Assessing the need for arthritis training among paid carers in UK residential care homes: A focus group and interview study

Objective

The aim of the study was to perform an educational and training needs assessment for arthritis care in residential homes.

Methods

Qualitative data were collected from three purposively selected residential homes: one independent, one in a regional chain and one in a national chain. Three researcher‐led focus groups were conducted with paid carers (N = 22) using vignette exercises; interviews were undertaken with 12 residents with joint pain (N = 12), five managerial staff and two general practitioners (GPs). Data were compared and analysed thematically around care practices, communication and training.

Results

There is a lack of arthritis awareness among paid carers, although they regularly identify and manage arthritic symptoms. Residents rely on paid carers to recognize when pain and mobility problems are treatable. Senior staff and GPs rely on carers to identify arthritic problems. However, paid carers themselves undervalued the health significance of their activities and lacked the confidence to communicate important information to healthcare professionals. Few of the paid carers had received training in arthritis and many expressed a strong desire to learn about it, to improve their ability to provide better care.

Conclusions

Education for paid carers regarding arthritis is lacking and lags behind education about conditions such as dementia and diabetes. To meet the expectations of their care roles fully, paid carers require an awareness of what arthritis is and how to recognize symptoms. We suggest that training should be aimed at improving confidence in communicating with colleagues, residents and health professionals, with senior care staff receiving more in‐depth training.     

Freiwillige Helferinnen und Helfer zur Entlastung der Angehörigen demenzkranker Menschen

Caring for a dementia patient in the family often turns out to be a full-time job for family carers. So home visitors-for example volunteers spending time with the patient and thus offering some respite to the family-may be a very important aspect of stabilizing home care. This study investigates the expectations of volunteers concerning their training and their future voluntary work, as well as their visiting experiences, and their reasons for stopping the voluntary work. A total of 40 volunteers were interviewed three times over a 18 month period. The interviews were based on interview guidelines and were problem-centered. The interviewees' replies were subject to a summarizing qualitative content analysis. Of the study participants 85% were women, 48% had previously been family carers themselves, and 50% had previous experience of other voluntary work. Their wish "to do something useful" and "to learn more about dementia" were the main reasons for participation in voluntary work. The interviewed persons tend to learn most about communicating with dementia patients through case studies and practical exercises. Work pressures or restarting employment were the most common reasons to stop the voluntary work. Only if the volunteers are supported by professionals--particularly in the form of a contact person who is always available when problems occur--can this type of respite for family carers be maintained.     

Uncovering the care setting–turnover intention relationship of geriatric nurses

In times of global demographic changes, strategies are needed for improving nursing staff retention. We examined the association of care setting (nursing homes and home care) with geriatric nurses’ intention to leave their job and their profession. Thus far, it is unclear why nurses’ turnover intention and behaviour do not differ between care settings, although working conditions tend to be better in home care. We used the Job Demands-Resources model to explain indirect and buffering effects by job demands (time pressure, social conflicts) and resources (task identity, supervisor support, and co-worker support) via nurses’ perceived health and job satisfaction on nurses’ leaving intentions. The present cross-sectional questionnaire study was conducted with a sample of N = 278 registered nurses and nursing aides in German geriatric care. As expected, there was no direct relationship between care setting and leaving attitudes. Demands and resources predicted the intention to leave with job satisfaction as mediator. We found more demands in nursing homes but no differences in resources. Serial mediation effects of care setting on intentions to leave via demands/resources and health/job satisfaction as mediators were found only for time pressure and social conflicts. Unexpectedly, there were no clear differences between intention to leave the job and the profession. As hypotheses were only partly confirmed, other buffering and detrimental effects on leaving intentions are discussed. The present data suggest that detailed concepts for personnel and career planning in geriatric care are needed.     

