The implementation of snoezelen in psychogeriatric care: an evaluation through the eyes of caregivers

Many intervention studies lack an investigation of the extent to which the intervention was implemented as intended, which makes outcome measures difficult to interpret. The aim of the present study was to gain insight into the implementation process of snoezelen in 24-h dementia care. The intervention in each of six experimental wards comprised training sessions in 'snoezelen for caregivers', evaluated using a questionnaire. To study experience with implementation, the follow-up and general meetings (20 in total) were attended and semi-structured interviews (six in total) were conducted. The results indicated that the implementation of snoezelen effected a change from task-oriented care to resident-oriented care. The nursing assistants also experienced changes at the resident level and organisational changes. However, the lack of intervention in the organisational structure and obstructive factors such as under-staffing seemed to get in the way of the integration of multi-sensory stimulation in the daily care in two of the six wards.     

Restorative care nursing activities: pilot testing self-efficacy and outcome expectation measures

Implementing restorative care programs often involves changing the behavior of individuals who work in long-term care settings. The theory of self-efficacy has been used to facilitate such change. The purpose of this study was to test two new measures, the Self-efficacy for Restorative Care Nursing Activities and the Outcome Expectancy for Restorative Care Activities. The study included a sample of 27 nursing assistants; testing was done at baseline and repeated 2 weeks later. Developing reliable and valid measures of self-efficacy and outcome expectations for nursing assistants' performance of restorative care activities is useful to help establish weaknesses in the expectations of nursing assistants and allow for the development and testing of interventions to strengthen self-efficacy and outcome expectations related to restorative care activities and thereby improve adherence among nursing assistants.     

Use, misuse and non-use of health care assistants: understanding the work of health care assistants in a hospital setting

AIM(S): This study is concerned with understanding the work of non-registered nurses (health care assistants) in a UK hospital setting. BACKGROUND: There are increasing numbers of health care assistants employed by the National Health Service in the UK to support registered nurses providing nursing care. However, little is known about the make-up of the health care assistant workforce and the changing nature of their role. This study addresses some of these gaps in the research-based literature. METHODS: A single case study design using mixed methods (survey, interviews, participant observations, focus groups and documents) was used to generate an in-depth account of health care assistants' work in one organization. The study is built upon what health care assistants say they do, compared with what they actually do in practice. It explores how and whether the work of health care assistants is adequately supervised, tensions between the work of health care assistants and registered nurses and the subsequent effects on teamwork and patient care. FINDINGS: There are policy expectations associated with the work of health care assistants. However, this study reveals significant deviations from these goals. The workplace arena and the negotiations between health care assistants and registered nurses that take place within it, actively shape the health care assistants' work. Findings suggest dynamic patterns of use, misuse and non-use of the health care assistants as a resource to patient care. DISCUSSION AND IMPLICATIONS FOR PRACTICE: The changing roles of registered nurses have direct implications for the roles of health care assistants: as registered nurses take on extra duties and responsibilities they are conceding some of their role to health care assistants. This has implications for nurse managers. The competence of health care assistants to carry out nursing work needs to be reassessed and there also needs to be ongoing monitoring and supervision of their work to maximize, and further develop, their contribution to patient care and to ensure quality standards. Managers also need to be aware of the importance of workplace negotiations in the interpretation of formal policies and the subsequent shaping of health care assistants' work at the level of service delivery.     

The effect of a feeding skills training program for nursing assistants who feed dementia patients in Taiwanese nursing homes

A quasi-experimental 2-group repeated-measures design was used to test the impact of a feeding skills training program on 67 nursing assistants (treatment group n = 31; control group n = 36) regarding their knowledge, attitudes, perceived behavior control, intentions, and behaviors in feeding dementia patients. The treatment group received a feeding skills training program. Nursing assistants' knowledge, attitudes, perceived behavior control, and intentions were measured before (Pretest) and after the program (Posttest 1), and again 4 weeks later (Posttest 2). Nursing assistants (treatment group n = 20; control group n = 16) and the same number of dementia patients were measured on feeding behaviors during mealtimes before and after the training. The treatment group had significantly more knowledge (P < .001), greater intention to feed (P = .05), and better behaviors toward feeding dementia patients (P = .009) than the control group. There were no significant differences between the groups in attitude (P = .85), intention beliefs (P = .11) or perceived behavior control (P = .99). Thus, the intervention was effective at changing knowledge, intention, and behaviors among nursing assistants.     

