Older adults' perceptions of navigating eye health care in Denmark: a qualitative study

BACKGROUND

Vision impairment can have an impact on cognition, health, and social function. Vision loss may be avoided if detected early and treated promptly. Eye health is a minor topic in general practice, but the ongoing relationship between doctor and patient has the potential to assist the patient in navigating the healthcare system and guaranteeing timely healthcare service delivery.

AIM

To explore the attitudes of older members of the public (aged ≥60 years) towards navigating primary sector eye health care in Denmark, with a focus on optometrists, practising ophthalmologists (POs), and GPs.

DESIGN & SETTING

Qualitative study in Copenhagen, Denmark.

METHOD

Focus group interviews were performed in the spring of 2022 with 21 older members of the public.

RESULTS

Older members of the public perceived optometrists and POs to be the most relevant health professionals to consult about eye health. Opportunities were identified for enhancing the function of general practice including detecting early signs of visual impairment, being in charge of further referrals, and managing issues affecting quality of life such as dry eyes.

CONCLUSION

Older members of the public sought help from health professionals who are directly qualified to treat symptoms of vision impairment that patients are experiencing or expect to face in the near future. Participants identified a potential for GPs to address vision impairment. This included focusing on the patient's general health and function, as well as potential comorbidities influencing treatment trajectories. The current denigration of general practice risks missing out on the potential benefits of robust engagement from general practice in eye health.

Nursing home managers' descriptions of multi-level barriers to leading person-centred care: A content analysis

BACKGROUND

Research suggests that person-centred care can be beneficially implemented and sustained, even though barriers remain that prevent uptake in clinical practice. Understanding barriers to person-centred care seems important, as this has an impact on care practices and resident outcomes. Moreover, there is limited knowledge about nursing home managers' descriptions of barriers when leading person-centred care.

OBJECTIVES

To explore barriers to leading person-centred care as narrated by nursing home managers.

METHODS

A descriptive qualitative design was used to collect data using individual interviews with 12 nursing home managers in highly person-centred nursing homes. Data were analysed using content analysis.

RESULTS

Multi-level barriers to leading person-centred care were identified on the (1) person level, (2) team level and (3) organisational level. Placing professional and family considerations ahead of resident considerations was described as a barrier on the personal level (1). Also, staff's divergent care values, processes, and priorities together with turnover and low foundational knowledge were identified as barriers on the team level (2). On an organisational level (3), constrained finances, functional building design and group level rostering were identified as barriers.

CONCLUSION

Multi-level barriers influence nursing home managers' ability to lead and promote person-centred care. Promoting the development of person-centred practices requires efforts to eliminate barriers on person, team and organisational level.

IMPLICATIONS FOR PRACTICE

Identifying and overcoming barriers at various levels in nursing home care has the potential to promote person-centred practices. This study can inform stakeholders and policymakers of challenges and complexities in person-centred practices. Multi-level strategies are needed to target challenges at person-, team- and organisational level when striving to develop person-centred care.

Unrecognised depression among older people: a cross-sectional study from Norwegian general practice

BACKGROUND

Depression is common in old age and is associated with disability, increased mortality, and impairment from physical diseases.

AIM

To estimate the prevalence of depression among older patients in Norwegian general practice, to evaluate the extent they talk about it during their consultation, whether it was previously known or suspected by their GP, and how frequently patients with depression visit their GP.

DESIGN & SETTING

Cross-sectional study among patients and GPs at 18 primary care clinics in the south of Norway.

METHOD

Patients aged ≥65 years who visited their GP were asked to complete the Patient Health Questionnaire-9 (PHQ-9). The GPs reported what kind of issues the patient presented at the consultation, if a current depression was known, and the consultation frequency.

RESULTS

Forty-four (11.4%) of 383 patients reported moderate or severe depressive symptoms (PHQ-9 ≥10). Among the cases with data from both patient and GP (n = 369), 38 patients (10.3%) reported moderately depressive symptoms. Of these, only 12 (31.6%) mentioned psychological problems to their GP during their consultation; 12 (31.6%) with previous depression were neither known to the GP nor suspected of currently having depression; and 67.6% of them visited their GP ≥5 times a year.

CONCLUSION

Older patients tend to speak little of their depression to the GP. Almost one in three older patients with moderate depressive symptoms were unrecognised by their GP. Older patients who frequently visit the GP should be suspected of potentially having mental health problems.

