Residential care placement: perceptions among elderly Chinese people in Hong Kong

A qualitative study was designed to explore the perceptions of residential care placement among elderly Chinese people in Hong Kong. Content analysis of the semi-structured interviews with 20 community residents aged 60 years or over revealed that elderly people in Hong Kong generally had mixed feelings towards such placement. While they believed that residential care was an unavoidable alternative to family care in their later lives it was an important source of fear in their later years, especially for those who perceived their health as deteriorating. Residential care homes were generally seen as the ultimate 'dumping place' where one would 'idle till death' and the quality of care provided in these homes was anticipated to be problematic. It was found that most of these beliefs were formed as a result of indirect experience through 'listening to stories of neglect or abuse from friends and relatives whose relatives were residential care home residents'. Implications for professionals working with elderly people are discussed in the light of these findings.     

Transition to residential care: experiences of elderly Chinese people in Hong Kong

A qualitative study was designed to explore the experiences of transition into residential care among elderly Chinese people in Hong Kong. With the elderly people's consent, in-depth interviews were conducted with 10 residents 1 week after their admission into a residential care home. The purpose of the interviews was to explore what the transition experience was like for the Chinese elders and how they settled into residential life. Content analysis of the interview data revealed the significance of cultural influences in the transition experiences. A number of issues suggested in the literature as barriers to adjustment to residential care, such as living with rules and regulations, lack of privacy and autonomy were not regarded as important by the Chinese elders. The Chinese values of balance, harmony and collectivism have made it easier for them to remain open and accept the communal way of living. Yet, these same values have restricted the elders in developing new relationships with staff and other residents. This appears to be the particular challenge facing Chinese elderly residents. Implications for professionals working with elderly residents are discussed in the light of these findings.     

Chronic pain management: a qualitative study of elderly people's preferred coping strategies and barriers to management

Although the majority of pain complaints, in Australia, are among the elderly population, the focus of treatment is not on this age group. In order to achieve effective management of elderly people's chronic pain, their perspective of pain and coping strategies used needs to be understood. This qualitative study explored the preferred strategies of elderly people and the barriers they encountered in trying to manage their pain. Elderly people (n=72) with chronic pain, over 65 years of age and living in the community, were interviewed for the study. Data were collected using six focus group and 12 in-depth interviews and a biographical questionnaire. Preferred coping strategies were those that could be self-administered and included both physical and cognitive elements. Elderly people wished to be active in their treatment, make informed choices and were willing to try new methods. Least-preferred strategies were the conventional treatments of medications, exercise and physiotherapy. Many barriers have to be overcome to achieve relief for their pain such as cost, access to health care, related disorders, attitudes of health professionals, lack of communication and fear of losing independence. Health professionals need to be aware of elderly people's perspective of pain and their preferred strategies and reasons for these choices. Health services must meet their specific needs.     

Chronic pain management: a qualitative study of elderly people's preferred coping strategies and barriers to management

Although the majority of pain complaints, in Australia, are among the elderly population, the focus of treatment is not on this age group. In order to achieve effective management of elderly people's chronic pain, their perspective of pain and coping strategies used needs to be understood. This qualitative study explored the preferred strategies of elderly people and the barriers they encountered in trying to manage their pain. Elderly people (n = 72) with chronic pain, over 65 years of age and living in the community, were interviewed for the study. Data were collected using six focus group and 12 in-depth interviews and a biographical questionnaire. Preferred coping strategies were those that could be self-administered and included both physical and cognitive elements. Elderly people wished to be active in their treatment, make informed choices and were willing to try new methods. Least-preferred strategies were the conventional treatments of medications, exercise and physiotherapy. Many barriers have to be overcome to achieve relief for their pain such as cost, access to health care, related disorders, attitudes of health professionals, lack of communication and fear of losing independence. Health professionals need to be aware of elderly people's perspective of pain and their preferred strategies and reasons for these choices. Health services must meet their specific needs.     

Attitudes towards hospitalized older adults

BACKGROUND: A number of studies have explored nurses' attitudes toward older people. However many of those have produced inconclusive results. Moreover dated attitudinal measures have been used to answer a broad range of questions relating to older people. AIM: The aim of this paper is to report a study examining whether negative attitudes and beliefs toward older adults persist. METHODS: Focus group interviews were used identifying factors which may influence attitudes and beliefs both negatively and positively. Nine Registered Nurses from care of older adult areas, four from acute areas, six nurse teachers, and 17 nursing students participated in the study. Ten themes were identified from the findings. FINDINGS: The findings show that the student nurses had varying experiences in older adult settings. Some of which had the effect of turning them away from the specialty. However, nurses who worked with older adults were very positive about their work and the nursing opportunities they had to offer student nurses. They were rather critical of the content of the pre-registration curriculum, which they perceived to over-rely teaching the negative aspects of ageing, and there was also criticism of the currency of teachers' knowledge. Nurses who worked in acute settings also did not escape criticism, in that they were identified as attributing a lack of sense of humour to older adults. The limitations include the small sample size although it is congruent with qualitative research. CONCLUSIONS: All nursing staff need to be more aware of their influence on the attitudes of student nurses toward older people. Good practice includes the ability to demonstrate that older people in hospital settings are valued. Nurse teachers need to review the way they prepare students for this specialist work in order to avoid inadvertently conveying negative attitudes.     

