Physically restraining elder residents of long‐term care facilities from a nurses' perspective

Ben Natan M, Akrish O, Zaltkina B, Noy RH. International Journal of Nursing Practice 2010; 16 : 499–507
Physically restraining elder residents of long‐term care facilities from a nurses' perspective The purpose of the current study was to identify and analyse major variables affecting intended decisions of nursing staff to physically restrain elder residents of long‐term care facilities. The study explored whether a research model constructed of staff characteristics and resident characteristics would prove useful for predicting behavioural intentions. A total of 120 reliable and validated questionnaires, based on the research model, were administered to nurses working in a large long‐term care facility for older adults in central Israel; 104 questionnaires were returned for a response rate of 86%. The research findings indicate that most of the nurses who responded (67.2%) reported that they had physically restrained elder residents more than 10 times over the past year; however, the nurses had a low intention of restraining residents during the coming year. The research results indicate that the intended decision of nursing staff to restrain elderly residents is a derivative of their behavioural beliefs and attitudes, normative beliefs and subjective norms, as well as of residents' dementia, physical state and stress.     

Inadequate care in Norwegian nursing homes – as reported by nursing staff

Studies have shown that inadequate care, also referred to as abuse, violence, neglect and maltreatment occur in nursing homes in many countries. The aim of this study was to describe the frequency and types of inadequate care committed by staff in nursing homes. Another aim was to investigate if nursing staff reported differently depending on age, education level and years of experience working at nursing homes. A questionnaire survey was conducted among nursing staff (n = 616) in 16 nursing homes in the central part of Norway. Twenty items concerned staff behaviour in forms of acts of inadequate care. The respondents were asked to report how often they had observed colleagues commit acts and how often they themselves had committed such acts. The response rate was 79%. All in all, 91% of the nursing staff reported that they had observed at least one act of inadequate care and 87% reported that they had committed at least one act of inadequate care. Acts of negligent and emotional character were most frequently reported, both as observed and committed. Depending on the higher educational level that the nursing staff had more acts of all types were observed and committed. The oldest staff and those with longest experience at the present nursing home reported more observed and committed acts of physical character than did the others. The extent of inadequate care confirms that this is a common part of activities in nursing homes. Because emotional and negligent acts can be just as harmful as physical acts, more knowledge is needed about the reasons in order to take preventive actions.     

Challenges for institutional elder care in Slovenian nursing homes

Aims and objectives. To investigate deficiencies in the institutional elder care that is being offered to residents of nursing homes in Slovenia. Background. Public criticism of the provision of elder care in nursing homes is growing all over the world, including in Slovenia. Many studies on this issue have been conducted, but seldom have assessed different viewpoints simultaneously. Design. A qualitative research design that involved individual unstructured interviews was used in 2007. The participants (n?=?48) comprised 16 residents, 16 relatives and 16 members of the nursing staff from four nursing homes in Slovenia. Methods. The data generated were subjected to qualitative content analysis. Results. The major themes that emerged from this analysis were neglect, unprofessional communication, uncomfortable physical environment and inadequate administration. Conclusions. The participants of the study identified issues in institutional elder care in Slovenia that have also been highlighted by international research. Due to staff shortages, low motivation, insufficient communication skills and inexperience, members of the nursing staff reported that they were not in a position to offer the best possible quality of care. Relevance to clinical practice. To improve the living environment in nursing homes, it is important to consider the opinions of all those who are involved closely in institutional elder care. Correction of deficiencies should be a priority and should result in more engagement with residents.     

Primacy of existential pain and suffering in residents in chronic pain in nursing homes: a phenomenological study

The study's rationale:  Chronic pain is a major health problem among the elderly, both in the community and within nursing homes.
Aims and objectives:  The purpose of the study was to examine the essentials of the experience of residents in chronic pain in nursing homes.
Methodological design and methods:  The research approach was interpretive phenomenology. Data were collected in 23 dialogues with 12 residents, ages 74–97. Mean age was 86 years.
Results:  The main finding is the primacy of existential pain and suffering in residents in chronic pain in nursing homes. Indeed they recounted a culmination of existential pain and suffering, e.g. loss of loved ones, loss of former home, health and independence, as well as loss of connectedness. Many seemed to be in some kind of grief and their work towards reconciliation to their life and circumstances seemed an ongoing process with successful results while others seemed more haltering or even stuck. Living with chronic pain in a nursing home is indeed a challenge and many blocks to successful pain management were identified. The main sources of strength were loved ones who were seen as lifelines . Nurses seemed distant in their narratives of pain management.
Study limitations:  Frailty of residents is a limitation as a few were starting to forget from one interview to the other and some were actually in pain at the time of our dialogue.
Conclusions:  It is important to support a healthy process of grieving and reconciliation in elderly people who live with chronic pain in nursing homes. Those who suffer in silence with their pain and discomforts and do not seek help should be identified and cared for. The residents' own sources of strength should be identified and supported. Multi-professional collaboration with educational thrust is needed towards quality pain management of elderly people in nursing homes where existential pain and suffering is not excluded.     