On welfare pluralism, social policy and the contribution of sociology: Revisiting Robert Pinker

On occasion it makes sound sense to undertake a retrospective review of a late colleague's contribution to his or her subject area. This applies to Robert Pinker, Professor of Social Administration at the London School of Economics, who died at the age of 89 in February 2021. Over a long life he made a major impact on working for press freedom and to social work studies, but this article concerns his work on social policy, and particularly on the idea of welfare pluralism, a many-faceted idea the exploration of which powered two pathbreaking books Social Theory and Social Policy (1971) and The Idea of Welfare (1979). In the twentieth century many states including the United Kingdom had greatly expanded their welfare provisions for their citizens, and, in some, an academic subject area, often called social administration or social policy had grown in response. Pinker started writing in the 1960s, dissatisfied with the conventional approach of Richard Titmuss and others, almost exclusively concerned with the state and welfare. He made the case for a radical rebalance toward including everyday experiences of obligations and how familial informal welfare practices are strengthened, weakened or modified by formal social services. However, ahead of his time, Pinker was arguing for an enhanced sociological imagination in the study of social policy and on the very idea of "welfare". This article has sections reflecting the facets of Pinker's thinking about welfare pluralism, including "social policy's past", "exchange and stigma", "taking informal welfare seriously", "divergent views of altruism", "comparative studies", "on a mixture of means to welfare" and "aspects of Pinker's legacy". The idea of welfare pluralism is now familiar. But Pinker's crucial pioneering role, depth of understanding of the issues and grasp of their intertwining is seldom recalled. This article should help to meet the need for his contribution to be reinserted into the mainstream of sociological thought on welfare, so enriching new research.

Does telehealth influence the decision to transfer residents of residential aged care facilities to emergency departments? A scoping review

BACKGROUND

Emergency Departments (ED) can be crowded places and not ideal environments for Residential Aged Care Facilities (RACF) residents awaiting assessment. Assessment and care planning may be made available via telehealth thereby avoiding unnecessary transfer to ED, without compromising the quality of care for the older person. Telehealth is attractive addition to improving healthcare decision-making in RACFs.

OBJECTIVES

The aim of this scoping review is to explore the evidence around the use of telehealth and whether it influences the decision to transfer residents of RACF to ED.

METHODS

All peer reviewed literature that focused on RACFs, decision-making and assessment of residents using telehealth in real time, was included. All study designs, pilot studies and some systematic reviews were considered. Databases Medline, Embase and CINAHL were used in this search in June 2022. Search terms were a combination of the population: RACF residents, decision-making and assessments using telehealth, and or transfer to the ED. The search was assisted by a senior university research academic librarian/information specialist and reviewed by senior researchers. The PRISMA-ScR guidelines were used to report this study.

RESULTS

Of the 124 articles initially identified, 31 were eligible for inclusion for synthesis. The date range of the included studies was 2001 to 2022, with 15 published in the last five years. Critical appraisal was conducted using the Mixed Methods Appraisal Tool.

CONCLUSION

This scoping review has mapped evidence that telehealth has been widely used in multiple settings. The association between the use of telehealth with improved clinical outcomes highlights its potential utility in enhancing care delivery for an older population in RACFs. Telehealth has shown that it can improve the decision-making for residents in RACFS, but more robust research designs are needed.

IMPLICATIONS FOR PRACTICE

Using video/telehealth appears to improve RACF staff access to expert clinicians who can then assess and jointly plan care/management that can be provided in the resident's home. Knowledge and skills of RACF staff appear to be improved through joint assessment and decision-making with the use of video/telehealth access to expert clinicians.

Live and let live: Residents' perspectives on alcohol and tobacco (mis)use in residential care facilities

BACKGROUND

Alcohol and tobacco use could cause health problems in older adults. Older adults who become in need of 24/7 care due to physical and/or neurological disabilities may need to move to a Residential Care Facility (RCF). RCFs aim to provide person-centred care (PCC) to enhance quality of life (QoL) of residents.

OBJECTIVES

This study aims to explore perspectives of residents on alcohol and tobacco use, which is essential to provide PCC.

METHODS

A qualitative research design was chosen, and semi-structured interviews were conducted. Residents who use alcohol and/or tobacco and those who do not use these substances were purposively selected in two organisations on two types of units: psychogeriatric units and units providing care for residents with mainly physical disabilities. The results were analysed using thematic analysis.

RESULTS

Thematic analysis resulted in five themes: Current use and self-reflection, knowledge and attitudes, addiction or habit, policies and availability, dependency versus autonomy.

CONCLUSION

Residents in this study value their autonomy regarding alcohol and tobacco use. They experience dependency on their (in)formal caregivers to use these substances and acknowledge that their use could cause a nuisance to others, challenging the ability of caregivers to implement PCC. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health and safety risks for all.

IMPLICATIONS FOR PRACTICE

This study could help care professionals to become aware of the habits and wishes of residents regarding alcohol and tobacco use and to discuss the possibilities and limitations within RCFs.

In-hospital medical complication in older people after spine surgery: a scoping review

OBJECTIVE

Worldwide, older people are suffering from lumbar degenerative disease at an annual rate of 266 million. Although spine surgeries restore mobility, reduce pain and resolve neurological damage, these procedures can place older persons at high-risk for medical complications due to multiple comorbid conditions that are often present in this population. However, the prevalence of complications occurring in older people prior to discharge is unknown. Postoperative medical complications lead to increased healthcare costs as well as pain and potential harm for the patient. Hence, this scoping review aimed to provide an overview of the current knowledge state regarding in-hospital medical postoperative complications in older people (≥65 years) after elective spine surgery.

METHOD

A scoping review was conducted following Arksey and O'Malley's framework. Four databases (PubMed, Cochrane, Scopus and CINAHL) were systematically searched. Inclusion criteria were medical complication(s) after elective spine surgery prior to discharge, age ≥65 years and English language. Co-occurrence analysis was used to examine how often each complication was examined in the literature and how often the complications co-occur.

