The nursing home as a home: a field study of residents' daily life in the common living rooms

Aim. This Norwegian‐based study investigates how and to what extent the idea of the nursing home as a home has been realized. Background. For the last two decades, Norway, as other Western Country has had an explicit national policy that nursing homes should become more like homes. The research literature indicates that residents in nursing home seem to lack the opportunities to maintain a private sphere. Design. A field study design was conducted. Methods. Data were collected in 1999 in two long‐term units in a traditional nursing home by using participant observation and interviewing the residents. A phenomenological hermeneutic analysis strategy was used to get an impression of the residents’ everyday life. Results. The residents spend most of their time in the common living room. The common living room has an ambiguous boundary between the public and private spheres, unlike the clear boundaries characterizing a home. The relationship among the residents is fragile, and the residents who can, withdraw from the common living room. Conclusions. Despite having single rooms and more home‐like interior decoration, the residents in nursing home still have reduced opportunity to develop a private everyday lifestyle. The long‐term unit examined in this research had a forced relationship between the residents, and the residents with best health resources systematically withdraw from the common area to control both where and with whom they wish to spend their time. Relevance to clinical practice. This study lays the foundation for rethinking daily routines in long‐term units in nursing homes. One way to realize the idea of the nursing home as a home could be to define the living room as a clear public area and to give the residents a chance to develop a more private lifestyle by alternating between their private rooms and a public common living room.     

A comparative study of the social conditions of spouses of long term patients cared for either in nursing homes or home care.

In order to study the social conditions of spouses of patients suffering from long term illnesses structured interviews were performed. The interviewees were divided into two groups: spouses of persons with chronic conditions cared for at home and spouses of patients cared for in nursing homes. Each group consisted of 27 spouses and there were no differences in physical health score, Mini mental score or ability to manage primary Activities of Daily Living functions between the groups. Home care spouses paid fewer visits to children, had fewer friends and paid fewer visits to friends and they also had time for hobbies or interests significantly more seldom (reading, visits to church) than nursing home spouses. There were no significant differences between the groups concerning sex, socio-economic class, housing conditions and amount of home health services. Their contact with children and their feelings of loneliness were reported to be the same.     

Collaboration between relatives of elderly patients and nurses and its relation to satisfaction with the hospital care trajectory

Background: Relatives are often involved in the care of frail elderly patients prior to admission and are thus important collaborative partners for nurses. They hold valuable knowledge, which may improve care planning for the benefit of the patient and the hospital care trajectory. Satisfaction among relatives may be an indicator of this. Aim: To investigate collaboration between relatives and nurses among those relatives reporting high versus low satisfaction with the hospital care trajectory. Further, the aim was to investigate the relationship between satisfaction with the hospital care trajectory and (i) participants’ characteristics and (ii) the dimensions of collaboration. Sample: Relatives of elderly patients (n = 156) in acute hospital wards. Women constituted 74.8%, adult children 63.9% and spouses 20% of the participants. Mean age was 60.78 (SD 11.99). Design: Cross‐sectional, comparative, analytical. Method: A self‐report, structured questionnaire covering attributes, prerequisites, outcome and barriers/promoters for collaboration. Respondents reporting high versus low satisfaction were compared with regards to characteristics and mean scores in dimensions of collaboration. Multivariate logistic regression analyses examined predictors for satisfaction with the hospital care trajectory. Findings: Low satisfaction was significantly related to low level of collaboration. Other predictors for low satisfaction were: feelings of guilt and powerlessness, having provided help for less than a year and not providing psychosocial help. Conclusion: Satisfaction with care as a hypothesized outcome of collaboration was supported in this study. Hitherto, research has mainly focussed on relatives as potential clients; this study has focussed on relatives as competent collaborative partners in care. A new role for relatives as partners in decision‐making rather than passive recipients of information is indicated for the benefit of care quality. Further, increased collaboration between relatives and nurses, assigning relatives’ influence, may reduce their powerlessness and guilt and thereby indirectly increase their satisfaction.     

Of ethics committees, protocols, and behaving ethically in the field: a case study of research with elderly residents in a nursing home

In this paper we discuss differing discourses of research ethics committees and the clinical research field. Reflections on our experience of conducting research in a nursing home are used to highlight the tensions and inconsistencies that arise from these discourses and the need to behave ethically in the field. While accepting the need for adherence to guiding principles of duty based ethics, we have found that practical moral decisions in the field required that, as individual researchers, we needed to exercise discretionary judgement, informed by the ethic of care and the concern for the well-being of research participants.     

Roles of assistive devices for home care staff in Sweden: A qualitative study

Purpose.?To explore home care staff experiences in relation to assistive devices and the use of assistive device at work.

Method.?Individual conversational interviews with 14 home care staff were used. Qualitative content analysis was used to analyse the data.

Results.?A broad meaning attached to the use of assistive devices at work emerged in three themes. In ‘staff's role at work in relation to assistive devices’, their different roles emerged in relation to knowledge and instruction as well as safeguarding the user. ‘Assistive devices as a product and their significance for staff’ showed that devices were an integrated part of staff work in the users' home. Devices influenced staff cooperation, feelings and were significant in relation to time and finance. Regarding ‘assistive devices and their significance for the user from the staff's perspective’, the staff felt that devices were a prerequisite for the user coping with everyday life and they also had an emotional significance.

Conclusion.?Assistive devices play a significant and important role for home care staff. An increased understanding among prescribers and other health care staff about home care staff knowledge about, work with and experience from assistive devices could contribute to a better care and rehabilitation for home care recipients.     

A before and after study assessing the impact of a new model for recognizing and responding to early signs of deterioration in an acute hospital

Aim. To evaluate the impact of a new model for the detection and management of deteriorating patients on knowledge and confidence of nursing staff in an acute hospital. Background. International evidence shows that clinical deterioration is not always recognized or acted on by nurses. The use of physiological track and trigger scoring systems accompanied by a graded response strategy has been recommended to monitor all adult patients in acute UK hospitals. However, little is known about the impact of these new systems in practice. Design. A single centre, mixed methods before‐and‐after study. Methods. A mixed methods before‐and‐after study, set in a district general hospital in England, in 2009, including a survey (n = 213) and qualitative interviews (n = 15) with nursing staff. The questionnaire examined knowledge and confidence in recognition and management of deteriorating patients 6 weeks before and after an intervention which included training, new observation charts and a new track and trigger system. Interviews further explored participants’ perspectives. Comparisons were made between registered and unregistered nurses. Results. Following the intervention, knowledge, and confidence to recognize and manage deteriorating patients increased; the number of concerns were reduced. Scores were higher for registered than unregistered nurses before and after the intervention. Interviews confirmed these findings and provided detail on how nurses felt the new system had improved practice. Conclusion. The new model had a positive impact on the self‐assessed knowledge and confidence of registered and unregistered nurses. Similar initiatives should take into account the clinical context and tailor training packages accordingly.