Demonstration of the usefulness of a theoretical framework for humanising care with reference to a residential aged care service in Australia

Aims and objectives. To demonstrate the usefulness of a theoretical framework for humanising care of dementia patients. Background. The term humanisation of care has been increasingly used to describe an approach to health care that is informed by core dimensions of what it means to be human. Recent developments in dementia care highlight the importance of maintaining personhood in people with dementia. Design. A conceptual framework is proposed by which the humanisation of care can be understood and applied. Eight dimensions that articulate core features of what needs to be attended to in order for a person to feel more deeply ‘met’ as a human being are discussed. Evidence from an evaluative study of a dementia outreach service is used to illustrate the usefulness of the humanising framework. Methods. Case study examples demonstrate the value of this framework by describing how a dementia outreach service enables care staff in residential aged care facilities to change their focus in the provision of care to residents with dementia. Each of the eight dimensions of humanisation/dehumanisation is used to illustrate how the dementia outreach service team have led to the improvements in resident care. Results. Positive outcomes can be achieved by providing humanised care to residents with dementia. Conclusion. The paper highlights the potential for the humanising framework to be used in dementia care and shows how the framework can be helpfully translated into practice so that carers are supported to adopt an inclusive view of care delivery. Relevance to clinical practice. A comprehensive framework, grounded in a strong philosophical foundation, can name a breadth of criteria for humanly sensitive care and can be translated into practice in such a way as to potentially transform the provision of care to residents in residential aged care facilities.     

我国老年保健中社区护理问题分析及展望

分析我国老年人的健康问题、社区护理在老年保健中的作用、老年社区护理现状以及老年社区护理目前存在的问题,展望我国老年社区护理的发展模式.     

Improving networks between acute care nurses and an aged care assessment team

Background. Acute care nurses have an important role in the discharge planning of older people from hospital to home. However, few nurses understand the changing aged care system or the consequences of poor referral on the lives of older people postdischarge. Aims and objectives. This paper reports the findings of a research project, which aimed to investigate the possibilities for facilitating the transition of older people from hospital to home through improving the working relationship between nurses and members of a multidisciplinary aged care assessment team (ACAT). Design and methods. The paper reports one action research cycle from a larger project. Action research was chosen because its focus on knowledge development and action leads to practical solutions to clinical problems. The research approach included interactive forums designed to facilitate effective collaboration between the nurses and ACAT in the discharge planning of older people. Data collection strategies included audiotapes of ACAT research discussions, field notes, policy documents, referral forms and an evaluation tool. Results and conclusions. The findings illustrate that ward nurses have, at best, a limited knowledge and understanding of the aged care system, its function, or how to access services. They need assistance to develop their knowledge of services available to support older people following discharge. The conduct of interactive forums, which utilize a case study approach, facilitated such knowledge development and empowered the nurses to become more involved in discharge planning. Participation in the forums also facilitated new collaborative partnerships between the nurses and ACAT, which enhanced effective discharge planning. Relevance to clinical practice. The paper outlines practical strategies to support collaboration between ward nurses and community providers and/or multi disciplinary assessment services. It provides a list of key considerations for the development of effective ward/community networks to facilitate the discharge of older people.     

Transition to residential care: experiences of elderly Chinese people in Hong Kong

A qualitative study was designed to explore the experiences of transition into residential care among elderly Chinese people in Hong Kong. With the elderly people's consent, in-depth interviews were conducted with 10 residents 1 week after their admission into a residential care home. The purpose of the interviews was to explore what the transition experience was like for the Chinese elders and how they settled into residential life. Content analysis of the interview data revealed the significance of cultural influences in the transition experiences. A number of issues suggested in the literature as barriers to adjustment to residential care, such as living with rules and regulations, lack of privacy and autonomy were not regarded as important by the Chinese elders. The Chinese values of balance, harmony and collectivism have made it easier for them to remain open and accept the communal way of living. Yet, these same values have restricted the elders in developing new relationships with staff and other residents. This appears to be the particular challenge facing Chinese elderly residents. Implications for professionals working with elderly residents are discussed in the light of these findings.     

Community psychiatric nurses for the elderly: well tolerated,few side-effects and effective in the treatment of depression

• ? Depression in elderly people is a common yet treatable psychiatric problem.
• ? The Gospel Oak depression study researched this much overlooked group and has shown that a community psychiatric nurse (CPN) was able significantly to improve the mental state of depressed elderly people.
• ? A multifaceted package of care was co-ordinated and delivered by one CPN over a study period of 3 months.
• ? A detailed account is given of those interventions implemented, highlighting those which were of most benefit for the patient.
• ? Outcome was assessed independently and it was found that those patients allocated to CPN care improved significantly compared to the non-intervention control group.
• ? Ways in which nurses can enhance care given to patients in the community are discussed.

