International Journal of Older People Nursing最新文献

Background

Primary care structural capabilities (i.e., electronic health records, care coordination, community integration, and reminder systems) can address the multiple needs of persons living with dementia (PLWD).

Objectives

This study describes structural capabilities in primary care practices where nurse practitioners (NPs) provide care to PLWD and compares the presence of structural capabilities in practices with a high and low volume of PLWD.

Methods

We conducted a secondary analysis of cross-sectional data from 293 NPs in 259 practices in California. Logistic regression models were used to determine the association between the volume of PLWD and the presence of structural capabilities.

Results

NPs reported that 96% of practices had electronic health records, 61% had community integration, 55% had reminder systems and 35% had care coordination capabilities. Practices with a high volume of PLWD were less likely to have community integration compared to practices with a low volume of PLWD.

Conclusion

Many PLWD-serving practices do not have the essential infrastructure for providing optimal dementia care. Practice managers should focus on implementing the essential structural capabilities to address the complex needs of PLWD.

Implications for practice

Clinicians and practice administrations can use the findings of this study to improve the delivery of care in practices that provide care to PLWD.

Background

The surge of positive COVID-19 cases taxed the local health care system and left many older adults initiating home self-care practices. The study aimed to explore the psychological experiences of home-quarantined older women diagnosed with COVID-19 in Hong Kong.

Methods

Ten semi-structured telephone interviews were held among older women from March to April 2022. Inductive thematic analysis was used to analyse the data.

Results

Older women experienced psychological distress, anxiety and depression after being infected with COVID-19. The source of their psychological difficulties included fear of losing control over one's health and dignity, feeling a burden to one's family, conflict in balancing risks and responsibilities, and being overwhelmed by the tragic news reported in media. Meanwhile, the participants demonstrated resilience following the infection and found meaning in their experiences, and grew mentally.

Conclusions

The older women in this study have identified the negative impact having a diagnosis and being home-quarantine means to them and their family. Yet, they were also able to take some positives from this. Importantly, the older women report being able to build greater resilience, optimism and wisdom towards COVID-19 in general and feel better prepared for the potential of future positive diagnoses.

Introduction

To critically synthesise evidence in relation to the holistic care impacts (physical, psychological, social, spiritual, and environmental well-being) among individuals living in residential aged care facilities (RACFs) with restrictions during the COVID-19 pandemic.

Methods

An integrative systematic review followed a pre-registered protocol and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines. Electronic databases were searched from inception to June 2022. Qualitative, quantitative, and mixed methods studies were included. All articles were double screened according to a pre-determined eligibility criterion. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted.

Results

18 studies were included. The impact of restrictive practices and periods of lockdown impacted older people on all levels of individual quality-of-life. With or without COVID-19, residents experienced functional decline and many experienced malnutrition, increased incontinence, increased pain, and poorer general health and significant psychological distress. Depression increased with reduced social contact, as did anxiety and loneliness. Some residents spoke of suicidal ideation.

Conclusion

It is highly plausible that further outbreaks may prompt knee-jerk reactions from public health departments and governing bodies to continue to restrict and lockdown facilities. Public health COVID-19 outbreak policy for aged care across the globe will need to consider the benefits verses risk debate given the findings uncovered in this review. These findings showed that it is vital that policy considers quality-of-life domains not solely survival rates.

Introduction

The development of resident safety culture in nursing homes (NH) represents a major challenge for governments and NH owners, with a requirement for suitable tools to assess safety culture. Indonesia currently lacks suitable safety cultures scales for NH.

Objectives

To evaluate the psychometric properties of the translated Indonesian version of the Nursing Home Survey on Patient Safety Culture (NHSOPSC-INA).

Methods

This study was a cross-sectional survey conducted using NHSOPSC-INA. A total of 258 participants from 20 NH in Indonesia were engaged. Participants included NH managers, caregivers, administrative staff, nurses and support staff with at least junior high school education. The SPSS 23.0 was used for descriptive data analysis and internal consistency (Cronbach's alpha) estimation. The AMOS (version 22) was used to perform confirmatory factor analysis (CFA) on the questionnaire's dimensional structure.