RESULTS

Twenty-six studies met inclusion criteria. The most frequently examined postoperative medical complications after spine surgery are delirium and urinary tract infection, followed by gastrointestinal and pulmonary embolus. Despite the list of in-hospital medical complications, definitions or criteria for measurement of any identified complication were sparse and inconsistent. There is a lack of definition or instruments to comprehensively assess medical complications incurred by older people following spine surgery, including characteristics, classification methodology and temporality. To date, no research has been conducted on how older people experience or perceive a medical complication after elective spine surgery.

CONCLUSION

The findings highlight the importance to develop comprehensive instruments to assess co-occurrence of postoperative medical complications and design interventions to mitigate the negative impacts of medical complications incurred by older people after spine surgery.

Oral health care beliefs among care personnel working with older people - follow up of oral care education provided by dental hygienists

Objectives

The proportion of older people in the population is increasing rapidly. Along with this comes an increase in the number of people requiring assistance in daily living, including oral care. Swedish law stipulates that care personnel who work with older people should be offered oral health education every year. The aim of this study was to investigate oral health care beliefs among such personnel.

Methods

A questionnaire study was conducted among 2167 personnel providing care to older people at special accommodation sites and in home care. Data were collected using the Nursing Dental Coping Beliefs Scale. Descriptive statistics were calculated and logistic regression analysis was performed.

Results

Personnel working in home care had lower odds of having an internal locus of control than those working in special accommodation, and personnel with less than 10 years of working experience had lower odds than their more experienced counterparts. Men had higher odds of having an external locus of control than women.

Conclusions

It seems important to ensure that home care personnel and less experienced personnel attend oral care educational sessions, and to encourage male staff to focus on oral care work.

Translation and psychometric properties of the Persian version of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+)

OBJECTIVES

This study aimed to evaluate the validity and reliability of the Persian version of Health of the Nation Outcome Scales for Elderly People (HoNOS65+) in Iran's elderly population.

METHODS

The scale English version translated to Persian using a forward and backward translation method. The scale was filled for two elderly population groups (inpatient and outpatients) (N = 300). Simultaneously with HoNOS+65, the Clinical Global Impressions Scale (CGI) was completed. Two separate therapists were filled HoNOS+65 for thirty-one patients (inter-rater reliability test). In general, content validity, consistency, confirmatory factor analyses (CFA), convergent validity, and criterion validity were examined.

RESULTS

Using exploratory factor analysis, three factors were extracted. Inter-rater reliability in some items has a slight agreement. Content validity ratio (0.75) and index (0.90) were calculated for each item. Cronbach's alpha total score was 0.82. According to the largest modification indices, CFA showed satisfactory fit indices. The convergent validity between HoNOS +65 and CGI was (r = 0/71, sig = 0.000). Finally, the optimal cut-off point was achieved 13. Sensitivity and specificity for the HoNOS +65 were 88.89% and 81.16%, respectively, with the Youden index of 0.7005.

CONCLUSION

The Persian version of HoNOS65+ has high reliability, validity, specificity, and sensitivity in multidimensional assessment of Iranian geriatric mental health.

Cold wind of change: Associations between organizational change, turnover intention, overcommitment and quality of care in Spanish and Swedish eldercare organizations

Aim

To examine the association between organizational change, turnover intentions, overcommitment and perceptions of quality of care among nurses and nursing assistants employed in eldercare organizations.

Design

A longitudinal survey (baseline, 12-month follow-up) was used.

Methods

A panel sample of 226 eldercare employees in Spain and Sweden responded to survey questions concerning organizational change, turnover intentions, overcommitment and perceptions of quality of care. The data were analysed using structural equational modelling.

Results

We found a statistically significant positive relationship between organizational change, employees' turnover intention and overcommitment. We also found a statistically significant negative relationship between organizational change and perceived quality of care.

Working with national quality registries in older people care: A qualitative study of perceived impact on assistant nurses' work situation

Aim

The aim was to investigate assistant nurses' perceptions of how working with national quality registries affected their work situation in care of older people.

Design

Qualitative interview study.

Methods

Sixteen semi-structured interviews were conducted at four special housing units in Sweden, and a conventional content analysis, with elements of thematic analysis, was applied.

Results

The introduction of national quality registries contributed to role clarifications and the development of new formal work procedures in terms of documentation and arenas and routines for communication. The increased systematics and effectiveness gained from these changes had a perceived positive effect on the work situation, workload, work satisfaction, staff interactions and learning and reflection.

Development of practice guidelines for daily oral care in care-dependent older adults to complement the InterRAI suite of instruments using a modified Delphi approach

Aim

To develop practice guidelines for nursing assistants who provide daily oral care to older adults.

Background

The interRAI suite of instruments is internationally used in professional health care to assess the needs of care‐dependent older persons. An optimised oral health section was developed recently to identify care clients with poor oral health and hygiene. Internationally shared guidelines for daily oral care are needed to complement the optimised oral health section of the interRAI suite of instruments.

