Impact of community care in enabling older people with complex needs to remain at home

Aim.  This aim of the study was to explore the impact of community care in enabling older people with complex needs to remain at home.
Background.  Changing demographic trends and successive government policies have led to an increase in the number of older people with complex needs residing in the community.
Design.  A qualitative approach using semi-structured interviews was used to collect data from older people ( n  = 17) and carers ( n  = 14).
Method.  Social workers were asked to identify community dwelling older people (65+ years) with multiple needs requiring interventions from a range of health and social care practitioners.
Results.  Community care enabled older people with complex needs who would otherwise have required residential or nursing home care to remain in their own homes. This was the expressed wish of both the older people and carers interviewed.
Conclusions.  The provision of high-quality community care for older people is a globally significant challenge and one that requires creative solutions, both at a local and strategic level.
Relevance to clinical practice.  Nurses and other health and social care professionals need to understand the significance of 'home' for older people and take steps to ensure that additional and appropriate resources are targeted towards community care.     

An evaluation of the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people

Objectives.  This paper reports the results of a study that aimed to evaluate the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people.
Background.  With repeated exposure to very sick older people in hospitals or nursing homes, nursing students are at risk of adopting stereotypical views about this section of the population as frail and dependent.
Design.  A pre- and post-test design was used to conduct the study.
Methods.  Using Kogan's Attitudes Towards Old People Scale, the attitudes of nursing students were tested at the beginning of a degree programme in Adult Nursing ( n  = 130) and one year later ( n  = 94) following a series of visits to a well-older person in the community.
Results.  Nursing students reported positive attitudes towards older people and these were retained throughout the first year of their nurse training. No statistically significant differences were found associated with any of the five independent variables in either pre- or postintervention students.
Conclusions.  The attitudes of nursing students towards older people remained positive. While it is possible that the experiential and educational interventions utilized in this study may have contributed to the retention of positive attitudes, further research is required to test this hypothesis.
Relevance to clinical practice.  Nurses have a major role to play in responding to the health and social care needs of older people and their families. The cultivation of positive attitudes is a key factor in enabling practising nurses to respond to this challenge.     

Retention of nurses in the primary and community care workforce after the age of 50 years: database analysis and literature review

Title.  Retention of nurses in the primary and community care workforce after theage of 50 years: database analysis and literature review.
Aim.  This paper is a report of a study conducted to explore strategies for retaining nurses and their implications for the primary and community care nursing workforce.
Background.  An ageing nursing workforce has forced the need for recruitment and retention of nurses to be an important feature of workforce planning in many countries. However, whilst there is a growing awareness of the factors that influence the retention of nurses within secondary care services, little is known about those that influence retention of nurses in primary and community care. Little is known about the age profile of such nurses or the impact of the ageing nursing workforce on individual nursing specialities in the England.
Methods.  Nursing databases were analysed to explore the impact of age on nursing specialities in primary and community care. The nurse retention literature was reviewed from 1995 to 2006.
Findings.  Workforce statistics reveal that primary and community care nurses have a higher age profile than the National Health Service nursing workforce as a whole. However, there are important gaps in the literature in relation to the factors influencing retention of older primary and community care nurses. Specific factors exist for older nurses within primary care that are unique. Implications for their retention are suggested.
Conclusion.  Particular attention needs to be paid to factors influencing retention of older nurses in primary and community care. These factors need to be incorporated into local and national policy planning and development.     

Models of mental health care for older adults: a review of the literature

Aim.  This paper reviews literature that draws on models of mental health care for older adults.
Background.  It is predicted that as a consequence of the aging of the population the incidence of mental health disorders, common in older populations, will also rise. Many such disorders can be successfully managed if detected early. Assessment and management requires collaboration between health professionals who are skilled and educated in the management of older adults with mental illness and the use of models of care appropriate to this population.
Results.  The paucity of research in this area is demonstrated.
Conclusion.  The need for mental health nurses to challenge current models of mental health care for older adults is identified so that they take on an expanded and developed specialist role in care of older adults with mental illness.     