Using drama to improve person-centred dementia care

kontos p.c., mitchell g.j., mistry b. & ballon b. (2010) Using drama to improve person-centred dementia care. International Journal of Older People Nursing 5 , 159–168 Aims and objectives. We implemented a 12-week drama-based educational intervention to introduce to dementia practitioners person-centred care that emphasizes the notion of embodied selfhood (defined as non-verbal self-expression). Background. Person-centred dementia care guidelines emphasize the assessment of individual needs, and where appropriate, the use of non-pharmacological interventions before resorting to pharmacological management. However, dementia care is not consistent with these guidelines suggesting conceptual limitations and reliance on passive knowledge translation strategies. Design and methods. Focus groups and semi-structured interviews with practitioners (n = 24) in two nursing homes in central Canada were undertaken to assess the effectiveness of the drama-based components of the intervention. Results. Our findings suggest that drama was effective as an educational modality, and helped implement the person-centred approach into practice. Significant practice outcomes included: new awareness that residents’ body movements and dispositions can convey meaning; seeking biographical information from families; increased time efficiency; and supporting residents’ independence. Conclusions. Our findings make an important contribution to person-centred dementia care by broadening the notion of personhood, and by facilitating implementation using drama. Implications for practice. As an enhancement of person-centred care, the support of embodied selfhood may significantly improve residents’ quality of life, quality of care, and practitioners’ care-giving experience.     

Nursing assistants' perceptions of their ability to provide continence care

More than 50% of all elderly nursing home residents suffer from urinary incontinence (UI). Although effective urinary continence programs exist, successful implementation continues to be a problem. This qualitative study involved seven focus groups of three to seven nursing assistants each (total n = 31) to examine their perceptions about factors that either promote or inhibit continence care. Better cooperation and increased communication emerged as factors that would improve teamwork and decrease workload. This article includes quotes from individual nursing assistants and a discussion of the factors most commonly identified as promoting or inhibiting care. Nursing assistants are valuable members of the health care team. Knowing their perceptions should allow professional nurses and facility administrators to develop continence programs that better meet the needs of both the nursing assistants who implement them and the residents for whom they care.     

对我科基础护理实施现状及认知的调查与分析

目的了解护理人员基础护理实施现状,以便采取有效对策,提高基础护理质量,为病人提供更优质的服务。方法采用自行设计问卷对护士、护生、护工及病人进行调查,了解我科护理人员基础护理的实施现状及认知情况。结果护理人员缺乏对基础护理内涵的认识,过分依赖于护工,导致基础护理落实不到位。结论要提高基础护理质量,必须注重护士、护生职业素质的培养、教育,转变观念及态度,增强其主动服务意识,明确护工职责,加大护理管理力度。     

The meaning of work for nursing assistants who stay in long‐term care

Aims and objectives. The purpose of this study was to investigate the meaning of work for nursing assistants who stay in long‐term care. Background. Nursing assistants are important caregivers in long‐term agencies. While studies have examined why nursing assistants leave, their motivation to stay has not been well studied. Design. An existential‐phenomenological study was conducted using Pollio's approach. Methods. In‐depth interviews were conducted with 11 nursing assistants in four nursing homes. Interviews were analysed within the context of an interpretive research group. Findings were represented in a diagram of interrelated figural/ground themes. Conclusions. The meaning of work emerged as an experience of family, pride and control, in spite of an environment fraught with hostility, disrespect and lack of control. Relevance to clinical practice. Nursing assistants provide most of the care to residents of long‐term facilities. Understanding their perspective offers insight into nursing administrators in creating environments in which safe, compassionate and cost‐effective care co‐exist. Implications for clinical practice are framed within King's theory of goal attainment.     

