'Mastering an unpredictable everyday life after stroke'--older women's experiences of caring and living with their partners

Scand J Caring Sci; 2012; 26; 587–597 ‘Mastering an unpredictable everyday life after stroke’– older women’s experiences of caring and living with their partners Introduction: The shift from older persons living in institutions to living in the community naturally affects both the older persons and their partners. The informal care is often taken for granted, and the research that focuses on the diversity of older female carers needs is scarce. Aim: To explore and learn from the older women how they experience their life situation and formal support as carers of their partners after stroke and to suggest clinical implications. Method: The design of the study is qualitative being based on the focus group method. Sixteen carers, median age 74 years (range 67–83), participated in four focus group discussions, which each met once for not more than 2 hours. Findings: The discussions resulted in one comprehensive theme; ‘Mastering an uncertain and unpredictable everyday life’. Three subthemes emerged from the material: ‘Living with another man’ where the carers discussed not only the marked change in their partner’s personality, but also the loss of a life‐companion and their mutual intellectual contact; ‘Fear of it happening again’, comprising the carers’ experiences of fear and confinement, of always having to be ready to help and of being trapped at home; ‘Ongoing negotiation’, referring to the carers’ struggling and negotiating not only with their partners, but also with themselves and formal care for time to themselves. Conclusion: This study helps us to understand how these older women tried to master an uncertain and unpredictable life. Their life had changed radically; now they were always on call to help their partners and felt tied to home. The results draw attention to the carers’ need for time to themselves, a greater knowledge of stroke and continuous support from formal care.     

A systematic review of the effectiveness of in-home community nurse led interventions for the mental health of older persons

Aims and objectives. The aim was to systematically review evidence about the effectiveness of in‐home community nurse‐led interventions for older persons with, or at risk of, mental health disorders, to inform best practice nursing care with this focus. The primary review question was ‘How effective are in‐home community nurse‐led interventions for older persons with or at risk of mental health disorders for improving mental health?’ The outcome indices of interest were nursing actions to determine incidence or prevalence of mental health disorders, any change in a patient’s attitude towards their mental health condition, any change in objective measurement of mental health, or a change in diagnostic status. Background. The rising incidence of mental health disorders in older persons is a major concern for community nurses in developed countries. Effectively facilitating improved mental health for older persons is necessary in this era of ageing populations with increased demands on health funding. Disseminating systematically reviewed evidence for in‐home community nursing that positively impacts on the mental health of older persons is crucial to ensure effective care is provided to this vulnerable patient group. Results. This review reveals that there is evidence to support the superiority of applying validated screening tools for mental health disorders over relying on community nurses’ opinions and non‐validated tools about this matter. Design. Systematic review. Methods. Search of electronic databases. Conclusion. A clear need for replication and multi‐centre trials of reviewed pertinent studies is identified. Relevance to clinical practice. Community nurses should consider using validated screening tools for this focus. Until such time as higher quality evidence is available about other nursing interventions, the reviewers suggest that the prime nursing action should be the identification of whether older persons receiving community nursing care might have a mental health disorder and, if so, then collaborative referral is made to appropriate services.     

The feeling of being trapped in and ashamed of one's own body: A qualitative study of women who suffer from eating difficulties

The aim of this study was to explore women's bodily experiences of suffering from eating difficulties (ED). The research question was: How do women who suffer from ED experience the bodily aspects related to their condition? Women suffering from ED experience problems in both the physical and emotional areas. Few qualitative studies have specifically addressed sufferers' bodily experiences related to ED. An explorative design was used. The data were collected by means of focus group interviews on the subject of ED‐related problems, guilt and shame, and being a mother. The interpretation of the qualitative data was inspired by hermeneutic content analysis. The main theme, ‘Powerful feelings of being trapped in and ashamed of one's own body’, comprised two themes: ‘The feeling of being trapped by overwhelming physical sensations’ and ‘The feeling of being ashamed of one's own body’. Bodily experiences were reported as strong. One clinical implication for nurses is to acknowledge this fact and make it possible for these women to articulate their difficulties, especially those connected to the feelings of being trapped and ashamed. Support groups focusing on these themes could be one way of assisting women and easing some of the negative feelings associated with ED.     

Daily life after moving into a care home--experiences from older people, relatives and contact persons

Aims and objectives. To describe older people's experiences of daily life at the care home after admittance with respect to their perceptions of participation in the decision to move. Furthermore, the aim was to study the experiences of their relatives and contact persons with respect to the daily life of the same residents. Background. When older persons move into a care home, the whole family often play an important part. Thus, it is interesting to study how newly admitted older people, their relatives and staff members experience daily life in a modern care home. Methods. Qualitative design. The participants comprised a purposive sample of 13 residents, recently admitted to a care home, 69–90 years old, both single living and married, both moving from their own homes and from different institutions. Interviews were carried out with the older people (n = 13), their relatives (n = 10) and contact persons (n = 11). Results. The majority of the residents reported satisfaction with care home living. The relatives were also satisfied, secure and appreciated the privacy and homely atmosphere of the flat. The disadvantage of one‐room flats was that the residents might have felt lonely. The relatives felt that the residents were bored, but few residents desired more activities, even if some of them longed for people to socialize with. For many older people, perhaps talking is the most important ‘activity’ at care homes. Concerning self‐determination, some residents did not find it satisfactory. Relevance to clinical practice. Staff members must pay attention to residents’ need to talk with people. For many older people, talking is perhaps the most important ‘activity’ at care homes. Nurses must safeguard residents’ self‐determination. When residents are in control of their lives, they may become satisfied with time.     

