Peer and manager support are essential and effective in coping with work pressures. There is a need to develop models of effective support to alleviate staff's practical, emotional, and interpersonal pressures. However, due to the isolating nature of homecare work, managers may not recognise early signs of their staff finding stress unmanageable and miss the opportunity to mitigate these negative effects.

Mothers' experiences of their work as healthcare assistants for their chronic disabled child

BACKGROUND

To the best of our knowledge, no research of the work situation of full-time, paid, parental HC assistants has been done.

AIM

To examine how parents experienced their work as HC assistants for their chronic disabled child.

METHODS

Semi-structured interviews based on the Work Environment Impact Scale (WEIS-S) were done with nine mothers who had a child aged 8-17 years old with a cognitive or/and physical chronic disability. Content analysis was used with the Model Of Human Occupation as a framework.

RESULTS

The studied mothers always needed to be stand-by for their child, and they highlighted physical and psychological health problems caused by their work situation. There were several difficulties working in different environments because of the child's need of technical devices. Further they described the support from their employers as important and in general the participants perceived a lack of understanding about their work situation in the society.

CONCLUSION

The mothers in the present study had unclear job descriptions, they often worked more than full-time, and had low occupational balance.

SIGNIFICANCE

Occupational therapists could improve the HC assistants' work place focusing on the physical and psycho-social work environment as well as on their occupational balance.

The evolving role of the personal support worker in home care in Ontario, Canada

To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.

The impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage

OBJECTIVE

To investigate the impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage.

METHOD

A repeated measure design was employed to quantify the effectiveness of an educational intervention, consisting of one pre-test and two post-tests.

RESULTS

Education was provided to home support workers and this was followed by an assessment of their ability to correctly classify 20 photographs detailing varying stages of skin damage severity. At the baseline (pre-education), 58% of the photographs were classified correctly. At post-test 1, 55% of the photographs were classified correctly. In post-test 2 this increased to 58%, achieving the original baseline scores. There was a moderate negative relationship between pre-training and post-test 2 scores (r=-0.44; n=27; p=0.02).

CONCLUSIONS

The educational intervention has been shown not to have a statistically significantly positive effect on home support workers' ability to detect early pressure ulcer damage. The moderate negative relationship between pre-training and post-test 2 scores concur with the aforementioned qualitative findings, and similarly indicate behaviour associated with individuals experiencing difficulty comprehending new health terms.

'I need complete trust in nurses' - home mechanical ventilated patients' perceptions of safety

BACKGROUND

Although home care has advanced over the last few decades, little research on patient safety has been carried out in this setting. Furthermore, it is unclear how patients perceive their situation and safety. The insiders' views might be especially relevant for technology-dependent individuals, such as users of home mechanical ventilation (HMV).

AIM

The aim of this study was to examine how HMV patients perceive their situation and what makes them feel safe or unsafe.

DESIGN

Explorative qualitative study.

METHODS

Data were collected in two regions in Germany between April and December 2014 by means of semi-structured interviews with 21 HMV patients. Thematic analysis was used to analyse data.

FINDINGS

Three themes emerged: the meaning of an interpersonal relationship between the nurse and HMV patient is expressed in the theme Being familiar - Having trust. The importance of the attentiveness of nurses for the patients' feeling of safety is described in the theme Being able to communicate - Being noticed. The theme Experiencing continuity - Feeling presence points to the organisational dimension of HMV care provision.

CONCLUSIONS

The interpersonal nurse-patient relationship plays a key role in promoting HMV patients' feeling of safety. Thus, HMV patients have a relational approach to safety. In order to enhance the patients' feeling of safety, nurses should strive to develop a trusting relationship with patients and demonstrate their presence and attentiveness. Regarding the provision of care, competent and continuous care should be made a priority.

Personal care assistants' experiences of caring for people on home mechanical ventilation

AIM

The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home.

METHODS

Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner.

FINDINGS

Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul.

CONCLUSIONS

The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations.

District nurses' experiences of preventive home visits to 75-year-olds in Stockholm: a qualitative study

Aims This study had two aims: to describe the dialogue between district nurses (DNs) and older people in preventive home visits (PHVs) from the perspective of the DNs, and to identify barriers to and facilitators of this dialogue as perceived by the DNs.

BACKGROUND

The number of older people is rapidly increasing in all western countries, and as people's age increases, the probability that they will have multiple diseases also increases. Planned actions are therefore needed to promote health and prevent diseases among older people so they can remain in good health and live in their homes for as long as possible. In Sweden, PHVs to 75-year-olds by DNs are one such action.

METHODS

This qualitative study included five group interviews with 20 DNs. Data were analysed with qualitative content analysis. Findings DNs' experiences of barriers to and facilitators of a successful health dialogue were sorted into five domains. Together, these domains provided a systematic description of the interaction between the DN and the older person in the PHV. The domains included: establishing trustful contact, conducting a structured interview, making an overall assessment, proposing health-promoting activities and offering follow-up. The barriers and facilitators could be related to the older person, the DN or the home environment. The latent content of the interviews was evident in three themes that were related to the DNs' experiences of barriers and facilitators. These themes illustrated professional dilemmas that the DNs had to resolve to achieve the purpose of the PHV. The study demonstrates that the interaction between a DN and an older person in a PHV can be described as a complex social process in which the DN balances a personal and professional approach, combines a person-oriented and a task-oriented approach and employs both a salutogenic and pathogenic perspective.

Exploring the activity profile of health care assistants and nurses in home nursing

Are home nurses (also known as community nurses) ready for their changing role in primary care? A quantitative study was performed in home nursing in Flanders, Belgium, to explore the activity profile of home nurses and health care assistants, using the 24-hour recall instrument for home nursing. Seven dates were determined, covering each day of the week and the weekend, on which data collection would take place. All the home nurses and health care assistants from the participating organisations across Flanders were invited to participate in the study. All data were measured at nominal level. A total of 2478 home nurses and 277 health care assistants registered 336 128 (47 977 patients) and 36 905 (4558 patients) activities, respectively. Home nurses and health care assistants mainly perform 'self-care facilitation' activities in combination with 'psychosocial care' activities. Health care assistants also support home nurses in the 'selfcare facilitation' of patients who do not have a specific nursing indication.

Health Care Assistants in Home Nursing

What are the experiences of home health care workers with regard to the delegation of nursing activities, the supervision of health care assistants (HCAs), and the impact of these changes on the work of home nurses (HNs). In-depth interviews were performed with 12 HNs, 12 HCAs, and eight managers in home nursing. HCAs take care of a less care dependent patient population, allowing the HNs to spend more time on more complex, technical nursing care. However, the analysis revealed some barriers, such as a knowledge gap and insecurity felt by HCAs leading to unnecessary patient visits by HNs, unfamiliarity of HNs with the role of delegating activities and supervising HCAs, and poor face-to-face communication between HNs and HCAs.

Nursing Older People—Competence Evaluation Tool: Development and Psychometric Evaluation

Background and Purpose: To evaluate the quality of care provided to older people, the competence of the nursing staff must be measured. This study evaluates a new instrument called Nursing Older People—Competence Evaluation Tool (NOP-CET). Methods: A 65-item questionnaire was completed by 1,016 community-based nursing staff and evaluated for validity, reliability, precision, interpretability, acceptability, and feasibility. Results: The survey demonstrated good content validity; conceptually coherent factor structure explaining 54.98% (knowledge items), 65.03% (skills items), and 52.83% (personal attribute items) of the total variance; and internal consistency (.77–.93). Conclusions: The NOP-CET showed good validity and reliability as a measure of community-based nursing staff competence and may be used in further investigations of competence in older people nursing.