The provision of palliative care in nursing homes and residential care homes: a survey of clinical nurse specialist work

The provision of end-of-life care within nursing and residential care homes is of concern to policy makers and specialist palliative care providers. There is evidence of an increasing number of initiatives involving clinical nurse specialists (CNS) with the care of residents within these care settings, but the extent to which this is occurring in the UK has not been documented. A survey of 730 community CNS in palliative care was undertaken to describe the extent to which these practitioners are involved with the care of residents in nursing and residential care homes and the nature of this work. Although 92% of the CNS surveyed had worked with nursing homes and 80% of the CNS with residential care homes, the responses showed that this work was primarily reactive and undertaken infrequently. The majority of the work undertaken by CNS involved caring for patients with malignant conditions with a clinical focus addressing the management of physical symptoms.     

Ongoing consent to care for older people in care homes

Obtaining informed consent is a fundamental part of the care-giving process. Current policy documents emphasise the importance of including patients in planning their care. This article explores the concept of consent and the challenges to this concept for older people in long-term care, where consent is not a one-off event requiring a 'consent form', but just one stage in the continuum of involvement for service users. At one end of the spectrum, service users may be unaware that they have a service user plan (care plan), while at the other end they may be enabled to complete an advance statement of their wishes, thus demonstrating significant involvement in planning their care.     

Guide to providing mouth care for older people

The authors provide an overview of oral health, why it is important for older people and how poor oral health can affect nutritional status and quality of life. Practical advice is given on assessment of oral health; cleaning of natural teeth and dentures; and care of oral problems that commonly affect older people. An oral healthcare education session is recommended to provide hands-on advice to caregivers. The article is not intended as an exhaustive reference and the reader should always ask for professional dental advice and assistance if in doubt about any aspect of oral care.     

Developing palliative care practice in nursing and residential care homes: the role of the clinical nurse specialist

The development of practice is but one aspect of Clinical Nurse Specialists' (CNSs) work, and a number of factors act to shape the extent to which CNSs are able to work with and develop practice with nursing and residential care homes. A postal survey of 730 community CNSs in palliative care working in the UK was undertaken to explore the involvement of these nurses with nursing and residential care homes. Much of the focus of the involvement was reactive work meeting the direct clinical needs of residents, primarily with cancer. Although the CNSs perceived that there were some educational and care deficits in these care settings, the amount of proactive work undertaken to improve practice was limited. The development work undertaken was focused on educational initiatives and establishing link nurse systems. There is potential to develop palliative care practice in nursing and residential care homes through practice development initiatives.     

Promoting nutrition in older people in nursing and residential homes

Malnutrition and dehydration are serious and common problems among older people in nursing and residential care homes. The situation is exacerbated because staff may not be trained to recognize the signs and symptoms of malnutrition and dehydration and hence opportunities for early intervention are missed. A nutrition assessment should form part of the admission process to identify whether an individual has, or is at risk of developing, malnutrition and dehydration. This article suggests key questions that should be asked to assist this process. The individual and organizational risk factors that affect nutrition and health status are discussed, and practical suggestions given to help address any problems recognized. The causes and consequences of dehydration are explained and practices that place an individual at risk of dehydration considered. Suggestions are given to help identify when a person is not drinking sufficiently so that early rapid intervention can be initiated. Helping an older person to eat and drink independently is a practical activity that is often undervalued. Its importance needs to be recognized in all nursing and residential care settings.     

District nurses' experiences of providing care in residential care home settings

Little research describes the involvement and contribution of primary health care services in residential homes, despite policy and research concerns that older people in residential homes are a vulnerable population for whom care must be improved. The aim of this research was to explore the actual and potential contribution of primary care nurses in residential homes for older people, particularly district nurses. Five focus groups were held with district nurses in one county in England, to explore how participants represented their views, values and experiences of working in residential homes. Our major finding was the importance of context in shaping the experience of district nursing involvement. General practitioner attachment determined the frequency of visiting homes and affected workload. District nurses had regular contact with residential homes for discrete nursing tasks, but appropriateness of referrals and input was not agreed. The focus group discussions with district nurses revealed how problematic their work in residential homes was and a lack of consensus about their role. The data suggested that uncertainty about providing care in a setting that straddles the health and social care, public and private divide, and anxieties about managing their workload overshadowed their acknowledged concerns about the older people in residential care homes. Further research is needed to substantiate the findings, obtain residents' views and address issues of how to achieve integrated and equitable health and social care for this group.     