Masters of their own time? Working carers’ visions of retirement

Retirement is often seen as a period dedicated to the enjoyment of one’s own leisure interests after many years of gainful employment. On the other hand, retired people are expected to remain productive by continuing to work, volunteering or by being involved in various caring tasks. When do Finnish working carers plan to retire and how do they envisage the weight of their care commitments related to other activities once they have left full-time work? The 19 female interviewees were born in 1953 or earlier, and they helped their parent(s). They were working full-time or part-time or were semi-retired at the time of the interview. The interviewees were selected from a larger sample of working carers. The future prospects of the interviewees are given in terms of their different visions of retirement activities, and principles of qualitative analysis are applied. Some interviewees indicated that helping their parent(s) would be an essential part of their personal retirement activities, and some of them had chosen or were considering part-time retirement in order to have more time for their parents. However, the interviewees often also stressed that they wanted to have time to pursue their own personal work and leisure interests after leaving full-time employment. Persons approaching their own retirement want to be ‘productive’ but they also want to ensure that they retain a certain amount of individually defined ‘personal-time’. Leaving gainful employment does not necessarily mean leaving ‘productive roles’ as citizens. However, pensioners’ contributions as carers are socially and personally meaningful only if the pensioners’ different valuations regarding the future are respected.     

Living with Advanced Chronic Obstructive Pulmonary Disease: A Qualitative Interview Study with Patients and Informal Carers

Abstract

The disease trajectory in chronic obstructive pulmonary disease (COPD) is characterised by a progressive decline in overall function, loss of independence and reduction of health-related quality of life. Although the symptom burden is high and care is often demanding, patients’ and informal carers’ experiences in living with advanced COPD are seldom described. This study sought to explore patients’ and informal carers’ experiences in living with advanced COPD and to understand their awareness about palliative care provision in advanced COPD. About 20 patients and 20 informal carers were recruited in a respiratory care service in Southern Switzerland. Semistructured individual interviews with participants were conducted on clinic premises and audio-recorded. Interviews lasted between 35 and 45?min. Data were analysed using thematic analysis.

Living day to day with COPD, psychosocial dimension of the disease and management of complex care were the main themes identified. Patients and informal carers reported a range of psychological challenges, with feelings of guilt, discrimination and blame. Most of the participants had no knowledge of palliative care and healthcare services did not provide them with any information about palliative care approaches in advanced COPD. The reported psychological challenges may influence the relationship between patients, informal carers and healthcare professionals, adding further complexity to the management of this long-term condition. Further research is needed to explore new ways of managing complex care in advanced COPD and to define how palliative care may be included in this complex care network.     

Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly

The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor-employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice.     

Relations between work stressors and well-being among nursing assistants in nursing homes

BACKGROUND AND AIMS: Nursing assistants undertake a variety of activities related to personal and environmental care. A review of nursing assistants' employment conditions reveals relatively low salaries, virtually no assessment or promotion system, and rarely incentives or rewards offered for excellence. This study examines nursing assistants' work stressors and their influence on nursing assistants' subjective well-being. METHODS: The research hypotheses were: a) Personal and job characteristics affect the subjective well-being of nursing assistants; b) Work stressors are negatively related to subjective well-being; c) Differences are found in work stressors and subjective well-being between nursing assistants working with the frail elderly and those working with the totally dependent; d) Social support proves to be a moderating factor of work stressors and contributes to higher levels of subjective well-being. The sample included 198 nursing assistants from various nursing homes in northern Israel (102 working in wards for frail elderly, and 96 in wards for totally dependent elderly). RESULTS: The main findings show that work stressors are negatively related to subjective well-being, especially role conflict and work demands. CONCLUSIONS: Findings describe a profile of nursing assistants' characteristics in nursing homes from unique point of view regarding Israeli culture.     

WHO CARES…………FOR THE CARERS?

This paper is about carers; a family member or members who provide unpaid care to a loved one with a chronic condition. Caring for someone who is chronically ill permeates every aspect of life. Dreams may be shattered, plans for the future may have to be radically altered or shelved permanently. Psychological stress is common, but many carers find it difficult to access services. Resources are there to support the person diagnosed, or, on treatment. What resources are directed to the care and support of carers? Drawing on relevant literature and my own clinical experience I give examples of the demands, often unrelenting, and difficulties carers face. I suggest some interventions that can support and facilitate carers, enabling them to continue their role in a healthy, life giving manner.     

