Assessment of the nutritional status among residents in a Danish nursing home - health effects of a formulated food and meal policy

Aims and objectives. To gain information about the effects of implementation of a written food and meal policy and to evaluate to what extent systematic nutritional assessment and intervention would result in weight stability among the residents. Background. Studies have shown that aged residents living in institutions suffer from malnutrition or are at risk of malnutrition. Health policies have pointed out that more attention should be given to individualised nutritional care. Several techniques are available to identify malnourished nursing home residents, but very few studies have reported findings of studies based on systematic nutritional assessment. Design and methods. A quasi‐experimental study based on a time series design used the residents as their own controls. The study included all 20 residents who resided at the nursing home at baseline in September 2004. Five residents died during the study period (mean age 84·4 years, range 62–91 years). Altogether 15 residents (75%) were assessed all five times during the study period. Results. The proportion of weight‐stable residents increased significantly over the study from 52·6% (CI 99%: 23·1–80·2) at baseline to 87·7% (p < 0·01) at the end of the study. The proportion of weight losers significantly decreased from 42% (CI 99%: 23·1–80·8) to 13·3% (p < 0·01). The weight ranges indicate substantial weight changes, but over time the weight ranges became narrower, indicating a tendency towards weight stability. Conclusions. Although the nursing home had a formulated food and meal policy, this study shows the importance of a regular nutritional assessment combined with an individualised care planning. Relevance to clinical practice. Regular weighing combined with individualised care planning results in weight stability in nursing home residents. Individualised approach for nutritional care led by a qualified nurse is just as important in nursing homes as it is in hospitals.     

Factors Associated With Nursing Diagnosis Utilization in Canada

PURPOSE. To investigate factors associated with nursing diagnosis utilization.
METHODS. A retrospective chart audit was conducted on four hospital units over a 5-month period and linked to the nurses (N = 65) who participated in a survey on attitudes toward nursing diagnosis.
FINDINGS. Computer-generated nursing care plans resulted in the greatest frequency of nursing diagnosis documentation. Nurses who did not document nursing diagnoses, and nurses employed in hospitals without nursing diagnosis implementation programs, had more positive attitudes toward the value of nursing diagnosis in practice compared with nurses who documented nursing diagnoses and nurses employed in hospitals with implementation programs.
CONCLUSIONS. Nurses have a greater tendency to document nursing diagnoses when institutions have formal educational programs and computer-generated care plans.     

Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents: a comparative study

The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses’ physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly’s functional levels may illuminate the extent of the carers’ workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi‐Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly’s need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.     

Is the influence of nurse care practices and nursing home organization understood? A qualitative study

palacios-ceña d., cachón-pérez j.m., gómez-pérez d., gómez-calero c., brea-rivero m. & fernández-de-las-peñas c. (2012) Journal of Nursing Management
Is the influence of nurse care practices and nursing home organization understood? A qualitative study Aim To describe residents’ experience of nursing home organization and nursing care practices in a region of Spain. Background Nursing home organization, nursing practices and rules within the institution may all influence residents’ daily living and their perception on the quality of care provided. Design A qualitative approach was conducted, using purposeful and theoretical sampling. Data were collected from nursing home residents, following unstructured and semi-structured interviews, researcher field notes and residents’ personal diaries and letters. Giorgi analysis was conducted. Results Two main themes emerged. (1) ‘Following nursing home rules’. Norms may be seen as boundaries, especially for those residents who were independent before admission. (2) ‘Prioritizing nursing care in residents’. Prioritizing the nursing care may limit the autonomy of residents because it does not meet their preferences and needs. Conclusion Understanding the meaning of nursing home organization and nursing care practices with nursing home residents might provide deeper insight into their expectations. Implications for nursing management Nursing staff should have greater involvement in the nursing home organization, as well as in prioritizing the care provision based on resident’s needs and preferences.     

Predictive validity of a modified fall assessment tool in nursing homes: Experience from Slovenia

The aim of the study was to evaluate the predictive validity of the Modified Fall Assessment Tool (MFAT) in a nursing home setting. The study involved 83 residents from a nursing home in Slovenia with an average age of 81 years. To determine the predictive characteristics of the MFAT, a receiver operating characteristic curve analysis was applied. During the observation period of 12 weeks, 18 residents fell. The fallers had a significantly higher history of falls, a higher number of diagnoses, more medication, and a higher MFAT score than the non-fallers. Using the estimated criterion of 20 points, the sensitivity of the MFAT score was 61%, its specificity was 80%, its classification accuracy was 64%, its positive likelihood ratio was 3.1, its negative likelihood ratio was 0.5, its positive predictive value was 46%, and its negative predictive value was 88%. The results showed that the MFAT is suitable for the prediction of falls and, hence, also the prevention of falls in nursing homes, whereby the recommended criterion score is 20 points.     

Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses

AIM: The aim of the study was to find out how nursing home residents, their families and nurses experienced the change to primary nursing in the nursing home. BACKGROUND: This study was carried out in a nursing home in Finland. Following years of functional nursing, the change to primary nursing had started 18 months prior to data collection. The transition was preceded by staff training, planning for the change to primary nursing and discussions with staff members. Meetings were also arranged with family members to inform them of what was happening and why. Staff implemented the changeover independently with the support of the institution's management. METHODS: The data were gathered in focused interviews. There were five interview themes: change in the nursing home, the position of the resident in the nursing home, the relationship between the resident and nurse, the relationship between family member and nurse, and the role of the nurse as provider of nursing care. FINDINGS: Residents reported no major changes in nursing care or in their relationship with nurses. However, family members had noticed changes in the behaviour of the nursing staff. Staff members had become friendlier, spent more time with the residents and showed a strong job motivation. Cooperation between nurses and family members had changed very little. Some nurses in the early stages of the change tended to show signs of resistance. Others said that there had been many changes during the past year, that they acted more independently and could use their own decision-making authority more freely than before. They treated residents as individuals and gave them a greater say in decision-making. They felt responsible for the development of the workplace as a collectivity. CONCLUSIONS: Primary nursing is one way in which nurses and family members can work more closely in the best interests of older residents. The findings of this study speak in favour of making the change from functional to primary nursing and at the same time highlight certain problems and possibilities in this process.     

Studying side effects of dental amalgam

Risk factors for permanent admission to a nursing home were studied in a prospective study of persons 70 years and over who received home nursing. Demographic data and use of psychotropic drugs were registered, and mental capacity, behaviour, and performance of activities of daily living (ADL-function) estimated. 214 patients received home nursing. 166 patients were available for the follow-up study after 16 months, of whom 31 had been admitted to a nursing home. Senile dementia and stroke were the most frequent diagnoses of admitted patients. Mental impairment, age, and amount of home nursing were associated with permanent admission to a nursing home. The odds for being admitted were 10.2 (C. I. 2.3–44.4) times higher in moderately and severely mentally impaired persons than in not mentally unpaired persons. The odds for admittance for those 85 years and over, compared with those younger than 80, were 5.0 higher (C. I. 1.6–15.6); and those receiving home nursing three times weekly or more had 3.8 (C. I. 1.4–9.8) times higher odds than those with less help.     

Rated cognition in nursing home residents with multiple sclerosis: cross-sectional and longitudinal analyses

Purpose.?To examine cognitive change in nursing home residents with multiple sclerosis (MS) over the first year of a nursing home stay and to predict cognition functioning in these residents at admission and the 1-year annual assessment.

Method.?In the first part of this study, the cognitive functioning of nursing home residents with MS (n?=?1890) and without MS (n?=?22,985) were compared. In the second part, demographic and other variables were used to predict cognition at the admission and 1-year annual assessment for MS residents.

Results.?Nursing home residents with MS had better cognitive functioning than residents without MS at admission and 1 year later. Regression analyses demonstrated that higher education and pain predicted higher Minimum Data Set Cognition Scale (MDS-Cog) at admission and at 1 year later, but poorer activities of daily living predicted worse MDS-Cog at admission and 1 year later. For the longitudinal analysis, MDS-Cog at the admission assessment was an independent predictor of MDS-Cog scores at the 1-year annual assessment.

Conclusions.?Nursing home residents with MS have significantly better cognitive functioning than non-MS residents and, over the first year of a nursing home stay, higher education and pain, but lower activities of daily living, predict poorer cognitive functioning.     

Family and staff perceptions of the role of families in nursing homes

Family and staff perceptions of the role of families in nursing homes Admission to a nursing home is generally regarded as the termination of family care and the commencement of institutional care. Research suggests that following placement families are often expected to relinquish their dependent older relative to the bureaucracy of the institution. The aim of this study was to investigate family and nursing home staff perceptions of the role of families caring for residents in nursing homes. A convenience sample of 44 family carers and 78 nursing home staff completed questionnaires, and interviews were conducted with 10 family carers and 10 nursing home staff. The results suggest that family carers perceived themselves to have a greater role in caring for relatives than that perceived by the nursing home staff. Either families overestimated their involvement, or staff underestimated family involvement in caring for residents in nursing homes. Families were mostly satisfied with their role and with the care provided in nursing homes. They perceived nurses as providers of technical care and they perceived themselves as having an important role in providing social and emotional care. Families trusted the clinical judgement of the staff but the staff were reluctant to trust family carers, especially in situations where care involved an element of risk. Family roles were limited by members' own ability to care and the dependency of the resident, while professional responsibility and accountability discouraged nurses from sharing some caring roles. The results indicate that families in this study were more willing to help in nursing home care and were perhaps under-valued as a resource within the nursing home setting.     

