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.     

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.     

Nursing home care for older people in Taiwan: a process of forced choice

Aim. To generate a substantive theory for understanding the phenomenon of nursing home care for older people in Taiwan. Background. Taiwanese culture shows great respect for older people and older people are traditionally cared for at home by their families. However, the older population in Taiwan is rapidly increasing and this demographic shift, together with various socio‐economic changes, has resulted in nursing homes becoming a new and significant care option. Design. A grounded theory approach was used to study the residents and relatives from three nursing homes in Taiwan. Methods. Formal and informal interviews and participant observation data were collected over two months in each nursing home. Forty nursing home residents and 20 of their relatives were recruited. The data were analysed using the constant comparative method and involved the use of theoretical memos and theoretical sampling procedures. Results. The study found that nursing home care for older people in Taiwan is understood to be a process of forced choice, involving three stages; namely, ‘becoming a problem’, ‘making a forced choice’ and ‘coping with the forced choice’. Conclusion. Taiwan is in a state of conflict with regard to providing care for older people, a situation in which the influence of traditional cultural and that of industrialisation exist side by side. The consequence of having to relocate older people into nursing homes means that both parties are the victims of this choice. Relevance to clinical practice. This conceptual explanation helps us to understand how the Taiwanese respond to the issue of care for older people and how they resolve their main concerns related to it. Subsequently, it is hoped that this will help health care practitioners to provide care more effectively to meet the needs of the Taiwanese with the aim of enhancing the standards of care for older people.     

Fall risk factors in older people with dementia or cognitive impairment: a systematic review

Title.  Fall risk factors in older people with dementia or cognitive impairment: a systematic review.
Aim.  This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case–control studies.
Background.  People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies.
Data sources.  The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007.
Review methods.  A systematic review was conducted. Cohort or case–control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality.
Results.  Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density.
Conclusion.  There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed.     

The senses in practice: enhancing the quality of care for residents with dementia in care homes

Aim. The study aimed to develop, deliver, and evaluate a training programme in care homes to enhance the quality of care for people living with dementia based on the principles of relationship‐centred care expressed through the Senses Framework. Background. There are increasing numbers of people living with dementia worldwide with a growing proportion requiring residential long‐term care. This makes the quest for enhancing the quality of care and quality of life for people with dementia ever more pressing. Design. A mixed‐methods design was used adopting a Practice Development approach. The findings from one care home in the North West of England are reported. Methods. Eight facilitated workshops based on the principles of relationship‐centred care were completed and evaluated in 2010, using pre‐ and postintervention design. A focus group was undertaken with staff on completion of the study to gain a more comprehensive understanding of the practice/training context, augmented by case examples of changes in practice identified from the study workshops. Results. Structured questionnaires were used to profile the care home before and after the training. Following the workshops, staff felt more able to collect and use biographical information. In particular, staff reported how this information supported them to initiate meaningful conversations with the person with dementia as part of everyday care routines, thus improving overall feelings of well‐being. Conclusion. Using a biographical approach to care planning structured through the Senses Framework helped staff to develop a greater understanding of the person with dementia.