Appreciating the ‘person’ in long‐term care

Background. Internationally, approaches to the long‐term care of older people are changing. New models are being developed that aim to de‐institutionalise care settings, maximise opportunities for older people to participate in decision‐making and move from a predominant medical model of care to one that is community orientated. Aims. The aim of this study is to highlight similarities and differences between the different models that exist and explore the implications of these for the role of the registered nurse in long‐term care. Methods. We chose three models for review as these represent a range of views of person centredness, each having distinct roots and focus. The models chosen were as follows: (i) culture change, (ii) person‐centred practice and (iii) relationship‐centred care. Results. The review highlights two key issues – (i) the distinctiveness of different models and frameworks and (ii) different interpretations of ‘person’. Firstly, we identify a disconnection between espoused differences between models and frameworks and the reality of these differences. The evidence also identifies how some models and frameworks adopt a more inclusive conceptualisation of person and personhood and do not define personhood in relation to role (resident, nurse and family member). Conclusions. There is merit in the development of models and frameworks that try to make explicit the different dimensions of person centredness in long‐term care. However, the focus on the development of these, without sufficient attention being paid to evidence of best practices grounded in the concept of personhood, person‐centred care is in danger of losing its original humanistic emphasis. Further, models and frameworks need to take account of the personhood of all persons. Implications for practice. Registered nurses need to have an understanding of the concept of personhood to make sense of the various person‐centred practice frameworks that exist. Without this understanding, there is a danger that the essence of personhood may be lost in the zeal to implement particular models and frameworks.     

To feel betrayed and to feel that you are betraying the older residents: caregivers' experiences at a newly opened nursing home

Background. In Sweden and internationally, little research has focused on the working situation of Enrolled Nurses and Nurses’ Aides who form the majority of workers in geriatric care today. With this in mind, it is important to focus on how these occupational groups experience their working situation with older residents in municipal care. Aims and objectives. The aim of the study was to investigate the deeper meaning of work satisfaction and work dissatisfaction at a newly opened nursing home for older residents. The study focused on the narratives supplied by the caregivers at the nursing home. The participants included: one Registered Nurse, sixteen Enrolled Nurses, and three Nurses’ Aides. All were directly involved in patient care. Design. The present study is part of a larger longitudinal study within the municipal geriatric care system in Sweden, with a quasi‐experimental design. Method. The interviews were analysed with a phenomenological‐hermeneutic method inspired by the philosophy of Ricoeur. Result. The caregivers experiences of work satisfaction and work dissatisfaction was expressed in four themes: (i) ‘Experience of betrayal’ describes how the staff felt let down in several ways; (ii) ‘Experience of failing others’ describes how the staff felt that they did not pay enough attention to older people, in several different ways; (iii) ‘Experience of insufficiency’ describes how the staff encountered overwhelming demands from several directions; (iv) ‘Experience of work satisfaction’ describes how the staff felt that they were given support in various ways. Each theme emerged from several subthemes that originated from the caregivers’ narratives. Conclusions. The study shows that the caregivers’ experience of work dissatisfaction overshadows their experience of work satisfaction. It also suggests that their feelings of failing the older residents are connected to their own experiences of feeling betrayed. Relevance to clinical practice. The findings can be used when other nursing homes in municipal care are opened, as a means of preventing work dissatisfaction and increasing work satisfaction among future employees.     

Aged‐care nurses’ knowledge of nursing documentation: an Australian perspective

Aim. This study investigated registered nurses’ knowledge of documentation used in aged‐care nursing home facilities in Queensland, Australia. Background. The purpose of nursing documentation is to communicate health information, facilitate quality assurance and research, demonstrate nurses’ accountability and, within Australia, to support funding of residents’ care. Little is known about the relationship between RNs’ knowledge of nursing documentation, the documentation process within residential aged care and the outcomes of the documentation. Design. Cross‐sectional, retrospective design. Method. The study was conducted with a large sample of RNs (n = 360) located in 162 Queensland aged‐care facilities. Participants completed a postage‐return questionnaire in which they identified factors that influence their knowledge and understanding of documentation. Results. Participants reported that they have considerable knowledge of nursing documentation. They also indicated that they were most knowledgeable about policies on documentation and writing discharge instructions. However, their knowledge of nursing assessments ranked fifth and they were least knowledgeable about reading reports each shift. Conclusions. The modified version of Edelstein's questionnaire provided a valid and reliable instrument for measuring RNs’ knowledge of nursing documentation. A factor analysis of the 16 items in the Knowledge scale showed excellent reliability. The data indicated that RNs in aged‐care facilities have high levels of knowledge about documentation. Specific recommendations relate to the implementation of comprehensive documentation education programs that reflect the needs of organisations and the level of RNs’ skills and knowledge concerning documentation. Relevance to clinical practice. Accurate nursing documentation is relevant to residents’ care outcomes and to government funding allocations. Measuring RNs’ knowledge of nursing documentation can identify factors that impede and facilitate their documentation of care.     

Caring for elders: the role of registered nurses in nursing homes

Gerontological care in nursing homes receives little interest from students and newly qualified nurses alike. Yet, this population does have ever‐more complex needs that call for a wide array of nursing competencies. This article highlights the essential contributions of registered nurses in the context of nursing homes and is part of a research study aimed at grasping the nature of caring for elders. The researchers used the methodology inspired from activity analysis using focus groups. Situations identified by the respondents as being disruptive have been looked at in cross‐perspective. The results show that the work carried out by the registered nurses constitutes the linchpin of institutional functioning. Their contribution consists of coordinating all the activities that take place, while striving to make them relevant to the caretakers, residents, and their relatives. This key role comprises three fields of activities: organizational and innovative activities; autonomous, person‐centered activities; and ethical tension management activities. By helping to meet the daily challenges pertaining to the care and monitoring of very old people and by dealing with situations that are often tragic, they carry out tasks that are stimulating on human, intellectual, and relational levels.     

Delivering ‘Gold Standards’ in end‐of‐life care in care homes: a question of teamwork?

Aim. This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end‐of‐life care into care homes in England. Background. The Gold Standards Framework was developed in primary care to improve the care provided for people at the end‐of‐life. Following its successful introduction to this setting it was adapted and implemented in care homes. Design. A case study approach was appropriate for this study of a care programme into a ‘real life’ setting. Method. Fourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used. Results. It was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established. Conclusion. Effective teamwork was necessary for changes in end‐of‐life care to be achieved in the care homes. If end‐of‐life care and other improvements in practice are to continue, teamwork will need to be supported and developed. Relevance to clinical practice. Effective teamwork appears to be a pre‐requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first.     

Missed nursing care as an ‘art form’: The contradictions of nurses as carers

This article draws on the free‐text commentaries from trans‐Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self‐effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms.