The transition of elderly patients between hospitals and nursing homes. Improving nurse-to-nurse communication

Lack of patient information is a particular problem when a patient is transferred from one health care facility to another. The lack of information needed to develop a timely and effective plan of care for an older adult transferred to the nursing home facility may exacerbate disruptions in the older adult's care. Also, adjustment or readjustment to the nursing home or hospital environment may be prolonged. Persistence of problems or difficulty in adjustment may then lead to exacerbation of the disease processes and, ultimately, hospital readmissions. Evidence suggests that elderly patients discharged from the hospital have high readmission rates. Although the patient is most affected by a breakdown in communication, everyone in the nursing home involved in the resident's care is also affected. All staff who provide care to the resident, including nursing, medicine, nutrition, pharmacy, social work, and physical therapy staff members, must be cognizant of issues related to communication for patients being transferred. In this article, the authors discuss the development, implementation, and results of a model designed to increase the communication surrounding the transition of elderly patients from an inpatient unit to and from nursing homes.     

The quality of nursing home care in Taiwan

This study describes the quality of care in nursing homes in Taiwan using demographic data, functional status measures, resident clinical care outcomes, and resident's ratings of satisfaction with nursing home care. Three hundred and eight randomly selected elderly residents in 13 nursing homes were interviewed through a structured interview process and demographic and medical information was collected from their nursing home records. Nursing home residents were younger and less functional than their counterparts in the United States. Stroke and dementia were the most common primary diagnoses and more than 27% of the residents had a history of urinary tract infections while more than 25% had been physically restrained within the past 3 months. There was no correlation between the number of nursing home staff per resident and the prevalence of selected clinical care outcomes. A moderate level of satisfaction with nursing home care was reported with acceptance of family visits and nursing home cleanliness rating highest, and loss of personal belongings and life as boring rating lowest. Level of satisfaction with nursing home care was positively correlated with the number of RNs and nursing assistants (NAs) on staff. Recommendations for improving the quality of nursing home care in Taiwan include increased recruitment of multidisciplinary professional and technical nursing home staff; restrictions in the use of restraints with development of alternatives; and use of standardized resident assessment, care planning, and evaluation tools. The authors recommend continuing education in geriatric nursing and continued nursing research focusing on identifying structure and process variables that affect clinical care outcomes and satisfaction with nursing home care.     

End of life in an Icelandic nursing home: an ethnographic study

Aim: To examine care of the dying elderly in a nursing home in Iceland. Methods: An ethnographic study design was adopted. The study sample comprised all of the nursing home residents, their relatives, and all of the staff working in the nursing home, but with a particular focus on the 11 registered nurses (RNs) on the site. Data was collected through participant observation, semi-structured group interviews with the RNs, and an examination of the nursing home's official records. Underlying themes were discovered using interpretative phenomenology. Findings: Two main themes emerged: that palliative care is the most important element of care in the home, and that RNs are the pillars of caring for the dying elderly in the nursing home. Conclusions: The findings suggest that RNs' professional knowledge can greatly contribute to the care of dying elderly residents in nursing homes. There seem to be many parallels between the condition and wellbeing of very frail nursing home residents and patients in specialized palliative care units for the elderly. Public awareness of palliative care of the elderly in Icelandic nursing homes should be encouraged.     

The effect of living in a nursing home on socialization in elderly people

The effects of institutionalization on elderly people are of significance both socially and physically Currently, about 5% of elderly people in the United States live in long-term care institutions, although approximately 33% of all elders will be institutionalized for at least a short period of time The effects on socialization of living in a nursing home have been studied and commented on from several perspectives Several studies directed attention to the elderly person living in an institution Others investigated the institution's response to residents' needs Some studies have focused on attitudes of health care workers towards elderly people, and still others have examined the interaction between workers and residents This review of the literature will first present studies focused on nursing home residents, then the institutions themselves, followed by studies of nursing home staff, and finally those focusing on the interaction between staff and residents Discussion of possible directions for both practice and research will follow The studies reported here were conducted in the United States, England, Northern Ireland and Finland     

