Significance of close relationships after the tsunami disaster in connection with existential health--a qualitative interpretive study

Scand J Caring Sci; 2012; 26; 537–544 Significance of close relationships after the tsunami disaster in connection with existential health – a qualitative interpretive study Background: In an existential health perspective, the potential for recovery and development through natural life circumstances provides a factor to be taken into account. Earlier research on disaster‐stricken people indicates that people create their own ways of recovering and that natural caring encounters (with family or friends) imply important health factors. Aim: The aim of the study is to acquire an in‐depth understanding of the significance of natural close relationships for survivors of the tsunami disaster in Southeast Asia in connection with the development of existential health and understanding of life in a long‐term perspective. The sample consists of 19 persons afflicted by the 2004 tsunami in Southeast Asia, both Swedish tourists and relatives at home. Data were collected from interviews recurring five times during 2006. Findings: What is evidently seen is how the ontological aspects are expressed in data in relation to the existential and relational aspects. In concrete terms, this is understood when survivors say that their lives are completely changed (an ontological turn in their understanding of life). A change also occurs in the way they relate to others (a concrete existential turn), for example, in their families. When the findings on communion as an utterance of interdependence were read comprehensively, it was seen that human encounters in the aftermath of a disaster are not only about relationships but inherently affect people’s entire understanding of life both ontologically and existentially. Relationships with others and communion become a way of understanding or defining life. To conclude, in line with the aim of the study, the data suggest that relationships and communion with other people helped the survivors of the tsunami to discover a new understanding of life. It is also clear that natural encounters have had great importance for progress in existential health.     

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.     

Burnout as an existential deficiency – lived experiences of burnout sufferers

Scand J Caring Sci; 2011; 25; 294–302
Burnout as an existential deficiency – lived experiences of burnout sufferers Aiming at a deeper and existential understanding of burnout, by looking especially at the patterns of health, suffering and expressions of understanding of life in a longitudinal perspective, qualitative data from 18 Swedish women and men were analysed. Burnout as an illness has been subject to constant questioning during its incidence in western societies. Yet it is generally agreed that people afflicted by burnout experience huge problems and suffering. Data from interviews face to face, telephone follow‐up interviewing during 1 year and e‐mail interview dialogues were collected. With a nursing science perspective in which health and suffering are basic concepts, an interpretive analysis revealed signs of existential deficiencies in the lived experience of the people afflicted. The images of the patterns of lived experience elucidated reveal a discord between the people and their work, a blindness towards their own actions, bodily illness as signs of burnout, experiencing a collapse as a ‘crossroad’, secondary suffering related to the social system and a struggle towards a way out. Our interpretation reveals assumptions concerning three levels of life: actions, values and universal existence, which is somewhat different from previous studies. Unless a person is in contact with these three dimensions, he/she seems to find it difficult to maintain health in his/her encounters with life. Implications for health care are existential interest on the part of caregivers and understanding of life as signs of universal values. Patients’‘shut off’ and restrained longings understood as signs of ‘darkness’ in their understanding of life may induce caring acts on the part of caregivers that offer patients an opening and a glimpse of what it might be like to find health in the midst of their suffering. The caregivers’ own natural light of understanding of life can then work as a caring component.     

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.     

Interventions for preventing and reducing the use of physical restraints in long‐term geriatric care – a Cochrane review

Aims and objectives. To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people requiring long‐term nursing care. Background. Physical restraints are commonly used in geriatric long‐term care. However, they are associated with adverse outcomes. Therefore, freedom from physical restraints should be the aim of high‐quality nursing care. Design. Systematic review of randomised controlled trials. Methods. This review followed the methods of the Cochrane Handbook of systematic reviews of interventions. The systematic search (September 2009) covered the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO and LILACS. Results. Six cluster‐randomised controlled trials met the inclusion criteria. All studies investigated educational approaches targeting nursing staff. In addition, two studies offered consultation, two guidance and one support and free access to technical aids. Five studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Overall, the methodological quality of studies was low. Their results were inconsistent. One study with good methodological quality in the nursing home setting documented an increase in physical restraints use in both groups, while the other four studies with lower quality found reduced use of physical restraints in the intervention group. The single study in group dwelling units found no change in physical restraints use in the intervention group but a significant increase in the control group. Conclusions. There is insufficient evidence supporting the effectiveness of educational interventions targeting nursing staff for preventing or reducing the use of physical restraints in geriatric long‐term care. Relevance to clinical practice. Our findings indicate that educational programmes targeting nursing staff might not be effective in reducing the use of physical restraints in geriatric long‐term care. It remains unclear which components should be included in educational programmes aiming to reduce physical restraints.     

Combining garden therapy and supported employment – a method for preparing women on long‐term sick leave for working life

Women are overrepresented among the group people suffering from long‐term illness. In addition to their illness, suffering long‐term sick leave leads to economical restraints as well social distress. There are gaps in our understanding of the challenges these women face. There is also lack of knowledge about how these challenges can be effectively addressed in rehabilitation. This deficiency is problematic from an ethical, justice and a caring perspective. In this study, changes in health‐related quality of life (HRQoL) among women on long‐term sick leave were investigated during and after participating in a rehabilitation programme combining two validated methods, Garden Therapy and Supported Employment (SE). The study also discusses difficulties in realising research related to vulnerable under‐privileged people. From a population of 329 women who had reported their interest to participate, 245 were randomised to the programme. Of these 144 accepted participation in the research project and of these 123 women accepted to answer the SF‐36 questionnaire. The participants were between 21 and 62 years with poor physical and mental health. They had received public financial support from <1 year to >10 years. The SF‐36 measurement was carried out at baseline, after completion of Garden Therapy and after completion of SE. The results are based on data of respondents who participated at all the three occasions (n = 52). When comparing HRQoL baseline with the following occasions, the participants' General Health (GH), Vitality (VT), Social Functioning (SF) and mental health had improved significantly. The Four Leaf Clover (FLC) programme could be an appropriate method for reducing socially induced suffering. However, to conduct intervention studies where vulnerable persons are involved, it is off vital importance to consider whether the participants have the strength to complete the intervention.     

