Nurses’ attitudes towards perinatal bereavement care

Title. Nurses’ attitudes towards perinatal bereavement care. Aim. This paper is a report of a study conducted to explore the factors associated with nurses and midwives’ attitudes towards perinatal bereavement care. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. In some situations nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they feel unable to deal with the enormity of the parental feelings of loss. Method. A correlational questionnaire study using convenience sampling was carried out in Singapore in 2007 with 185 nurses/midwives in one obstetrics and gynaecology unit. Results. Regression models showed that nurses/midwives with religious beliefs and those with more positive attitudes to the importance of hospital policy and training for bereavement care were statistically significantly more likely to have a positive attitude towards perinatal bereavement care. Nurses emphasized their need for increased knowledge and training on how to cope with bereaved parents and requested greater support from team members and the hospital. Conclusion. Bereavement counselling education and preceptorship supervision are recommended to reduce this stressful experience, increase the confidence and expertise of novices, and lead to increased quality of care for bereaved parents.     

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

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

The physical environment,activity and interaction in residential care facilities for older people: a comparative case study

The physical environment is of particular importance for supporting activities and interactions among older people living in residential care facilities (RCFs) who spend most of their time inside the facility. More knowledge is needed regarding the complex relationships between older people and environmental aspects in long‐term care. The present study aimed to explore how the physical environment influences resident activities and interactions at two RCFs by using a mixed‐method approach. Environmental assessments were conducted via the Swedish version of the Sheffield Care Environment Assessment Matrix (S‐SCEAM), and resident activities, interactions and locations were assessed through an adapted version of the Dementia Care Mapping (DCM). The Observed Emotion Rating Scale (OERS) was used to assess residents’ affective states. Field notes and walk‐along interviews were also used. Findings indicate that the design of the physical environment influenced the residents’ activities and interactions. Private apartments and dining areas showed high environmental quality at both RCFs, whereas the overall layout had lower quality. Safety was highly supported. Despite high environmental quality in general, several factors restricted resident activities. To optimise care for older people, the design process must clearly focus on accessible environments that provide options for residents to use the facility independently.     

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.     

Interventions for preventing and reducing the use of physical restraints in long‐term geriatric care – a Cochrane review

Aims and objectives. To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people requiring long‐term nursing care. Background. Physical restraints are commonly used in geriatric long‐term care. However, they are associated with adverse outcomes. Therefore, freedom from physical restraints should be the aim of high‐quality nursing care. Design. Systematic review of randomised controlled trials. Methods. This review followed the methods of the Cochrane Handbook of systematic reviews of interventions. The systematic search (September 2009) covered the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO and LILACS. Results. Six cluster‐randomised controlled trials met the inclusion criteria. All studies investigated educational approaches targeting nursing staff. In addition, two studies offered consultation, two guidance and one support and free access to technical aids. Five studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Overall, the methodological quality of studies was low. Their results were inconsistent. One study with good methodological quality in the nursing home setting documented an increase in physical restraints use in both groups, while the other four studies with lower quality found reduced use of physical restraints in the intervention group. The single study in group dwelling units found no change in physical restraints use in the intervention group but a significant increase in the control group. Conclusions. There is insufficient evidence supporting the effectiveness of educational interventions targeting nursing staff for preventing or reducing the use of physical restraints in geriatric long‐term care. Relevance to clinical practice. Our findings indicate that educational programmes targeting nursing staff might not be effective in reducing the use of physical restraints in geriatric long‐term care. It remains unclear which components should be included in educational programmes aiming to reduce physical restraints.     

Factors influencing the decision of older people living in independent units to enter the acute care system

Aims and objectives. This South Australian‐based study explored and described the factors influencing the decision of older people living in the community in independent living units to enter the acute care system. Background. Community‐based older Australians, an increasing population segment, make choices about support needed to optimize health and well‐being. This includes when to enter the acute care system. Entering this system has potential risks as well as benefits. The current South Australian Department of Human Services policies of ‘keeping older people out’ of the acute care system has implications for prevention and early intervention measures and requires an understanding of how and why older people enter the acute care system. Method. In‐depth interviews were conducted with older people (N = 31) and their families (N = 10), drawn from three South Australian aged care organizations providing independent living unit accommodation, and focus groups (N = 14) were conducted with stakeholders to identify factors influencing the decision of older people living in independent living units to enter the acute care system. Findings. Analysis of the data revealed eight facets influencing this group of older people's decision‐making with respect to entering the acute care system; they were: expectations of support in the independent living unit not being met; the presence/absence of safety nets; lack of after‐hours support; the desire to remain independent; the general practitioner as pivotal; the influence of others; perceptions of the emergency department; and having access to information. Relevance to practice. These facets provide insights into entry processes, links and relationships that form an interface between primary care, community care, the aged care industry and the acute system. Analysis of these insights highlight prevention and early intervention responses that can promote the health and well‐being of older people, potential ways to streamline services, as well as gaps in current services.