Community matrons: primary care professionals' views and experiences

Title.  Community matrons: primary care professionals' views and experiences.
Aim.  This article is a report of a study exploring how the role of the community matron is progressing and any barriers or facilitators to performing the role.
Background.  Long-term conditions are distressing for patients and costly for healthcare services. Government policy in western countries has increasingly focussed on more integrated and pro-active management of patients with multiple long-term conditions to maintain the ability of the aging population to function independently. The role of community matrons has been introduced in England in an attempt to address these issues.
Method.  A purposive sample of 31 health and social care professionals participated in five focus group discussions. Reported experiences of the community matron role by community matrons, district nurses, social workers and general practitioners were analysed according to the principles of grounded theory. Data were collected in 2007.
Findings.  The community matron role was seen as effective in meeting the medical and social needs of patients. This was achieved through patient education, developing patients' self-management of their health conditions and monitoring their social needs. Potential barriers to success of the role were associated with lack of role definition prior to its introduction.
Conclusion.  It is unclear whether the role is financially viable in its current form. Further research is required to examine differing models for implementing the role and judging its effectiveness in bridging the primary-secondary care interface.     

Improving the oral health of older people in long-term residential care: a review of the literature

Background.  Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care.
Aims and objectives.  The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents.
Conclusions.  Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools.
Relevance to clinical practice.  The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.     

Palliative care in nursing homes: exploring care assistants' knowledge

Aim.  To explore the level of palliative care knowledge and to identify educational needs of care assistants (CAs) working within a nursing home context.
Background.  In the United Kingdom (UK) many patients at the end-of-life are admitted to (or reside in) nursing homes, where they receive care from unqualified CAs who have little formal training. Mandatory training in specific skills to meet palliative care needs are absent.
Method.  Questionnaire to CAs in 48 of 91 private nursing homes in one UK region.
Findings.  A population of 1135 CAs were targeted with a response rate of 45% ( n  = 508). A high proportion of CAs in this sample required information about the philosophy and principles of palliative care. Results support the need for an educational initiative to improve palliative care in nursing homes.
Conclusion.  Although recognized as a common place of death for older people, CAs are often unprepared to provide end-of-life care to nursing home residents. It is recommended that attention be given towards developing the skills and knowledge of this staff group.     

A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care

hasson h. & arnetz j.e. (2009)   A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care. International Journal of Older People Nursing   5 , 5–15
doi: 10.1111/j.1748-3743.2009.00186.x
Background.  Comparisons of different stakeholders' ratings of the quality of older people care can help to drive quality improvement.
Aim.  The aim was to compare staff, older care recipients' and their relatives' quality of care ratings.
Design.  Cross-sectional questionnaire surveys in 2003 and 2004, using a repeated measures design on an organizational level.
Methods.  Nursing staff, care recipients and relatives in two older people care organizations were included. The ratings of an overall quality grade, information, activities, general care and staff skills were compared between the respondent groups.
Results.  Care recipients in both organizations rated the overall quality grade significantly higher than nursing staff and relatives. Staff ratings of the information given to care recipients were significantly more positive than care recipients' and relatives' ratings. All three groups gave lowest ratings to the quality of activities offered to care recipients, with lowest ratings from nursing staff.
Conclusions.  Concurrent measurements of staff, care recipients and relatives' care quality perceptions can provide a broad evaluation of an organization's strength and limitations.
Relevance to clinical practice.  Staff, care recipients' and relatives' perceptions can be useful for older people care organizations and decision makers in developing care processes and outcomes of care.     

Professional influences on the provision of mental health care for older people within a general hospital ward

Recent policy initiatives within the United Kingdom have recognized that effective care for older people can only be achieved if health care staff are willing and skilled enough to address patient needs in a holistic way. The preliminary stages of the action research project described here focused on the perceptions of nursing staff regarding the factors that impacted on their ability to address mental health needs within a general hospital ward. A phenomenological approach allowed us to identify the experience of addressing mental health needs in this setting from the perspective of the research participants. A focus group was facilitated with nursing staff whose primary professional focus was the provision of physical health care within an older adult unit. Thematic content analysis was used to analyse the focus group data, and four key themes emerged, namely 'disruption', 'role conflict', 'professional resources' and 'professional distress'. These themes provide a focus for the ongoing development of the action research methods and will embed future work in the experience of those charged with ensuring that mental health care is a key element of their practice. This study highlights the urgent need for further work in this area, as we contend that it is only by addressing the professional needs of the staff concerned, that effective patient-centred care can be ensured.     

