Documentation practices of nurses in long-term care

Documentation of nursing care is an important source of reference and communication between nurses and other health care providers. This article describes a study of the documentation practices of nurses in a long-term care institution. Results revealed a number of positive aspects of nurses' documentation practices and areas requiring modification or change which could be facilitated through redesigning the documentation system. Implications for professional practice are discussed, which include the need for a concise, non-duplicating system of documentation, and the importance of nursing documentation in support of evidence-based practice.     

上海市中心城区长期护理保险护工服务质量调查

目的 调查了解黄浦区150名从事长期护理保险服务的护工基本情况,评估长期护理保险服务对象对护工满意度情况。方法 研究对象来自上海市老西门街道、淮海中路街道和南京东路街道3个社区,从已经通过评估失能程度为二至六级且已经享受相应的长期护理保险待遇的居民名单中,以随机方式从中抽样,每个社区抽取50名护工完成问卷调查。结果：护理人员入职门槛低,文化水平普遍不高,护工年龄集中在41-50 岁之间,高中以上学历只有23人, 占15.2%,以农村户口居多,所占比例为56.95%;护理人员没有工作热情,对职业规划不强,工作比较盲目; 前期从事养老护理行业的人员较少,仅17.21%,68.87%的护工从事该工作的主要原因是收入较多,而爱好护理行业的人员仅占17.88%;各年龄段和文化程度对服务效果影响不明显(无统计学意义);但在老人的认可度比较中,文化程度高中的护理人员,老人认可度越高。结论： 因服务内容多限于生活照料,技术含量不高,所以对护工年龄、文化程度要求不高;政策宣传不足,居民对长护险提供的内容了解不透彻;定位不清晰,目前服务项目倾向于养老服务的生活护理,医疗护理内容较少,护理内容容易产生误解。     

Dimensions of quality in long-term care facilities in Taiwan

AIM: This article presents the results of a qualitative study designed to explore the perceptions of Taiwanese elders about the quality of their care while in residence at a long-term care facility. BACKGROUND: As the population of elders in Taiwan is increasing rapidly, quality long-term care has become both a necessity and social responsibility. Research related to quality of care has focused on structure, process and outcomes as well as perceptions of quality of care and life satisfaction. Few authors have considered residents' perspectives within a cultural context. METHOD: A convenience sample of 22 residents, aged between 61 and 86 years and living in four Taiwanese care facilities, participated in semi-structured interviews. The data were generated during 2001/2002 and were analysed using content analysis. RESULTS: Six key dimensions of quality care were elicited. The dimensions were: a caring attitude, respect for individual differences, emotional support, social interaction, a supportive environment, and accessible care. These dimensions are discussed within a cultural context supportive of family connectedness and filial piety, values underpinning care expectations of elders. CONCLUSIONS: The findings provide a foundation for increased understanding of the perceived gaps between residents' aspirations about quality care and priorities identified in other studies. Additional studies based on these data are planned in order to generate a culturally relevant, psychometrically sound resident assessment tool to evaluate the quality of care from a resident perspective in long-term care facilities in Taiwan.     

How nurses manage time and work in long-term care

AIMS OF THE STUDY: The aim of this study was to better understand the ways in which conditions of work, including staffing, affect how nurses in long-term care (LTC) facilities do their jobs and the quality of care they provide. BACKGROUND: The research reported here was performed in the context of public policy debates about the relationship between staffing levels and quality in LTC. METHODS: In 1995 and 1996, interviews and participant observation were used to examine how 18 licensed nurses employed in two LTC facilities in the midwestern United States experience their day-to-day work. RESULTS: Time was an extremely salient work condition for the nurses interviewed. Under conditions of too little time and many interruptions, nurses compensated by developing strategies to keep up or catch up. These strategies included minimizing the time spent doing required tasks, creating new time and redefining work responsibilities. Although these strategies allowed nurses to complete the tasks for which they were accountable, there were adverse consequences for nurses and residents. Nurses realized that time demands often made it impossible to provide care of high quality. They expressed their ideas about quality care as the notion of 'should do' work. In effect, time pressures forced them to forego the 'should do' work to complete the 'must do' work. CONCLUSION: Increased staffing could improve the quality of care in LTC facilities.     

