Using the caring dimensions inventory as an indicator of person‐centred nursing

Aims. This paper reports findings from a large‐scale quasi‐experimental study that used a measure of caring as a means of evaluating person‐centred nursing and aims to illustrate the synergy between the concepts of caring and person‐centredness. Background. Evidence would suggest that effective person‐centred nursing requires the formation of therapeutic relationships between professionals, patients and others significant to them in their lives and that these relationships are built on mutual trust, understanding and a sharing of collective knowledge. This correlates with the conceptualisation of caring that is underpinned by humanistic nursing theories. Design. A pretest post‐test design was used in this study to evaluate the effect of person‐centred nursing on a range of outcomes, one of which was nurses’ and patients’ perception of caring. Methods. The Person‐Centred Nursing Index was the main data collection tool. The Caring Dimension Inventory and Nursing Dimensions Inventory, were component parts of the Person‐Centred Nursing Index and were used to measure nurses’ and patients’ perceptions of caring. The Person‐Centred Nursing Index was administered at five points in time over a two‐year intervention period. Results. Nurses had a clear idea of what constituted caring in nursing, identifying statements that were reflective of person‐centredness, which was consistent over time. This was in contrast to patients, whose perceptions were more variable, highlighting incongruencies that have important implications for developing person‐centred practice. Conclusion. The findings confirm the Caring Dimension Inventory/Nursing Dimensions Inventory as an instrument that can be used as an indicator of person‐centred practice. Furthermore, the findings highlight the potential of such instruments to generate data on aspects of nursing practice that are traditionally hard to measure. Relevance to clinical practice. The findings would suggest that nurses need to be aware of patients’ perceptions of caring and use this to influence changes in practice, where the prime goal is to promote person‐centredness.     

Evaluation of a model of nursing care for older patients using participatory action research in an acute medical ward

Aims and objectives. The main aim of this study was to improve the quality of nursing care for older acutely ill hospitalized medical patients through developing, implementing and evaluating a new model of care using a participatory action research process. Background. One of the challenges of nursing today is to meet the health‐care needs of the growing older population. It is important to consider what quality of nursing care means to older patients if nurses are to address gaps between their own perceptions and those of older patients themselves and to consider conceptual models of care appropriate for older patients care in order to improve the quality of care provided. Design. This study is a mixed method triangulated study, involving the use of both quantitative and qualitative methods through participatory action research methodology to establish an evidence‐base for an evolving model of care. Methods. The model was tested on 60 acutely ill patients aged at least 65 years. The medical ward nurses selected a key reference group including the researcher to facilitate the participatory action research process to develop, implement and evaluate a new model of care based on Orem's self‐care model incorporating the Nurses Improving Care to Health System Elders Faculty (Am J Nurs 1994; 94:21) medication protocol to improve the nursing care provided for acutely ill older patients. Results. The participatory action research process resulted in improved heath‐care outcomes for the patients, such as significant improvements in activities of daily living capabilities between admission to discharge, significant improvements in knowledge levels regarding their medication regimes, as well as increased satisfaction with nursing care activities as perceived by older patients and nursing staff. The implementation of educational sessions during the model of care improved the older patient's functional activities and knowledge levels of their medication regime prior to discharge. In addition, by repeatedly explaining procedures, nurses became more involved with their individual patient's care, developing a patient‐centred care relationship based on Orem's self‐care model. Conclusions. This study demonstrates the efficacy of a new model of nursing care in improving the quality of nursing care for older patients in the acute medical ward setting. Relevance to clinical practice. This study is significant because of its evidence‐base and demonstrates how the participatory action research process empowered nurses to make sustainable changes to their practice. The nurses in the study wanted to affect change. The planned change was not dictated by management, but was driven by the clinical nursing staff at the ‘grass roots’ level. Therefore, being involved in the decision‐making process provided an incentive to actively implement change.     

