Satisfaction with caring and living conditions in nursing homes: views of elderly persons, next of kin and staff members

The aim was to describe satisfaction with the caring and living conditions of elderly persons in nursing homes, expressed by the elderly persons, next of kin and staff members. Elderly persons were interviewed about their caring and living conditions. Next of kin and staff members completed a questionnaire about satisfaction with caring and living conditions of elderly persons. The main results showed significantly low levels of satisfaction regarding: altered health, influence on care, rehabilitation and meaningful occupation, as expressed by the elderly persons. Next of kin stated low satisfaction with staff contacts, influence on care, rehabilitation from staff and meaningful occupation for their elderly relatives. Staff members expressed low satisfaction with influence on care and meaningful occupation. The results present important evidence to guide the heads of nursing homes and those responsible for elderly care, which will help to improve the caring and living conditions of elderly persons.     

Relationship between perceived empowerment care and quality of life among elderly residents within nursing homes in Taiwan: a questionnaire survey

BACKGROUND: It is essential for nurses to have a solid understanding of what may influence the quality of life (QOL) among elderly residents within nursing homes. Although many factors have been demonstrated to be related to the QOL among elderly people, the relationship between perceived empowerment care and QOL among elderly residents within nursing homes has not been investigated thoroughly. OBJECTIVES: The aim of this study is to explore how demographic characteristics, perceived empowerment care and functional status affect perceived QOL among the elderly residents who reside in nursing homes. DESIGN: This study employed a cross-sectional design. SETTINGS: Eight nursing homes throughout southern Taiwan were recruited into this study. PARTICIPANTS: One hundred and two residents aged 65 years or older residing in nursing homes for at least 6 months, who did not have moderate to severe obstacles in cognitive ability, were recruited as participants. METHODS: A questionnaire including demographic data, a physical function scale, an activity of daily living (ADL) scale, a patient empowerment scale, and a QOL index was used in this study. RESULTS: The results showed a medium rating level of QOL among elderly residents. Elderly residents did not feel excessively disempowered care. Perceived empowering care, ADLs and marital status were significant predictors of QOL, which explained 45.3% of the total amount of variance in QOL. Perceived empowering care was the most important predictor of QOL. CONCLUSIONS: Nurses should pay attention to the effect of empowering care on QOL of elderly residents within nursing homes. Empowering care should be considered as a strategy of nursing care in nursing homes.     

Feeling old: being in a phase of transition in later life

The aim of the study was to illuminate very old persons' experiences of feeling old in order to get a nuanced understanding of the ageing process in later life. Fifteen persons 85-96 years of age, living in their own homes, were interviewed in-depth. Data were analysed utilising a phenomenological-hermeneutic approach. Eight persons reported that they felt old. The experience of feeling old entailed four characteristics: being able to date the beginning of feeling old, fear of helplessness and of being unable to manage one's life situation, not recognising one's former self, and feeling different from others. These characteristics corresponded to the main properties of a transition process. The comprehensive understanding was that the very old persons who also felt old were in a phase of transition. The distinguishing qualities of those that felt old were also found to be in line with the dystonic dominance in the ninth stage designated by Joan Erikson of the previously described life cycle. Knowledge about transition processes and sensitivity to very old people's experiences of feeling old are of great importance to nursing in order to provide adequate health care services and prevent unhealthy transitions.     

Elderly Finnish people''s experiences with coping at home

Pietilä A-M, Tervo A. International Journal of Nursing Practice 1998; 4: 19–24
Elderly Finnish people's experiences with coping at home
The aim of this study was to describe the experiences of elderly Finnish people with coping at home. Twenty elderly inhabitants of the city of Oulu in Finland, over 75 years of age, who live at home were interviewed. Content analysis was used as the method. According to the analysis, elderly people's coping at home consisted of social contacts, daily events as the substance of life, and previous life experiences. Social contacts consisted of family, public health services, and neighbours. Daily events as the substance of life included taking part in activities of daily living. The contents of previous life experiences consisted of thinking back to organize one's life experiences and their influence on one's own life. The factors that promoted coping at home were maintenance of health, the experience of well-being, and security.
The findings of this study indicate that by supporting elderly people to cope at home, it is possible to influence their sense of safety and well-being and hence their quality of life.     

