Working in long-term care settings for older people with dementia: nurses' aides

Aim. This paper reports a study exploring the reasons for continuing to work among nurse aides who cared for older people with dementia in long‐term care settings in Taiwan. Background. High nurse aide turnover has been a major problem for many managers of long‐tem care facilities in Taiwan. Most studies on nurse aide turnover have focused on the factors on why they left, but little is known about their reasons for continuing to work in long‐term care settings in Taiwan. Methods. A qualitative research design was used. Sixteen nurse aides were interviewed individually using a semi‐structured interview guide and content analysis was used to identify the major themes in the data. Results. Five major themes emerged from interview data: monetary needs, relationships with residents, working environment, training opportunities and gratification (listed in order of frequency of occurrence). Conclusion. Nurse aides face challenges in caring for the increased number of older people with cognitive impairment and it is important to assess their perspectives towards their work in the changing environment. The findings suggest that it is essential for nursing managers to assess nurse aides’ needs to increase job retention and to improve the quality of resident care in long‐term care settings. Relevance to clinical practice. Careful appraisal of prospective nurse aides’ attitudes, regular training programmes in dementia care, adequate staffing and equipment, performance‐based pay rises and subsidized training are practical retention strategies for these nurse aides.     

Service needs of residents in community-based long-term care facilities in northern Taiwan

Aim. The purpose of this study was to quantify the service needs of residents in community‐based long‐term care (LTC) facilities and to determine their predictors. Background. Disabled older family members in Taiwan are often eventually sent to community‐based LTC facilities. Many service needs of these residents are likely to go unmet. Methods. A cross‐sectional survey was used. This involved purposive sampling of 132 residents from 10 LTC facilities in Taipei City. A previously developed LTC service need assessment scale was used to collect information about the residents’ needs in terms of five kinds of LTC services, namely health education, skilled nursing services, referral services, activities of daily living (ADL) assistance and instrumental activities of daily living assistance. Results. The mean age of residents was 75·2 years. The average period of institutionalization was 21·93 months. Overall, 70% of the residents had either complete or partial ADL function dependency. Among the specific ADL function dependencies of the residents, inability to take a bath was the most common. The most significant predictors of service needs were health status, age, number of children, number of medical diagnoses and whether the stay is self‐choice. These combined variables explained between 25·5% and 41·6% of the variance of the need for LTC services. Conclusion. The findings of this study show that age, health status, number of children, number of medical diagnoses and whether the stay is self‐choice are significant determinants of residents’ needs in terms of LTC. Assessment of the extent to which facilities meet the residents’ needs is the first step in providing the most cost‐effective allocation of scarce resources. Relevance to clinical practice. It is suggested that, if reimbursement by the National Health Insurance system of physician visits, including psychiatric visits, to LTC facilities were allowed, this would improve quality of care.     

'Finding home': a grounded theory on how older people 'find home' in long-term care settings

cooney a. (2011) ‘Finding home’: a grounded theory on how older people ‘find home’ in long‐term care settings. International Journal of Older People Nursing 7 , 188–199
doi: 10.1111/j.1748‐3743.2011.00278.x Background. A link between residents ‘feeling at home’ in long‐term care facilities and ‘quality of life’ is emerging in the literature. Few studies, however, have focused on what helps residents to find a home in long‐term care settings. This study aimed to fill this gap. Aim. This study aimed to understand older peoples’ perceptions of ‘being at home’ in long‐term care settings and the factors that influence these perceptions. Design. Grounded theory guided the study design. Residents (n = 61) living in public or private long‐term care settings were interviewed using unstructured interviews. Findings. Four categories were identified as critical to finding a home in long‐term care settings: ‘continuity’, ‘preserving personal identity’, ‘belonging’ and ‘being active and working’. ‘Finding Home’ was conceptualised as the core category. The potential to ‘find home’ was influenced by mediating and facilitating/constraining factors. Conclusions. The Theory of Finding Home was generated from the data. This theory describes the factors critical to ‘finding home’ in long‐term care settings. Implications for practice. The Theory of Finding Home gives insight into what matters to older people living in long‐term care settings. Strategies to help generate a feeling of home in long‐term care settings are shared.     