Benchmarking life quality support interventions in long‐term care using the Long‐Term Care Quality of Life scale

We aimed to develop a graphical procedure for benchmarking quality of life care results using the Long‐Term Care Quality of Life (LTC‐QoL) scale. While clinical care quality benchmarking is now well established, similar research for quality of life (QOL) aged care benchmarking has received scant attention. Data from 10 facilities utilizing the LTC‐QoL scale were analysed to establish baseline statistics for developing a graphical procedure for QOL benchmarking. Client LTC‐QoL records were tested with varimax rotation factor analysis revealing three viable benchmarking themes: B1 (Self‐efficacy), B2 (supporting relationships), and B3 (outlook on life) were selected for benchmark development utilizing Analysis of Means to generate graphical outputs using Minitab version 17.3.1. In this way, in the absence of verified industry standards, it is possible to compare organizations providing similar services using the same indicators, against group averages. In conclusion, the benchmarking protocol produced comparative information on three benchmarks for 10 facilities. Similar analysis is feasible for a single facility over time. The results of these analyses provide evidence for on‐site discussion of quality of life care quality performance.     

Factors associated with change in health‐related quality of life among individuals treated with long‐term mechanical ventilation,a 6‐year follow‐up study

Aims

To examine changes and explanatory variables for changes in health‐related quality of life in patients treated with long‐term mechanical ventilation over a 6‐year period.

Background

Long‐term mechanical ventilation is a treatment for individuals with chronic hypercapnic respiratory failure, primarily caused by neuromuscular diseases, obesity hypoventilation syndrome, chronic obstructive pulmonary and restrictive thoracic diseases. Studies on long‐term outcome on health‐related quality of life and factors influencing it are lacking.

Design

Prospective cohort study.

Methods

Data were collected from the Norwegian Long‐Term‐Mechanical‐Ventilation Registry and from patient‐reported questionnaire in 2008 and 2014. Health‐related quality of life was measured by the Severe Respiratory Insufficiency questionnaire, containing 49 items and seven subdomains. Linear mixed effects models were used to measure changes and identify factors for changes.

Results

After 6 years, 60 patients were still participating, out of 127 at baseline. Health‐related quality of life improved significantly in the total score and in four subdomains of the questionnaire. Satisfaction with training in long‐term mechanical ventilation was an explanatory variable for improved ‘psychological well‐being’ and follow‐up for improvement of ‘anxiety’. Side effects of the treatment like facial soreness were associated with the total score. High age and high forced vital capacity were related to lower ‘physical function’ and improved ‘social functioning’, respectively.

Conclusion

Long‐term mechanical ventilation over 6 years improved health‐related quality of life in most patients. Patient training, follow‐up and reduction of side effects, largely delivered by trained nurses, contribute to achieve the main goal of the treatment—improved health‐related quality of life.     

Intention to receive the seasonal influenza vaccine among nurses working in a long‐term care facility

The factors affecting influenza vaccine uptake among nurses might vary between different medical facilities. The purpose of the present study was to explore factors that affect the intention of nurses at a long‐term care facility to receive the influenza vaccine and whether the health belief model predicts this intention. In this cross‐sectional quantitative correlational study, a convenience sample of 150 nurses employed at a large long‐term care facility in central Israel completed a questionnaire based on the health belief model. Data collection took place between January and February of 2016. Forty‐two percent of the respondents reported having been vaccinated against influenza in the current year. The health belief model explained 53% of the variance (p < .01), with perceived (personal) benefits of the vaccine being the most significant factor. The number of times of receiving the influenza vaccine in the past was strongly correlated with the intention to receive the vaccine (p < .01). To improve nurses' compliance with influenza vaccination at long‐term care facilities, we find that it is necessary to emphasize the benefits of vaccination and, particularly, the personal benefits. Annual vaccination behavior should be promoted to make it become a routine.     

Physically restraining elder residents of long‐term care facilities from a nurses' perspective

Ben Natan M, Akrish O, Zaltkina B, Noy RH. International Journal of Nursing Practice 2010; 16 : 499–507
Physically restraining elder residents of long‐term care facilities from a nurses' perspective The purpose of the current study was to identify and analyse major variables affecting intended decisions of nursing staff to physically restrain elder residents of long‐term care facilities. The study explored whether a research model constructed of staff characteristics and resident characteristics would prove useful for predicting behavioural intentions. A total of 120 reliable and validated questionnaires, based on the research model, were administered to nurses working in a large long‐term care facility for older adults in central Israel; 104 questionnaires were returned for a response rate of 86%. The research findings indicate that most of the nurses who responded (67.2%) reported that they had physically restrained elder residents more than 10 times over the past year; however, the nurses had a low intention of restraining residents during the coming year. The research results indicate that the intended decision of nursing staff to restrain elderly residents is a derivative of their behavioural beliefs and attitudes, normative beliefs and subjective norms, as well as of residents' dementia, physical state and stress.