Material and methods

The modified Delphi approach started with the preparation of an initial draft. Subsequently, an online survey and a face‐to‐face discussion were conducted with international experts. Their feedback was used to revise the draft. Two additional online surveys were conducted with the experts to reach consensus agreement for each item of the revised version. The same group of experts was invited to the different study phases.

Results

The three surveys were completed by 26, 27 and 23 international experts, respectively. A group of 18 experts completed each survey, whereof a subgroup of 11 experts also took part in the face‐to‐face discussion. Experts were dental hygienists, dentists, nursing scientists, physicians and psychologists from 14 different countries. After the final survey, consensus agreement was reached for 54 of the 57 (94.7%) items, representing the final version of the guidelines.

Conclusion

Available evidence was combined with practical feedback from international experts to develop clear and concise practice guidelines for daily oral care in older adults.

Implications for practice

The guidelines will help to improve knowledge and reduce barriers of nursing assistants to provide daily oral care.

"You're at their mercy": Older peoples' experiences of moving from home to a care home: A grounded theory study

BACKGROUND

Internationally, it is recognised that the transition to a care home environment can be an emotional and stressful occasion for older people and their families. There is a paucity of research that takes into consideration the initial phase of the relocation process, incorporating individuals' experiences of the move.

AIM

To explore individuals' experiences of moving into a care home. This paper has a specific focus on the preplacement (7 days) and immediate postplacement (within 3 days) period of the move to the care home.

DESIGN

A grounded theory method was used to conduct semi-structured interviews with 23 participants.

RESULTS

Data analysis revealed five distinct categories that captured the experience of the preplacement and immediate postplacement period. These were as follows: (a) inevitability of the move: "I had to come here," (b) making the move: "Abrupt Departures," (c) decision-making and exercising choice: "What can I do, I have no choice," (d) maintaining identity: "Holding on to self" and (e) maintaining connections: "I like my family to be near." Together, these five categories formed the basis of the concept "You're at their Mercy" which encapsulates the perceived transition experience of the older people within the study. Participants felt that the move was out of their control and that they were "at the mercy" of others who made decisions about their long-term care.

CONCLUSIONS

Moving to a care home represents a uniquely significant relocation experience for the individual. Key factors influencing the move were the individuals' perceived lack of autonomy in the pre- and postrelocating period of moving to a care home. Nurses have a key role to play in working with older people to influence policy and practice around decision-making, planning and moving to a care home with greater emphasis on autonomy and choice so that older people do not feel "at the mercy" of others as they navigate such a major transition.

IMPLICATIONS FOR PRACTICE

There is a need to standardise approaches and develop person-centred interventions to support older people considering relocation to a care home and nurses have a key role to play in making this happen.

An explorative study of workplace violence against nurses who care for older people

Aim

To explore the prevalence of workplace violence among nurses who care for older people and its association with working stress, job satisfaction and quality of care in Jordan.

Design

A cross-sectional design was used.

Methods

A cluster random sampling was used to select three public hospitals, three private hospitals and 17 healthcare centres in Amman, Jordan. The researcher used a convenience sampling method to select 485 nurses. Data were collected between 2015-2016.

Results

Almost 60% of the participants have been victims of violence at the workplace during the past year. Nurses who consider violence a problem at work have high levels of working stress (p < .01) as well as lower levels of quality of care (p < .01) and job satisfaction (p < .001).

"All for One" experiences of interprofessional team members caring for older adults: A metasynthesis

BACKGROUND

There is some evidence that healthcare professionals prefer an interprofessional approach to care and this approach is of particular importance to older people due to their complex needs and multitude of chronic conditions.

OBJECTIVE

This metasynthesis aimed to synthesise and unearth new understandings of the experiences of interprofessional team members that are caring for older people from a variety of qualitative studies.

DESIGN

This review is designed as a metasynthesis based on the method put forth by Noblit and Hare for synthesising qualitative research.

DATA SOURCES

A search for qualitative and mixed methods articles that included healthcare professionals' experiences of caring for older people as a member of an interprofessional team was conducted via an electronic database search of CINAHL, PubMed, SCOPUS and PsycINFO.

REVIEW METHODS

The inclusion criteria were as follows: (a) the method of the study was qualitative or included a qualitative component, (b) an interprofessional team cared for an older person, (c) data regarding interprofessional team members' experiences were gathered, (d) published in English and (e) between the period of 2000 and 2019. Key metaphors were extracted from the data and juxtaposed until themes emerged.

RESULTS

A total of 1807 full-text articles were retrieved and screened via their titles and abstracts. Nine studies were included in this metasynthesis based upon full-text relevance and meeting the inclusion criteria. Six themes emerged describing the experience of interprofessional team members caring for older people: All for One: Unifying the Team for a Meaningful Purpose; The Cast; A Shared Vocabulary; Collaboration and Integration; A Functional-Dysfunctional Family and Appreciate the Lifeworld. Team members appreciated this model of care.

CONCLUSIONS

The emergent themes suggest potential buy-in from interprofessional team members to this care model for older people. Nursing can assert their unique knowledge and practice into the role as the team leader to mitigate potential barriers and team conflicts.