Bringing caring and competence into focus in gerontological nursing: a longitudinal, multi-method study

BACKGROUND: The recent literature suggests that caring has become increasingly devalued as health systems focus primarily on cure. This is a worrying trend, particularly for gerontological nursing, where cure is often not possible. Consequently, work with older people is often not seen as an attractive career option, a perception that is frequently reinforced during students' practise placements, which exert a considerable influence on the values that inform their future professional practise. AIMS AND OBJECTIVES: To explore longitudinally the way that students experience their placement, and to identify the characteristics of an 'enriched' environment of care that potentially creates a positive view of work with older people. METHODS: A multi-method longitudinal study using a constructivist methodology and comprising both conceptual and empirical phases was undertaken. This paper concentrates on the results emerging from 57 focus groups completed over a 3 year period in four School's of Nursing in England, short visits to 33 placement areas and in-depth visits to seven placement areas. FINDINGS: The paper describes a temporal model of the student placement experience in which their focus of attention and effort varies over time. Five 'foci' are identified-self as focus, course as focus, professional care as focus, patient as focus, person as focus. The extent to which students are able to achieve person as focus is crucially dependant upon the input of their mentor, and their exposure to enriched environments of care that can be understood in terms of the 'senses framework'. RELEVANCE TO PRACTISE: The paper describes several important ways in which students' placement experiences can be enhanced, enabling them to form and consolidate a more rounded and positive view of gerontological nursing. Numerous practical suggestions for achieving an 'enriched' environment of learning that enables students to appreciate the value of care as well as cure are identified.     

Person‐centred care: clarifying the concept in the context of inpatient psychiatry

This paper reports an analysis of the concept of person‐centred care in the context of inpatient psychiatry. It has been suggested that person‐centred care in inpatient psychiatry might differ from person‐centred care in other contexts, indicating a need to clarify the concept in this specific context. Scholarly papers from health‐related disciplines were identified following a systematic search of the electronic databases CINAHL, PUBMED and PsycINFO, covering records indexed up until March 2014. An evolutionary approach to concept analysis was applied, integrating principles for data extraction and analysis in integrative reviews. The concept of person‐centred care was defined as cultural, relational and recovery‐oriented. It aspires to improve care and calls for a transformation of inpatient psychiatry. The concept is closely related to the concepts of recovery and interpersonal nursing. The result is described in terms of attributes, antecedents, consequences and related concepts. It is concluded that the further development of the concept needs to consider the contexts of the concept at both conceptual and praxis levels. Further research should explore the nature of and relationships between context, culture, care practice and outcomes in inpatient psychiatry from a perspective of person‐centred care. The results of this analysis can provide a framework for such research.     

Processes,outcomes and evaluation: challenges to practice development in gerontological nursing

When aligned to participants’ needs, evaluation may be used to enhance practice developers’ work. Process evaluation enables practice developers to evaluate as they develop; making evaluation an integral part of practice development rather than an ‘add on task’. It is contended that beginning practice developers can discharge their need to evaluate their work through the practice development techniques of critical reflection, dialogue and action learning. These form the basis of iterative and formative evaluation activity. However other types of evaluation are important for different audiences in practice development. Consideration of the purpose and utility of evaluation in a range of contexts in which gerontological nursing occurs, brings some clarity regarding the scope of the evaluation required to sustain practice development initiatives. In addition, it helps to clarify the nature of the evaluation required to provide evidence of patient‐centred outcomes from developments in the practice of gerontological nursing.     

Working with older people: what do the next 10 years hold?

This article briefly considers the challenges facing gerontological nursing over the next 10 years. It suggests that future quality of care will depend largely on the ability to recruit and retain staff who actively choose to work with older people. This will mean raising the status and profile of gerontological nursing and identifying a philosophy that provides direction and purpose for future care practices.     