Feeling at home in nursing homes

AIM: The purpose of this study was to examine determinants of feeling at home and in particular the privacy in nursing homes in The Netherlands. The first question was to what extent nursing homes differed in the degree residents feel at home and experience privacy. The second question was whether feeling at home is related to privacy in the nursing homes. BACKGROUND: Feeling at home is of particular importance to residents of nursing homes because the average length of stay in The Netherlands is about 16 months. A growing number of people are of the opinion that the privacy of the residents has to be improved. Privacy in nursing homes, therefore, has been high on the political agenda over the last few years. Four aspects of privacy were distinguished: privacy related to the characteristics of the building, privacy as a consequence of the attitude of nurses towards residents, privacy in terms of choice and control over time schedules and activities, and privacy related to the amount of disturbance caused by other residents. DESIGN: The data were collected from individual interviews with 686 residents and family-members in 36 nursing homes in The Netherlands. RESULTS: Following quantitative data analysis, it was found that nursing homes differed in the proportion of residents feeling at home as well as in three aspects of privacy. Differences in feeling at home were found to be related to privacy, especially to the perceived attitudes of nurses and perceived disturbance caused by other residents. A weak relationship was found between residents and their perceived privacy of the building. CONCLUSIONS: A significant amount of variation in privacy was found at the nursing home level. This implies that feeling at home is not only individually determined but can be influenced by the nursing home's management policy.     

Nursing assistants' perceptions of their role in the resident experience

The aim of this study was to examine nursing assistants' perspectives of their role in the nursing home resident experience. Recent efforts to improve nursing home quality are focused on providing person‐centered care and improving the resident experience. However, the literature on nursing home quality lacks the perspective and experiences of nursing assistants themselves, despite their crucial role in the resident experience. Semistructured interviews were conducted with 25 nursing assistants from 17 organizations and seven states. Data were analyzed using an interpretive approach that identified relevant codes and themes. Respondents perceived that they play a pivotal role in the resident experience by providing choices, communicating important information, comforting, and living within the daily reality of cognitively impaired residents. Nursing assistants' challenges included using non‐verbal communication, balancing personal care while maintaining boundaries, and dealing with a perceived lack of trust. Nursing assistants are integral to interpersonal engagement with residents and relationship‐based activities, such as communication, caring, and protecting. Increased nursing assistant input into programs and policies to improve the resident experience is warranted. Quality assessment should incorporate direct input from residents and nursing assistants regarding person‐centered care.     

Drug Consumption Among Elderly—A Four-Year Study

The aim of the study was to analyse whether a radical structural change in the provision of care for the elderly, including changes in the pattern of drug administration, might influence drug consumption among residents in a Danish nursing home. A comprehensive reorganization of the care of the residents took place in the mid-1980s. The general approach to self-care, with greater autonomy and influence over one's own life was also disseminated to the area of administration of medication. Previously the nurses had been responsible for this area but a new model was introduced in 1986 in principle permitting all residents to be in charge of their own medication. The study was carried out as a survey over four consecutive years from 1985 to 1988, and included 48 residents in a nursing home of whom 24 participated in all four surveys. A minimum of drugs were administered immediately after the change in regimen. Although a slight increase was recorded in the subsequent years, the level of drug consumption did not reach pre-intervention levels. The total number of regularly administered drugs per day in survey 1 averaged 4.6 drugs/person. In survey 2 this had decreased to average 3.6 (p <0.05).     

Life situation and daily life in a nursing home as described by nursing home residents in Sweden

Aims and objectives.  The overall aim of this study was to investigate nursing home residents' opinion of their life situation in a nursing home and of their earlier life.
Background.  Few studies have focused on residents' perception of their daily life and life situation in nursing homes.
Design.  A qualitative explorative design was used.
Methods.  Residents in a nursing home were interviewed and qualitative content analysis was performed.
Results.  The views of life residents described and how they apprehended their situation were quite different. The findings give an understanding of what it is like to live in a nursing home and show that residents apprehend their situation in very different ways. All individuals who were content with their situation in the nursing home were also content with their earlier life.
Relevance to clinical practice.  For the nurse in gerontological care, it is a challenge to get to know each resident and to provide the best nursing care and the best individual treatment for each resident. Another challenge is to help each resident find a life in the nursing home that is acceptable for him/her, and one aspect of this involves helping residents in their ageing process. The present study highlights what an important role staff have in relation with nursing home residents.     

The emergence of Medicare hospice care in US nursing homes

Although Medicare-financed hospice care has been provided in nursing homes in the USA for over 10 years, very little is known regarding the use of this government health care benefit in nursing homes. Using resident assessment data and hospice and inpatient Medicare claim data from five US states, we were able to identify and describe nursing home residents receiving hospice care between 1992 and 1996, and their hospice utilization patterns. Six per cent of all dying nursing home residents received hospice care at some point in time and, in 1996, an estimated 24% of all Medicare hospice patients in the five study states received hospice while in a nursing home. Of those residents beginning hospice care after nursing home admission, 48% were 85 years or older, 70% were female, 94% were white, 76% were unmarried and 62% had a non-cancer principal diagnosis. The average length of stay in the hospice programme for residents receiving hospice care while in the nursing home was 90.6 days, the median 35 and the mode 2. Hospice care in US nursing homes is a prevalent model of care that appears further to extend the Medicare hospice benefit to older adults who are female and to those with non-cancer diagnoses. Lengths of stay in the programme are similar to those observed in the community and the average length of stay is substantially shorter than previously estimated by an influential government study.