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.     

Transition in care: family carers' experience of nursing home placement

This paper explores families' experience of nursing home placement, which emerged as a significant aspect of a larger hermeneutic phenomenological study of family caring in nursing homes. Hermeneutic analysis of 14 family carers' stories of nursing home placement uncovered five shared meanings: experiencing a loss of control; being disempowered; feeling guilt, sadness and relief simultaneously; possessing a sense of failure; and having to make a forced and negative choice. Discussion of the findings focuses upon the importance of family carer support during the transition period from home care to nursing home care and the subsequent benefits realized as a result of having received such support. Particular emphasis is placed upon how such support assists family carers to begin the process of reconstructing a valued and positive identity through which new possibilities for meaningful caring within a nursing home context can be realized.     

The role of community staff in care home placement in Sweden

The role of community staff in placing a relative in a care home is a relatively unexplored area of practice. Interviews with a variety of community staff in Sweden suggest that they play a significant role in helping family carers, particularly spouses, research the decision about the need for placement. This role can include recognition that placement is required (seeing the need), initiating and sustaining discussions about placement (sowing the seed and nurturing the seed) and legitimating the decision. However, once the decision has been made relatively little attention is given to the emotional consequences of the move and attention is focused largely on instrumental aspects. Despite showing sensitivity in the decision-making phase, community staff could do more to help carers deal with the guilt they experience and to initiate contact with the care home.     

Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge in Taiwan

BACKGROUND: Providing appropriate follow-up health/long-term care services after hospital discharge for elderly persons is important to enhance health and quality of life. Therefore, identifying factors that affect follow-up service utilization has become an important concern. Most studies of predictors of follow-up service utilization for elderly persons after discharge were conducted in the United States of America (USA). Taiwan differs substantially from the USA in health care system, clinical practice, case-mix, culture, and social organization; thus the findings from the USA need to be validated in Taiwan to ensure appropriate discharge referrals. AIM: To investigate pre-discharge predictors of follow-up care including home nursing services and nursing home placement for elderly patients, discharged from hospitals in Taiwan. METHODS: A prospective study with a case-control design was used. FINDINGS: The strongest predictors of institutionalization in a nursing home at 1, 3 and 6 months after discharge were the elderly person's pre-admission institutionalization (0.33 to 0.48) and the caregiver's preference for institutional displacement (0.23 to 0.85). The strongest predictors of use of home nursing services were the elder's self-care ability (0.69 to 0.76), conscious level (0.51 to 0.73), and tubes remaining before discharge (0.58 to 0.79). These predictors were stable at 1, 3 and 6 months after discharge and could correctly classify 60-89% of sample. CONCLUSIONS: When taking nursing home and home nursing utilization into considerations at the same time, the elderly person's pre-admission institutionalization and the caregiver's preference for institutional displacement strongly predicted nursing home utilization after hospital discharge. The elder's self-care ability, conscious level, and tubes remaining before discharge strongly predicted the use of home nursing services after discharge.     

基于HIS的医院护理工作量测量与评价

目的:了解该院16个主要住院病房的护理工作量情况。方法:采用赋分法对该院HIS系统中与护理工作相关的160条项目赋分,对2009年1-12月该院HIS中产生的护理工作量数据进行统计、分析。结果:该院16个住院病房2009年的年人均护理工作量最多的科室是胸外科,比较内、外科的年人均护理工作量无统计学差异(P0.05),相关分析显示影响该院人均护理工作量的相关因素有收费护理工作量、非收费护理工作量、非专科护理工作量。结论:目前该院内、外科的护理人力配置较合理,我国目前的医院计费标准对于护理服务的计费标准不合理。     

Comparisons of the cost-effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients

AIM: This study compared the cost and effectiveness of long-term institutional care and home care for stroke patients with severe physical disabilities. BACKGROUND: Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. METHODS: From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. RESULTS: Information on family costs for caregiving, including pay for long-term services utilized, labour costs for caregiving and out-of-pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. CONCLUSIONS: The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.     

我国家庭护理的现状

对家庭护理的概念、需求、管理等内容进行了综述,分析了我国家庭护理的现状,提出家庭护理有广阔的发展前景。     

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.     

'It's not the same as him being at home': creating caring partnerships following nursing home placement

Admission to a nursing home is a major life event for both older people and family carers. Despite a policy of community care in both the UK and the US, entry to nursing homes will be an increasingly common event. Family carers are often the key decision makers but little is known about their experience of placement, especially adjustment after the event. Antagonistic relationships can often develop between staff and relatives, as the former seek to take over care and the latter to develop new roles. There is a need to create a partnership between staff and family so that the care of the older person is improved and the carers' need to remain involved is acknowledged.     

Formal service utilization by the frail elderly at home during the last 6 months of life

Abstract The purpose of this study was to examine how the use of medical/social services by elderly persons changes over time as they approach death. This research was conducted at a public visiting nursing office in Tokyo. Nursing records of all elderly persons, those who died at home or died within 1 week of hospital admission between April 1993 and June 1997 were reviewed. The percent of patients using each type of medical or social service was calculated for three time periods before death: more than 6 months, 1–6 months and within 1 month. This retrospective examination clearly demonstrates a shift in specific service usage by elderly persons during the months prior to death. As terminal illness becomes more advanced, the use of medical services increases more remarkably than the use of social services. The increase in nurse visits is far greater than that of home aid visits. Visiting nurses should demonstrate their skills of care appropriate to the changeable conditions of the elderly and their families in the terminal stage.     