Methodological issues in interviewing families in family nursing research

AIM OF THE STUDY: The aim of this study is to discuss what methodological problems can be met in family research with one family member as an interviewee speaking on behalf of the whole family and, vice versa, what is the meaning of having multiple family members or the whole family unit as informants. BACKGROUND: Family nursing research is part of multidisciplinary research with families. It is a basis for family nursing and contributes to research, especially from the perspective of family welfare and its promotion. Family nursing research generates knowledge concerning families' and family members' wellbeing and experiences and expectations of nursing and health care. METHODS: The examination of methodological problems while pursuing family research is based on two studies conducted in Finland. FINDINGS: Quantitative methods add to the general knowledge of families. Qualitative methods are well suited to the study of family experiences. Family interviews performed for research purposes differ from interviews aiming at caring for families. They aim at obtaining knowledge of families on a general level so as to improve family nursing. Family research has to be looked at as a whole. It faces many challenges such as the definition of the family, gaining access, methods of data collection and data management. CONCLUSIONS: A family is a complex system and research with families need flexible, sensitive and practical methods. Family research should also aim at developing new methods for data collection and analysis.     

Students' ideals for nursing older people in practice

Aim. Drawing on research exploring nursing students’ experiences of working with older people, this paper aims to demonstrate how context and culture can impact on the realization of their ideals. Background. The principles underpinning individualized and person‐centred approaches to care resonate with those focal to gerontologic nursing. Restrictive contexts of care and pervasive workplace cultures render nurses unable to deliver care in accord with these. Design and method. This interpretive study was informed by phenomenological–hermeneutic theory. A purposive sample (n = 10) was recruited from a single educational institution. Data were generated in two phases using loosely structured interviews and supplementary activity. Themes explicating their experiences were identified via systematized detailed analysis and issues pertaining to nursing students’ orientation towards older people cut across these. Findings and discussion. Students perceived that older people were prone to depersonalization and marginalization, so sought to show respect by coming to know individuals, form human connections with them and personalize care accordingly. Giving respect, promoting personhood, asserting reciprocal identity and maintaining dignity were prominent features of this but were often frustrated by practices and cultures encountered in mainstream settings. Conclusions. Nursing students’ approaches to older people are contextual and reflect elements of person‐centred ideology. Their attempts upholding their ideals are liable to be subverted by workplace norms. Preparatory education should address these, assist students to learn how to attend to personhood in restrictive environments and offer targeted placements in age‐specific and non‐acute services. Relevance to clinical practice. Demographic trends mean that working with older people has increased significance for nurses in most settings. Person‐centredness is seen as beneficial for older people but contemporary service imperatives and enduring practices are inhibitory, preventing entrants to nursing from developing related skills.     

Cancer and older people

This article considers some causes of cancer, diagnostic assessments and treatment options, as well as some of the myths surrounding the appropriate care of older people with cancer. It stresses the importance of employing the specialist knowledge of gerontological and cancer professionals in caring for the older person with cancer, and emphasises the central role of the nurse in delivering effective care.     

Concerns relating to the application of frameworks to promote person‐centredness in nursing with older people

There is an increasing need to develop a multi‐dimensional discussion and critique around the concept of ‘person‐centred’ in the context of the delivery of nursing care for older people. As the context of nursing being considered here, it is primarily nurses who should be leading with this discourse, although drawing on a broad range of ideas from outside of nursing. The person‐centred movement, commonly believed to originate in the care of those with dementia in the UK, is growing, especially in the UK and Australia, with signs of it moving across parts of Western Europe and North America. Person‐centredness has a big emotional appeal to many nurses working with older people, perhaps because it ‘has the right feel’ for them and nurses believe it ‘feels right’ for older people. It has grabbed the attention of many practising nurses in the UK in a way that humanistic nursing theory and the various associated nursing models from previous decades, seemed to have missed. This paper contributes to the discussion by suggesting that there are conceptual frameworks that nurses can draw on to help them understand and enhance their practice. However, it is suggested that these frameworks are either in their infancy or incomplete and they still need to convince nurses of their utility for day to day practice. It is also pointed out that the underpinning concept of ‘personhood’ has not yet been fully clarified by nursing.     

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.     