Staying in 'the stream of life': rehabilitation of older people in their own homes following total hip replacement

Background.  According to World Health Organization (WHO), rehabilitation should be based on the person's entire situation with a focus on body functions, level of activity, participation and environment. But different types of investigations show an unclear concept of rehabilitation in professional nursing.
Aims and objectives.  This study aims to identify older persons' (≥75 years of age) experiences of the rehabilitation process after total hip replacement.
Design and methods.  Qualitative interviews were undertaken with six persons who were rehabilitated in their own homes following total hip replacement. The interviews were guided by Max van Manen's phenomenological methodology with its focus on the life world as described through patients' experience of time, space, body and interpersonal relations.
Results.  Staying in the stream of life confirmed the importance of the life world. What is essential in the rehabilitation process is to get back into everyday life as soon as possible and participate in activities which are meaningful and which are linked to being at home where 'you can be who you are'. The home is the framework for being in the stream of life, and it provides the centre of gravity for the people's welfare.
Conclusion.  Staying in the stream of life is about being the author of one's own meaningful life. It takes into account life phenomena embodied in the maintenance aspect of health care; dignity in relation to identity and integrity; and an understanding of the dialectical relation between frailty and strength.
Relevance to clinical practice.  Rather than focusing exclusively on patient participation and goal-directed activity, nursing actions should integrate life phenomena as key aspects of rehabilitation with older people in their own right.     

Clinical prioritizations and contextual constraints in nursing homes – a qualitative study

Scand J Caring Sci; 2010; 24; 533–540
Clinical prioritizations and contextual constraints in nursing homes ‐ a qualitative study Aim: The aim of the study was to describe nurses’ and physicians’ experiences of prioritization factors in nursing homes. Background: What are the experiences of health care personnel when prioritizing treatment and care for elderly residents in nursing homes? Little research has been done in this area, yet with the growing elderly population and limited health care budgets there can be little doubt about its relevance. Method: The study was conducted through semi‐structured interviews with 13 physicians and nurses in six nursing homes. The interviews were analysed by manifest content analysis based on first‐ and second‐level categories describing relevant factors. The categories were developed after preliminary readings of the texts. Results: This study revealed that there was a complex set of contextual constraints which influenced the care provided. There were three main findings: (i) some overall challenges related to providing good care to nursing home residents; these in turn influenced (ii) prioritizing dilemmas and (iii) factors influencing prioritization decisions. Discussion: Contextual constraints and higher level prioritizations seem to play a key role in clinical prioritizations in nursing homes. The combination of implicit rationing and the factors described as most predominant in the clinical prioritizations in nursing homes may result in inadequate and unjust health care services for some of the nursing home residents. In particular, those patients who do not speak up or do have comprehensive needs are at risk of being neglected.     

Deprescribing: An Approach to Reducing Polypharmacy in Nursing Home Residents

There is an urgent need to address the growing problem of polypharmacy in the elderly. Elderly patients are often prescribed multiple medications, some of which are high risk or no longer necessary, which increases the risk for adverse drug reactions and health care costs. Reducing polypharmacy should be a priority for clinicians working in nursing homes. Clinicians should consider care goals, disease trajectory, and life expectancy when discontinuing medications. This article discusses the challenges associated with deprescribing, the ethical and clinical uncertainty that can exist in the indefinite use of some medications, and the guidelines available to help clinicians.     