Dealing with disclosure: Perspectives from HIV-positive children and their older carers living in rural south-western Uganda

There are limited data on the challenges faced by carers, in particular older carers, in managing the difficult task of status disclosure for HIV-positive children. We report findings from qualitative interviews with 18 care dyads of older people and HIV-positive children living in rural south-western Uganda. Our data provide insights into perceptions and norms influencing communication during and following disclosure among both carers and children, including those shaped by gendered expectations of girls’ and boys’ sexual behaviour. Young participants reported several advantages of knowing their status and showed considerable resilience in the face of HIV disclosure. Better and more support is needed to help health workers and carers (particularly older carers) manage cross-generational communication around HIV disclosure and other related aspects of sexual and reproductive health as critical aspects of children’s psychosocial development and well-being.     

HIV and employment among Black men who have sex with men in Baltimore

ABSTRACT

Employment status is a key social determinant of health, and many populations in the United States that are impacted by HIV have unequal access to education and employment opportunities which contributes to HIV-related disparities. Black men who have sex with men (BMSM) are one of the groups most heavily burdened by HIV. With improved health outcomes associated with advancements in HIV treatment, research suggests that more people living with HIV want to work. This study describes employment among BMSM living in Baltimore, assesses differences in employment by HIV status and assesses predictors of full-time employment among BMSM. The study found that BMSM have limited access to full-time employment and that this disparity is even more pronounced among BMSM living with HIV. Men living with HIV were less likely to be employed full-time compared to men not living with HIV controlling for education and social contextual factors (OR 0.40 95% CI (0.22–0.73)). HIV will most likely have important implications for employment patterns and trajectories of BMSM over the life course. Additional research is needed among BMSM living with HIV to understand work histories and experiences, facilitating factors, and the impact of various work experiences on the health and wellbeing.     

Should people with a history of an eating disorder work as eating disorder therapists?

Much recent attention has focused on the fitness to practise of health professionals. Patients expect their care to be provided by therapeutic staff who can give support and guidance without unhelpful subjective influence. On the other hand, those recovered from health problems expect their employment prospects to be free of discrimination. Eating disorder services increasingly encourage patient and public involvement in service design and monitoring but reservations are sometimes expressed about employing staff who have themselves suffered with an eating disorder. This survey canvassed the views of patients, carers and professionals on the suitability of employing people with a history of an eating disorder as therapists in the same field. With some reservations (mainly from professionals), there was a widespread belief that those who had recovered would have therapeutic advantages as a result of their experience. Therapists with a current eating disorder, however, were thought to lack objectivity and to be vulnerable. Current UK policies on employment appear unnecessarily discriminatory and stigmatizing. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Rituals of visiting people with dementia in residential care

Objectives : Visiting a family member with dementia in residential care can be an unpredictable and stressful experience, particularly in the early days of admission and little is known of how carers lessen their distress during this time. Method : A qualitative study of 25 family carers was carried out in which the carers were interviewed on three occasions for more than a year from shortly after their relative entering residential care. Three carer focus groups were also undertaken. Results : Many family carers developed routines in their visiting that indicated five different forms of ritual: repetitive visiting patterns, formalised elements to visits, symbolic caregiving, reward giving and visit reframing. These routines helped carers manage the experience of visiting. From the accounts of family members, residential staff often seemed unaware of the significance of the rituals and unknowingly discouraged them. Conclusion : These findings suggest that visiting involves complex processes that are insufficiently understood and their value underestimated. Strategies are discussed for assisting family carers to sustain their visiting practices. Further research is needed in this area to provide guidance for family members and those working in residential care. Key words: Dementia, ritual, residential care, caregiving, visiting, relationships, communication     

Changing the environment in eating disorders: working with carers/families to improve motivation and facilitate change