养老机构管理者对质量管理体会的质性研究

目的探索养老机构管理者对于质量管理的感受及需求。方法采用质性研究方法,深入访谈北京市10名养老机构管理者,并运用Colaizzi的7步分析法分析资料。结果养老机构管理者的体验提炼为3大主题：面临的难题、支持与使命感、挑战与机遇。在质量管理中他们面临管理标准及评价体系缺失、理念模糊等难题,但国家的政策支持及做好养老服务的使命感促使其应对压力,并在此过程中感受到挑战,主动寻找发展机遇。结论应尽快完善养老机构服务质量管理标准与质量评价体系,为质量管理与评价提供理论支持。     

Staffing adequacy, supervisory support and quality of care in long-term care settings: staff perceptions

Title. Staffing adequacy, supervisory support and quality of care in long‐term care settings: staff perceptions Aim. This paper is a report of a study to explore relationships between perceived care quality, self‐assessed professional skills, and the perceptions of the quality‐related factors. Background. The work in long‐term care is more demanding than in the past. The quality of care is strongly related to the well‐being and job satisfaction of staff. Those emerge in part through a perception of resources allocated to caring and also through a perception of the quality achieved. Method. Data were collected in Finland in 2002 using a questionnaire sent to the nursing staff working in 112 wards in 40 long‐term care institutions monitoring their care with the Resident Assessment Instrument System. Institutions were invited to participate the survey. The response rate was 70·2% (n = 1262). The respondents represented 3·8% of nursing personnel working in long‐term care institutions. Findings. Staff members who perceived staffing levels as inadequate and supervisory support as insufficient had lower perceptions of their own professional skills and the quality of care. Perceptions of empowering support behaviour were more strongly associated to self‐assessed skills and to perceived care quality than perceptions of skills‐oriented support activities. Staff members with short professional training, older staff members and staff members with long work experience in the unit had lower perceptions of their professional skills than other groups. Conclusion. The perception of adequate staffing and of sufficient supervisory support, especially empowering support increases the probability of perceiving the care quality as good. If supervisors concern themselves with staff members’ perceptions, they can better identify the staffing needs and also the support needs of personnel.     

Ranked motives of long-term care providing family caregivers

Family caregivers provide long-term care to their chronically ill loved ones and as a consequence they experience physical, relational and financial problems. This study investigates how long-term family caregivers rank 12 motives for caregiving. Motives are derived from the views of four philosophical anthropologists and are related to self-reported stress and joy and to several different background characteristics of respondents. Motives that focus on feelings concerning the relationship between caregiver and care recipient are more popular as a first choice than motives stemming from feelings of obligation or a general feeling of happiness and are also more popular than more self-directed motives. An analysis of full ranking data shows that two groups can be distinguished, one group of family caregivers with mixed motives and one group of family caregivers with motives that focus on reciprocal mutually equal relationships. The latter are mainly women taking care for a partner or a child, the former report high levels of stress. Implications for intervention programmes and health policy are being discussed.     

‘I cannot be missed yet’: A qualitative study of carers of family members with an intellectual disability about long-term care planning during the COVID-19 pandemic

Background

Family carers of people with an intellectual disability sometimes need to transfer their caregiving tasks for example because of illness or ageing. We examined carers' experiences with long-term care planning and the impact of the COVID-19 pandemic on their intentions to engage in long-term planning in the Netherlands.

Method

Twenty-five semi-structured interviews with family carers of people with an intellectual disability were conducted and 169 answers to an open question were thematically analysed. Data collection took place at three timepoints during 2020 and 2021.

Results

Family carers were recurrently concerned with long-term care planning, especially with finding people to whom they can entrust their tasks. However, they perceived barriers in care planning. The COVID-19 pandemic reinforced awareness of long-term care planning and moved some to action.