Caregivers' beliefs regarding pain in children with cognitive impairment: relation between pain sensation and reaction increases with severity of impairment

OBJECTIVES: To determine whether caregivers of children with cognitive impairment (CI) have systematic beliefs regarding the pain of this special group of children and whether these beliefs are related to their general attitudes towards people with mental challenges, or their experience with, or knowledge about, children with CI .PARTICIPANTS: Sixty-five caregivers (52 parents and 13 health care providers) of children with significant CI. MEASURES: Caregivers completed the Mental Retardation Attitude Inventory-Revised and provided information regarding their previous experience and learning about children with CI. They also completed the Pain Opinion Questionnaire, indicating the percentage of children with mild, moderate, or severe/profound CI that they believe experience 5 facets of pain "less than", "the same as", or "more than" children without CI: sensation, emotional reaction, behavioral reaction, communication, and frequency. RESULTS: Caregivers believed children's pain Sensation becomes greater, relative to children without CI, as severity of CI increases and that pain reaction is most consistent with pain sensation for children with severe CI. They also believed children with mild CI may over-react to pain. Caregivers' beliefs regarding pain were not influenced by their general attitudes about people with mental challenges or by their experience with children with CI, but those with more learning regarding children with CI believed that they experience pain less than children without CI. CONCLUSIONS: Caregivers have a priori beliefs regarding pain in children with CI that vary with level of cognitive impairment and pain facet. These beliefs could impact children's care.     

Ethical dilemmas in charging for care: contrasting the views of social work and legal professionals

This article draws on the findings of a recent study funded by the Nuffield Foundation. The study explored attitudes, practices and policy in relation to charging and assessing older people who were considering entering residential and nursing home care. In five differing local authorities, a sample of social services practitioners (care managers) completed a postal questionnaire and interviews were held at a number of levels with staff. At the same time, independent legal practitioners in these areas, who are involved in advising older people, were surveyed and a small number of individual practitioners were interviewed. The focus of this article is on contrasting the attitudes and views of care managers and legal practitioners towards their work in relation to older people, finances and charging for long-term care. In particular, there will be an emphasis on the ethical dilemmas identified by the respondents from the different professions involved in the study.     

Focus group interviews as a data collecting strategy

BACKGROUND: Focus group interviews are a method for collecting qualitative data and have enjoyed a surge in popularity in health care research over the last 20 years. However, the literature on this method is ambiguous in relation to the size, constitution, purpose and execution of focus groups. AIM: The aim of this article is to explore some of the methodological issues arising from using focus group interviews in order to stimulate debate about their efficacy. DISCUSSION: Methodological issues are discussed in the context of a study examining attitudes towards and beliefs about older adults in hospital settings among first-level registered nurses, nursing lecturers and student nurses. Focus group interviews were used to identify everyday language and constructs used by nurses, with the intention of incorporating the findings into an instrument to measure attitudes and beliefs quantitatively. CONCLUSIONS: Experiences of conducting focus group interviews demonstrated that smaller groups were more manageable and that groups made up of strangers required more moderator intervention. However, as a data collecting strategy they are a rich source of information.     

Giving Voice to Elderly People: Community-Based Long-Term Care

Abstract Information gained from elderly people regarding their needs for community-based long-term care is necessary for informed and responsive policy development. Informed policy development is essential given demographic projections and the need to develop cost-effective alternatives to institutionalization. The purpose of this study was to understand the context within which elderly people would be able to continue residing in their communities. Programs have been developed based on providers' perceptions of services that are necessary to maintain elderly people at home. There is a lack of information about elderly people's perceptions. Data were collected from 9 elderly people who represented the phenomenon of being at risk for institutionalization. Participants were interviewed serially and contingently in stages using naturalistic methodology. The interviews were tape-recorded, transcribed verbatim, and analyzed by the inquirer. Findings of the study indicated that the desire of elderly people to stay at home is motivated by their need to maintain control over their daily lives and have their individualized needs addressed. Perceptions related to nursing homes, roles of family, essential services, and future needs for assisted living emerged as major themes. The findings suggest policy implications for professional nurses related to the long-term care system, providers, and nursing homes.     

