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.     

The challenge of providing palliative care in the nursing home: part 1 external factors

One impact of the baby boom generation and improved medical care is that nursing homes will be the place of care and site of death for growing numbers of frail, older persons dying of chronic progressive illnesses. The nursing home settings may appear to be an appropriate environment wherein residents could receive palliative care, but the literature suggests that provision of such care is replete with challenge. Some of these challenges are external to the nursing home environment and are beyond the setting's control, others have internal origins and to some extent may be under the home's control. In part I of this two-part article, we review and critically analyse the primary external factors identified in the literature -- characteristics of the residents -- as they impact on the ability of care homes to deliver palliative care.     

Nursing home recruitment: Trials,tribulations, and successes

Many challenges are inherent when conducting research in the older adult population as well as in the nursing home environment. The safety and quality of care provided in nursing homes need further examination through research. The purpose of this paper is to discuss research issues and recruitment barriers experienced by a research team collecting data for a study assessing the education and learning needs of nursing home nurses in central Illinois and related resident outcomes. Research barriers identified in this study include organizational and administrative barriers in addition to staff barriers. The strategy that was most helpful in gaining access to nursing homes in central Illinois was face to face contact. Future nursing home researchers are encouraged to familiarize themselves with the nursing home environment, communicate with nursing home trade associations, and develop personal contacts with area nursing home administrators.     

Supporting student nurses on placement in nursing homes: the challenges for the link-tutor role

Practice-based learning has always been a key feature of nursing education, and the quality of student learning is heavily influenced by the quality of the clinical experience. In addition, with an ageing population, nurses will need to better develop the particular clinical skills related to meeting the needs of older people in diverse settings. Increasingly, health care faculties in universities are turning to nursing homes to provide clinical placements for student nurses. This paper examines the literature related to the benefits and challenges of using nursing homes as placement areas for student nurses, with particular reference to the challenges that nursing home placements present for link tutors. The paper concludes with a proposal for a model for the link-tutor role in nursing homes.     

Home and nursing home care of the dependent elderly patient

The factors that make an elderly person at risk for increased dependency and institutionalization are becoming more clearly defined. Family physicians should be familiar with the potential sources of support that can maintain increasingly dependent older persons in their own homes. A nursing home placement requires careful consideration to ensure appropriate placement and continuing family involvement in the life of the nursing home resident.     

The role of hospice care in the nursing home setting

The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing homes may be excessive, has perhaps slowed the adoption of hospice services into the nursing home setting. Currently, access to hospice care in nursing homes is inequitable across facilities, and across geographic areas. In nursing homes where hospice is available and present, however, recent research documents superior outcomes for residents enrolled in hospice, and perhaps for nonhospice residents. Still, more research is needed, particularly research focusing on the government costs associated with the provision of hospice care in nursing homes. If subsequent research continues to support the "added value" of hospice care in nursing homes and at the same or less total costs, the issue of foremost concern becomes how equitable access to Medicare hospice care in nursing homes can be achieved. Access may be increased to some extent by changing government policies, and conflicting regulations and interpretive guidelines, so they support and encourage the nursing home/hospice collaboration.     

‘I feel like a salesperson’: the effect of multiple‐source care funding on the experiences and views of nursing home nurses in England

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses’ reluctance to work in these settings are determined. This paper considers the influence that multiple‐source care funding issues have on nursing home nurses’ experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with ‘selling beds’; and coping with self‐funding residents’ changing expectations of care. The findings of the study suggest that multiple‐source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention.     

The risk of placement in a nursing home after acute hospitalization

Using data from an urban Professional Standards Review Organization, the authors examined the pattern of discharges for persons aged 65 years and older from acute hospitals for 1979 and 1980. Of the 9% of elderly persons who were discharged to nursing homes, those older than 85 years were 10 times as likely to enter a nursing home as those aged 65; females were twice as likely as males; and those with a diagnosis of mental illness were more likely than those with a diagnosis of physical disease, but the effects were additive. Even after adjustments for patient source, patient characteristics, and therapeutic service, the university teaching hospital was less likely to discharge elderly patients to nursing homes than were the 10 community hospitals in the area.     

Cancer care in nursing homes

OBJECTIVES: To review the available scientific literature on cancer care in nursing homes and recommendations for clinical practice and further research are offered. DATA SOURCES: Research studies and review articles. CONCLUSION: Overlooked issues for older adults with cancer in nursing homes include screening, treatment, and symptom management. Cancer care and survivorship in nursing homes receives little direct attention. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can improve cancer care and survivorship in nursing homes by considering nursing homes as a practice venue.     

Oral care in older adults with dementia: challenges and approaches

Multiple factors impact the successful provision of oral care in America's nursing homes. After reviewing the importance of oral care in general, the article focuses on the unique challenges of providing oral care to older adults with dementia and explores elements of a comprehensive approach to oral care. The article concludes with emerging evidence-based practices to improve oral care among older adults with dementia in America's nursing homes.     

