1
|
Lynch B, Ryan AA, O’Neill M, Penney S. The factors that influence care home residents’ and families’ engagement with decision-making about their care and support: an integrative review of the literature. BMC Geriatr 2022; 22:873. [PMID: 36396991 PMCID: PMC9672635 DOI: 10.1186/s12877-022-03503-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background: As care homes play an important role in the lives of an increasing number of older people, it is pivotal to understand how residents’ and their families engage in decision-making about their care and support. Internationally, there is an increasing emphasis in long-term care settings on the right of residents to be actively involved in all aspects of decision-making about their care and support. However, the steps necessary to achieving a culture of shared decision-making in long-term care settings remain unclear. The aim of this literature review is to summarise what is known in the literature about the factors that influence care home residents’ and families’ engagement with decision-making about their care and support. Methods: An integrative literature reviews was carried out, guided by the methodological framework proposed by Whittemore and Knafl (2005). CINAHL, Medline Ovid and ProQuest Health and Medical databases were searched for relevant articles from 2011 to 2021. A three-step method was used, including the use of reference and citation management software to manage search results and identify duplicate citations. Abstracts and full texts were reviewed by two reviewers. Details of the selected articles were then extracted using the Data Extraction Form. Results: In total, 913 articles were located and 22 studies were included in the final analysis. The thematic analysis identified three main themes that illustrate the complexities of shared decision-making in care homes: (a) a positive culture of collaborative and reciprocal relationships; (b) a willingness to engage and a willingness to become engaged; and (c) communicating with intent to share and support rather than inform and direct. Conclusion: The implementation of shared decision-making in care homes is highly dependent on the support and nurturing of collaborative and reciprocal relationships between residents, families, and staff. Part of this process includes ascertaining the willingness of residents and families to become engaged in shared decision-making. Communication skills training for staff and guided approaches that view decision-making as a supportive process rather than a once off event are essential prerequisites for implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03503-8.
Collapse
|
2
|
Chen W, Modanloo S, Graham ID, Hu J, Lewis KB, Gifford W. A mixed-methods systematic review of interventions to improve leadership competencies of managers supervising nurses. J Nurs Manag 2022; 30:4156-4211. [PMID: 36194186 DOI: 10.1111/jonm.13828] [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: 07/12/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 01/04/2023]
Abstract
AIM This study aimed to synthesize evidence on interventions to improve leadership competencies of managers supervising nurses. BACKGROUND In recent years, numerous interventions have been developed to improve the leadership competencies of managers supervising nurses. However, researchers and nursing leaders are unclear about what aspects of interventions are effective for developing which competencies. METHODS We conducted a mixed-methods systematic review following the Joanna Briggs Institute (JBI) approach for evidence synthesis. The Medline (Ovid), CINAHL, Embase, Scopus, Nursing and Allied Health Database were reviewed. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total of 69 studies (35 quantitative, 22 mixed methods, 12 qualitative) evaluating 68 interventions were included. Studies showed that interventions used modal activities such as lectures, group work and mentoring that generally had positive effects on improving leadership competencies such as supporting, developing and recognizing nurses. Opportunities to interact with peers increased managers' engagement in the interventions; however, many barriers existed for managers to use the competencies in practice including understaffing, insufficient time and lack of support from supervisors and staff. CONCLUSIONS Leadership interventions were shown to have beneficial effects on developing different competencies. Managers predominately felt positive about participating in leadership interventions; however, they expressed many difficulties applying what they learned in practice. IMPLICATIONS FOR NURSING MANAGEMENT Leadership interventions should include multimodal activities that give managers opportunities for interaction. When considering interventions for developing the leadership of managers, it is imperative to consider the practice environments for managers to be successful in applying the competencies they learned in practice.
Collapse
Affiliation(s)
- Wenjun Chen
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Shokoufeh Modanloo
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Ian D Graham
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epodemiology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Gifford
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada.,Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Brommeyer M, Liang Z. A Systematic Approach in Developing Management Workforce Readiness for Digital Health Transformation in Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13843. [PMID: 36360722 PMCID: PMC9658786 DOI: 10.3390/ijerph192113843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic has sped up digital health transformation across the health sectors to enable innovative health service delivery. Such transformation relies on competent managers with the capacity to lead and manage. However, the health system has not adopted a holistic approach in addressing the health management workforce development needs, with many hurdles to overcome. The objectives of this paper are to present the findings of a three-step approach in understanding the current hurdles in developing a health management workforce that can enable and maximize the benefits of digital health transformation, and to explore ways of overcoming such hurdles. METHODS A three-step, systematic approach was undertaken, including an Australian digital health policy documentary analysis, an Australian health service management postgraduate program analysis, and a scoping review of international literatures. RESULTS The main findings of the three-step approach confirmed the strategies required in developing a digitally enabled health management workforce and efforts in enabling managers in leading and managing in the digital health space. CONCLUSIONS With the ever-changing landscape of digital health, leading and managing in times of system transformation requires a holistic approach to develop the necessary health management workforce capabilities and system-wide capacity. The proposed framework, for overall health management workforce development in the digital health era, suggests that national collaboration is necessary to articulate a more coordinated, consistent, and coherent set of policy guidelines and the system, policy, educational, and professional organizational enablers that drive a digital health focused approach across all the healthcare sectors, in a coordinated and contextual manner.