Factors associated with nursing home entry for older people in Taiwan,Republic of China

Taiwan is facing a rapid change in the composition of its population. As the population ages, a greater demand for long-term care services and, in particular, nursing homes is expected. Before deciding who really needs nursing home care, it is important for policy makers to understand the current pattern of utilisation and what factors are associated with entry. This research assesses the relative importance of predisposing, enabling and need factors that lie behind this. It is based on a survey of elderly people in registered nursing homes, a comparison with a national sample of elderly people in their own homes and interviews with the lucid elderly patients (i.e. could communicate with no problems) and their carers. It was found that nursing home entry was associated with advanced age, gender, educational level and dependency levels of elderly people. After controlling for age, need factors have the greatest impact on admission. Specific medical problems such as cardiovascular, neurological and skeletal muscular diseases were also major contributors. Although most elderly people in Taiwan are cared for in their own homes by their families, under certain circumstances entry to a nursing home seemed inevitable. Decisions about nursing home entry were mainly taken within a family context with adult children being the main players while professionals played a relatively minimal role.     

Experiences of family members of elderly patients in the emergency department: A qualitative study

BackgroundElderly patients are more frequent users of emergency department (ED). An elderly patient entering the ED is often accompanied by a family member who has an important role in the patient’s life. Current literature does not adequately address the question of the experiences of family members accompanying elderly patient in ED, although they could give us valuable and interesting knowledge and information about nursing practices.AimThe aim of this study was to describe the experiences of family members of elderly patients aged over 65 in the ED for internal medicine.MethodThis interview study based on the experiences of family members (n = 9) of elderly patients being cared for in the ED. The interview material was analyzed using inductive content analysis.ResultsFamily members of elderly patients perceived themselves as satisfied participants, invisible participants, or disappointed outsiders in the ED. Family members accompanying an elderly patient wanted to be active participants not being excluded, but this was possible only because of their own active attitude.ConclusionsBroader educational initiative for ED staff about the family presence and involvement in care in the ED is needed, because the family members’ experiences showed that they were left as outsiders. Family members are well aware of the elderly patient’s previous level of functional capacity and their medication, which is decisive information when planning further care and thinking patients coping at home.     

乌鲁木齐市养老机构老年人医疗护理服务需求调查研究

目的了解乌鲁木齐市养老机构老年人的现状,探讨养老机构入住老年人的医疗护理服务需求。方法对乌鲁木齐市8所养老机构的487名老年人进行问卷调查。结果入住养老机构老年人的自我保健知识的需求率为50.31%、疾病护理与健康指导的需求率为63.24%、医疗护理技术服务需求率为80.70%。结论入住养老机构的老年人对医疗护理服务需求程度较高,提示应该对养老机构老年人给予更多的支持与帮助,从而更好地满足他们的医疗护理服务需求,提高其生活质量。     

西安市养老机构服务因素对入住老年人生活质量的影响

目的：了解西安市养老机构老年人生活质量现况,探讨养老机构服务因素对老年人生活质量的影响。方法采用随机整群抽样的方法,调查西安市27所养老机构555名老年人。调查工具包括简明健康测量量表以及自行设计的养老机构调查问卷和老年人一般情况调查表,采用多元线性回归分析养老机构服务因素对养老机构老年人生活质量的影响。结果养老机构老人的生活质量处于良、中、差水平的比例分别是53.2％、44.3％、2.5％。养老机构配备医务室、护理员持证上岗、护理员有职称,以及养老机构提供心理护理、康复护理、文娱活动、临终关怀服务者,其入住老人生活质量更高。结论西安市养老机构老年人总体生活质量处于中等偏上水平,养老机构应加强医务室建设和管理,引进专业护理员并加强护理员管理,改善心理护理、康复护理、文娱活动、临终关怀等服务,更好地满足老年人的需求,提高老年人的生活质量。     

Quality of life in nursing homes: perception of physically frail elderly residents