Hospital discharge of older adults. How nurses can ease the transition

When an older adult is discharged from the hospital, she or he should have an individualized, comprehensive discharge plan to help prevent unnecessary complications and rehospitalization. But the large number of older adults who are hospitalized and their typically greater needs can make creating such a plan a challenge for clinicians. Clear communication among hospital personnel, patients, family members, case managers, and community caregivers (such as home health care nurses and long-term care staff) is essential. In examining effective discharge planning for this population, this article examines five discharge models.     

Moving forward together: evaluation of an action group involving staff and relatives within a nursing home for older people with dementia

Background.  This paper describes the implementation and evaluation of an action group within a nursing home for older people with dementia. Over a two-year period, researchers worked with staff, residents and relatives on a series of initiatives aimed at improving experiences of living and working within the home. The action group, involving staff, residents and their relatives was the vehicle through which a number of important changes were achieved. The project was underpinned by ideas about relationship-centred care and the Senses Framework.
Methods.  A constructivist methodology informed both the initial development and the evaluation of the project. This paper reports findings from interviews with staff and relatives and process recordings of group discussions.
Findings.  Data from the evaluation provide evidence of ways in which the project has contributed to creating the senses (security, significance, belonging, purpose, continuity and achievement) for each of the key stakeholder groups. Factors supporting and hindering the project were also identified.
Conclusions.  The development approach using the Senses Framework adopted within the project is a useful model for partnership working in settings providing continuing care for older people.
Relevance to clinical practice.  Findings from this small-scale but intensive project suggest that staff within care homes should seek to engage with a range of stakeholders in order to improve experiences for all involved in long-term care. Academic staff within schools of nursing should consider innovative, action-oriented approaches to supporting developments within care homes.     

Health care and nursing in Saudi Arabia

Aim:  This paper reviews healthcare provision in Saudi Arabia and the development of nursing together with its current challenges.
Background:  Health care in Saudi Arabia is developing fast with multiple governmental and independent service providers. Economic growth has impacted upon health needs through population and health behaviour change. The development of the indigenous nursing workforce has been slow resulting in much nursing care being delivered by migrant nurses.
Conclusion:  There is a need to increase the proportion of indigenous nurses so that culturally appropriate holistic care can be delivered. Without shared culture and language, it will be difficult to deliver effective health education within nursing care to Saudis.     

Patient-centred care and nurses' health: the role of nurses' caring orientation

Title.  Patient-centred care and nurses' health: the role of nurses' caring orientation.
Aim.  This paper is a report of a study of the moderating effect of caring orientation on the relationship of patient-centred care to nurses' physical and mental health.
Background.  Providing effective patient-centred care is well-accepted as an important contributor to a host of patients' health outcomes. Based on two theoretical perspectives – person–environment fit and emotional labour – I suggest that providing patient-centred care per se does not potentially harm nurses' health; the cause is the fit (or non-fit) of a nurse's caring orientation and the displayed patient-centred care behaviours.
Method.  Data were collected in 2007 with a random sample of 325 registered nurses working in the Israeli public healthcare sector in in-patient units. Caring orientation, health and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations.
Results.  The mental health of nurses who exhibited high caring orientation combined with high patient-centred care, or that of nurses who exhibited low caring orientation combined with low patient-centred care, was statistically significantly higher in comparison with the mental health of nurses who exhibited incongruent (low/high or high/low) caring orientation and patient-centred care behaviours. For nurses' physical health, the findings revealed that providing patient-centred care was associated with worsened health, and possessing a caring orientation was associated with better health.
Conclusions.  The findings support the hypotheses that were derived from person–environment fit and emotional labour only with regard to mental health. Separate theory needs to be developed on how to maintain nurses' physical health.     

