The transition of an older person from a home environment into long-term care is frequently unplanned and complex. Little is known about how relatives make sense of supporting the transition of their relatives to long-term care.
This study explored family members' narratives of the process of supporting the transition of their older relative into long-term care.
Life stories of six relatives who supported transitioning their older family relatives into a nursing home were collected using open narrative questioning in accordance with the Biographical Narrative Interpretive Method. Data was analysed using a dialogic/performance analysis narrative analytic method.
Four key life story phases were identified: before transition, crisis event, transition and after transition. These phases varied in time duration and involvement of healthcare providers. The longest phase was ‘before transition’ where a process of slow deterioration became more apparent to the participants retrospectively. This was followed by the shortest period ‘crisis event’ where the older person was admitted to tertiary care. Two permeating themes: family dynamics and knowledge/understanding underpinned all life story phases.
Relatives' knowledge, family dynamics and positioning of self-informed the duration of the life story phases of participants as they navigated the transition. Understanding nuanced differences in relatives' life story phases highlights how timing of information provision can affect the emotional adjustment of relatives experiencing this challenging process.
Both community and gerontological nurses' offer real potential to provide tailored and effective responses to relatives depending on each life phase. Sequencing of information appropriate to the life phase could potentially ease the stress associated with transitioning to nursing home care, possibly preventing a crisis event from occurring. Anticipatory conversations also offer potential to alleviate relatives' concerns through life story phases.
Care homes can create a culture of community where residents, their families and staff are supported to develop positive relationships with one another, to interact and explore ideas together in an informal way. This concept is reported in the literature as a Westernised construct and so far, little is known about its meanings from a Middle Eastern cultural perspective and context.
The aim of this study is to contribute to the understanding of how partnership between the three stakeholders may contribute to changing the organisation and focus of care homes, supporting a transition to the development of a community culture.
A constructivist case study method is employed following Stake's collective case study model. Two care homes were chosen purposively to capture the experience of residents, families and staff working in different types of care homes. Data collection methods include interviews, focus groups and field observations with triangulation of methods and data. Data collection and data analysis occurred simultaneously.
Analysis of data resulted in the emergence of four themes: organisational flexibility, a vision of care incorporating fundamental elements such as caring and dignity, connectedness/reciprocity, enhancing job satisfaction and morale of staff. These findings indicate that residents, staff and families are interdependent, and this needs to be considered when fostering a culture of community in care homes as an important value. Findings prove that organisational flexibility and individualised care should be set as priorities over care only directed towards disease and illness.
The findings will have implications for developing policy and practice in care homes to improve experience of older residents thus enhancing quality of life in care homes in Lebanon.
Nurses' competencies are crucial in providing effective dementia care in healthcare settings for older people. Understanding nurses' current knowledge, attitudes and confidence in this area is essential for developing education programmes for healthcare professionals to improve patient care. The purpose of this study was to assess the knowledge, attitudes and confidence related to providing dementia care among nurses practicing in geriatric hospital wards and nursing homes in Hanoi, Vietnam.
A total of 269 out of 313 (response rate was 86%) full-time nurses working at six geriatric wards in hospitals and nursing homes in Hanoi were surveyed using three self-administered questionnaires: the Dementia Knowledge Assessment Scale (DKAS), Dementia Attitude Scale (DAS) and the Confidence in Dementia Scale (CODE). Multiple regression models were constructed to identify factors associated with dementia care knowledge, attitudes and confidence.
The overall mean scores of nurse's knowledge, attitudes and confidence were 28.1 ± 8.0, 102.1 ± 13.4 and 28.3 ± 6.4, respectively. A positive correlation was reported between the knowledge and attitude scores and between the attitudes and confidence scores. Greater seniority (β: 0.29; 95% CI: 0.03–0.56) and having learned information through colleagues or experts (β: 3.02; 95% CI: 0.88–5.16) were associated with better dementia knowledge. A higher level of dementia training desirability was associated with increased knowledge (β: 0.74; 95% CI: 0.28–1.20) and favourable attitudes (β: 0.94; 95% CI: 0.15–1.74), whereas frequent exposure to dementia cases was associated with higher confidence (β: 3.56; 95% CI: 1.39–5.73) and more favourable attitudes (β: 3.96; 95% CI: 0.27–7.66).
Our study highlights deficits in knowledge, low levels of social comfort in nurses' attitudes towards people with dementia and a lack of confidence in providing effective care among nurses practicing in healthcare settings for older adults in Hanoi, Vietnam. With the ageing of the population and with increasing numbers of persons living with dementia, our findings suggest the importance of improving the training of nurses to specifically address these deficits.
Multidisciplinary consultation meetings need to be encouraged in the healthcare workplace setting as well as ensuring the presence of qualified counse
Digital health tools can significantly contribute to the continuum of care and support for persons with their self-management role. Despite the increasing adoption of digital health tools, little is known about the uptake and comfort of use among older persons.