Decision-making for acutely ill nursing home residents: nurses in the middle

Title.  Decision-making for acutely ill nursing home residents: nurses in the middle.
Aim.  This paper is a report of a study to generate a model of nursing behaviours and social processes inherent in decision-making for acutely ill nursing home residents.
Background.  Most research concerning clinical decision-making in nursing homes focuses on the perspectives of doctors. Much less is known about the perspectives and actions of nurses with regard to decision-making, despite the centrality of their roles in nursing homes.
Method.  Grounded theory was used. Data were collected in 2004 in four nursing homes in the United States of America using in-depth, semi-structured interviews, 74 hours of non-participant observation and informal conversational interviews with key nursing staff involved in decision-making.
Findings.  Nurses strive to create a plan of care acceptable to family members and doctors, consistent with wishes of residents and most comfortable for residents. A unifying theme of satisfying all sides emerged as representative of the negotiation strategies used by nurses to address these competing points of view. Four phases in this negotiation occurred: weighing the significance ; notifying the family ; feeling it out ; and playing the middleman . The outcome was either a decision for life-prolongation or for palliative care.
Conclusion.  Decisions for nursing home residents are complex and involve weighing and balancing the interests and preferences of many concerned participants, including residents, families and doctors. This process requires skill in clinical judgment, communication and collaboration.     

Attitudes of Egyptian nursing home residents towards staying in a nursing home: a qualitative study

Aim.  The aim of this study was to identify the attitudes of Egyptian nursing home residents towards staying in a nursing home and to differentiate between various types of these attitudes.
Background.  The number of older persons in Egypt who require nursing care is increasing. In response, nursing homes in bigger cities like Cairo were founded, although family care seems to be the prevalent norm.
Methods.  Semi-structured guideline interviews were performed with 21 residents from four different nursing homes in Cairo. Interviews were analyzed using qualitative content analysis.
Findings.  One category of resident was those who were sent to the nursing home by persons closely related to them. Another category made their own decision to move to a nursing home. Relationships with social networks and self-help abilities are factors of importance in influencing decision-making.
Conclusion.  Nursing homes in Egypt fulfil different functions for different types of older persons. Charitable institutions are a last resort for those with no income and a disrupted social network. For better-off older persons, nursing homes may provide the benefits of socialising with peers and receiving medical treatment.     

Implementation of a nutritional programme in elderly people admitted to resident homes

Aim:  The aim was to test the hypothesis that education provided to staff regarding nutritional needs and individualizing nutritional care will improve the nutritional status and functional capacity of elderly people newly admitted to resident homes.
Design:  Pre- and posttest, quasi experimental.
Setting:  Resident homes.
Subjects:  Sixty-two residents (20 men, 42 women) in the experimental group and 53 (14 men, 39 women) in the control group were consecutively included. Mean age was 85 years.
Methods:  On admission and after 4 months, nutritional status was assessed using a combination of anthropometry (weight index, arm muscle circumference and triceps skinfold thickness) and biochemical measurements (serum albumin and transthyretin). Functional capacity and overall cognitive function were also assessed. In the experimental unit, the staff received education about nutritional needs and individualized nutritional care.
Results:  After 4 months the number of residents assessed as protein energy malnourished decreased from 20 to seven in the experimental (p = 0.004), and from 17 to 10 in the control group (p = 0.1). In the experimental group, motor activity (p = 0.006) and cognitive function (p = 0.02) increased. In the control group, motor activity decreased (p = 0.02).
Conclusions:  The results indicate that the intervention had effects, as the number of protein energy malnourished residents decreased in the experimental group and motor activity and cognitive function improved. No such improvements were seen in the control group.     

Palliative care in nursing homes: exploring care assistants' knowledge

Aim.  To explore the level of palliative care knowledge and to identify educational needs of care assistants (CAs) working within a nursing home context.
Background.  In the United Kingdom (UK) many patients at the end-of-life are admitted to (or reside in) nursing homes, where they receive care from unqualified CAs who have little formal training. Mandatory training in specific skills to meet palliative care needs are absent.
Method.  Questionnaire to CAs in 48 of 91 private nursing homes in one UK region.
Findings.  A population of 1135 CAs were targeted with a response rate of 45% ( n  = 508). A high proportion of CAs in this sample required information about the philosophy and principles of palliative care. Results support the need for an educational initiative to improve palliative care in nursing homes.
Conclusion.  Although recognized as a common place of death for older people, CAs are often unprepared to provide end-of-life care to nursing home residents. It is recommended that attention be given towards developing the skills and knowledge of this staff group.     