IMPLICATIONS FOR PRACTICE

Interprofessional team members caring for older people can improve their experience. Improved experiences for interprofessional team members can lead to better care for older people. Professionals need specialized training prior to practicing interprofessionally.

Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF): rationale and protocol for a multi-method study

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is less well understood than heart failure with reduced ejection fraction (HFrEF), with greater diagnostic difficulty and management uncertainty.

AIM

The primary aim is to develop an optimised programme that is informed by the needs and experiences of people with HFpEF and healthcare providers. This article presents the rationale and protocol for the Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF) research programme.

DESIGN & SETTING

This is a multi-method programme of research conducted in the UK.

METHOD

OPTIMISE-HFpEF is a multi-site programme of research with three distinct work packages (WPs). WP1 is a systematic review of heart failure disease management programmes (HF-DMPs) tested in patients with HFpEF. WP2 has three components (a, b, c) that enable the characteristics, needs, and experiences of people with HFpEF, their carers, and healthcare providers to be understood. Qualitative enquiry (WP2a) with patients and providers will be conducted in three UK sites exploring patient and provider perspectives, with an additional qualitative component (WP2c) in one site to focus on transitions in care and carer perspectives. A longitudinal cohort study (WP2b), recruiting from four UK sites, will allow patients to be characterised and their illness trajectory observed across 1 year of follow-up. Finally, WP3 will synthesise the findings and conduct work to gain consensus on how best to identify and manage this patient group.

RESULTS

Results from the four work packages will be synthesised to produce a summary of key learning points and possible solutions (optimised programme) which will be presented to a broad spectrum of stakeholders to gain consensus on a way forward.

CONCLUSION

HFpEF is often described as the greatest unmet need in cardiology. The OPTIMISE-HFpEF programme aims to address this need in primary care, which is arguably the most appropriate setting for managing HFpEF.

Burden of caring for people with dementia - comparing family caregivers and professional caregivers. A descriptive study

Purpose

Caring for people with dementia is known to be accompanied by burden for the caregiver. This study aims at describing family caregivers’ and professional caregivers’ burden immediately after hospitalization of the person with dementia.

Materials and methods

Twenty-five family caregivers and twenty-five professional caregivers of the locked gerontopsychiatric ward of a hospital in Northern Germany completed a questionnaire (BIZA-D-PV), which was evaluated in matched samples. The distribution of frequencies, differences in mean values and correlations were determined. Furthermore, family caregivers were categorized into risk groups.

Results

Family caregivers perceived a higher burden due to cognitive impairment as well as aggressive and disoriented behavior of the person with dementia compared to professional caregivers. Differences with regard to care tasks were not detected. Female family caregivers rated a higher burden compared to male family caregivers, whereas in the sample of professional caregivers males perceived a higher burden. Correlations between several dimensions of burden and caregivers’ age, severity of dementia as well as physical symptoms were described. Categorizing family caregivers into risk groups showed high risks for depression of the caregiver, violence against the person with dementia and institutionalization of the person with dementia within the next months in 44–72% of cases.

Conclusion

Our findings emphasize the importance of acquiring knowledge about caregivers’ burden in the course of time in order to develop targeting interventions to decrease caregivers’ burden and to prevent hospital admissions of people with dementia due to a crisis of home caring.

Strengths and support of older people affected by precarity in South Louisiana

BACKGROUND

Few empirical studies have examined strengths and support of older people in circumstances of precarity. A better understanding of this problem has the potential to contribute to the development of care planning and delivery.

PURPOSE

To investigate how older people deal with episodes of precarity in South Louisiana.

METHOD

More than 300 hr of participant observation and interviews were conducted with 20 predominantly older African American women in a housing complex for low-income older persons and two senior citizen centres.

RESULTS

The findings demonstrate five central negative conditions of precarity that older people had to manage: (a) loss and discontinuity of home-based healthcare services, (b) stress after loss or disruption of social support, (c) problems of poverty, (d) cognitive impairment and declining health and (e) stress of eviction. Strengths and support that older people used were as follows: (a) spiritual faith, (b) psychological strengths, (c) spiritual relationships, (d) family support, (e) friendships of love and friendships of helpfulness, (f) care and support performed by home-based services, (g) senior centre and housing complex activities, (h) church memberships and activities, and (i) grocery store and café contacts.

CONCLUSION

Home-based services were not sufficient to prevent and reduce precarity for older people because of a lack of and discontinuities in these services.

IMPLICATIONS FOR PRACTICE

This study adds to the literature about precarity among community-based older people by demonstrating gaps in care support and medication access. The findings suggest that ongoing state funding and support by home-based services are necessary to support frail older people in precarious living conditions to survive and handle stressful life events by reducing vulnerability and enhancing strengths and supportive resources of older people.

Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care

BACKGROUND

Medication reviews may improve the safety of prescribing and the National Institute for Health and Care Excellence (NICE) highlights the importance of involving patients in this process.

AIM

To explore GP and pharmacist perspectives on how medication reviews were conducted in general practice in the UK.