The aim of this paper is to consider the needs of carers of people with adult anorexia nervosa both from a theoretical and practical basis. Families have been successfully involved in the management of adolescent anorexia nervosa but it is uncertain how best to work with the families of people who have a more chronic course of illness. The management of severe, persistent, eating disorders has benefited from the application of theory derived from models of health behaviour. These theory‐driven approaches can also be applied to work with carers. We argue that illness perception theory can also have potential utility in understanding the needs and difficulties faced by carers. In this paper we briefly review these theoretical models and consider how they can be applied to carers of people with chronic anorexia nervosa. Finally we discuss how these theory driven approaches can guide the development of interventions for use with carers. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Role clarity and role conflict among Swedish diabetes specialist nurses

AimTo explore diabetes specialist nurses (DSNs)’ perceptions of their role in terms of clarity, conflict and other psychosocial work aspects.MethodsA cross-sectional study was conducted among DSNs in a county in northern Sweden. The DSNs answered the Nordic Questionnaire of Psychological and Social Factors at Work (QPS Nordic) about psychosocial aspects of their work. Statistical analysis compared DSNs with a reference group of different health professionals. Correlations between role clarity, role conflict, and other variables were analysed.ResultsThe DSNs perceived more, and higher, job demands, including quantitative, decision-making and learning demands, but also more positive challenges at work compared with the reference group. Role clarity correlated with experiences of health promotion, perception of mastery, co-worker support, and empowering leadership, while role conflict correlated with quantitative and learning demands.ConclusionsThe DSNs perceived high demands but also positive challenges in their work. Their role expectations correlated with several psychosocial work aspects. It is important that DSNs should be presented with positive challenges as meaningful incentives for further role development and enhanced mastery of their work.     

Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: a randomized controlled trial

Context Due to the chronic nature of cocaine dependence, long‐term maintenance treatments may be required to sustain abstinence. Abstinence reinforcement is among the most effective means of initiating cocaine abstinence. Practical and effective means of maintaining abstinence reinforcement programs over time are needed. Objective To determine whether employment‐based abstinence reinforcement can be an effective long‐term maintenance intervention for cocaine dependence. Design Participants (n = 128) were enrolled in a 6‐month job skills training and abstinence initiation program. Participants who initiated abstinence, attended regularly and developed needed job skills during the first 6 months were hired as operators in a data entry business and assigned randomly to an employment‐only (control, n = 24) or abstinence‐contingent employment (n = 27) group. Setting A non‐profit data entry business. Participants Unemployed welfare recipients who used cocaine persistently while enrolled in methadone treatment in Baltimore. Intervention Abstinence‐contingent employment participants received 1 year of employment‐based contingency management, in which access to employment was contingent upon provision of drug‐free urine samples under routine and then random drug testing. If a participant provided drug‐positive urine or failed to provide a mandatory sample, then that participant received a temporary reduction in pay and could not work until urinalysis confirmed recent abstinence. Main outcome measure Cocaine‐negative urine samples at monthly assessments across 1 year of employment. Results During the 1 year of employment, abstinence‐contingent employment participants provided significantly more cocaine‐negative urine samples than employment‐only participants [79.3% and 50.7%, respectively; P = 0.004, odds ratio (OR) = 3.73, 95% confidence interval (CI) = 1.60–8.69]. Conclusions Employment‐based abstinence reinforcement that includes random drug testing is effective as a long‐term maintenance intervention, and is among the most promising treatments for drug dependence. Work‐places could serve as therapeutic agents in the treatment of drug dependence by arranging long‐term employment‐based contingency management programs.     

Enhancing Dignity for Older Inpatients: The Photograph-Next-to-the-Bed Study

Objectives: Older inpatients compromised by illness and cognitive decline may be stripped of physical and cultural identifiers, making them vulnerable to erosion of dignity. This study explored the experiences of patients, carers and clinical staff in response to a simple intervention that could enhance the dignity of care for older inpatients.

Methods: All patients in a rehabilitation ward were encouraged to have a photograph of themselves next to their bed. Of those who participated, focus groups were recruited for patients, family members and staff to explore their reflections. Discussions were transcribed and analyzed using a deductive approach to capture evolving themes relating to patient care.