Professionalising care into compliance: The challenge for personalised care models

One of the most basic understandings of nursing is that a nurse is a caregiver for a patient who helps to prevent illness, treat health conditions, and manage the physical needs of patients. Nursing is often presented as a caring profession, which provides patient care driven by ideals of empathy, compassion and kindness. These ideals of care have further been foregrounded through the development and implementation of stress on patient centred care (PCC) and/or person-centred practice (PCP). Although the idealisation of nursing as a caring profession is common, and one certainly seen as integral by nurses and written into the heart of regulatory documentation, we contend that the actual delivery of care is being undercut by the very regulatory climate that strives to professionalise care. As we outline, with specific reference to the context of Australian Nursing, this transformation delivers a commodified, even McDonaldized, model of patient management rather than care. It seems that even with its explicit stress on PCC and PCP, Australian Nursing cannot live up to its own care ideals. Having outlined this problem, the paper then demonstrates the ways in which PCC is thwarted at the coal face of nursing practice and that there must be an institutionalised change to be able to provide genuine patient-centred care.     

养老院护理员对老年痴呆病人护理的认知和依从性研究

[目的]研究养老院护理员(简称养老护理员)在护理老年痴呆病人方面的认知和依从性情况。[方法]利用自行设计的调查问卷,对248名养老护理员的认知和依从性两方面进行调查,并进行量化分析。[结果]年龄<40岁,工作年限为1年~3年,高中或以上文化程度的养老护理员对老年痴呆病人护理认知程度提高、依从性最好;认知程度低组和依从性差组主要归因于疾病护理、生活护理、心理护理这3个方面得分较低,而安全护理方面与对照组无显著性差异(P>0.05)。[结论]精选执业人员,加强职业教育,建立监督机制是提高养老护理员对护理痴呆老人的认知和依从性的3个重要举措。     

An interprofessional collaboration of care to improve clinical outcomes for patients with diabetes

ABSTRACT

This project addressed interprofessional team-based care to improve management and outcomes of complex patients with diabetes. A collaborative model between Family Medicine and Nursing was developed to determine if having nursing students as case managers would improve the quality of care. From 2015–2016, patients with diabetes at greatest risk for poor outcomes (N = 58) received an intervention from senior nursing students (N = 6) at a Family Practice Center. Nursing students shared responsibilities with physicians, medical students, and medical assistants to deliver high quality care. For the intervention, nursing students reviewed charts, called patients for follow-up visits, and facilitated patients’ adherence to providers’ recommendations. Students also conducted group education sessions on nutrition, medication adherence, obesity, and exercise for patients. The control group included 61 randomly selected patients with diabetes who did not receive the intervention during the same period of time. Compared to the control group, the intervention group showed significantly improved outcomes in HgA1C levels (66% vs. 40.8%; p = .009), blood pressure control (61.1% vs. 36.8%; p = .009), and urine microalbumin test completion (87.5% vs. 48.3%; p< .0001). Outpatient practices offer an optimal opportunity for nursing students to practice case management. This team-based care approach suggests better outcomes for patients with diabetes.     

护理干预对乳腺癌癌性疲乏患者生活质量的影响

目的:探讨护理干预对乳腺癌癌性疲乏患者生活质量的影响。方法:选择我院2009年1月～2012年12月收治的乳腺癌患者100例,将其随机等分为观察组和对照组。观察组实施护理干预方法,对照组则实施常规护理,如体位护理、饮食干预、一般护理、心理干预等,比较两组患者干预后Piper疲乏量表结合应对量表得分情况、生活质量及对护理工作满意度。结果:观察组行为及严重程度、情感、感觉、认知及情绪应对量表得分低于对照组(P0.05),活动能力、健康感受、日常生活、生活感受及家庭支持得分高于对照组(P0.05),患者对护理服务、护理技术、心理关怀、住院环境满意度高于对照组(P0.05)。结论:护理干预能促使患者以更为积极的态度面对乳腺癌的发生,同时改善发病后的生活质量,增进护患关系,提高护理满意度。     

'Knowing what makes them tick': Motivating cognitively impaired older adults to participate in restorative care

Nursing home residents with dementia represent a majority of the most functionally impaired individuals residing in nursing homes. Although many perceive this population as having little restorative potential, maintaining resident functional abilities for as long as possible helps to optimize quality of life and decrease caregiver burden. This study used a qualitative design with a focus group methodology to explore facilitators and barriers to engaging cognitively impaired residents in functional activities and exercise. A purposive sample of seven geriatric nursing assistants who were experts in dementia care participated in the study. Twenty-seven codes were reduced to three themes: (i) knowing what makes them tick and move; (ii) teamwork and utilizing resources; and (iii) barriers to restorative care. The study findings were used to revise the Restorative Care for the Cognitively Impaired Intervention and could direct future implementation of programmes in nursing home settings.     