Conclusions

The perceived urge to plan by family carers has grown due to the COVID-19 pandemic. The current study provides valuable insights for stakeholders to support them in this.     

Less money, less care: how nurses in long-term care allocate hours of needed care in a context of chronic shortage

The average funding of long-term care in Quebec, Canada, currently covers < 70% of the care hours required, which means that 30% of needs are unmet. The aims of this study were to understand how nurses, when they are in a position to do so, assign care hours, which needs are unmet by care dimensions and whether dimensions with unmet needs vary with client profiles. One-hundred-and-four nurses working in long-term care facilities participated in the study. They filled out individual questionnaires containing three case studies in the form of vignettes. When obliged to cut 30% of the care hours, the nurses ensured that treatment and diagnostic methods were done as prescribed and that vital feeding and elimination functions were preserved. However, they made the choice to cut some mobility and personal-care activities and, especially, communication with patients, families and other professionals. In this, they partly follow the theoretical care prioritization approach of Lefebvre and Dupuis, who take into account the degree of discomfort caused by the situation, the problem's place in Maslow's hierarchy of needs and the availability of a solution. Thus, although the choices made by the nurses follow a logical pattern, they could result in medium-term deterioration in the functional autonomy of their older patients. The overall consequences of these decisions are discussed.     

The family: long-term care research and policy formulation

In industrialized democracies, contractionist social welfare policies have transformed healthcare systems. This has led to reallocations of long-term care work that have perpetuated gender inequities. The appropriated work of female family caregivers substitutes for paid nursing work, and the household is the primary site for long-term care delivery. In this article, central premises of critical social theory are used to analyse current long-term care policy and to explicate how research facilitated the development of mixed economies of care. Problematic consequences of home caregiving are revealed through a depiction of contemporary Canadian families, a critique of the related empirical research literature, and a discussion of the assumptions that underlie long-term care policies. The article concludes with suggestions which nurse researchers could use to contribute to the reformulation of policies to render them just and equitable.     

Advanced home care: patients' opinions on quality compared with those of family members

Background. Advanced medical care in the patient's home setting is becoming more common. Many of the patients who receive this kind of care have severe illnesses and are unable to respond to questions about the quality of care. The research question was: are the patients’ opinions congruent with those of family members? Aim. To explore and compare the relationship between patients’ perception of the quality of care and close family members’ perception of this care as well as their perception of the patients’ perception. Methods. Sixty‐seven patients receiving advanced home care, 82 family members (54 matched patient + family member pairs) participated. Data were collected using a short version of the quality from the patient's perspective questionnaire modified to advanced home care. Results. A high degree of perceptual congruence was found between patients and their family members. The similarity was also high between family members’ own opinion and their appraisal of how the patient perceived the care. A subgroup of family members who met the patient once a week or less often deviated from this pattern. Conclusion. Patients’ views on the quality of care are congruent with the opinions of family members if they meet every day (live together) and share the same everyday and care‐related experiences. The results can be understood in the light of empathic accuracy theory. Relevance to clinical practice. The findings of this study have important implications for clinical nursing practice. Family members’ perception of the quality of care may be a valuable data source for nurses in the case of advanced home care if the patient and family member share the same everyday, care‐related experiences, otherwise family members’ perception tend to be more critical than those of the patients themselves.     

Staff satisfaction with work, perceived quality of care and stress in elderly care: psychometric assessments and associations

AIMS: To evaluate validity and reliability of three questionnaires measuring 'work satisfaction', 'patient care' and 'staff health' for staff in elderly care and to study the relationship between staff members' satisfaction with work and perceived stress. BACKGROUND: Increased workload, difficulties in recruiting and retaining nurses are reported in elderly care. Valid and reliable instruments measuring staffs' perceptions of work are needed. METHODS: A convenience sample of 299 staff answered the questionnaires. RESULTS: Factor analysis of 'work satisfaction' gave eight factors, 'patient care' four factors and 'staff health' two factors, explaining 52.2%, 56.4% and 56.8% of the variance. Internal consistency was mostly satisfactory. Multiple regression analysis revealed a model that explained 41% of the variance in perceived stress symptoms. CONCLUSIONS: There was support for the instruments' validity and reliability. Older age, higher scores/satisfaction with workload, cooperation, expectations and demands, personal development and lower scores on internal motivation contributed to less stress.     