Results: All groups reported that the photograph provided “connection” and means of communication between patients and staff. Staff spoke positively of gaining additional insights into patients’ lives. Benefits included enrichment of inter-personal relationships between patients and staff, between staff and families and between patients themselves.

Conclusions: A bedside photograph improved connections between staff, patients and carers, promoting patients’ dignity of identity.

Clinical Implications: Displaying a bedside photograph as a visual reminder of the patient in the pre?illness state helps preservation of an individual’s dignity, a core concept in patient?centered care.     

Considering childbearing in the age of highly active antiretroviral therapy (HAART): Views of HIV-positive couples

Objectives: Based on a qualitative study conducted in Bulawayo, Zimbabwe, this article examines how the availability of HAART since April 2004 may impact the views and choices of HIV-positive couples on childbearing. Methods: In-depth interviews were conducted with 15 couples where at least one partner was HIV positive. All respondents were of reproductive age and had or were confronting reproductive and sexual decision-making. Results: HAART seems to have had a profound impact on the subject of childbearing among those who still desire to have children. Where hitherto individuals had only a desire for a child many are now, as a result of the availability of HAART, actively planning to have one. HAART has not only transformed their physical state but it has also transformed mostly what had been desire into intention. The impact, however, has not been uniform. Some respondents still desired to have a child but were not yet convinced about the efficacy of HAART in preventing vertical transmission. Some respondents felt that HAART may have a negative impact on the foetus and as such were against childbearing by HIV-positive people. No respondent indicated that their desire or intention to have a child had been extinguished by the advent of HAART. Conclusion: Based on the findings of the study, HAART seems to have had a differential but nonetheless significant role in the reproductive plans of HIV-positive couples. The study also notes that there is a need to make available complete and unbiased information on HAART, mother-to-child transmission risk (MTCT) and pregnancy to HIV-positive couples so as to enable them to make informed decisions.     

Dementia Care Staff and Family Carers: Their Relationships in the Context of Care

Objectives: This research examines relationships between care staff specifically employed to care for residents with dementia and family carers. Method: The study employed a qualitative approach involving multiple methods of data collection (in-depth interviews, participant observation, assessment of the physical and mental function of residents). A non-random sample consisting of fifteen care staff from seven residential care settings was used. Results: Care staff perceive that family carers are generally grateful and undemanding and that a significant number lack sufficient involvement in residents' care. Policy and organisational factors may produce positive understanding between care staff and family carers, while at a less visible level, may prevent both groups from voicing more difficult concerns related to care. Conclusions: Policy and organisational change is needed to enable staff and family carers to voice the tensions inherent in their relationship. Funding arrangements for residential care need to include time for staff to develop relationships with family carers.     

Work Ability Index in Israeli Hospital Nurses: Applicability of the Adapted Questionnaire

Background/Study Context: The Work Ability Index (WAI) questionnaire is widely used for evaluation of the work ability of workers. This is the first application of the validated Hebrew version of this questionnaire to Israeli nurses in order to evaluate factors affecting their work ability.

Methods: A cross-sectional study was conducted among 515 nurses from two general hospitals in Israel (87.3% female).

Results: A significant negative correlation was found between the WAI score and age, years in current job, and number of reported diagnoses. The most frequently reported illnesses (as diagnosed by a physician) were musculoskeletal disorders, endocrine/metabolic diseases, and cardiovascular diseases. Agreement between illnesses as diagnosed by a physician and as self-reported by nurses was low, especially with respect to mental/emotional stress, (kappa statistics = 16.4%, p < .001).

Conclusions: Mean WAI score found in Israeli hospital nurses is relatively high as compared with that of European nurses. It gradually decreases with age. The WAI questionnaire enables the early identification of those nurses with compromised work ability and who are in need of assistance in order to prevent early retirement. As retirement age is currently advancing, keeping elderly workers in the workforce is of prime importance.