Results

The NHSOPSC CFA test originally had 12 dimensions with 42 items and was modified to eight dimensions with 26 items in the Indonesian version. The deleted dimensions were ‘Staffing’ (4 items), ‘Compliance with procedure’ (3 items), ‘Training and skills’ (3 items), ‘non-punitive response to mistakes’ (4 items) and ‘Organisational learning’ (2 items). The subsequent analysis revealed an accepted model with 26 NHSOPSC-INA items (root mean square error of approximation = 0.091, comparative fit index = 0.815, Tucker-Lewis index = 0.793, CMIN = 798.488, df = 291, CMIN/Df = 2.74, GFI = 0.782, AGFI = 0.737, p < 0.0001) and a factor loading value of 0.538–0.981. Expert feedback confirmed the relevance of the instrument items (content validity index [CVI] = 0.942).

Conclusion

The modified NHSPOSC-INA model with eight dimensions (26 items) fits the data set in the context of Indonesian NH services.

Implications for practice

The NHSPOSC-INA is a valid and reliable instrument for assessing staff perceptions of NH resident safety culture in Indonesia. The questionnaire can now be used to evaluate interventions for resident safety in Indonesian NH.

Background

Observational tools can support the understanding of the complex needs of older people with dementia and aid delivery of person-centred care. However, existing tools are complex and resource intensive to use.

Objectives

To develop and evaluate the acceptability and feasibility of a low-resource, observational tool to support staff reflection and practice development.

Methods

Intervention development of the Person-Centred Observation and Reflection Tool (PORT) and acceptability and feasibility study, using surveys and focus groups in the UK, Norway and Spain.

Results

PORT was reported as easy, accessible and acceptable to use. The observation was identified as powerful for individual staff development and provided an evidence-based source for underpinning individualised care planning. Potential time challenges associated with implementation were identified.

Conclusion

Initial evaluation indicates PORT is an acceptable and feasible tool for use in health and social care settings for older people. Further research is needed on implementation models and the impacts of PORT use.

Implications for Practice

PORT may be a useful tool to support individual staff development in care settings and person-centred care planning for people with dementia.

Background

Family members in many countries often share caregiving responsibilities for an older relative recovering from an injury. However, few studies have examined strategies employed when multiple family members provide care for an older relative recovering from hip-fracture surgery.

Objective

This study aimed to understand family group caregiving strategies when two or more family members provide caregiving for an older relative recovering from hip-fracture surgery.

Methods

This study used a grounded theory design. Semistructured interviews were conducted over 1 year with 13 Taiwanese family caregivers from five families. Caregivers shared caregiving responsibilities for an older relative (62–92 years of age) recovering from hip-fracture surgery. Transcribed interviews were analysed using open, axial and selective coding.

Results

The core category describing caregiving among family members was ‘Preventive Group Management: strategies for family group caregiving’. Three strategies were employed: explicit division of labour (two stem/patriarchal families and one older two-generation/democratic family); disconnected caregiving (one nuclear/noncommunicative family) and patriarchal caregiving (one extended/traditional Chinese family). Strategies reflected family type, structure, cultural values, communication patterns and available outside support. Components of family group caregiving involved family type's division of labour, approaches to caregiving and implementation challenges and allowed family caregivers to maximise safety and stability and prevent harmful events during their relative's recovery from surgery.

Conclusions

There was no one-size-fits-all approach for the strategies of family group caregiving. Components of Preventive Group Management varied with family type, cultural values, communication patterns and available outside support. Healthcare professionals should be sensitive to the dynamics of family caregivers.

Implications for Practice

Enhance group management for family caregivers by developing interventions to optimize collaboration, thereby better addressing the needs of older adults recovering from hip fracture surgery.

Background

The older person care home population is increasing. As skin ages, it becomes vulnerable to dryness, itching, cracks and tears. These are experienced by most older people, they impair quality of life and can lead skin breakdown, increased dependency, hospital stays and greater financial and human costs. Dryness, itching, cracks and tears can be prevented, but despite best practice guidance, concordance is suboptimal.