DESIGN AND SETTING

Analysis of semi-structured interviews with GPs and pharmacists working in the South West of England, Northern England, and Scotland, sampled for heterogeneity. Interviews took place between January and October 2017.

METHOD

Interviews focused on experience of medication review. Data saturation was achieved when no new insights arose from later interviews. Interviews were analysed thematically.

RESULTS

In total, 13 GPs and 10 pharmacists were interviewed. GPs and pharmacists perceived medication review as an opportunity to improve prescribing safety. Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPs, a medication review was done 'in the quickest way possible to say that it was done'. Pharmacists were perceived by both professions as being more thorough but less time efficient than GPs, and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work.

CONCLUSION

Practices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance.

A longitudinal study of nurses' career choices: The importance of career expectations on employment in care of older people

AIMS

To investigate how undergraduate nursing students' career expectations relate to their career choices, particularly employment in care of older people, in the first 10 years of nurses' careers.

BACKGROUND

Due to an increasing demand for nurses, it is important to understand nurses' career choices over the course of their careers.

DESIGN

A quantitative longitudinal study of 445 undergraduate nursing students based on a questionnaire survey and register data.

METHODS

Data were analysed by multinomial logistic regression analyses. The questionnaire was distributed to all undergraduate nursing students in 2001-2003 in their final study semester at four universities in Norway (N = 445) to collect the students' career expectations. Register data on clinical fields for the first 10 years after graduation were merged into the survey in 2014 (Statistics Norway).

RESULTS

With exception of the very first years after graduation, care of older people is the most common field for undergraduate nurses to enter for a career. This choice can be understood in light of nurses' career expectations. Among newly educated nurses, the choice to work in care of older people (rather than general hospital care) correlates with expectations of achieving a management position. Ten years after graduation, the likelihood of working in care of older people rather correlates with nurses' expectations of part-time work.

CONCLUSION

The likelihood of moving into care of older people increases with time in nursing careers and relates to nurses' career expectations such as achieving a leadership position and working part-time.

Hospital readmission: Older married male patients' experiences of life conditions and critical incidents affecting the course of care, a qualitative study

BACKGROUND

Despite the frequency of hospital readmissions, there is still a relatively incomplete understanding of the broader array of factors pertaining to readmission in older persons. Few studies have explored how older persons experience readmission and their perceptions of circumstances affecting the course of care. Research indicates that males experience poorer health outcomes and are at higher risk of readmission compared to women.

AIM

To explore life conditions and critical incidents pertained to hospital readmission from the perspective of older males.

METHODS

The study used a qualitative explorative design using the Critical Incident Technique. A purposive sample of four males aged 65-75 were recruited from two internal medical wards. Data were collected through narrative double interviews. The study was registered by the North Denmark Region's joint notification of health research (ID 2008-58-0028).

FINDINGS

The analysis revealed four themes of life conditions: 'Ambiguity of ageing', 'Living with the burden of illness', 'Realisation of dependency' and 'Growing sense of vulnerability and mortality'. Critical incidents comprised four areas: 'Balancing demands and resources in everyday life', 'Back home again - a period of recovery', 'Care interaction' and 'Navigating within and between healthcare system(s)'.

CONCLUSION

This study illustrated the interconnectedness, dynamics and complexity of life conditions and critical incidents that over time and across diverse healthcare sectors affected the course of care in older persons. Hospital readmissions seem related to a complex web of interacting life conditions and critical incidents rather than growing age or specific illnesses.

Adaptation and evaluation of the Family Involvement and Alienation Questionnaire for use in the care of older people, psychiatric care, palliative care and diabetes care

AIM

To adapt the Family Involvement and Alienation Questionnaire (FIAQ) for use in the care of older people, psychiatric care, palliative care and diabetes care and to evaluate its validity and reliability.

BACKGROUND

Involvement in the professional care has proven to be important for family members. However, they have described feelings of alienation in relation to how they experienced the professionals' approach. To explore this issue, a broad instrument that can be used in different care contexts is needed.

DESIGN

A psychometric evaluation study, with a cross-sectional design.

METHOD

The content validity of the FIAQ was evaluated during 2014 by cognitive interviews with 15 family members to adults in different care contexts. Psychometric evaluation was then conducted (2015-2016). A sample of 325 family members participated, 103 of whom in a test-retest evaluation. Both parametric and non-parametric methods were used.

RESULTS

The content validity revealed that the questionnaire was generally understood and considered to be relevant and retrievable by family members in the contexts of the care of older people, psychiatric care, palliative care and diabetes care. Furthermore, the FIAQ (Revised), demonstrated satisfactory psychometric properties in terms of data quality, homogeneity, unidimensionality (factor structure), internal consistency and test-retest reliability.

CONCLUSION

The study provides evidence that the FIAQ (Revised) is reliable and valid for use in further research and in quality assessment in the contexts of the care of older people, psychiatric care, palliative care and diabetes care.

Self-care among older people living with chronic conditions

PURPOSE

The aim of this study was to clarify the concept of self-care among older people living with chronic health conditions. This concept clarification will assist nurses in addressing self-care among older people through research, policy and practice in offering an expanded conceptual model.