Work motivation for Japanese nursing assistants in small- to medium-sized hospitals

Nursing assistants can work without a professional certification to help registered nurses and licensed practical nurses. Nursing assistants engage in various tasks, e.g., washing laundry, cleaning up, and clerk tasks regarding nursing. Enhancing work motivation among nursing assistants is essential for every hospital, because when nursing assistants do their jobs well, it allows registered nurses and licensed practical nurses to complete their own specialized jobs. We examined the predictors significantly associated with nursing assistants' work motivation. For those predictors, we produced items to examine job satisfaction. Those items are classified into intrinsic and extrinsic facets. The subjects for this study were Japanese nursing assistants working in 26 hospitals with 62-376 beds (4 public and 22 private hospitals). A total of 516 nursing assistants were analyzed, with the average age and standard deviation of 42.7 ± 12.9 years; the age of 456 female subjects was 43.8 ± 12.7 years and that of 60 male subjects was 34.3 ± 11.0 years. Our results show that "work motivation" is significantly associated with "free time to do one's own things," "nursing assistants as important partners on the job," "feeling helpful to patients," "participating in decision making," and "job-skill improvement." Free time to do one's own things is an extrinsic item. Hospital administrators must monitor the workload and their quality of life among nursing assistants. All the other significant items are intrinsic. Nursing assistants are not only motivated by money. They highly value the intrinsic nature and experience of their jobs.     

A communication intervention for nursing staff in chronic care

Title.  A communication intervention for nursing staff in chronic care.
Aim.  The paper is a report of a study conducted to evaluate the effect of a brief, focused educational intervention on the quality of verbal interactions between nursing staff and patients in a chronic care facility.
Background.  Positive nurse–patient communication in chronic care is crucial to the quality of life and well-being of patients. Despite this, patients are dissatisfied with these interactions and nursing staff indicate the need for additional training.
Method.  A repeated-measures design was used to collect data between April 2003 and February 2004, by audiotaping verbal interactions between nursing staff and patients during morning care. Baseline data were analysed and an educational intervention was developed based on the results of the pretest. Five months after the educational intervention, interactions between the same nursing staff and patients were audiotaped. Twenty-seven randomly chosen patients and selected nursing staff participated in the study. Data were analysed using a qualitative comparative method, and a quantification technique was developed to compare the quality of the interactions before and after the intervention.
Findings.  Preintervention interactions were task-oriented, superficial and dominated by nursing staff. Results statistically significantly improved after the intervention was implemented. Nursing staff were less authoritative, used more solution-focused communication and interactions had a statistically significantly higher positive ratio.
Conclusion.  Brief interventions can change nursing staff's communication practice and they realized the importance of effective communication as a fundamental component to deliver patient-focused care.     

护理干预对慢性阻塞性肺疾病患者的影响

目的:探讨护理干预对慢性阻塞性肺疾病(COPD)患者的影响.方法:将180例COPD患者随机分为观察组和对照组各90例.对照组给予常规护理,观察组在此基础上加强病房环境管理、心理护理、吸痰护理、人工气道护理及口腔护理等护理干预.对两组临床疗效及遵医情况进行统计比较.结果:观察组临床疗效及遵医情况均优于对照组(P<0.05).结论:护理干预对提高COPD患者的治疗效果有重要意义,值得临床推广应用.     

Differentiated practice, patient-oriented care and quality of work in a hospital in the Netherlands

This article describes a quantitative study of the relationship between differentiated practice on the one side and patient-oriented care and quality of work on the other. Nursing wards where differentiated practice has been implemented (intervention group) have been compared with wards where differentiated practice has not been implemented (reference group). The research variables with regard to differentiated practice, patient-oriented care and quality of work have been measured by questionnaires. Subjects were 68 nurses and six supervisors from six nursing wards from one hospital. The results show that the extent to which differentiated practice had been implemented varied between the wards. With regard to patient-oriented care differences have been found between the intervention and reference group on the variables patient assignment and use of the nursing process, but not on the variables of tasks and communication. Concerning quality of work, differences have been found on: social support from the supervisor, social-emotional leadership and health complaints. Rank order correlations between differentiated practice and patient-oriented care and between differentiated practice and quality of work were not significant. Practical implications with regard to the use of differentiated practice and implications for further research are discussed.