Nursing home care for older people in Taiwan: a process of forced choice

Aim. To generate a substantive theory for understanding the phenomenon of nursing home care for older people in Taiwan. Background. Taiwanese culture shows great respect for older people and older people are traditionally cared for at home by their families. However, the older population in Taiwan is rapidly increasing and this demographic shift, together with various socio‐economic changes, has resulted in nursing homes becoming a new and significant care option. Design. A grounded theory approach was used to study the residents and relatives from three nursing homes in Taiwan. Methods. Formal and informal interviews and participant observation data were collected over two months in each nursing home. Forty nursing home residents and 20 of their relatives were recruited. The data were analysed using the constant comparative method and involved the use of theoretical memos and theoretical sampling procedures. Results. The study found that nursing home care for older people in Taiwan is understood to be a process of forced choice, involving three stages; namely, ‘becoming a problem’, ‘making a forced choice’ and ‘coping with the forced choice’. Conclusion. Taiwan is in a state of conflict with regard to providing care for older people, a situation in which the influence of traditional cultural and that of industrialisation exist side by side. The consequence of having to relocate older people into nursing homes means that both parties are the victims of this choice. Relevance to clinical practice. This conceptual explanation helps us to understand how the Taiwanese respond to the issue of care for older people and how they resolve their main concerns related to it. Subsequently, it is hoped that this will help health care practitioners to provide care more effectively to meet the needs of the Taiwanese with the aim of enhancing the standards of care for older people.     

Association between self-reported care needs and the allocation of care in Norwegian home nursing care recipients

sævareid h.i., thygesen e., lindstrom t.c. & nygaard h.a. (2012) Association between self‐reported care needs and the allocation of care in Norwegian home nursing care recipients. International Journal of Older People Nursing 7 , 20–28
doi: 10.1111/j.1748‐3743.2010.00247.x Objectives. This study investigated the relationship between patients’ self‐reported illness, daily afflictions, and the frequency of home nursing care, and whether patients’ coping resources influenced the allocation of care. Design, sample and measurements. A cross‐sectional survey was adopted. Two hundred and forty‐two people aged 75 years and above receiving home nursing care participated in the study. Binary logistic regression model was used to test the effects of the independent variables on home nursing care. Results. Poor capacity to perform activities of daily living and high level of education were directly associated with a high frequency of home nursing care. Lack of perceived social support affected the amount of home nursing care allocated only when feelings of loneliness were connected with poor activities of daily living functioning. Interaction effects revealed that perceived social support influenced the amount of home nursing care in persons with higher education, in persons with low education, no such association were found. No associations were found between coping resources and home nursing care. Conclusions. Impaired capacity to perform activities of daily living was the main reason for care allocation. Education was associated with more formal care. Patients with low perceived social support combined with a low education level was a particularly vulnerable group.     

'Finding home': a grounded theory on how older people 'find home' in long-term care settings

cooney a. (2011) ‘Finding home’: a grounded theory on how older people ‘find home’ in long‐term care settings. International Journal of Older People Nursing 7 , 188–199
doi: 10.1111/j.1748‐3743.2011.00278.x Background. A link between residents ‘feeling at home’ in long‐term care facilities and ‘quality of life’ is emerging in the literature. Few studies, however, have focused on what helps residents to find a home in long‐term care settings. This study aimed to fill this gap. Aim. This study aimed to understand older peoples’ perceptions of ‘being at home’ in long‐term care settings and the factors that influence these perceptions. Design. Grounded theory guided the study design. Residents (n = 61) living in public or private long‐term care settings were interviewed using unstructured interviews. Findings. Four categories were identified as critical to finding a home in long‐term care settings: ‘continuity’, ‘preserving personal identity’, ‘belonging’ and ‘being active and working’. ‘Finding Home’ was conceptualised as the core category. The potential to ‘find home’ was influenced by mediating and facilitating/constraining factors. Conclusions. The Theory of Finding Home was generated from the data. This theory describes the factors critical to ‘finding home’ in long‐term care settings. Implications for practice. The Theory of Finding Home gives insight into what matters to older people living in long‐term care settings. Strategies to help generate a feeling of home in long‐term care settings are shared.     