Collapse
Affiliation(s)
- Mark Brommeyer
- College of Business, Government and Law, Flinders University, Adelaide 5042, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia
| | - Zhanming Liang
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia
| |
Collapse
|
4
|
Haunch K, Downs M, Oyebode J. Leading by example: Nursing home staff experiences of what facilitates them to meaningfully engage with residents with advanced dementia. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5805. [PMID: 36040653 PMCID: PMC9541111 DOI: 10.1002/gps.5805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Meaningful connections promote the quality of life of people living with advanced dementia in nursing homes. However, evidence internationally suggests people living with advanced dementia in nursing homes spend the majority of time alone, with little contact with anyone. Frontline care workers are in powerful positions to meaningfully engage with residents, yet research to date has not focused on their experiences. The aim of this study was to explore the experiences of nursing home staff, specifically, what care workers feel enables them to meaningfully engage with residents living with advanced dementia. METHODS/DESIGN Semi-structured interviews were conducted with 21 staff from seven nursing homes. Inductive thematic analysis was used. RESULTS Four themes were important for facilitating care workers to meaningfully engage with residents with advanced dementia: support from managers and nurses, support from experienced care workers, a caring culture and an appropriate physical environment. CONCLUSION Effective leadership was the key thread that ran throughout. It was evident that meaningfully engaging with residents with advanced dementia was hard, particularly for new or inexperienced care workers. Those with experience (of care work and the residents they cared for), as well as those in formal leadership positions played key roles in facilitating care workers to: perceive it was their role to connect, understand, accept and empathise with residents, understand the importance of getting to know residents' and express their own caring attributes. Future research should focus on empirically testing leadership models that promote meaningful engagement.
Collapse
|
5
|
O’Neill M, Ryan A, Tracey A, Laird L. 'The Primacy of 'Home': An exploration of how older adults' transition to life in a care home towards the end of the first year. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e478-e492. [PMID: 33242367 PMCID: PMC9292794 DOI: 10.1111/hsc.13232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/18/2020] [Accepted: 10/20/2020] [Indexed: 05/12/2023]
Abstract
This grounded theory study sought to explore how older adults' experience the transition from living at home to a care home with a specific focus on the latter part of the first year of the move. The study was carried out within a large Health Trust in the UK between August 2017 and May 2019. Purposive sampling was used in the initial stages of data collection. Thereafter and consistent with grounded theory methodology, theoretical sampling was employed to undertake semi-structured interviews with 17 individuals from eight care homes between 5 and 12 months after the move. This paper reports five key categories which were: (a) The lasting effect of first Impressions 'They helped me make my mind up' (b) On a Journey 'I just take it one day at a time', (c) Staying connected and feeling 'at home' 'You get something good out of it you know…you get hope'. (d) Managing loss and grief 'It was important for me to say cheerio to the house' and (e) Caring relationships 'I didn't realise that I was lonely until I had company'. Together these five categories formed the basis of the core category 'The Primacy of 'Home' which participants identified as a place they would like to feel valued, nurtured and have a sense of belonging. This study identifies that it is important for individual preferences and expectations to be managed from the outset of the move. Individuals and families need to be supported to have honest and caring conversations to promote acceptance and adaptation to living in a care home while continuing to embrace the heart of 'home'. Key recommendations from this study include the need to raise awareness of the significance of the ongoing psychological and emotional well-being needs of older people which should be considered in policy directives and clinical practice.
Collapse
Affiliation(s)
- Marie O’Neill
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
| | - Assumpta Ryan
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
| | - Anne Tracey
- School of PsychologyUlster UniversityColeraine, Co LondonderryNorthern Ireland
| | - Liz Laird
- School of Nursing and Institute of Nursing and Health ResearchUlster UniversityCo LondonderryNorthern Ireland
| |
Collapse
|
6
|
Martín-Carbonell M, Riquelme-Marín A, Fernández-Daza M, Ortigosa-Quiles JM, Méndez-Mateo I. Exploring the Psychometric Properties of the Questionnaire on Family Members Adapting to an Older Adult's Admission to a Nursing Home (CAFIAR-15) in a Colombian Sample. Behav Sci (Basel) 2021; 12:4. [PMID: 35049615 PMCID: PMC8773060 DOI: 10.3390/bs12010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022] Open
Abstract
Institutionalization to a nursing home can be one of the most significant and traumatic events in a senior's life, and for their family. For this reason, it is especially important to have validated instruments that evaluate the family member's adaptation to admitting the senior to a nursing home. The study included 139 family members recruited equally in two types of institutions (low-income nursing home (LINH) vs. high-income nursing home (HINH)). A sociodemographic questionnaire with questions to study antecedents and conditions for care and the Questionnaire for Admitting an Older Adult to a Nursing Home (CAFIAR-15) were used. Examining the communalities indicated that four of the five items in factor 3 presented communalities lower than 0.30 and differences in the factorial structure of the CAFIAR-15 were found. There were differences in the antecedents and conditions for care between the relatives of the older adults at LINH and HINH. Cultural differences and differences between LINH and HINH may be the basis for flaws in the conceptual validity of the CAFIAR-15 in the Colombian sample.