Cultural diversity in heart failure management: findings from the DISCOVER study (Part 2)

Self-management is a critical dimension in managing chronic conditions, particularly in heart failure (HF). Knowledge, attitudes and beliefs, relating to both illness and wellness, are strongly influenced by culture and ethnicity, impacting upon an individual's capacity to engage in self-care behaviours. Effective management of HF is largely dependent on facilitation of culturally informed, self-care behaviours to increase adherence to both pharmacological and non-pharmacological strategies. The Understanding the cultural experiences of individuals with chronic heart failure (CHF) in South East Health (DISCOVER) study is an exploratory, observational study investigating health patterns, information needs and the adjustment process for overseas-born people with HF living in Australia. An integrative literature review was augmented by qualitative data derived from key informant interviews, focus groups and individual interviews. A key finding of this study is that culture provides an important context to aid interpretations of attitudes, values, beliefs and behaviours, not only in illness but in health. While individual differences in attitudes and beliefs were observed among participants, common themes and issues were identified across cultural groups. Data from the DISCOVER study revealed the primacy of family and kinship ties. These relationships were important in making decisions about treatment choices and care plans. Participants also revealed the critical role of the 'family doctor' in assisting people and their families in brokering the health care system. In this study, heart disease was considered to be a significant condition but cancer was the condition that people both feared and dreaded the most, despite the high mortality rates of HF. This sample reported that religious and traditional beliefs became more important as people aged and considered their mortality. As HF is predominately a condition of ageing, the information derived from this study will assist clinicians to tailor health care service delivery for older people with HF, across multiple ethnic backgrounds.     

The Future Care Plans of Older Adults with Intellectual Disabilities Living at Home with Family Carers

The topic of future care provision for adults with intellectual disability living in the family home is becoming of increasing interest to researchers since epidemiological evidence indicates that this group of people will make increasing demands for residential provision in the future. Deriving information from a previously reported study on the structure and characteristics of the informal support networks, this paper describes the future residential and financial provision planned for a group of people with intellectual disability over the age of 40 years living with relatives in the family home and investigates the factors which influence carers' decisions to plan for the future. A semi-structured interview enabled both quantitative and qualitative data to be collected. Results indicated that plans for the future residential care were minimal. Only 28% of carers had made any concrete plans for future residential care of their relative. In the majority of cases, carers were committed to maintaining long-term home care for their relative with intellectual disability for as long as possible. Attention is drawn to the significant number of elderly parental carers (82% of this sample) who have not made concrete future residential arrangements. Carers were more likely to establish financial plans than residential plans for their family member. No clear differences were found between carers to indicate factors influencing whether they had made preparations for the future. Explanations for the reluctance of carers to plan for the future were, therefore, explored. The overall conclusion to be drawn from the research is that ‘crisis’ resettlement due to ill health or death of the main carer is highly likely. The potential role of service-providers is briefly discussed.     

Registered nurses’ knowledge,attitudes and beliefs about end-of-life care in non-specialist palliative care settings: A mixed studies review

AimThe aim of this study was to describe, evaluate and synthesise the literature on registered nurses’ knowledge, attitudes and beliefs towards end-of-life care in adult non-specialist palliative care settings.BackgroundLittle is known about the knowledge, attitudes and beliefs of Registered Nurses working in non-specialist palliative care settings about end-of-life care.DesignA mixed-methods systematic review and narrative synthesis was conducted (PROSPERO Registration No: CRD4202148114). Five databases (Medline, CINAHL, PubMed, PsycINFO and Web of Science) were searched from inception to August 2020. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsNineteen studies met the inclusion criteria. Registered nurses in non-specialist palliative care settings demonstrated good knowledge of pain symptoms and management and positive attitudes towards caring for dying patients and their families. Knowledge deficits were identified in the psychosocial and spiritual aspects of end-of-life care and registered nurses reported negative attitudes towards communication about death. Only five of the included studies explored registered nurses’ beliefs towards end-of-life care.ConclusionsThere is a need to enhance palliative care education in clinical practice settings and in undergraduate programs to improve registered nurses’ knowledge, attitudes and beliefs about end-of-life care. Future studies that use reliable and validated methods to measure registered nurses’ beliefs about end-of-life care should be conducted.Tweetable abstractRNs in non-specialist palliative care settings want more education on pain management & greater knowledge on communicating about death/dying.     

Influence of a persuasive strategy on nursing students' beliefs and attitudes toward provision of care to people living with HIV/AIDS.