Measuring nursing workload in neonatal intensive care

AIM: To determine if a suitable method of measuring nursing workload could be developed in neonatal intensive care units (NICUs). BACKGROUND: Nursing is a multifunctioning activity and previous methods measuring the demand for nurses do not put enough emphasis on the individual capabilities. The reporting of NICU activity has traditionally been related to bed occupancy and the number of infants requiring ventilator support. A classification system based on activity, hours of care and nursing staff ratios has been used; however, it does not consider the clinical ability of the individual nurses. METHODS: A 5-month prospective study was undertaken in which nurses in two NICUs scored their patients' level of dependency and professional assessment of the level of intensity of care required by the infants in each shift. In addition, serial measures of severity of illness scores for each patient were collected. KEY ISSUES: The study identified methods of measuring workload that consider the individual nurse's ability and contributing organizational factors. We found that the estimates of nursing hours using the two traditional dependency measures did not match the current practice or take into account the skill of the nurses. A method in which the nurses indicated the intensity of nursing care required by their patients was suitable one for capturing their individual capabilities. System factors were also found to contribute to the nursing workload. CONCLUSIONS: It is not sufficient to use patient acuity or severity of illness alone. Other factors such as the nurse's assessment of the intensity of care required and the organizational factors are important components of workload estimates.     

养老院中护理服务模式探讨

[目的]探讨养老院中的护理服务模式,旨在提高养老院护理服务质量。[方法]讨论国内外养老院中的护理服务模式,重点阐释了国内3种模式：传统养老护理模式,中西医结合养老护理模式和开放式的养老院护理模式。[结果]通过对国内外养老院护理服务模式探讨,认为中西医结合养老护理模式是适应社会发展和老人喜爱的养老院护理服务模式,可提高生活质量。[结论]养老院中的护理服务模式要不断探讨与创新,以更好的服务老年人,解决个人、家庭及社会的负担。     

Home care for the frail elderly based on urinary incontinence level

Incontinence is a common problem in the frail elderly. We conducted interviews focusing on urinary incontinence with 249 elderly clients in the home care setting, and studied differences of the needs among three (mild, moderate, and catheter) groups based on incontinence level. The mild group had the highest number of professional care needs, although their problems were not as serious as the other two groups. The moderate group required the highest amount of daily care by caregiver. A similar need pattern was shown in the moderate and catheter groups, while more diversified needs were required in the mild group. Portable toilet, rehabilitation, and short-stay services were frequently used in the mild group. The use of telephone consultation was the highest in the moderate group, and the use of doctor visit and bathing service were higher in the catheter group. The most important challenge was significantly different in each group: preventive efforts to maintain activities of daily living (ADL) in the mild group, interpersonal relationships in the moderate group, and infection control in the catheter group. Education was necessary for caregivers in all three groups. These findings help to project realistic care needs for each client based on his or her incontinence level.     

北京市养老院护士关爱能力及影响因素调查

目的调查北京市养老院护士的关爱能力现状,并分析其影响因素。方法采用关爱能力问卷,对北京市2所公立养老院的154名注册护士进行调查。结果养老院护士关爱能力总分为（180．36±16．58）分,各维度得分均低于国外常模（P〈0．01）,87．66％的护士关爱能力总体处于低等水平。多元回归分析显示,职务、学历、有无子女是关爱能力的影响因素（P〈0．01）。结论养老院护士总体关爱能力水平较低,尤其是职务为普通护士、学历为本科、无子女的护士。应在教育和培训中强化护士关爱能力的培养,并呼吁家庭和社会营造关爱氛围。     

Transitions in men's caring identities: experiences from home-based care to nursing home placement

Objectives.  The aim of this study is to describe, from a gender identity perspective, the experiences of older men involved in the process of caring for a partner at home and the placement into a nursing home.
Background.  Few studies have paid attention to the importance of gender when considering the social experiences of older men providing care for an ill spouse and finally placing a partner in a nursing home. Further understanding is much needed of how older men experience the process of caring for a spouse from a gender identity perspective.
Design.  A qualitative constructivist approach was adopted for this study.
Participants.  Data consists of interviews with seven men that have been informal carers and experienced the placement of their wife in a nursing home.
Methods.  Interviews were analysed with a constructivist approach.
Results.  The results indicate that men go through two transitions in their gender identity during the caregiving process and placement. From the mutual loving relationship of being a loving husband , the social responsibility of daily care of their wives changes the situation into that of being a caring husband , and finally with the move to a nursing home there is a transition from intimate care to a relationship based on friendship .
Conclusions.  The results show that older caregiving men undergo a process involving a reconstruction of gender identity. To formally recognize men's caring activities and to make them sustainable, we believe that men in an informal caring relationship need support.
Relevance to clinical practice.  Nurses need to recognize the identity struggles resulting in sadness and suffering that are related to changes in men's lives during the caregiving process. Understanding the dynamics and changes that occur when men take on a caring task is important for the development of their role as carers.     

The changes in caregiver burden following nursing home placement

This longitudinal study explored changes in perceived burden among Taiwanese family caregivers (n=77) from nursing home placement of an elder to four months postadmission. Higher burden at placement was related to the level of dependence of the care recipients (p=0.004), or caregiver's poor health (p<0.01). After nursing home placement for four months, global burden decreased (p<0.01) contributed primarily by lessened burden in three sub-scales: lack of family support, impact of schedule and impact of health. Burden scores on caregiver esteem and impact of finances were not decreased after placement. Duration of caregiving was the only demographic factor predicting change in global burden (p<0.001). Changes in impact on finances, and impact on health were, respectively, predicted by the perceived health (p=0.005), and religious preference (p=0.01). These results provide valuable information to healthcare providers for an understanding of the changes of caregiving burden after nursing home placement and the correlates of these changes, which may help devise an appropriate policy for alleviating the caregiver's burden.