Nurses' perceptions of quality and the factors that affect quality care for older people living in long-term care settings in Ireland

Aim. The aim of this research was to determine the factors that facilitate or hinder high quality nursing care for older people in long‐term care settings in Ireland. Background. The quality of care for older people living in long‐term care has been identified as an issue of concern in many nursing research studies. While many factors which have an impact on care have been identified, it is difficult to determine key factors from current research. Method. This was a mixed method study, which involved qualitative and quantitative approaches. A self‐response questionnaire was generated from data gathered by interview and analysis of literature. Information was collected from 498 nurses working in long‐term care settings within a Health Board. A 68% response rate was achieved. Factor analysis was used to identify facilitating and hindering factors of quality care for older people. Results. Nine factors where identified six facilitating factors of quality and three hindering factors of quality care. The six factors, which facilitate quality, were: an ethos of promoting independence and autonomy; a homelike social environment; person centred, holistic care; knowledgeable, skilled staff; knowing the person and adequate multidisciplinary resources. The three factors which hindered quality care; these were: a lack of time and patient choice, resistance to change and bound by routine. Conclusions. The findings of this research provide nurses with a clear set of facilitating and hindering factors of quality care for older people and reveal some of the complexities and challenges of providing this care. Relevance to clinical practice. Long‐term care is the home of many older people and attention within these environments to the facilitating and hindering factors of quality is required. It is hoped that the factors generated in this study add to understanding in relation to quality care and the factors that influence this.     

Measuring patient assessments of the quality of outpatient care: a systematic review

Rationale, aims and objectives The aim of the study was to answer three questions: first, what methods have been used to measure patient assessments of the quality of care? Second, how do outpatients rate their care? And third, what needs to be taken into account in measuring patient assessments of the quality of care? Methods Systematic review of the literature. Electronic searches were conducted on Medline, CINAHL and the Cochrane Database of Systematic Reviews. To be included, articles were to deal with patients’ assessments of health care in ambulatory units for somatic adult patients. They were to have been published between January 2000 and May 2005, written in English, Swedish or Finnish with an English abstract, and the research was to have been conducted in Europe. The search terms used were: ambulatory care, ambulatory care facilities, outpatient, outpatients, patient satisfaction and quality of health care. The articles were screened by two independent reviewers in three phases. Results Thirty‐five articles were included. The quality of care was measured using both quantitative and qualitative methods. Only a few studies relied on the single criterion of patient satisfaction for quality measurements. It is easy to identify common sources of dissatisfaction in different studies. Sources of satisfaction are more closely dependent on the target population, the context and research design. Conclusion Patient satisfaction is widely used as one indicator among others in assessing the quality of outpatient care. However, there is no single, universally accepted method for measuring this.     

Prevention, treatment and healing of pressure sores in long-term care patients

ABSTRACT Of 515 consecutive patients newly admitted to the long-term medical ward, 16% already had skin lesions which were classified as pressure sores upon arrival in the ward, and 7.6% developed pressure sores during the observation period which was more than three days but not more than 26 weeks. The relation between the condition of the patient and the development of pressure sores and their prevention and treatment was followed with a modified Norton scale. Proportionally more sores progressed which were initially recorded as skin discoloration as compared with the other stages, i.e. epithelial damage, damage to the full thickness of the skin and lesion with a cavity. Preventive measures were not used to a greater extent in those patients who developed pressure sores as compared with those who did not. Preventive measures were used rather as treatment or secondary prevention after a patient had already developed a lesion. The treatment measures were used in many different combinations. In this study no healing effect could be proved for the various treatment measures which were undertaken.