Long‐Term Care Quality‐of‐Life Scale utility in community home care

This study aimed to test the utility of the Long‐Term Care Quality‐of‐Life assessment scale within community home care contexts and to compare the scale against the World Health Organization Quality‐of‐Life scale in terms of reliability and validity. Both scales were administered concurrently to 109 older adults receiving home care. Analysis revealed the Long‐Term Care Quality‐of‐Life scale to have good test–retest reliability, modest but acceptable internal consistency, and pairwise comparison between the Long‐Term Care Quality‐of‐Life and World Health Organization Quality‐of‐Life scales' scores suggesting moderate‐to‐strong correlation of criterion validity and comparability between scales. The results showed that the assessment of individual perceptions of life quality within home care contexts can be monitored and recorded, and that Long‐Term Care Quality‐of‐Life scale monitoring in home and residential care can identify opportunities for quality‐of‐life support and care continuity, even with transitions between care services and systems. The implications of the present study lie in having access to a validated quality‐of‐life assessment scale that can be used across care contexts to support evidence‐based practice, continuity of care, and acknowledgement of individual circumstances in services and care planning.     

Person‐centred care in the Indonesian health‐care system

Person‐centred care (PCC) is defined as the health‐care providers selecting and delivering interventions or treatments that are respectful of and responsive to the characteristics, needs, preferences and values of the individual person. This model of care puts the person at the centre of care delivery. The World Health Organization suggests that PCC is one of the essential dimensions of health care and as such is an important indicator of health‐care quality. However, how PCC is implemented differs between countries in response to local cultures, resources and consumer expectations of health care. This article discusses person‐centred care in the Indonesian health‐care system.     

Needs for end‐of‐life care by home care nurses among non‐cancer patients in Korea and Japan

The purpose of this study was to undertake a comprehensive assessment of each stage of the end‐of‐life process and the home care nursing needs of non‐cancer patients. The total number of eligible patients was 117 in Korea and 121 in Japan, aged ≥ 40, receiving continuous home care nursing throughout the beginning, stable, and at final death stages and ultimately dying at home. The need for the ‘management of physical symptoms’ increased as patients progressed through the end‐of‐life stages to death. In both countries, the needs for ‘loss and grief care’ and ‘coordination among care team members’ were significantly higher in the stable stage than in the beginning or final death stages. Further research is needed to develop tailored nursing care programmes that meet the specific needs of patients in each stage of the end‐of‐life care at home.     

Validation of CARE‐Q in residential aged‐care: rating of importance of caring behaviours from an e‐cohort sub‐study

Aim and objective. To validate the Caring Assessment Report Evaluation Q‐sort questionnaire in the residential aged‐care setting. Based on this determination, to conclude with what degree of confidence the questionnaire can be used to determine the ranking of the importance of caring behaviours amongst aged‐care nurses and residents in residential aged‐care. Background. Perceptions of caring may be context specific. Caring in residential aged‐care may stand in contrast to the sense of caring understood and practiced in other settings. Design. Self‐administered survey. Methods. Residents from three not‐for‐profit aged‐care facilities, across both high‐care (nursing‐home) and low‐care (hostel care) were surveyed relying on the Caring Assessment Report Evaluation Q‐sort questionnaire. A sub‐sample of registered and enrolled nurses working in residential aged‐care and registered with the Nurses & Midwives e‐cohort study completed the same survey. Results. Although the Caring Assessment Report Evaluation Q‐sort questionnaire showed good internal consistency for the sample of nurses, the results for the residents were more erratic. Both groups displayed large ranges for the inter‐item correlations. The results of the Mann–Whitney U‐test indicated that the nurses rated the Comforts, Anticipates and Trusting relationship as significantly more important than the residents. Both groups rated the Explains and facilitates subscale as least important. All subscales, however, received median scores greater than, or equal to, six (seven‐point, Likert scale) indicating that all were considered important overall. Conclusion. Based on poor Cronbach's alpha coefficients, negative inter‐item correlations and qualitative observations, without further development within the residential aged‐care facility the free response format version of the Caring Assessment Report Evaluation Q‐sort may not be an appropriate measure to use with residential aged‐care residents. More research needs to be conducted into how residents and nurses are interpreting the items in the Caring Assessment Report Evaluation Q‐sort. Relevance to clinical practice. There will always remain a need for nurses to enact behaviours that are meaningful to residents (and patients generally).     

Reconciling evidence‐based medicine and patient‐centred care: defining evidence‐based inputs to patient‐centred decisions

Evidence‐based and patient‐centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards ‘cookbook’ medicine undermine the view of patients as unique particulars, and diminish what might be considered patient‐centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence‐based and person‐centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients’ uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner–patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence‐based and patient‐centred approaches.     

Caring in residential aged‐care. Qualitative findings from an e‐cohort sub‐study

Aim. The aim of this e‐cohort sub‐study was to explore and describe nurses’ understandings of ‘caring’ in residential aged‐care. Background. The quality of the work environment is an important issue for recruitment, retention and workforce planning. Knowledge about the people in and the place that is the residential aged‐care facility may assist with the problems surrounding the recruitment and retention of nurses in the workforce. Design. Qualitative electronic cohort sub‐study. Methods. This paper presents the qualitative research findings from an electronic cohort sub‐study of 58 registered and enrolled nurses working in the residential aged‐care sector in 2007. Data were collected through an open ended question and a qualitative content analysis was used to generate the core categories. Results. The concept of caring was grounded in and constrained by, the everyday reality of the nurses in the study. Organisational imperatives for the completion of documentation necessary for accreditation and funding combined with under‐staffing restricted the time available for caring practices. Some nurses represented residential care faculties as devoid of care, others as a place where the resident was central to their work and care. The staff perceived of themselves as an ageing workforce in need of rejuvenation and resourcing. Conclusion. The concept of caring is manifest in nurses’ language as they describe their workplace, the residents, themselves and the structures that impact on what they do. Good caring manifests itself when the residents are central to the business of the aged care facility. However, nurses in this study describe a range of restrictive factors impeding caring practices and diminishing workforce morale and motivation to create environments that can truly be called a ‘home‐away‐from‐home’ and one that all people would find acceptable. Relevance to clinical practice. These findings have implications for aged‐care sector recruitment, retention and workforce planning within residential aged‐care facilities.     

Religious observance and perceptions of end‐of‐life care

This study examines the impact of the level of religious observance on the attitudes toward end‐of‐life (EOL) decisions and euthanasia of Jews in Israel—where euthanasia is illegal—as compared to Jews living in the USA, in the states where euthanasia is legal. A self‐reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations.     

The Tri‐focal model of care: Advancing the teaching‐nursing home concept

Providing residential aged care is challenging because of the complexity of residents’ health status, difficulties recruiting and retaining skilled staff, and financial and regulatory constraints. This paper discusses some of these challenges and describes an innovative model of care, termed ‘The Tri‐focal model of care’. This model was developed based on the concepts of ‘partnership‐centred care’, ‘positive work environment’ and the need for evidence‐based practice to underpin all aspects of care. It is envisaged that the implementation of this model will provide a rich learning environment that advances the teaching‐nursing home concept and the quality of residential aged care.     

An Easy‐to‐Make,Low‐Cost Ultrasound Phantom for Simulation Training in Abscess Identification and Aspiration

We have created a low‐cost and easy to make phantom for abscess identification using point‐of‐care ultrasound. The phantom also allows needle tracking and abscess aspiration using ultrasound guidance.