Life situation and daily life in a nursing home as described by nursing home residents in Sweden

Aims and objectives.  The overall aim of this study was to investigate nursing home residents' opinion of their life situation in a nursing home and of their earlier life.
Background.  Few studies have focused on residents' perception of their daily life and life situation in nursing homes.
Design.  A qualitative explorative design was used.
Methods.  Residents in a nursing home were interviewed and qualitative content analysis was performed.
Results.  The views of life residents described and how they apprehended their situation were quite different. The findings give an understanding of what it is like to live in a nursing home and show that residents apprehend their situation in very different ways. All individuals who were content with their situation in the nursing home were also content with their earlier life.
Relevance to clinical practice.  For the nurse in gerontological care, it is a challenge to get to know each resident and to provide the best nursing care and the best individual treatment for each resident. Another challenge is to help each resident find a life in the nursing home that is acceptable for him/her, and one aspect of this involves helping residents in their ageing process. The present study highlights what an important role staff have in relation with nursing home residents.     

Implementation of the abilities-focused approach to morning care of people with dementia by nursing staff

Background.  The efficacy of the abilities-focused approach to morning care has been demonstrated in two studies. However, the extent to which nurses are aware of and actually implement abilities-focused interventions in day-to-day practice is not known.
Aim.  The study aimed to determine the type and number of abilities-focused interventions delivered by nursing staff to residents with dementia during morning care.
Methods.  A one-group repeated measure design was used. Seventy-nine nursing staff attended an educational session to instruct them in the application of abilities-focused interventions. Data on the type and number of interventions used by nurses were obtained before, after and 3-months following attendance at the session. Data were collected through participants' self-report and observation.
Results.  Most nursing staff used abilities-focused interventions when providing morning care. Introduction to resident, orientation to resident and conversation with resident were three types of interventions most often applied over time. The number of interventions implemented increased after attendance at the education session and returned to baseline level at 3-month follow-up.
Conclusions.  Future research is recommended to examine the long-term effects of alternative designs of educational sessions.     

Moving forward together: evaluation of an action group involving staff and relatives within a nursing home for older people with dementia

Background.  This paper describes the implementation and evaluation of an action group within a nursing home for older people with dementia. Over a two-year period, researchers worked with staff, residents and relatives on a series of initiatives aimed at improving experiences of living and working within the home. The action group, involving staff, residents and their relatives was the vehicle through which a number of important changes were achieved. The project was underpinned by ideas about relationship-centred care and the Senses Framework.
Methods.  A constructivist methodology informed both the initial development and the evaluation of the project. This paper reports findings from interviews with staff and relatives and process recordings of group discussions.
Findings.  Data from the evaluation provide evidence of ways in which the project has contributed to creating the senses (security, significance, belonging, purpose, continuity and achievement) for each of the key stakeholder groups. Factors supporting and hindering the project were also identified.
Conclusions.  The development approach using the Senses Framework adopted within the project is a useful model for partnership working in settings providing continuing care for older people.
Relevance to clinical practice.  Findings from this small-scale but intensive project suggest that staff within care homes should seek to engage with a range of stakeholders in order to improve experiences for all involved in long-term care. Academic staff within schools of nursing should consider innovative, action-oriented approaches to supporting developments within care homes.     

Pain prevalence, experiences and management strategies among the elderly in taiwanese nursing homes

The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among elderly residents of nursing homes in Taiwan. Stratified random sampling was used to recruit participants (n = 150). In these elderly nursing home residents, pain prevalence was 65.3% and the average number of pain sites was 3.24 (SD = 2.59). The mean pain intensity was 3.86 (SD = 1.90) and pain interference was 4.30 (SD = 2.28). “Aching” was the word most commonly used (77.6%) to describe pain. Most participants (54.21%) took prescribed medications for dealing with pain; doctors were the main information source for this self-care strategy. Although participants reported severe bouts of pain, they used limited self-care pain management strategies. Since health care providers play an important role in helping the elderly to manage pain, the authors recommend training nursing home staff to perform regular pain assessments and providing current knowledge about pain assessment and management strategies.     

The relationship between death anxiety and attitudes toward the elderly among nursing staff.