Nurses' experience of loss on the death of older persons in long-term residential care: findings from an interpretative phenomenological study

Background. Little is known of the experience of loss among nurses working with older persons in long-stay settings. Objectives. The aim of this study was to explore and describe the experience of loss among nurses working in a long-term residential care setting. Design. Interpretative Phenomenological Analysis (IPA) was the method adopted. Data was collected by semi-structured interviews undertaken with seven nurses. Results. The findings revealed three main themes: 'life's final journey', 'family' and 'professional carer'. Conclusions. The experience of loss on the death of an older person is described by nurses in the context of the care they give at end of life, and the relationships nurses developed with the older person's family. Where the older person has no contact with family, nurses become the 'family' and this contributed to the feeling of loss experienced. Finally, the loss experienced by nurses when an older person dies suddenly can often be emotive. Relevance to clinical practice. Supporting nurses in their provision of end-of-life care to older persons is essential. Nurses' attempts to keep memories of deceased residents alive by remembrance, helps place loss in the context of acknowledgment of the person's life.     

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.     

Relationships between nurses and older people within the home: exploring the boundaries of care

mcgarry J. (2009) Relationships between nurses and older people within the home: exploring the boundaries of care. International Journal of Older People Nursing 5 , 265–273
doi: 10.1111/j.1748-3743.2009.00192.x Aim. To explore the nature of relationships between nurses and older people within the home and to illuminate the nature and quality of caring boundaries within this setting. Background. Older people are increasingly receiving nursing care in the home. There has been little exploration of the nature of the nurse–older patient relationship within this setting. Methods. An ethnographic approach using semi-structured interviews with 16 community nurses and 13 older patients (aged 65 years and over), were undertaken to explore the nature of care relationships within the home setting. Findings. The study has highlighted the centrality of the location of care and the concept of ‘the home’ in terms of geographical and metaphorical meanings. Moreover, the study has clearly illuminated the complex nature of relationships and boundary construction from a number of perspectives. Conclusion. As the location of care for older people continues to move closer to home it is crucial that the implicit qualities that are valued within nurse–patient relationships within this context of care, and which contribute to the quality of care, are recognized and made more explicit at the organizational and policy level. Practice implications. For nurses working within the home there is a clear impetus to clearly define and articulate the full breadth of their role, the nature of relationships and issues surrounding professional boundary construction within this environment. There is also a need for the core qualities that underpin the receipt of care within the home and the facets of the nurse–patient relationship valued by older people to be fully recognized and accounted for.     

Preventive home care of frail older people: a review of recent case management studies

Preventive actions targeting community‐dwelling frail older people will be increasingly important with the growing number of very old and thereby also frail older people. This study aimed to explore and summarize the empirical literature on recent studies of case/care management interventions for community‐dwelling frail older people and especially with regard to the content of the interventions and the nurse's role and outcome of it. Very few of the interventions took either a preventive or a rehabilitative approach using psycho‐educative interventions focusing, for instance, on self‐care activities, risk prevention, health complaints management or how to preserve or strengthen social activities, community involvement and functional ability. Moreover, it was striking that very few included a family‐oriented approach also including support and education for informal caregivers. Thus it seems that the content of case/care management needs to be expanded and more influenced by a salutogenic health care perspective. Targeting frail older people seemed to benefit from a standardized two‐stage strategy for inclusion and for planning the interventions. A comprehensive geriatric assessment seemed useful as a base. Nurses, preferably trained in gerontological practice, have a key role in case/care management for frail older people. This approach calls for developing the content of case/care management so that it involves a more salutogenic, rehabilitative and family‐oriented approach. To this end it may be useful for nurses to strengthen their psychosocial skills or develop close collaboration with social workers. The outcome measures examined in this study represented one of three perspectives: the consumer's perspective, the perspective of health care consumption or the recipient's health and functional ability. Perhaps effects would be expected in all three areas and thus these should be included in evaluative studies in addition to measures for family and/or informal caregiver's strain and satisfaction.     

Nursing older people: constructing need and care

As the population of the world 'ages', older people are increasingly viewed as a 'problem' whose needs challenge the resources of care services. However, this view is predicated on the negative and nihilistic attitudes that are held throughout society about older people and the effectiveness of therapeutic intervention. It is these pessimistic views which colour professional understandings of the needs of older people and the most appropriate ways of delivering care to meet those needs. However, any knowledge of need and care is a constructed story, and is limited by the knowledge base on which it rests. For example, western healthcare is dominated by an orientation to identified problems, the minimizing of physical risk or harm, and a reductionalist approach to problem solving. A social critical challenge to prevailing understandings of need and care produces a very different story about older age; one which emphasizes an individual's strengths and their family and community relationships. In exploring these issues in policy and practice two key areas are highlighted. One is the role of critical gerontology in challenging the stories of negativity about old age, and replacing these with positive stories that allow older people to retain their social purpose. The second key area is the need to address issues of older age at both a practice and policy level, and to understand the interrelationship between them.