广州市养老机构护理人员人文关怀品质的现状调查

目的 了解广州市养老机构护理人员人文关怀品质现状和影响因素,为今后开展护理人员人文关怀教育,提升养老服务质量提供依据.方法 采用方便抽样的方法,抽取广州市8所养老机构270名护理人员为调查对象,使用一般资料调查问卷及护士人文关怀品质量表进行调查,并采用多元逐步回归法分析其影响因素.结果 广州市8所养老机构护理人员人文关怀品质总分（113.59±9.78）分,低于该量表设计者刘于昌等提供的2010年上海市部分综合性医院护士人文关怀品质评价的参考值（118.36±16.75）分,处于较低水平.护理人员的家庭所在地、政治面貌、同事关怀度、是否接受过人文关怀方面的教育培训不同,其人文关怀品质得分比较差异有统计学意义;多元线性回归分析显示,同事关怀度、是否接受过人文关怀方面的教育培训为主要影响因素.结论 广州市8所养老机构护理人员人文关怀品质偏低,关怀能力和关怀理念方面尤为薄弱.养老机构可与高校合作,制定一套养老机构护理人员人文关怀品质的培训课程,通过系统、规范的培训提升人文关怀品质,提高养老服务质量.     

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.     

Exploring the facets of continence care: a continence survey of care homes for older people in Birmingham

Aims. This study aimed to explore continence prevalence, knowledge and care in Birmingham care homes, UK. Background. There is an increasing need to respond to rising numbers of care home residents suffering from incontinence in the UK. A lack of staff knowledge, training and treatment options can make this problematic. Method. A survey was developed and sent to 186 care homes in Birmingham catering for those 65 years old and over. A freepost envelope was provided for return of the completed form. Results. Sixty‐six (35%) surveys were returned providing a representative sample. Eighty per cent of nursing home residents and 49% of residential home residents were reported incontinent. Half of the staff (53%) had some form of qualification in caring/nursing. Absorbent products were used to manage incontinence in over 50% of homes. Advanced age was cited as the main cause of incontinence. Sixty‐eight per cent of homes used the continence advisory service and/or district nursing services. Conclusions. While results proved encouraging in relation to numbers of qualified staff there is a need for improved continence awareness. Focus on aetiology, assessment procedures and treatment options are needed. While external service use levels were encouraging there appeared to be a need for an exchange of knowledge between services to optimize care. Relevance to clinical practice. While there is an existing body of knowledge relating to continence prevalence and management in nursing homes this research base is lacking for residential care settings. This survey addresses this imbalance by combining information from both settings. This paper also provides an insight into the components that have an impact upon continence promotion, prevention and management. By establishing a picture of current practice an indication of areas for improvement can be exposed.     

Discharging older people from hospital to care homes: implications for nursing

This paper summarizes a research study which explored the experiences of older people being discharged from hospital to nursing and residential homes in the North East of England. While there has been considerable research which has looked at the discharge of patients from hospital to their own homes, little literature could be found which addressed discharge to care homes. While this may reflect an assumption that this form of discharge is less problematic, it is arguable that this is only the case for staff - there is a body of literature on re-location which suggests that the move to a care home is a major life event for older people. Taking a qualitative approach, this study interviewed 20 older people and 17 of their family members after discharge from hospital to a care home. We found that few people had been offered opportunities to discuss their move with nurses, and that older people tended to adopt a stoical attitude. In focus groups, interviews and written responses from 23 members of staff in the hospital and in care homes, we found that there was a lack of clarity over whose role it was to initiate such discussions. The paper concludes with some discussion of the implications for nursing practice of changing care interfaces.     