The purpose of this study was to investigate the relationship between death anxiety and attitudes toward the elderly among nursing staff in nursing homes. Questionnaires were distributed to all 310 full-time nursing staff members in six nursing homes; 159 usable questionnaires (51 percent) were returned. The self-administered packet consisted of Templer's Death Anxiety Scale to determine high and low death anxiety groups. Palmore's Facts on Aging Quiz to identify positive or negative attitudes toward the elderly, and a self-developed demographic data questionnaire. A t-test was used to compare the mean attitude toward the elderly scores of the high and low death anxiety groups. Nursing staff with high levels of death anxiety had significantly more negative attitudes toward the elderly than nursing staff with low levels of death anxiety (t = 2.52; p. less than .01). A correlation coefficient was also used to analyze the relationship between death anxiety and attitudes toward the elderly for the entire study sample. The relationship was significant (r = -.21; p less than .007). Findings indicated no significant differences in death anxiety or attitudes toward the elderly when compared with various demographic variables.     

Prevalence of heart failure in nursing homes: a systematic literature review

Scand J Caring Sci; 2010; 24; 202–208
Prevalence of heart failure in nursing homes: a systematic literature review
Introduction:  Heart failure is an important problem in western countries. In nursing home residents heart failure is expected to be highly prevalent. However, accurate diagnosis of heart failure in these patients is often hampered due to atypical findings and concomitant co-morbidity. In order to deliver adequate nursing care and medical treatment, it is important to get insight into the prevalence of heart failure in this target group of patients.
Objectives:  To assess the prevalence of heart failure as well as the co-morbidity interfering with heart failure in nursing home residents.
Methods and results:  A systematic literature review was conducted in Medline, Embase, Cinahl and the Cochrane Library. Ten studies were ultimately included. Findings indicate that the mean prevalence of heart failure is 20% (range 15–45%) and that there is a significant level of co-morbidity (dementia, diabetes mellitus and chronic obstructive pulmonary disease) in nursing home residents with heart failure.
Conclusion:  The reported prevalence of heart failure in nursing home residents is higher than in the general population and is associated with considerably co-morbidity. However there are also indications that the prevalence of heart failure in nursing home residents is underestimated, negatively affecting quality of life and quality of care. Therefore, prospective prevalence studies and studies aiming to improve the care for nursing home residents with heart failure are warranted.     

A unique practice model for Nurse Practitioners in long-term care homes

Title.  A unique practice model for Nurse Practitioners in long-term care homes
Aim.  This paper is a report of a study examining a practice model for Nurse Practitioners (NPs) working in long-term care (LTC) homes and its impact on staff confidence, preventing hospital admission, and promoting early hospital discharge.
Background.  The recent introduction of NPs in LTC homes in Ontario, Canada, provided an opportunity to explore unique practice models. In a pilot project, two full-time equivalent NPs provided primary care to a consortium of 22 homes serving approximately 2900 residents. The practice model was based on the specific needs of the homes and residents.
Methods.  The NPs working in this project prospectively collected data (from July 2003 until June 2004) on their clinical activities and resident outcomes. Directors of Care ( n  = 18) of the participating homes completed a questionnaire (March 2004) assessing the impact on prevention of hospitalization and staff confidence.
Findings.  The NPs had 2315 clinical contacts in the 1-year period; the majority (64%) were follow-up contacts. Many contacts were for uncomplicated medical problems or more complex but straightforward medical issues, and had positive outcomes. Hospital admission was prevented in 39–43% of cases. NPs had a positive impact on improving staff confidence, but no impact on facilitating early discharge from hospital.
Conclusion.  Practice models designed to meet the distinctive needs of LTC homes and residents can enhance quality of care, even with low NP:resident ratios. Participation of key stakeholders in the identification of care priorities and planning contributed to the success of this model.     

不同类型养老机构老年人服药依从性调查

目的:调查并分析不同类型养老机构老年人服药依从性现状。方法:采用分层抽样法,通过问卷调查对重庆市12所养老机构的203例老年人进行横断面调查。结果:不同类型养老机构老年人的服药种类、服药方式、医疗保健费用承受度及药物不良反应发生率不同,不同机构工作人员对老年人服药情况关注度也不同;护养院老年人服药信念显著高于养老院和老年公寓;护养院老年人服药依从性显著高于养老院老年人;老年人的服药信念、服药频率及工作人员关注程度是其服药依从性的影响因素。结论:不同类型养老机构老年人的服药依从性存在较大差异,护养院老年人的口服用药相对较安全,应积极推进养老机构向"互联网+医养结合"方向转型发展。