Balancing struggles with desired results in everyday activities: strategies for elderly persons with physical disabilities

The number of elderly persons with disabilities needing support with everyday activities increasing in Japan and around the world. Yet, engagement in everyday activities can support the quality of their daily life. Despite research focusing on reported meanings of people's actions, there is still limited knowledge on how engagement in everyday activity is enacted along with the meanings of persons’ actions. The aim of the present study was to identify meanings of persons’ actions within everyday activities of elderly Japanese with physical disabilities. Five elderly persons with physical disabilities living in the community participated in this study. Data were gathered by 10 participant observations of everyday activities supplemented with 13 unstructured interviews. Narrative analysis was used to identify meanings of persons’ actions. The analysis identified an overall plot termed ‘balancing struggles with desired results’. This plot illustrated that participants’ and other involved individuals balanced problematic situations with finding situations that accommodated their needs. Meanings of these actions were further identified as three complementary strategies. Two of three strategies aimed to mitigate given problems, one by ‘acting on a plan to achieve one's goals’, the other by ‘taking a step in a preferred direction by capitalising on emerging opportunities’. The third strategy focused on avoiding undesirable experiences by ‘modifying problematic situations’. In conclusion, these findings call for care and rehabilitation providers’ sensitivity to shifting foci of what matters in daily life's situations as well as aligning with persons’ skills, resources and perspectives. Accordingly, the judicious and flexible use of these complementary strategies can enhance elderly persons’ quality of daily living through everyday activities.     

To feel betrayed and to feel that you are betraying the older residents: caregivers' experiences at a newly opened nursing home

Background. In Sweden and internationally, little research has focused on the working situation of Enrolled Nurses and Nurses’ Aides who form the majority of workers in geriatric care today. With this in mind, it is important to focus on how these occupational groups experience their working situation with older residents in municipal care. Aims and objectives. The aim of the study was to investigate the deeper meaning of work satisfaction and work dissatisfaction at a newly opened nursing home for older residents. The study focused on the narratives supplied by the caregivers at the nursing home. The participants included: one Registered Nurse, sixteen Enrolled Nurses, and three Nurses’ Aides. All were directly involved in patient care. Design. The present study is part of a larger longitudinal study within the municipal geriatric care system in Sweden, with a quasi‐experimental design. Method. The interviews were analysed with a phenomenological‐hermeneutic method inspired by the philosophy of Ricoeur. Result. The caregivers experiences of work satisfaction and work dissatisfaction was expressed in four themes: (i) ‘Experience of betrayal’ describes how the staff felt let down in several ways; (ii) ‘Experience of failing others’ describes how the staff felt that they did not pay enough attention to older people, in several different ways; (iii) ‘Experience of insufficiency’ describes how the staff encountered overwhelming demands from several directions; (iv) ‘Experience of work satisfaction’ describes how the staff felt that they were given support in various ways. Each theme emerged from several subthemes that originated from the caregivers’ narratives. Conclusions. The study shows that the caregivers’ experience of work dissatisfaction overshadows their experience of work satisfaction. It also suggests that their feelings of failing the older residents are connected to their own experiences of feeling betrayed. Relevance to clinical practice. The findings can be used when other nursing homes in municipal care are opened, as a means of preventing work dissatisfaction and increasing work satisfaction among future employees.     

Factors Influencing Long-Term Home Care Utilization by the Older Population: Implications for Targeting

This research was designed to explore factors that affect the choice of long-term care modalities in the older population and to discuss the appropriate target population of home health care services within the entire long-term care system. The study subjects' activities of daily living limitations, cognitive status, and sociodemograhic data at the time of admission were obtained from retrospective chart reviews. The sample included 134 older subjects who were receiving long-term care from a Long-Term Home Health Care Program or a nursing home in New York City. The results indicated that Long-Term Home Health Care Program use by older persons was characterized by a higher rate of being admitted from private homes, less cognitive impairments, less limitations in activities of daily living, and younger age than older patients who were nursing home residents. Consequently, in the choice of different care modalities, health-related factors of the older population were found to be more important predictors than sociodemographic characteristics or support system. The implication to both nurses and researchers is the development of eligibility criteria that captures the unique characteristics of disabled older persons in each of the different long-term care programs to serve them better in a cost-effective manner.     

Photographs of the ageing body in a nursing journal: a profession’s response

In New Zealand in 2006, a professional photographer undertook a photo essay of residents and staff in an aged care residential setting. The photographer captured the ‘lifeworld’ of the institution through photographing the images of daily life. The resulting photo essay, which included some photographs of older people naked and in semi‐dress, was published in New Zealand’s principal nursing journal in May 2006. There ensued an unprecedented reaction that divided New Zealand’s nursing world. In this paper, I explore possible meanings of the ‘photo furore’, through discourse analysis of the numerous letters to the nursing journal editors. These letters reveal reactions and opinions from both ‘sides’– rejection and disapproval, acceptance and approval – as the situation developed into dichotomy. In this paper, the further aim is to address the issue of attitudes and reactions of the exposed ageing body from theoretical perspectives. Results reveal conflicting discourses and attitudes within nursing towards photographs of the ageing body and underlying this, how nurses believe older people should be thought about and cared for. These attitudes are wide‐ranging and, on the one hand, include ageism and a desire to protect and supervise older people versus a greater tolerance and acceptance of older people as competent, autonomous beings.