Nurses' perceptions of quality and the factors that affect quality care for older people living in long-term care settings in Ireland

Aim. The aim of this research was to determine the factors that facilitate or hinder high quality nursing care for older people in long‐term care settings in Ireland. Background. The quality of care for older people living in long‐term care has been identified as an issue of concern in many nursing research studies. While many factors which have an impact on care have been identified, it is difficult to determine key factors from current research. Method. This was a mixed method study, which involved qualitative and quantitative approaches. A self‐response questionnaire was generated from data gathered by interview and analysis of literature. Information was collected from 498 nurses working in long‐term care settings within a Health Board. A 68% response rate was achieved. Factor analysis was used to identify facilitating and hindering factors of quality care for older people. Results. Nine factors where identified six facilitating factors of quality and three hindering factors of quality care. The six factors, which facilitate quality, were: an ethos of promoting independence and autonomy; a homelike social environment; person centred, holistic care; knowledgeable, skilled staff; knowing the person and adequate multidisciplinary resources. The three factors which hindered quality care; these were: a lack of time and patient choice, resistance to change and bound by routine. Conclusions. The findings of this research provide nurses with a clear set of facilitating and hindering factors of quality care for older people and reveal some of the complexities and challenges of providing this care. Relevance to clinical practice. Long‐term care is the home of many older people and attention within these environments to the facilitating and hindering factors of quality is required. It is hoped that the factors generated in this study add to understanding in relation to quality care and the factors that influence this.     

Nurses’ attitudes towards physical activity care among older people

Aims and objectives. To understand nurses’ attitudes towards physical activity care for older people in long‐term care facilities. Background. In long‐term care facilities, a common approach to daily physical activity is based on the identifiable portions of daily life during which the activity occurs. However, older people are at risk of falling when they perform daily physical activities. Nurses are the first‐line caregivers. What nurses’ think and do regarding older people’s participation in daily physical activities in long‐term care facilities is very important in terms of the clinical decision‐making regarding older people’s physical activity care. Design. An exploratory qualitative design. Methods. Twenty nurses with more than three years of clinical experience from 13 long‐term care facilities located in northern Taiwan were sampled purposively. Data were collected though semi‐structured interviews. The constant comparative data analysis method was used throughout the research. Results. Five themes emerged from the data analysis: ‘recognising the importance of participation in daily physical activity’, ‘encouraging participation in physical activity’, ‘respecting the autonomy of the residents regarding participation in physical activity’, ‘preventing falls’ and ‘facing a dilemma’. Conclusions. This study identifies that there is a conflict between the nurses’ perceptions of the residents’ daily physical activities, the risk of falls and encouraging greater independence. The majority of staff employed in long‐term care facilities is nursing personnel, and it is these nurses who have the most contact with the residents. It is therefore believed that nurses can make the greatest difference to the residents’ lives and support the quality of care if they can resolve this conflict. Relevance to clinical practice. The results suggest the need to increase the nurses’ knowledge base regarding the benefits of physical activity and also highlight the potentially adverse effect of restraint usage by nurses.     

'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.     

Perceptions of training for care attendants employed in the care of older people

BACKGROUND: Care attendants, have long assisted nurses in the provision of care for older people in a variety of care settings in Ireland. While there has been recent interest in the provision of formal training for this grade of health care worker the majority remain untrained and unregulated. AIM: This paper describes a study undertaken to explore the perceptions of nurses and care attendants regarding the provision of formal training for care attendants employed in the care of the older people in southern Ireland. The aim was to identify through empirical research, the perceived implications of this training on the role of both nurses and care attendants. RESEARCH METHODOLOGY: A qualitative research design was used to afford each set of respondents the opportunity to express their thoughts and concerns. The research sites were two settings providing long-term care for older people. The research sample nurses (n = 40) and care attendants (n = 40). Data was derived through the use of two research instruments, focus group discussion and a questionnaire containing open-ended questions. Themes were extracted from the data using content analysis. RESULTS: The study identifies positive attitudes towards training for care attendants by both nurses and care attendants but also a perceived link between the provision of training and a blurring of role boundaries. In addition, findings disclose that although nurses are positively disposed to the training of care attendants, this is not accompanied by a desire to become actively involved. CONCLUSIONS: The study indicates a positive view of training for care attendants, also highlighting the importance of role clarification. Results are particularly relevant in the present climate of demographic change, changes in nurse education and staff shortages in Ireland.     