A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care

hasson h. & arnetz j.e. (2009)   A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care. International Journal of Older People Nursing   5 , 5–15
doi: 10.1111/j.1748-3743.2009.00186.x
Background.  Comparisons of different stakeholders' ratings of the quality of older people care can help to drive quality improvement.
Aim.  The aim was to compare staff, older care recipients' and their relatives' quality of care ratings.
Design.  Cross-sectional questionnaire surveys in 2003 and 2004, using a repeated measures design on an organizational level.
Methods.  Nursing staff, care recipients and relatives in two older people care organizations were included. The ratings of an overall quality grade, information, activities, general care and staff skills were compared between the respondent groups.
Results.  Care recipients in both organizations rated the overall quality grade significantly higher than nursing staff and relatives. Staff ratings of the information given to care recipients were significantly more positive than care recipients' and relatives' ratings. All three groups gave lowest ratings to the quality of activities offered to care recipients, with lowest ratings from nursing staff.
Conclusions.  Concurrent measurements of staff, care recipients and relatives' care quality perceptions can provide a broad evaluation of an organization's strength and limitations.
Relevance to clinical practice.  Staff, care recipients' and relatives' perceptions can be useful for older people care organizations and decision makers in developing care processes and outcomes of care.     

Improving the oral health of older people in long-term residential care: a review of the literature

Background.  Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care.
Aims and objectives.  The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents.
Conclusions.  Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools.
Relevance to clinical practice.  The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.     

Retaining older nurses in primary care and the community

Title.  Retaining older nurses in primary care and the community.
Aim.  This paper is a report of a study conducted to examine issues associated with the impact of age on the retention of female primary and community care nurses in the National Health Service in England.
Background.  Little is known about why older nurses in the primary and community care workforce leave and what might encourage them to stay.
Methods.  A cross-sectional survey using a semi-structured postal questionnaire was carried out during 2005. Responses were received from 485 (61%) district nurses, health visitors, school nurses and practice nurses in five primary care trusts in England. Data were analysed to test for associations.
Results.  Older nurses were more likely than younger ones to report that their role had lived up to expectations ( P  = 0·001). Issues important for older nurses were feeling valued and being consulted when change was implemented. Important factors encouraging nurses to stay were pension considerations, reduced working hours near retirement, and reduced workload. For those with degree-level qualifications, enhanced pay was a factor encouraging retention ( P  = 0·044). Nurses might leave in response to high administrative workloads, problems in combining work and family commitments ( P ≤  0·001), and lack of workplace support ( P  = 0·029). Retirement and pensions advice was not widely available.
Conclusion.  Since two-thirds of nurses were generally happy in their role, it is important that the conditions necessary to maintain this level of satisfaction are continued throughout a nurse's working life. Nurses may all too easily consider leaving prematurely unless policy makers and managers ensure that their working environment reflects the issues nurses consider to be conducive to retention.     

How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse Analysis

Delirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease-based classification systems and clinical guidelines. There is little systematic study of nurses' day-to-day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses' care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses' language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person-centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion.     

Practice nurses and older people: a case management approach to care

Aim. This paper reports on aspects of a study designed to answer the research questions: (i) To what extent do practice nurses use the five cyclical elements of a case management approach when caring for people aged over 75 years? (ii) What determines or deters practice nurses’ use of the cyclical elements of a case management approach in caring for older people? Background. Case management is an approach that uses a cyclical process of assessment, planning, implementation, monitoring and evaluation to provide systematic proactive care to people with complex health and social care needs. In England, specialist practice nurse case managers for older people have been piloted in ten primary care trusts and the posts are to be implemented nationally by 2008. No baseline work has, however, considered the applicability of developing the existing generalist practice nurse workforce. Method. A 26‐item structured postal questionnaire was used to explore both practice nurses’ use of a case management approach when working with older people, and what factors influenced the care provided. A random sample of 500 practice nurses was selected from the Royal College of Nursing Practice Nurse Association member database. Results. A 45% response rate was achieved. Practice nurses assessed, planned and implemented care, but reviewing medication opportunistically and evaluating the care were uncommon. A case management approach was significantly (P = 0·005) more likely to be used in on‐going management activities than in one‐off treatment room care. Practice nurses with postregistration education in district nursing were significantly (P = 0·016) more likely to refer patients to social care services. Lack of time and the central role of the general practitioner were the main reasons for not incorporating case management into practice. Conclusions. The extent to which practice nurses used elements of a case management approach was highly variable and influenced by individual professional expertise, the nature of the consultation and the practice nurse's position in the general practice.     

Calling for an international dialogue on quality of life in care homes

meyer j. & owen t. (2008) International Journal of Older People Nursing 3, 291–294
Calling for an international dialogue on quality of life in care homes