A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands

A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands As result of an increase in the numbers of frail elderly people, most European countries are facing problems with the financing and provision of services by nursing homes. At the same time, the expectations of quality of these services continue to rise. The main question investigated in this study was that of how countries approach the problems of financing and service provision by nursing homes and, at the same time, attempt to increase the quality levels in these institutions. The study was conducted in Belgium, Denmark, Germany and the Netherlands. A study was made of the relevant literature and questionnaires were sent to experts in each country. The four countries are addressing the problems of financing and sufficient service provision by controlling the use of nursing home services. In addition, financial problems are approached by extending co-payments, encouraging cheaper forms of care and putting pressure on nursing homes to operate at lower costs. Problems in the provision of care are addressed by applying more selective admission criteria and offering alternative forms of care outside the nursing home. As a result nursing home beds are used for those with the greatest care-dependency. Nursing home services are adjusted to rising quality expectations by offering a greater range of provision, decreasing the number of residents per room, improving comfort and improving the training of nursing staff. Another way to increase the quality of care is to separate the housing and service functions. Many nursing homes nowadays collaborate intensively with other facilities for the elderly to cope with all these problems and changes. The workload for nursing home staff has increased because of the increasing care-dependency of residents, the demand for higher quality of services and the financial problems.     

Family and staff perceptions of the role of families in nursing homes

Family and staff perceptions of the role of families in nursing homes Admission to a nursing home is generally regarded as the termination of family care and the commencement of institutional care. Research suggests that following placement families are often expected to relinquish their dependent older relative to the bureaucracy of the institution. The aim of this study was to investigate family and nursing home staff perceptions of the role of families caring for residents in nursing homes. A convenience sample of 44 family carers and 78 nursing home staff completed questionnaires, and interviews were conducted with 10 family carers and 10 nursing home staff. The results suggest that family carers perceived themselves to have a greater role in caring for relatives than that perceived by the nursing home staff. Either families overestimated their involvement, or staff underestimated family involvement in caring for residents in nursing homes. Families were mostly satisfied with their role and with the care provided in nursing homes. They perceived nurses as providers of technical care and they perceived themselves as having an important role in providing social and emotional care. Families trusted the clinical judgement of the staff but the staff were reluctant to trust family carers, especially in situations where care involved an element of risk. Family roles were limited by members' own ability to care and the dependency of the resident, while professional responsibility and accountability discouraged nurses from sharing some caring roles. The results indicate that families in this study were more willing to help in nursing home care and were perhaps under-valued as a resource within the nursing home setting.     

社区护理服务需求研究

目的：拓展社区护理服务的内容,寻找社区护理服务潜在需求,为研究社区护理未来的发展方向,制定相关政策和计划提供参考依据。方法：采用问卷调查方法对护理人员和社区居民进行社区卫生服务需求等相关内容的调查。结果：①社区居民对健康教育、疾病康复、慢性病随访、家庭卫生服务（居家护理）、连续治疗等存在比较大的需求;②护理人员对未来社区护理服务的潜在需求,倾向于慢性病护理、老年护理和居家护理。结论：社区健康教育的内容应以健康咨询、健康指导、用药指导为重点内容,社区护理服务应该加大对慢性病病人的随访和连续治疗的护理服务和家庭康复的护理服务。同时,应加强我国社区老年护理的模式的研究,适应我国人口老龄化的需要。     

Using restraint with nursing home residents: a qualitative study of nursing staff perceptions and decision-making

The study reported in this paper applied a qualitative and interpretative approach to nursing staff perceptions of the use of restraint with elderly nursing home residents, and into nurses' decision-making on restraint use. The data were collected using unstructured interviews with a purposive sample of 20 trained and untrained nursing staff from two Swiss nursing homes. Data analysis was based on Colaizzi's phenomenological method. Three main themes were extracted from the data: (1) understanding the term restraint, (2) situations in which the decision to apply restraint is considered justified and (3) situations in which nursing staff are uncertain about the use of restraint. The underlying bases with respect to decision-making were: understanding restraint, the rights and responsibilities of both residents and staff, and the duties of staff. Staff members were ambiguous in their understanding of restraint and they showed positive as well as confused attitudes towards its use. Their behaviour was defensive and protective rather than challenging. Further research is required on what is meant by safety in care of the elderly nursing today. In nursing practice, as far as issues of restraint are concerned, greater attention should be devoted to the relationship between elderly residents' self-determination and responsibility for their actions.     

Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work

BACKGROUND: Occupational and resident characteristics affect levels of staff stress and satisfaction in nursing homes, and levels of staff turnover are high. Working with more cognitively impaired residents, especially on day shift, is associated with high levels of stress in nursing home staff. Workload is highly predictive of the experience of burden and job pressure, while these outcomes vary according to whether staff work full- or part-time. AIMS: To investigate the attitudes of nursing home staff towards residents, strain related to dementia care and satisfaction with work and their associations with demographic, occupational and behavioural disturbance in the home. METHODS: A cross-sectional design was adopted, using a self-completion questionnaire survey of 253 nursing home staff from 12 nursing homes in Sydney's eastern suburbs, and behavioural assessment of all 647 residents from 11 of the 12 homes. Staff attitudes and strain were measured using the Swedish Strain in Nursing Care Assessment Scale and satisfaction using the Swedish Satisfaction with Nursing Care and Work Assessment Scale. RESULTS: Staff members' five most prevalent perceptions of residents with dementia were that they are anxious, have little control over their difficult behaviour, are unpredictable, lonely and frightened/vulnerable. The five attributes staff found most difficult to cope with were being aggressive/hostile, having little control over their difficult behaviour, being stubborn/resistive, deliberately difficult, and unpredictable. Although 91% of staff reported that they were happy in their job, a quarter reported that residents provided no job satisfaction. The five satisfaction statements most agreed with were "The patients/residents at work nearly always receive good care", "It is important to try and enter into the way patients experience what happens to them", "Relatives are given enough information about care and treatment", "I enjoy my current work situation" and "Our work organisation is good". There were significant differences between homes in levels of strain related to dementia care that were not accounted for by the level of behavioural disturbance. CONCLUSIONS: Nursing home staff tended to perceive residents in more negative than positive ways. Staff were generally satisfied with their work. Factors other than resident behavioural disturbance are important influences in nursing staff strain.     

Attachment/detachment: forces influencing care of the dying in long-term care

Death occurs among older adults in institutions more often than at home with family and friends. The older people are, the more likely they are to die in a nursing home. The purpose of this study was to describe staff and administrator's perspectives on death and dying in long-term care and to explore problems in providing humane care to dying residents that fosters gentle closure to life. Using focus group interviews as the primary data collection method, 22 focus group sessions were conducted in 11 nursing homes. Separate group sessions were held for staff and administrators in the nursing homes. The core variable identified in this study was the attachment of staff to residents in long term care. Attachment enhanced the quality of terminal care and fostered a gentle closure to life. Mediating forces influencing the process of attachment were identified as individual forces, as well as forces internal and external to the nursing home.     

深圳市社区老年人家庭护理供需调查及其影响因素分析

目的调查分析深圳市社区老年人家庭护理服务供需现状及影响因素。方法采用自行设计的调查问卷随机对深圳市6个社区216名老年人和78家社区健康服务中心进行调查,了解老年人家庭护理服务的供需现状及相关影响因素。结果84％老年人对家庭护理有需求,接受过家庭护理服务者占38．1％。32项家庭护理需求项目中,居前6位的需求项目依次是血压监测、血糖监测、健康咨询、照顾者指导、心理护理、服药指导。78家社区健康服务中心有48家提供家庭上门服务,开展家庭护理服务的中心有44．0％提供10个以上项目,67．0％的中心提供5个以上项目,17．0％提供2个以下项目,30家不提供家庭上门服务。影响社区家庭护理服务开展的主要原因是护理人员配置不足、风险系数大、医疗环境及设施受限。结论老年人对家庭护理服务有较大需求,社区健康中心提供的家庭护理服务相对滞后,家庭护理服务供不应求,当务之急是增加社区护理人员数量,建立和完善社区家庭护理行业规范,促进家庭护理的稳定发展。     

Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents: a comparative study

The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses’ physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly’s functional levels may illuminate the extent of the carers’ workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi‐Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly’s need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.     