Staffing adequacy, supervisory support and quality of care in long-term care settings: staff perceptions

Title. Staffing adequacy, supervisory support and quality of care in long‐term care settings: staff perceptions Aim. This paper is a report of a study to explore relationships between perceived care quality, self‐assessed professional skills, and the perceptions of the quality‐related factors. Background. The work in long‐term care is more demanding than in the past. The quality of care is strongly related to the well‐being and job satisfaction of staff. Those emerge in part through a perception of resources allocated to caring and also through a perception of the quality achieved. Method. Data were collected in Finland in 2002 using a questionnaire sent to the nursing staff working in 112 wards in 40 long‐term care institutions monitoring their care with the Resident Assessment Instrument System. Institutions were invited to participate the survey. The response rate was 70·2% (n = 1262). The respondents represented 3·8% of nursing personnel working in long‐term care institutions. Findings. Staff members who perceived staffing levels as inadequate and supervisory support as insufficient had lower perceptions of their own professional skills and the quality of care. Perceptions of empowering support behaviour were more strongly associated to self‐assessed skills and to perceived care quality than perceptions of skills‐oriented support activities. Staff members with short professional training, older staff members and staff members with long work experience in the unit had lower perceptions of their professional skills than other groups. Conclusion. The perception of adequate staffing and of sufficient supervisory support, especially empowering support increases the probability of perceiving the care quality as good. If supervisors concern themselves with staff members’ perceptions, they can better identify the staffing needs and also the support needs of personnel.     

Patient‐centeredness in long‐term care of older patients – a structured interview

Aim. The aim of this study was to describe assessments of older people about patient‐centeredness in the long‐term care of Estonian hospitals, and to determine correlations between patients’ assessments and their socio‐demographic characters. Background. Patient‐centeredness increases patients’ satisfaction and enhances their recovery. Still, patients’ opinions are not always taken into account. Method. A cross‐sectional study included 111 older people in long‐term care of 14 Estonian hospitals. Data were collected in 2008 by means of structured interviews. Results. What patients agreed most was that they were given enough opportunity to carry out activities they were capable of performing themselves. Two thirds of participants had not been sufficiently consulted on who would be providing their care. Half of the participants were not given sufficient opportunity to decide what kind of care was needed and how they would receive it. The more assistance patients needed in daily living activities, the less they considered the care as patient‐centred. Conclusions. From the perspective of older people, the patient‐centeredness in Estonian long‐term care is above average. Providing patient‐centred long‐term care in Estonian hospitals deserves more attention. Relevance to clinical practice. Older people should be more involved in decision‐making, especially those who need more assistance in daily living activities.     

Nurse qualifications and perceptions of patient safety and quality of care in South Africa

A plethora of research links professional nurses' qualifications to patient outcomes. Also, research has shown that reports by nurses on the quality of care correspond with process or outcome measures of quality in a hospital. New to the debate is whether professional nurses' qualifications impact on their perceptions of patient safety and quality of care. This research aims to investigate professional nurses' perceptions of patient safety and quality of care in South Africa, and the relationship between these perceptions and professional nurses' qualifications. A cross‐sectional survey of 1117 professional nurses from medical and surgical units of 55 private and 7 public hospitals was conducted. Significant problems with regard to nurse‐perceived patient safety and quality of care were identified, while adverse incidents in patients and professional nurses were underreported. Qualifications had no correlation with perceptions of patient safety and quality of care, although perceptions may serve as a valid indicator of patient outcomes. Creating an organizational culture that is committed to patient safety and encourages the sharing of adverse incidents will contribute to patient safety and quality of care in hospitals.     