Objectives

(i) develop and test a theory-based diagnostic instrument to accurately and prospectively assess barriers and facilitators and (ii) survey barriers and facilitators to care home staff in the delivery of skin hygiene care.

Methods

Instrument development and survey. Barriers and facilitators identified from the literature and pilot study were categorised in a Delphi survey of experts (n = 8) to the Theoretical Domains Framework. This model was tested in three rounds for face validity (n = 38), construct validity (n = 235) and test–retest reliability (n = 11). Barriers and facilitators were surveyed in Round 2 and reported in accordance with TRIPOD.

Results

A 29-item valid and reliable instrument (SHELL-CH) resulted (χ2/df = 1.539, RMSEA = 0.047, CFA = 0.872). Key barriers were delivering skin hygiene care to agitated or confused residents, pressure to rush or engage in other tasks from colleagues, being busy and the unrealistic expectations of relatives. Knowledge of skin hygiene care was a facilitator.

Conclusion

This study has international significance having identified barriers and facilitators to skin hygiene care including barriers previously unreported.

Background

Existing gerontological nursing competencies include the requisite knowledge and skills required for aged care nursing. What were not previously considered were legal and ethical aspects and access to technology, e-health and social media.

Objectives

This study aimed to validate an Australian gerontological nursing competencies scale and assess the factors associated with for aged care nurses in Taiwan.

Methods

A methodological study design was used to validate the scale with a sample of 369 aged care nurses from aged care settings including nursing homes, long-term care facilities and aged care wards in Taiwan. The cultural adaptation and psychometric validation were evaluated. The content validity, construct validity through exploratory factor analysis and the internal consistency of the scale were assessed.

Results

The exploratory factor analysis extracted two levels of gerontological nursing practice, ‘essential’ and ‘enhanced’, which accounted for 80.8% of the total variance. The internal consistency, split-half reliability and test–retest reliability were excellent. Aged care nurses with higher levels of education, aged care education as their highest degree and continued education within 6 months, and certified long-term care education had higher gerontological nursing competencies scores than those who did not.

Conclusions

This validated gerontological nursing competencies scale is a reliable and valid tool that can be implemented in future workforce planning, research and postgraduate and undergraduate curriculum and education in Taiwan and other Mandarin-speaking locales.

Implications for practice

Using validated gerontological nursing competencies scales to explain different levels of specialist practice is crucial for addressing negative views about aged nursing and explicitly demonstrate the possibilities for career pathways in gerontological nursing.

Background

Evaluation of life satisfaction of older people using standardised tools can play a crucial role in evaluating the effectiveness of policy measures aimed at mitigating the effects of population aging.

Objectives

The aim of the study was to verify the psychometric properties of the Czech version of a 12-item scale (the Life Satisfaction Index for the Third Age) for older people living in the community.

Methods

The research involved 1113 older people from the Moravian–Silesian Region over 60 years of age living in a home environment. For the newly created Czech version of LSITA-SF12, we tested validity (construct validity and convergent validity) and reliability (internal consistency).

Results

We confirmed a single-factor model for the LSITA-SF12 scale (χ² = 71.33, p <  .001, CFI = 0.995, TLI = 0.994, RMSEA = 0.065, SRMR = 0.056, GFI = 0.999) by confirmatory factor analysis and load factor analysis (values of explorations ≥0.45). The internal consistency of the scale was satisfactory (α = 0.878). Furthermore, there was a medium correlation rate (r = 0.592; p <  .001) between the overall score of the LSITA-SF and quality-of-life score (OPQoL-Brief).

Conclusions

We found the Czech version of the LSITA-SF12 questionnaire to have satisfactory psychometric properties. The questionnaire is suitable for use in research and clinical practice to evaluate the effectiveness of preventive measures.

Clinical Trial Registration: ClinicalTrials.gov. PRS Protocol Registration and Results System; NCT05637177.

Implication for practice

The LSITA_SF12 questionnaire can beadministered by a community gerontological nurse and can be used in clinicalpractice and research.