BACKGROUND

Several policy influences over the past decade directly relate to the increased importance and economic necessity to require self-directed care for older people living with chronic health conditions to maintain their care at home in the community.

METHOD

A selective review of literature on the concept of self-care included 31 sources. The Norris Concept Clarification method (1982) was used for clarification. The phenomenon is described historically according to its antecedents, attributes and consequences.

RESULTS

A proposed definition is provided based on the clarification of this concept. A conceptual model is presented through an ecological framework. Self-care among older people living with chronic conditions is multidimensional and has multilevel influences (individual, community, system levels) and is mediated by the contexts and processes of ageing. Self-care originates along one's life course and is learned. Self-care responses are based on care needs when living with chronic health conditions.

CONCLUSION

Self-care is an individual capacity, disposition and activity older people manifest in living with multiple chronic conditions. These features (capacity, disposition, action) influence one another and are hierarchical and continuous. Research, practice and policies that promote self-care among older people can focus on these features to improve health outcomes and promote new models of care consistent with personal development and chronic care needs in older age.

IMPLICATIONS FOR PRACTICE

This concept clarification can offer a model to support self-care among older people living with chronic conditions.

"I'm not sure I'm a nurse": A hermeneutic phenomenological study of nursing home nurses' work identity

AIMS AND OBJECTIVES

To explore nursing home nurses' experiences and views of work identity.

BACKGROUND

Nursing home nurses are in a unique position as they work at the interface of health and social care. Little is known about nursing home nurses' perceptions and experiences of working within this context. Evidence suggests that using the concept of work identity can support understanding of how workers make sense of their work.

DESIGN

Hermeneutic phenomenological study.

METHODS

The study was carried out in seven nursing homes in North East England. Findings are based upon literary analysis of multiple episodic interviews with 13 nursing home nurses.

RESULTS

Participants' responses suggested that nursing "residents" is different to nursing "patients," and nursing home nurses are required to modify their care activities to account for these differences. Participants also proposed that they are isolated and excluded from the rest of the healthcare workforce group. These issues led participants to feel uncertain about work identity. Many participants attempted to strengthen their work identity by aligning their role with what they perceived the "nurse identity" to be.

CONCLUSION

Nurses' work activities and professional group identity influence their work identity. When work activities and professional group identity do not align with role expectations, as can be the case for nursing home nurses, work identity may be compromised. These nurses may attempt to change work practices to strengthen their work identity.

RELEVANCE TO CLINICAL PRACTICE

Health- and social care providers need to account for work identity factors in the organisation of care, and planning and implementation of integrated health- and social care initiatives.

Improving oral hygiene for patients

Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care.

Nurses' choice of clinical field in early career

AIM

To investigate how undergraduate nursing students' perceived professional qualifications and job values relate to their choice of clinical field after graduation, particularly about employment in care of older people and psychiatric fields.

BACKGROUND

In the light of greater demand for highly qualified nurses, it is important to understand how professional qualifications and job values relate to career choices.

DESIGN

A quantitative longitudinal study of 290 undergraduate nursing students based on a questionnaire survey and register data.

METHODS

Data were analysed by multinomial logistic regression analyses. The questionnaire was distributed to all undergraduate nursing students during the final semester of study at two university colleges in Norway (N = 411) to collect the students' perceived professional qualifications and job values (2001). Register data on clinical fields after graduation (2002-2006) were merged into the survey data in 2008 (Statistics Norway).

RESULTS

The tendency among undergraduate nursing students to choose care of older people rather than general hospital care after graduation increases as their score on altruism decreases, but is not correlated with their score on theoretical knowledge. The tendency to choose psychiatric fields rather than general hospital care increases with an increasing score on perceived practical skills and decreases with an increasing score on perceived theoretical knowledge.

CONCLUSION

The choice of clinical field after graduation correlates with undergraduate nursing students' perceived professional qualifications and job values.

Breast cancer threat appraisal: design and psychometric analysis of a new scale for older women

BACKGROUND

The prospect of being diagnosed with breast cancer generates emotional responses associated with a high degree of health threat. When considering screening, older women are faced with physical and psychological consequences inherent in considering the threat of disease.

AIMS AND OBJECTIVES

To describe the development and evaluate initial reliability and validity of the Breast Cancer Threat Appraisal Scale (BCTAS), a self-report instrument measuring psychosocial and situational factors related to breast cancer threat appraisal in older women.

DESIGN AND METHODS

Preliminary survey items for the Breast Cancer Threat Appraisal Scale (BCTAS) were designed using content experts and focus groups and subsequently tested by a sample of older women. Two hundred forty-three (n = 243) complete data sets were submitted to principal components analysis (PCA). Internal consistency reliability and construct validity of resulting factors were measured.

RESULTS

PCA with orthogonal rotation resulted in four components defined by 34 items with loadings of ≥0.40. Internal consistency reliability was evident in all four components (Component # 1 = 0.87, Component # 2 = 0.81, Component # 3 = 0.70 and Component # 4 = 0.72). Correlations between Breast Cancer Fear and total BCTAS (r = 0.29, P < 0.001) and Component # 3 (r = 0.39, P < 0.001) provided partial construct validity.