Specialized care unit: family and staff perceptions of significant elements

Specialized care units (SCUs) for nursing home residents with dementia are increasingly prevalent. Although reported to promote positive resident outcomes, the specific characteristics of SCUs most likely to yield these outcomes have not yet been identified. This article presents the findings of a qualitative study that investigated the perceptions of family members and staff about SCU characteristics that contribute to positive outcomes for residents with dementia. All family and staff members interviewed agreed that the SCU fostered feelings of personal space, personhood, and an unforced routine. These findings are discussed and provide specific direction for care of nursing home residents with dementia.     

Family and staff partnerships in long-term care. A review of the literature

Working with the family in aged care to provide the best care possible is consistent with modern nursing philosophy, which espouses holistic care. The quality and enjoyment of the experience, however, is frequently fraught with problems and challenges for both the family and the staff involved. In residential aged care, partnerships are a complex mix of interactions among the older adult resident, the family, and the caregiving staff. To understand how family involvement in this environment can be made more meaningful, nurses need to be cognizant of how family members experience the caregiving role and how they are perceived by nursing home staff and residents. The relevant literature of the past 20 years is reviewed and key issues central to an understanding of "family care" in the nursing home from the perspective of the family, the nursing home resident, and the nursing home staff are highlighted in this article.     

Better care in nursing homes: advanced practice nurses' strategies for improving staff use of protocols

This article describes a set of strategies used by gerontologic advanced practice nurses (GAPNs) in three nursing homes to integrate the use of protocols into the daily care of residents. The protocols were developed as part of a larger study on the quality of care in nursing homes carried out by nurse researchers at the University of Minnesota and funded by the National Institute of Nursing Research (R01-NR03490). The GAPNs worked regularly with nursing home staff to incorporate aspects of protocols into daily care routines for residents with four specific problems common in elderly residents of nursing homes: pressure ulcers, incontinence, depression, and aggressive behavior. Outcomes of the larger study showed that residents with these four problems had better outcomes in the homes in which care was planned by the GAPNs using protocols that were integrated into the daily routines of staff.     

深圳市社区老年人家庭护理供需调查及其影响因素分析

目的 调查分析深圳市社区老年人家庭护理服务供需现状及影响因素.方法 采用自行设计的调查问卷随机对深圳市6个社区216名老年人和78家社区健康服务中心进行调查,了解老年人家庭护理服务的供需现状及相关影响因素.结果 84%老年人对家庭护理有需求,接受过家庭护理服务者占38.1%.32项家庭护理需求项目中,居前6位的需求项目依次是血压监测、血糖监测、健康咨询、照顾者指导、心理护理、服药指导.78家社区健康服务中心有48家提供家庭上门服务,开展家庭护理服务的中心有44.0%提供10个以上项目,67.0%的中心提供5个以上项目,17.0%提供2个以下项目,30家不提供家庭上门服务.影响社区家庭护理服务开展的主要原因是护理人员配置不足、风险系数大、医疗环境及设施受限.结论 老年人对家庭护理服务有较大需求,社区健康中心提供的家庭护理服务相对滞后,家庭护理服务供不应求,当务之急是增加社区护理人员数量,建立和完善社区家庭护理行业规范,促进家庭护理的稳定发展.     

Death in the nursing home: resident, family, and staff perspectives

The actual experience of dying in the United States is far different from the expressed desires of most Americans. Although most Americans express a preference for dying at home, 73% of Americans die in medical institutions, with 23% dying in nursing homes (Teno, 2004). In this article, the author examines end-of-life care in the nursing home. A literature review identified more than 100 published articles relevant to end-of-life care in nursing homes. Of these, the author evaluated empirical research studies from the perspectives of residents, family members, and nursing home staff with findings specific to seriously ill nursing home residents. By identifying problematic issues and contributing factors, nurses can modify their practice to improve end-of-life care and substantially reduce suffering for nursing home residents and their families.     

Nursing home elderly. Social-environmental factors.

1. Independence, cohesion, and functional health are related to well-being in elderly nursing home residents. 2. Nursing home residents may not criticize staff due to fear of a withdrawal of support. 3. Social support provided by visitors outside the nursing home may decrease the need for social support from sources inside the nursing home.