Gerontological nursing. 1: Challenges nursing older people in acute care

This article, the first in a series of five, will briefly trace the emergence of gerontological nursing and highlight some of the tensions that currently exist in the context of acute care environments. The next two articles will consider the prospects and challenges for nurses working with older people in community and nursing home environments, while the fourth article uses hearing impairment across a range of care contexts as a case study to summarize the ways in which the nursing contribution to the health needs of older people could be significantly improved. The series will conclude with an article drawing together the challenges that gerontological nursing faces in the new millennium.     

The use of physical restraint in institutional care of older people in Finland: nurses’ individual,communal and alternative modes of action

Aims and objectives. The aim of the study was to map nursing staff’s individual, communal and alternative modes of action in situations where they used physical restraint of older people in Finland. Background. The use of physical restraint in institutional care of older people involves modes of action that are linked to the personalities and modes of operation of individual nurses or to communal modes of operation mutually agreed on in the workplace. Nurse’s individual modes of operation are linked to consideration towards older people when using physical restraint. Communal modes of operation include joint discussion among nurses, decision‐making and written guidelines concerning the use of physical restraint. Design. A quantitative survey. Methods. The data were collected from nurses (n = 1148) working in healthcare centre wards, municipal and private nursing homes in Finland using a structured questionnaire (response rate 78%). Results. Older nurses and those with the longest working experience were most active in using individual modes of operation in situations where physical restraint was applied. Nurses’ participation in continuing education in care of older people increased the use of both individual and alternative modes of action. The alternative modes of action were one that understands the older person and one that focuses on negotiation. The use of physical restraint was often discussed in the workplace during information sessions or during work, but only 33% had written guidelines on the use of physical restraint. Conclusions. Education can be used to increase nurses’ ability to use alternative modes of action and thus decrease the use of physical restraint in institutional care of older people. Nursing management has a key role in making sure that units caring for older people receive written guidelines on the use of physical restraint. Relevance to clinical practice. Locums especially need more education to avoid the use of physical restraint.     

Using action research to construct national evidence-based nursing care guidance for gerontological nursing

Aim. This paper explores the development of a low‐cost, involving methodology for constructing nursing‐focused evidence‐based national care guidance, known as Best Practice Statements, the intended users of which are gerontological nurses practising throughout Scotland. Design. The Best Practice Statement construction methodology forms one cycle in a five‐year longitudinal action research study that aims to achieve evidence‐based nursing, facilitate professional networking to support practice development and promote the principles and practice of gerontological nursing. Achieving these aims involved designing a virtual Practice Development College. Methods. A Community of Practice comprising practising gerontological nurses, expert advisors, academic teaching and research nurses collaborated in face‐to‐face meetings and in the virtual Practice Development College to delineate and refine the procedural model for Best Practice Statement construction. Focus groups, telephone interviews, analysis of on‐line archives and documentary outputs formed the analytic dataset. Results. Qualitative analysis indicated that, from the perspective of the community of practice, the emerging methodology facilitated the melding of knowledge sources reflecting the dominant evidence hierarchy with other forms of evidence valued by gerontological nurses, in the Best Practice Statement. Relevance to clinical practice. Current methods of care guidance construction rarely address the concerns of nurses and the evidence from which guidelines are developed is narrowly defined with regard to inclusion and acceptability. In contrast this model focuses on nursing issues, embraces a wider definition of evidence and ensures that the published Best Practice Statements are credible and achievable in gerontological practice, where they are tested and refined as an inherent aspect of the development process.     

Essential gerontological content for the associate degree nursing curriculum. A national study

1. The growing number of associate degree registered nurses caring for the elderly underscores the need for gerontological nursing preparation within associate degree programs. 2. The curriculum content validity theory of Taba and Zoot requires content selection criteria to reflect the relationship of course content to program outcomes. 3. Appropriateness of gerontological content for associate degree nursing was defined by the five practice roles of the associate degree nurse. 4. Gerontological nursing content rated essential by nationwide panels of associate degree nursing educators and practicing nurses includes items within the areas of commonly encountered health problems, ethical issues, chronic illness, long-term care of older adults, and nursing process.