CONCLUSIONS

Psychometric analysis provided initial evidence of reliability for four conceptually meaningful scales and partial construct validity for total score and one factor.

IMPLICATIONS FOR PRACTICE

Using these empirically derived scales may clarify for health providers how older women perceive personal threat of breast cancer and inform collaborative decision-making to foster screening.

Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity

Mental health promotion needs to be studied more deeply within the context of primary care, because persons with multiple chronic conditions are at risk of developing poor mental health. In order to make progress in the understanding of mental health promotion, the aim of this study was to describe the experiences of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity - what these seniors believe is important for achieving a dialogue that may promote their mental health. Seven interviews with six women and one man, aged 83-96 years, were analyzed using qualitative content analysis. The results were summarized into nine subcategories and three categories. The underlying meaning of the text was formulated into an overarching theme that embraced every category, "perceived and well-managed as a unique individual". These seniors with multimorbidity missed someone to talk to about their mental health, and needed partners that were accessible for health dialogues that could promote mental health. The participants missed friends and relatives to talk to and they (crucially) lacked health care or social service providers for health-promoting dialogues that may promote mental health. An optimal level of care can be achieved through involvement, continuity, and by providing a health-promoting dialogue based on seniors' needs and wishes, with the remembrance that general health promotion also may promote mental health. Implications for clinical practice and further research are discussed.

A pragmatist approach to the hope discourse in health care research

Hope is a central concept in nursing and other fields of health care. However, there is no consensus about the concept of hope. We argue that seeking consensus is futile given the multifaceted and multidimensional nature of the concept, but instead we encourage in-depth studies of the assumptions behind talk about hope in specific contexts. Our approach to the 'science of hope' is inspired by philosophical pragmatism. We argue that hope is a concept that opens different rooms for action in different contexts and that accordingly, all hope interventions are contextually sensitive. Careful attention to how the relative positions and power of nurses and patients influence what can be inferred from their different ways of talking about hope may make hopeful conversations more meaningful in health care relationships.

Activity restriction vs. self-direction: hospitalised older adults' response to fear of falling

BACKGROUND

Functional decline is a common complication in hospitalised older adults, associated with low mobility and physical activity. Fear of falling may contribute to limited mobility and physical activity, and loss of physical function. An understanding of this relationship, as well as contributing factors, may inform the development of safe, function-promoting interventions.

AIM

To describe fear of falling in hospitalised older adults and its relationship with patient characteristics and physical function and explore patient views of associated factors.

DESIGN

combined quantitative and qualitative approach using chart extraction, observation and interviews of older adults.

METHODS

(i) correlations and analysis of variance methods; (ii) content and thematic analysis; and (iii) evaluation of convergence, complementarity and dissonance of quantitative and qualitative data.

RESULTS

Depressed older persons were more likely to describe fear of falling (r = 0.47, P = 0.002). Fear of falling was associated with the loss of physical function from admission to discharge (F = 7.6, P = 0.009). The participant response to fear of falling was activity restriction vs. self-direction. Participants described the following factors, organised by social-ecological framework, to be considered when developing alternatives to activity restriction: intrapersonal, interpersonal, environmental and policy.

CONCLUSION

Fear of falling plays a significant role in restricting physical activity and function. A multifactorial approach may provide a viable alternative to activity restriction, by facilitating self-direction and functional recovery.

IMPLICATIONS FOR PRACTICE

Interventions to prevent falls and activities to promote functional mobility are ideally developed in tandem, with attention paid to the physical and social environment. Preventing hospital-acquired disability may require a shift in organisational values around safety, from a soley protective approach to one that reflects an enabling philosophy emphasising independence and self-direction. Such a paradigm shift would demonstrate a valuing not only of the absence of falls but also the preservation and restoration of function.

Being altruistically egoistic-Nursing aides' experiences of caring for older persons with mental disorders

Older persons with mental disorders, excluding dementia disorders, constitute a vulnerable group of people. With the future international increase in the older population, mental disorders will increase as well, thus entailing new challenges for their caregivers. These older persons often remain in their own homes, and in Sweden they are cared for by nursing aides. With little previous research, an increased workload and facing new strenuous situations, it is important to make use of the knowledge the nursing aides possess and to deepen the understanding of their experiences. The study aimed at illuminating the meaning of caring for older persons with mental disorders as experienced by nursing aides in the municipal home help service. Interviews with nine female nursing aides were performed and analysed with a phenomenological hermeneutical research method inspired by the philosophy of Paul Ricoeur. Being altruistically egoistic emerged as a main theme in the nursing aides’ narratives. The nursing aides’ experiences could be interpreted as a movement between being altruistic and egoistic. The findings revealed a continuous distancing by the nursing aides and their struggle to redress the balance between their altruistic and egoistic actions. Caring for these older persons constitutes a complex situation where distancing functions as a recourse to prioritize oneself and to diminish the value of caring. The study suggests that an increased knowledge base on older persons with mental disorders, followed by continuous supervision, is necessary for the nursing aides to improve the quality of the care given.