The development of palliative care knowledge in care homes for older people: the place of action research

Action research in health care is a relatively new research approach, which is adopted when one aim of the research is to bring about change in practice and to research the process of that change. This paper describes the way action research, as a research methodology, can be used to develop palliative care knowledge in generalist care settings. An overview of action research is presented and its relationship to more conventional research paradigms. Two action research projects, undertaken to develop knowledge about end-of-life care for older people in care homes, are used to illustrate the key principles of action research, methods of data collection and data analysis. Finally, the challenges of such, utilising an action research approach and its strengths, are discussed.     

Supporting care homes: the older people's specialist nurse

This article outlines the health needs of older nursing home residents and identifies the case for the role of an older people's specialist nurse within a multidisciplinary care homes support team (CHST). This model has been successfully introduced in the London boroughs of Lambeth, Southwark and Lewisham as a response to the profile of local health need among care home residents and changes in national policy such as the introduction of NHS-funding nursing care. The structure of the CHST is described, and the older people's specialist nurse is discussed in detail. The emergent role of the older people's specialist nurse as key to managing the interface between the nursing homes and primary care is highlighted as a key benefit of this unique role.     

Ensuring excellence: an investigation of the issues that impact on the registered nurse providing residential care to older Australians

The aim of this paper is to provide a comprehensive picture of the issues that impact upon the registered nurse providing residential aged care, in order to contribute to best practice initiatives to enhance both the health and well-being of older Australians and the professional working life of registered nurses working in this sector. The impact of an ageing population is being felt in Australia as in other western countries. In Australia, there is an estimated 12% of the population aged 65 and over, with a projected increase to 18% by 2021. Paradoxically, there is an emerging crisis in attracting and retaining skilled registered nurses to provide residential aged care. Little research evidence exists that provides a comprehensive picture of the issues impacting on this group of nurses. This exploratory qualitative study comprised three stages involving the use of interviews, focus groups, nominal groups and a series of workshops. Ongoing iterative analysis of the multiple data sources identified five key issues impacting on registered nurses providing residential aged care, as well as a range of strategies designed to address those issues. The final recommendations were developed with key stakeholders in terms of language, intention and ranked order, and are included in full.     

香港安老院老年人对隐私的理解及需求

为探讨居于安老院的中国老年人对隐私的看法及相关体验,采用了质性研究方法,深入访谈了来自12间安老院的71名老年人。研究结果指出在安老院生活中,大部分老年人认为隐私并非必要,也不是先决条件。他们似乎已接纳并依从安老院的生活模式,即重视团结、和谐、并以满足大多数人的集体利益为依归,而非集中在个人的需要上。中国文化对保持和谐及融洽的重视塑造了老年人对隐私的看法。研究有助于对安老院中拥有中国文化背景的老年人提供适宜的照顾,保障他们在长期护理设施内的隐私。     

Views on dignity in providing health care for older people

AIM: The aim of this study was to explore the salience and meaning of dignity and dignified care for care providers and the implications for the proviosion of care. The project forms part of an international study being undertaken in different European countries comparing health and social care workers' views on dignity. METHOD: Focus groups were chosen as the primary method of data collection. Twelve focus groups were carried out involving a total of 52 participants representing a range of occupational groups. RESULTS: All participants stated that dignity and respect were important for people of all age groups. The evidence that emerged from these focus groups showed that, in spite of the appropriate intentions of providers, older people were not consistently provided with dignified care. CONCLUSION: In order to ensure dignity in providing care for older people, tasks need to be organised around older people's needs and time frames. Without such changes there is a danger that 'institutional ageism' will persist in the health service.