The purpose of this research was to disclose the characteristics of quality of life as perceived by physically frail but lucid elderly people living in nursing homes to increase the understanding of the phenomenon of quality of life in this setting. Eight elderly residents living in two nursing homes in Iceland were interviewed on two occasions. The interviews were audio-taped and transcribed to generate text for hermeneutic phenomenological analysis. Observation was also undertaken at both nursing homes to enhance the understanding of the residents' narration. The participants' concern in relation to quality of life emerges in the following main themes: (i) Securing the insecure body; (ii) Seeking solace; (iii) Preparing for departure; and (iv) Affirmation of self. The findings indicate that the phenomenon quality of life is manifold and complex, having many dimensions. The most important aspects of quality of life were for the residents to feel secure in the nursing home, have a place of their own where they could be alone with their thoughts, set their affairs in order and be prepared for death. Furthermore, it mattered to be recognized as an individual with his or her roots in their own respective family and doing meaningful things. These aspects of life in a nursing home contribute to living in a meaningful world in which humanity is preserved. It is important in caring for this particular group of residents in the nursing home to know what matters most in relation to their quality of life.     

The quality of care in Norwegian nursing homes

BACKGROUND: Promoting the quality of life is an importing aim of the long-term care for the elderly, and the quality of life is related to quality of care (QoC). This way the QoC in nursing homes, and its correlates, is an interesting subject. AIM: To describe to what degree Norwegian nursing homes provide services in line with the core areas of the 'regulation of care' and whether patient or ward characteristics are associated with the QoC. METHODS AND MATERIAL: Cross-sectional study where data were collected in structured interview of the nursing staff in 251 wards regarding 1926 patients. RESULTS: Most of the patients receive good basic care in Norwegian nursing homes, but taking part in leisure activities and having the opportunity to go out for a walk are more often neglected. Acceptable QoC had a strongly negative association with patient characteristics such as low function in mental capacity, low function in activities of daily living and aggressive behaviour. In most of the measured areas of QoC, ward characteristics, such as type of ward, size of ward and staffing ratio, do have an influence on QoC.     

Stroke patients' experiences of sharing rooms with dementia patients in a nursing home

BACKGROUND: The mixed units that place lucid and dementia patients in same rooms have been viewed to benefit the dementia patients. However, many studies report negative attitudes of lucid residents towards mixed units, and there is a scarcity of research which explores the experiences of lucid residents while sharing rooms with the dementia patients in extended care homes. Currently many special care nursing facilities have mixed units in Korea, suggesting a need to examine their effects especially on cognitively lucid patients. OBJECTIVE: To explore lived experiences of stroke patients who were sharing rooms with patients with dementia in a nursing home. DESIGN: It was a qualitative study applying a phenomenological method to explore the experiences of stroke patients. SETTINGS: Data were collected in a specialized nursing home in Korea. The nursing home provides free medical and nursing care to persons suffering either from dementia or stroke. PARTICIPANTS: Fourteen participants without cognitive deficit and who were sharing rooms with dementia patients were recruited through a purposive sampling. METHOD: In-depth interviews RESULTS: Stroke patients sharing rooms with dementia patients were being seriously affected by intense, deeply disturbing, and persistent experiences. The experiences themselves seemed to evolve over time as each patient struggled on one's own to try to make sense out of what were happening. The stroke patients ended up having a sense of resignation and anger realizing that they had no power to change the policy or the situation. The stroke patients also were distraught about what were happening to themselves - change of their own character, continuous fear of becoming demented, and becoming to devalue life. They also became indifferent to others, and seemed to have lost motivation for activity resulting in a decreased or low activity level. Several personal and environmental factors were identified that tended to increase the level of suffering. We suggest that the whole concept of mixed units require further exploration, and there is a need for a comprehensive staff education program to help the staff become aware of the problems and provide support to patients. Orientation of stroke patients regarding dementia is also suggested.     