Quality of institutional care of older people as evaluated by nursing staff

Aims. The aim of this paper was to report on the quality of institutional nursing of older people as evaluated by nursing staff in 2001 and to compare the responses with those obtained in 1998. Background. The healthcare division of one Finnish city authorised an outside survey of long‐term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of care of older people were issued. A re‐survey was conducted in 2001, using the same criteria of quality assessment. Methods. A survey research method was used. All the seven institutions providing long‐term geriatric care, including a total of 53 wards, participated. In 1998, a total of 607 questionnaires was returned. The response percentage was 78·6%. In 2001, a total of 573 questionnaires was returned. The response percentage was 76·8%. Results. The staff considered their possibilities to help geriatric patients best in the domain of physical care and slightly less good in the domain of psychosocial care. The differences in staff estimates between the two years were very small. More than 90% of the respondents considered their knowledge of physical care adequate. The nursing staff's evaluations were roughly similar in 1998 and 2001. More than 98% of the respondents considered the helping of older people important or moderately important in the other subdomains except sexual expression. According to the nursing staff, intentional or unintentional negligence in care was more common than physically or psychically offensive conduct. Observations concerning maltreatment had increased from 1998 to 2001. The staff reported both physical and mental fatigue. Nevertheless, the nursing staff appeared to be quite content with their current workplaces. Relevance to clinical practice. The findings indicated that geriatric care mostly aims to respond to the physical needs of older people. Nursing should, therefore, be developed and improved because mere satisfaction of physical needs is not enough to guarantee a good quality of life for older people in long‐term institutional care.     

Caring for older people in prehospital emergency care: can nurses make a difference?

Aims and objectives. The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse‐led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people. Background. There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role. Conclusions. If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people. Relevance to clinical practice. The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients.     

Drug use and pressure ulcers in long‐term care units: do nurse time pressure and unfair management increase the prevalence?

Aims. This study examined the associations between nurse working conditions (time pressure and perceived unfair management) and quality indicators (prevalence of antianxiety or hypnotic drug use and pressure ulcers) in long‐term care units. Background. Differences persist across long‐term care facilities in their care processes and resident outcomes even after adjusting for residents’ clinical conditions. Little is known about how nurses’ working conditions influence the quality of care. Design. Survey. Methods. Data on working conditions were drawn in 2002 from 724 nurses in 66 long‐term care units that reported quality indicators based on the Resident Assessment Instrument system as measured by Minimum Data Set. Percentage change in the quality indicators from 2002 were estimated using hierarchical multiple regression analyses with adjustments made for the baseline quality indicators (2001) and unit structural factors (unit size and staffing level). Results. Unit time pressure increased the prevalence of both quality problems (p‐values <0·05). Perceived unfair management was related to increased drug use (p = 0·038). Conclusions. The findings of this research suggest that quality of care can be improved by enhancing nurse working conditions. Relevance to clinical practice. Organisational initiatives should be aimed at reducing time pressures and promoting fair managerial procedures that engage all nursing staff in the decision‐making in long‐term care settings.     

Nursing practice environment,quality of care,and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse‐reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross‐sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.     

Finnish nurses' perceptions of care of older patients

The aim of the study was to explore how far the perceptions of care of nurses in Finland take into account the preferences of the older patient and the patient's family members and to evaluate related background factors. The data were collected by questionnaire with nurses (n = 167) working in a geriatric hospital. The questionnaire contained items about shared decision‐making, attitudes to nursing patients, assessment of patients' functional ability and need for care, goal‐setting, evaluation of outcomes and discharge planning. This study showed that taking into account the preferences of the patient and the patient's family members regarding the patient's care was challenging for the nurses in practice. About one‐third of the nurses reported making the decisions on a patient's care themselves and not respecting patient autonomy in situations where patients are not able to assess their own situation. In addition, the nurses reported asking for the views of patients less frequently than those of family members when assessing and setting patient care goals. In practice, nurses need to be aware of this, during the transition from routine‐centred care to patient‐centred care.