Based on the theory of planned behavior and the elaboration likelihood model, the aim of this study was to verify the effect of persuasive messages on nursing students' beliefs and attitudes regarding provision of care to people living with HIV/AIDS. The assumption was that a persuasive communication strategy induces a constructive change in beliefs and attitudes regarding provision of care. Baseline data collection was performed among a group of 74 nursing students (experimental group = 27; control group = 47). The questionnaire assessed the variables of the theory of planned behavior (i.e., beliefs, attitudes, perceived behavioral control). The results confirmed that persuasive messages generated a change in beliefs and attitudes of the nursing students concerning providing care to people living with HIV/AIDS. It appears that this strategy of modifying behavioral predispositions is effective and generates cognitive and affective changes. Therefore, educational programs should take these observations into consideration to ensure that future nurses are better prepared to provide appropriate care to people living with HIV/AIDS.     

Outcomes from the work of registered nurses working with older people in UK care homes

heath h. (2010) Outcomes from the work of Registered Nurses working with older people in UK care homes. International Journal of Older People Nursing 5 , 116–127 Aims and objectives. This research sought to illuminate the distinct contributions made by Registered Nurses (RNs) and Care Assistants (CAs) to outcomes for older people in UK (nursing) care homes and to identify the outcomes of their work. This paper reports on aspects relevant to RNs. Background. Older people living in long-term residential care settings around the world are among the most vulnerable individuals within their communities and those with the most complex needs. Nursing has historically been fundamental in the delivery of these services but, in some countries, the role of Registered Nurses in residential care is coming under increasing scrutiny, particularly in the context of escalating costs and funding restrictions, a questioning of the need for a 24-hour ‘health’ professional presence in a ‘social care’ service and a lack of evidence on the distinct contribution that RNs make to outcomes in these settings. Design. A multi-method qualitative interpretive approach, adopting a structure–process–outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer (2003) . Methods. For Phase 1 of the study, RNs and CAs from care homes around the UK contributed examples of their work, which they identified as having made a ‘significant’ difference to older individuals. Phase 2 comprised researcher fieldwork (observations, interviews and documentary analysis) in three care homes around UK. Research participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes. Results. RN roles in care homes are broad and multifaceted. Distinct outcomes of RN work are consequent to their caring and their knowledge and skills developed through broad experience in a range of healthcare settings. Outcomes for residents from RN work include enhanced personhood and wellbeing, improved health and function, the prevention of problems/adverse outcomes and enhanced quality of life. RN outcomes have positive impact on relatives, staff and the homes in general. Conclusions. There is potential to reconsider the broad, ‘anything and everything’ nature of the RN role in care homes identified in the research. However, given the complex healthcare needs of the current resident population, the 24-hour RN presence is deemed essential.     

"The food here is tasteless!" Food taste or tasteless food? Chemosensory loss and the politics of under-nutrition

A common complaint voiced by older people living in residential care is that the food lacks taste. When older people find food tasteless, the pleasure gained from eating and therefore, their appetite may be compromised, as will their food choices, nutrition, immune systems, functional status and well-being. However, often nurses overlook these symptoms as 'inevitable and irreversible' aspects of ageing, which they are not. In fact, many older people experience chemosensory (taste and smell) disorders or loss which means they lose the ability to taste the flavour of food. Commonly overlooked is the fact that chemosensory loss may well be a significant contributing factor to the high level of under-nutrition reported in residential care in Australia. Our purpose in this article is to explore important issues related to taste and smell dysfunction; the physiology of these sensations; several causes distinct from ageing; and interventions to help older people again enjoy their food with the concomitant advantages to their health and well-being. We also consider the way in which legislation related to Government funding has influenced gerontological nurses' assessment skills and values, particularly concerning nutrition assessment to the detriment of not only older people living in residential care but also the profession of gerontological nursing. Attention is drawn to the need for nurses to up-date their clinical knowledge, assessment skills and practice including enhancing the flavour of food and the social occasion of dining for older people living in residential care.     

Elders' needs and experiences of receiving formal and informal care for their activities of daily living

Older people living in the community or institutional settings are more likely to require help with their activities of daily living, with women more likely than men to need some help. The interviews in this qualitative study were conducted with a convenience and purposive sample of 20 elders living in Southeast Washington, USA, at home or in institutional settings, receiving informal or formal health care. Findings related to personal and instrumental activities of daily living are reported and include elders' experiences and views relating to the help and assistance they receive. The majority of elders needed help with their instrumental activities of daily living, provided by informal networks, whether living at home or in institutional settings. This help constituted social care. Formal health care with personal activities of daily living was required only by a minority of elders and constituted those with the greatest disability and dependency.