Staff-family relationships in nursing home care: a typology of challenging behaviours

Aim.  This paper draws on data from a study which investigated how Australian nursing home staff constructed staff–family relationships.
Background.  Working with the family in aged care to provide the best care possible is consistent with modern nursing philosophy which espouses holistic care. The quality and enjoyment of the experience however, is frequently fraught with problems and challenges for both the staff and the family involved.
Design.  A qualitative constructivist design as described by Guba and Lincoln [ Fourth Generation Evaluation . Sage Publications, London.] was used.
Method.  Thirty paid caregivers drawn from eight nursing homes were interviewed about their experiences of working with residents' families. A constant comparative method of data analysis was used to arrive at the findings.
Results.  This paper reports on seven themes under the category of 'unacceptable behaviours'. These themes describe a range of attitudes and behaviours exhibited by families which staff members found undesirable.
Conclusions.  Staff members found a number of family behaviours challenging. Nursing home staff perceives the family as subordinate to their needs and want to retain control of the work environment.
Relevance to clinical practice.  Nursing home staff need to move away from custodial models of care focused on 'getting the work done' and develop more family friendly work practices that are inclusive of the needs of the family and view them as equal partners in care.     

Risk and ageing populations: practice development research through an international research network

Background.  Risk theories derive from a range of disciplines, with nursing traditionally concentrating on scientific medical perspectives. However, for older people, risk perception and management is filled with complexity and paradox, and the threat of focusing on physical safety only to the detriment of the well-being of the older person.
Method.  An international collaborative research network on risk in ageing populations has been developed, with 22 members in six countries (Britain, USA, India, South Africa, Australia and Northern Ireland). The network supports several independent projects, many of which have developed as a result of the network. An annual workshop for members has provided the opportunity to share and synthesize methodological experiences and to identify a developing model of risk for older people.
Findings.  The developing model highlights the importance for older people of engaging with risk in a positive way, and describes patterns of risk-philic and risk-phobic activity. The inter-relationship of the individual older person with their community, with practitioners and with society is specific to the context of different countries.
Conclusion.  Socio-critical practice development research can be a vehicle for advancing an understanding of risk theory for older people. Risk underpins concepts of choice and capacity to execute decisions. It is influenced by society, policy, health and social care services, and has a profound impact on the experiences of older people.     

Experiences of physical strain during person transfer situations in dementia care units

Caring for residents with dementia impose a higher challenge and workload on the nursing staff because of a higher degree of motor function and cognitive decline among the residents. Training in person transfer tasks for nursing staff has mostly been concentrated on ergonomics irrespective of the nature of the resident's functional decline. An increased knowledge about the nursing staffs' experiences of physical workload in dementia care and in how to reduce their physical strain is needed.
Aim:  The aim of the study was to describe nurse's aids' experiences of physical strain during person transfer tasks at dementia care units.
Method:  Four focus group interviews with altogether 16 nurses' aids, working at special care units for people with dementia, were performed.
Results:  The results show that knowledge about the disease and personality of residents in dementia care units can help to decrease the physical strain on nurses' aids in person transfer situations.
Nurse's aids need to be flexible when performing transfer tasks to accommodate variations in the resident's functional ability. Physical strain associated with person transfer tasks is not related to the weight of the resident. Misunderstandings because of cognitive decline and communication problems increase physical strain on nurses' aids. Specialized training in person transfer tasks is needed for nurse's aids working in dementia care.
Conclusions:  These results may serve to guide physiotherapists working in dementia care units in assessing residents' functional ability, in when to use assistive devices and mobility aids and in training and supervising nurse's aids in person transfer tasks.     

The use of touch to enhance nursing care of older person in long-term mental health care facilities

The self-care deficits experienced by older clients in long-term mental health settings, because of cognitive impairment, are likely to impact upon the clients' higher-order needs. The practice of nursing the elderly involves a lot of personal contact, during the delivery of fundamental physical care. While physiological and safety needs are crucial to clients in long-term settings, higher-order needs need also to be addressed. From the clients' perspective nurse's use of touch provides comfort, warmth and security, although there is a dearth of empirical evidence of these benefits. This paper explores the nurse's use of touch, the impact of touch and the experiences of touch on the older person in long-term settings. Because of the dearth of research in the use of touch with elderly clients in long-term care mental health facilities, a review of the literature was performed on the topic. This revealed that touch by nurses is frequently associated with routine tasks within nursing, and is less likely to be a caring touch intervention. Recommendations include further research on the topic and caution with widespread adoption of caring touch as an intervention.