Collapse
Affiliation(s)
- Marta Martín-Carbonell
- Psychology Department, Cooperative University of Colombia, Troncal del Caribe S/N, Santa Marta 47002, Colombia;
| | - Antonio Riquelme-Marín
- Department of Personality, Assessment and Psychological Treatments, University of Murcia, 30100 Murcia, Spain; (A.R.-M.); (J.M.O.-Q.)
| | - Martha Fernández-Daza
- Psychology Department, Cooperative University of Colombia, Troncal del Caribe S/N, Santa Marta 47002, Colombia;
| | - Juan Manuel Ortigosa-Quiles
- Department of Personality, Assessment and Psychological Treatments, University of Murcia, 30100 Murcia, Spain; (A.R.-M.); (J.M.O.-Q.)
| | - Inmaculada Méndez-Mateo
- Department of Evolutionary and Educational Psychology, University of Murcia, 30100 Murcia, Spain;
| |
Collapse
|
7
|
‘Knowing me, knowing you’: an exploration of the views and experiences of nursing home residents and staff on their nursing home as ‘home’. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The overall aim of this grounded theory study was to explore the context of a nursing home as ‘home’ from the perspective of residents and staff. Sixteen focus group interviews were used to collect qualitative data from nursing home residents (N = 48) and staff (N = 44). Five distinct categories captured the views and experiences of participating residents and staff. These were: (a) Starting off on the right foot, ‘First impressions can be the lasting ones; (b) Making new and maintaining existing connections, ‘There is great unity between staff and residents’; (c) The nursing home as home, ‘It's a bit like home from home for me’; (d) Intuitive knowing, ‘I don't even have to speak, she just knows’; and (e) Feeling at home in a regulated environment, ‘It takes the home away from nursing home’. Together these five categories formed the basis of the core category ‘Knowing me, knowing you’, which captures the experiences of participants who repeatedly highlighted the importance of relationships and feelings of mutuality and respect between and among staff and residents as central to feeling at home in a nursing home. The reciprocity and mutuality associated with the core category, ‘Knowing me, knowing you’, was at times challenged by staff shortages, time constraints, and conflicting priorities associated with the co-existence of a regulated and homely environment.
Collapse
|
8
|
Haunch K, Thompson C, Arthur A, Edwards P, Goodman C, Hanratty B, Meyer J, Charlwood A, Valizade D, Backhaus R, Verbeek H, Hamers J, Spilsbury K. Understanding the staff behaviours that promote quality for older people living in long term care facilities: A realist review. Int J Nurs Stud 2021; 117:103905. [PMID: 33714766 DOI: 10.1016/j.ijnurstu.2021.103905] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Little is known about how the workforce influences quality in long term care facilities for older people. Staff numbers are important but do not fully explain this relationship. OBJECTIVES To develop theoretical explanations for the relationship between long-term care facility staffing and quality of care as experienced by residents. DESIGN A realist evidence synthesis to understand staff behaviours that promote quality of care for older people living in long-term care facilities. SETTING Long-term residential care facilities PARTICIPANTS: Long-term care facility staff, residents, and relatives METHODS: The realist review, (i) was co-developed with stakeholders to determine initial programme theories, (ii) systematically searched the evidence to test and develop theoretical propositions, and (iii) validated and refined emergent theory with stakeholder groups. RESULTS 66 research papers were included in the review. Three key findings explain the relationship between staffing and quality: (i) quality is influenced by staff behaviours; (ii) behaviours are contingent on relationships nurtured by long-term care facility environment and culture; and (iii) leadership has an important influence on how organisational resources (sufficient staff effectively deployed, with the knowledge, expertise and skills required to meet residents' needs) are used to generate and sustain quality-promoting relationships. Six theoretical propositions explain these findings. CONCLUSION Leaders (at all levels) through their role-modelling behaviours can use organisational resources to endorse and encourage relationships (at all levels) between staff, residents, co-workers and family (relationship centred care) that constitute learning opportunities for staff, and encourage quality as experienced by residents and families.
Collapse
Affiliation(s)
- Kirsty Haunch
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Carl Thompson
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom; NIHR ARC Yorkshire and Humber
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | | | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom; NIHR ARC East of England
| | - Barbara Hanratty
- Population Health Sciences Institute, University of Newcastle, United Kingdom; NIHR ARC North East and North Cumbria
| | - Julienne Meyer
- School of Health Sciences, City, University of London, United Kingdom
| | - Andy Charlwood
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Danat Valizade
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Ramona Backhaus
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Jan Hamers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Karen Spilsbury
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom; NIHR ARC Yorkshire and Humber.
| |
Collapse
|