A mixed methods design was used to assess the feasibility and utility of the check-up (CU), a self-administered digital health assessment for older persons. For the older person, qualitative interviews and de-identified CU assessment data were collected. A focus group was held to gain the health provider perspective.
A total of 32 online CU assessments were completed, and 17 individuals participated in interviews. Three main themes were identified: digital literacy and accessibility, communication of risk and role within the circle of care.
Self-administered digital assessments are feasible for older adults. Strategies for adoption should focus on accessibility and collaboration with health professionals to maximise utility and understanding of assessment results.
Falls are a global public health problem and the second leading cause of death from unintentional injury. Globally, approximately 30%–50% of people living in nursing or residential care homes fall each year. Falls have an impact on quality of life and morbidity. Prevention of falls is gold standard care. When falls do occur, implementation of safe strategies to help the person rise is required. Structured risk assessment and the use of a ‘lifting’ cushion are one such strategy.
To evaluate the impact of the lifting cushion on management of falls and assess barriers and facilitators to staff use of the lifting cushion in 18 care homes.
Two-phase study involving (i) capturing quantitative pre- and post-cushion implementation data along with comparison of means testing and (ii) theoretically underpinned qualitative semi-structured interviews to explore barriers and facilitators to cushion implementation with inductive and deductive data analysis.
The cushion was used a total of 32 times out of 567 post-implementation recorded falls (6% of all falls). Barriers and facilitators to cushion use aligned to the Theoretical Domains Framework include knowledge, skills and confidence, emotion, beliefs about safety and decision processes, environmental context and resources and social influences.
The lifting cushion was poorly adopted. Identified barriers to adoption would not be addressed using routine train and cascade processes. We identified facilitators that could be enhanced to promote uptake. Theoretically underpinned implementation strategies, tailored to assess determinants, are known to be more effective; however, this approach has rarely been used in care homes. We have demonstrated a structured approach to implementation of cushion use; this may be transferable to other care home practices.
Cae home leaders should be aware that giving information alone will not change practice. Implementation or improvement strategies will be more effective.
Hospital readmission has a negative impact on older people and the healthcare system. Current hospital readmission research predominantly reports on clinical outcomes based on cross-sectional data. Research exploring patients' experiences and priorities is limited. This study aimed to explore older people's experiences of hospital readmission in order to develop an understanding of what matters most to them.
Semi-structured qualitative interviews were conducted to generate data that were analysed using principles of interpretative phenomenological analysis.
Ten participants over 65 years old, who had experienced unplanned hospital readmission within a period of 30 days, were recruited from a large single tertiary referral centre. Four themes emerged: ‘All about me without me’, ‘Fragmented and ad hoc post-discharge support’, ‘My readmission experience and what led me back’ and ‘Segregated health and social services that are detached from people's needs’.
The study findings suggest that patients should be more involved in decisions about their care, and health professionals should endeavour to better understand the contexts, resources and access to formal and informal support of patients. Effective communication and stronger continuum of care could be a key to patients' recovery and avoidance of hospital readmission. This research highlights the importance of shared decision-making and patient-centred care to improve quality of care, maintain independence and preserve older adult's right to feel valued.
During the COVID-19 pandemic, older people in Sweden's residential care facilities and home care services experienced high mortality rates. Prior to the pandemic, the care of older people in Sweden was challenged by organisational and regulatory changes, an ageing population and insufficient increases in staff numbers. These issues led to high staff turnover, increased workloads, stress, burnout and a perceived inability to provide satisfactory care. The pandemic brought about increased job strain, stress, anxiety, depression and post-traumatic stress disorder among the staff who cared for older people. The aim of this study was therefore to focus on assistant nurses and care aides' experiences of their work environments when caring for older people during the pandemic in Sweden.
The data were collected through four focus groups interviews and analysed using qualitative content analysis.
The results showed that the care staff had to navigate organisational and ethical challenges in poor and unsafe work environments. They lacked supportive leadership in their respective organisations, were neither valued, seen nor heard and were treated as ‘plain doers’. During the pandemic, they were unable to protect or communicate easily with the older people in their care, which had harsh consequences.
According to the participants, the pandemic left them, their working conditions and this part of the care system in a worse situation than before the pandemic. The pandemic thus revealed more unsustainable and unethical working conditions for the staff than before it, including the vulnerability of the older people in their care.
The findings highlights the need of policies that ensure adequate training and instruction on medical issues, for managers responsible for overseeing the care of older people. There are also a need of provision of sufficient support for care staff and health care professionals during crises. The findings also underscore the need of feasible and efficient strategies do disseminate care information and address the psychosocial needs of older people.
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