Primacy of existential pain and suffering in residents in chronic pain in nursing homes: a phenomenological study

The study's rationale:  Chronic pain is a major health problem among the elderly, both in the community and within nursing homes.
Aims and objectives:  The purpose of the study was to examine the essentials of the experience of residents in chronic pain in nursing homes.
Methodological design and methods:  The research approach was interpretive phenomenology. Data were collected in 23 dialogues with 12 residents, ages 74–97. Mean age was 86 years.
Results:  The main finding is the primacy of existential pain and suffering in residents in chronic pain in nursing homes. Indeed they recounted a culmination of existential pain and suffering, e.g. loss of loved ones, loss of former home, health and independence, as well as loss of connectedness. Many seemed to be in some kind of grief and their work towards reconciliation to their life and circumstances seemed an ongoing process with successful results while others seemed more haltering or even stuck. Living with chronic pain in a nursing home is indeed a challenge and many blocks to successful pain management were identified. The main sources of strength were loved ones who were seen as lifelines . Nurses seemed distant in their narratives of pain management.
Study limitations:  Frailty of residents is a limitation as a few were starting to forget from one interview to the other and some were actually in pain at the time of our dialogue.
Conclusions:  It is important to support a healthy process of grieving and reconciliation in elderly people who live with chronic pain in nursing homes. Those who suffer in silence with their pain and discomforts and do not seek help should be identified and cared for. The residents' own sources of strength should be identified and supported. Multi-professional collaboration with educational thrust is needed towards quality pain management of elderly people in nursing homes where existential pain and suffering is not excluded.     

Affecting culture change and performance improvement in Medicaid nursing homes: The Promote Understanding,Leadership, and Learning (PULL) Program

A growing number of nursing homes are implementing culture change programming to create a more homelike environment in which residents and direct care staff are empowered with greater participation in care activities. Although nursing homes that have adopted culture change practices have brought about positive transformation in their settings that have improved quality of care and life, as well as increased resident and staff satisfaction, they represent a minority of all nursing homes. Nursing homes that serve primarily a Medicaid population without supplemental sources of funding have been limited in the resources to support such change processes. The purpose of this project was to gain insight into effective strategies to provide culture change and quality improvement programming to low-performing, under-resourced nursing homes that represent the population of nursing homes least likely to have implemented this programming. Factors that interfered with transformation were identified and insights were gained into factors that need to be considered before transformational processes can be initiated. Effective educational strategies and processes that facilitate change in these types of nursing homes were identified. Despite limitations to the study, there was evidence that the experiences and findings can be of value to other low-performing, under-resourced nursing homes. Ongoing clinical work and research are needed to refine the implementation process and increase the ability to help these settings utilize resources and implement high quality cost effective care to nursing home residents.     

农村养老院失能老年人对“智慧医养结合”的期待研究

目的深入了解农村养老院失能老年人对智慧医养结合服务内容及运行的期待,为进一步推行农村智慧医养结合服务,提升失能老年人生活质量提供参考依据。方法采用目的抽样和滚雪球抽样的方法,选取河南省某市下属农村养老院13名失能老年人进行半结构式访谈,以描述性现象学研究法分析转录稿,运用Colaizzi七步分析法归纳主题。结果提炼出3个主题:对健康促进服务充满期待;对智慧医养结合平台的期待,包括平台界面适老化、服务模式多样化2个亚主题;对智慧医养结合运行机制的期待,包括组建专业服务团队、纳入医疗保险报销范畴、开通绿色转运渠道3个亚主题。结论农村养老院失能老年人对智慧医养结合服务的需求及期待较高,亟待构建乡土化、个性化、适老化、便捷化的服务供给体系,以多模态供给形式提供全周期、全方位的智慧医养结合服务。     

Learning to nurse in care homes: student support

An increasing number of care homes in the UK now provide placements for students undertaking pre-registration nursing programmes, enabling them to develop knowledge and skills in the continuing care of older people. In this article the authors describe an initiative to support nursing staff working in care homes and prepare them for their role in student education. The impetus for the initiative came from student feedback and evaluation of their placement experiences. These suggested that staff in some care homes were not fully prepared to help meet students' learning needs. Students' concerns about the quality of care in some homes also made clear the need for a forum in which the evidence base for practice in continuing care settings could be discussed and debated. The initiative combined the development of new roles with regular opportunities to share information and feedback.