The challenge of providing palliative care in the nursing home part II: internal factors

Nursing homes are increasingly becoming the place of care and site of death for growing numbers of frail older people dying of chronic progressive illnesses. Despite this increase, empirical evidence suggests that providing palliative care in nursing homes is replete with challenges. In a previous publication, the authors examined challenges external to the nursing home that influence the provision of palliative care, and which may be beyond the nursing home's control (Wowchuk et al, 2006). This paper reviews the primary internal factors identified in the literature that affect the provision of palliative care and are, to some extent, under the nursing home's control. The internal factors include: i) lack of care provider knowledge about the principles and practices of palliative care; ii) care provider attitudes and beliefs about death and dying; iii) staffing levels and lack of available time for dying residents; iv) lack of physician support; v) lack of privacy for residents and families; vi) families' expectations regarding residents' care; vii) hospitalisation of dying residents. Suggestions for practice, education and research are provided.     

The Norwegian teaching home program: developing a model for systematic practice development in the nursing home sector

Background. In the mid-1990s, there was persistent critique of the quality of care provided in residential aged care facilities in Norway, in line with similar concerns expressed in many other countries. Difficulties recruiting qualified staff and high turnover led to difficult working conditions. Little prestige was associated with providing geriatric care. Collaboration between educational institutions, universities and elderly care institutions with the purpose of strengthening education, competence development, practice development and research within elderly care was poorly developed. The Norwegian teaching nursing home (NTNH) program was launched to address these issues. Aim. The purpose of the NTNH was to contribute to the quality of care of frail older persons by improving the competence of staff, improving the prestige of working with older people, stimulating development of services, facilitating research into the care of older persons, and developing good learning environments for students. Methods. The NTNH-program was developed over a period of seven years, applying a participatory action research design. Progressing through four phases, it involved a number of people and institutions across Norway. Results. Formal and informal competence of staff was increased. A large number of practice development projects contributed to increased quality of care in selected problem areas. Models of competence development were disseminated to other institutions, thereby improving the level of competence beyond the NTNHs. Learning conditions for students were improved. Following a formal evaluation of the program, teaching nursing homes (TNHs) were established on a permanent basis in 2004, with financial support from the Department of Health and Social Services. In 2008, a total of 20 TNHs are part of the NTNH program. Conclusions. The NTNH program led to permanent establishment of a series of TNHs responsible for contributing to competence development, practice development and research on a continuous basis in order to secure high levels of care to the Norwegian nursing home population. The program has created substantial enthusiasm within the nursing home sector and has increased the prestige of these institutions.     

Health-Related Profile and Quality of Life Among Nursing Home Residents: Does Pain Matter?

The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents’ demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents’ physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents’ pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.     

The nursing home: occupational therapy services in an institution.

The nursing home as an institution was described by presenting information from the literature and from the author's personal experience. Sociological definitions of the term institution were applied to the nursing home, and the negative effects of the institutionalization process on older persons were discussed. The plight of the residents was further exemplified in a discussion of the setting, staffing, financing, and services of nursing homes. Finally, the need for occupational therapy services was indicated, and therapists were urged to assume available jobs as therapists, consultants, or administrators in nursing homes as an initial step toward meeting this need.     

Taking on the challenge of clinical teaching in nursing homes

While the goal of professional nursing programs is to ensure that students have a basic level of competency to care for older adults in a variety of care settings, the greatest challenge is to garner students' enthusiasm about caring for older adults in nursing homes. To increase and strengthen the professional nursing workforce in nursing homes, schools of nursing must ensure that students have appropriately placed, well-designed, and innovative clinical experiences in nursing homes with faculty who are knowledgeable about the nursing home environment and the professional nursing care needs of its residents. Four factors identified as keys to success in developing exemplary clinical experiences for students in nursing homes include: (a) nursing homes with positive reputations and providing quality care, (b) faculty knowledgeable and enthused about nursing homes, (c) committed partnerships between schools of nursing and nursing homes, and (d) creative and innovative clinical teaching strategies.     

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.     

Depressive symptoms among older residents at nursing homes in Taiwan

Aims and objectives. To examine the depressive symptoms of older residents at nursing homes and the relationship between their depressive symptoms and certain selected variables. Background. Depression has become a major healthcare concern among the older people, but nursing home‐based studies on risk factors of depression have still hardly been well performed in Taiwan. Design. A cross‐sectional design was developed and implemented. Methods. A research sample of 138 older residents was recruited from eight nursing homes located in southern Taiwan. During face‐to‐face interviews, the Center for Epidemiological Studies Depression Scale, Social Support Scale, Chronic Condition Checklist and Socio‐demographic Inventory were used for data collection. Results. The results showed that 81·8% of those residents were identified as being depressed. It was further discovered that the length of residency, number of chronic conditions, perceived health status and the amount of social support from their family and relatives could explain 38·8% of the total variances in depressive symptoms. Conclusions. Our study suggests that, in Taiwan, older people who live in nursing homes suffer from more depressive symptoms than those in community dwellings. To maintain and improve the health status for the elderly as much as possible, it is suggested that healthcare providers at nursing homes should develop an effective health promotion program for these older peoples. Relevance to clinical practice. There exists a high rate of depressive symptoms among older residents at nursing homes. It is imperative that a proper identification and its correspondent treatment for this health problem on the older residents are required. In late life, to maintain a higher level of quality of life, it is important to suggest that the health providers should regularly screen older people to increase the likelihood of diagnosis and improved treatment of late‐life depressive symptoms.