     

A study of nurses' knowledge of a palliative approach in residential aged care facilities

Aim. To identify residential aged care nurses’ current knowledge of palliative care for older residents in need of end‐of‐life care. Background. Recently, there has been a growing interest in the delivery of palliative care in residential aged care facilities. While it is recognized that aged care nurses do possess palliative care knowledge the actual level of their knowledge has not been well documented. Design/method. An analytical study using a validated questionnaire tool – Palliative Care Quiz for Nursing, developed by Ross et al. [Journal of Advanced Nursing 23 (1996) 126–137] , combined with a demographic survey of Registered Nurses and assistants in nursing working in five high care residential aged care facilities in inner city region of Sydney, Australia. Results. The total Palliative Care Quiz for Nursing score possible was 20. The mean score for Registered Nurses was 11.7 (SD 3.1) and for AINs 5.8 (SD 3.3), the difference between scores being significant (t = 8.7, df 95, P = 0.000). Misconceptions in palliative care were identified for both the groups of carers. Conclusion. This research has highlighted the need for ongoing palliative care education for both the groups of primary carers. Relevance to clinical practice. The findings of this research highlight the existing palliative care knowledge of residential aged care nurses and provides evidence for education programmes.     

养老机构老年人主观幸福感的影响因素研究

目的调查养老机构老年人的主观幸福感情况及影响因素,为养老机构提高老年人生活质量,促进老年人身心健康提供依据。方法采用一般资料调查表、SF-36健康调查量表、老年人能力评估问卷对北京市6所养老机构的375名老年人进行调查。结果北京市6所养老机构老年人主观幸福感得分为(38.54±9.86)分;经济来源、能力等级、躯体健康、精力、心理健康是老年人主观幸福感的影响因素(P0.01或P0.05)。结论政府部门和养老机构的相关工作人员应注重增强老年人的精力,改善其躯体健康状况,注重其心理健康,进而增强其主观幸福感。     

Communities of practice in residential aged care: A rapid review

Background

Communities of practice (CoPs) have the potential to help address the residential aged care system's need for continuing education and quality improvement. CoPs have been used in healthcare to improve clinical practice; however, little is known about their application to the unique residential aged care context.

Objectives

This rapid review of CoPs for residential aged care was conducted to summarise the features of CoPs, how they are developed and maintained, and assess their effectiveness.

Methods

MEDLINE and CINAHL databases were searched for studies published from January 1991 to November 2022 about CoPs in residential aged care. Data were extracted regarding the CoPs' three key features of ‘domain’, ‘community’ and ‘practice’ as described by Wenger and colleagues. Kirkpatrick's four levels of evaluation (members' reactions, learning, behaviour and results) was used to examine studies on the effectiveness of CoPs. The Mixed Methods Appraisal Tool was used for quality appraisal.

Results

Nineteen articles reported on 13 residential aged care CoPs. Most CoPs aimed to improve care quality (n = 9, 69%) while others aimed to educate members (n = 3, 23%). Membership was often multidisciplinary (n = 8, 62%), and interactions were in-person (n = 6, 46%), online (n = 3, 23%) or both (n = 4, 31%). Some CoPs were developed with the aid of a planning group (n = 4, 31%) or as part of a larger collaborative (n = 4, 31%), and were maintained using a facilitator (n = 7, 54%) or adapted to member feedback (n = 2, 15%). Thirteen (81%) studies evaluated members' reactions, and three (24%) studies assessed members' behaviour. The heterogeneity of studies and levels of reporting made it difficult to synthesise findings.

Conclusions

This review revealed the variation in why, and how, CoPs have been used in residential aged care, which is consistent with previous reviews of CoPs in healthcare. While these findings can inform the development of CoPs in this context, further research is needed to understand how CoPs, including the membership makeup, delivery mode, facilitator type and frequency of meetings, impact quality of care.     

A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care

hasson h. & arnetz j.e. (2009)   A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care. International Journal of Older People Nursing   5 , 5–15
doi: 10.1111/j.1748-3743.2009.00186.x
Background.  Comparisons of different stakeholders' ratings of the quality of older people care can help to drive quality improvement.
Aim.  The aim was to compare staff, older care recipients' and their relatives' quality of care ratings.
Design.  Cross-sectional questionnaire surveys in 2003 and 2004, using a repeated measures design on an organizational level.
Methods.  Nursing staff, care recipients and relatives in two older people care organizations were included. The ratings of an overall quality grade, information, activities, general care and staff skills were compared between the respondent groups.
Results.  Care recipients in both organizations rated the overall quality grade significantly higher than nursing staff and relatives. Staff ratings of the information given to care recipients were significantly more positive than care recipients' and relatives' ratings. All three groups gave lowest ratings to the quality of activities offered to care recipients, with lowest ratings from nursing staff.
Conclusions.  Concurrent measurements of staff, care recipients and relatives' care quality perceptions can provide a broad evaluation of an organization's strength and limitations.
Relevance to clinical practice.  Staff, care recipients' and relatives' perceptions can be useful for older people care organizations and decision makers in developing care processes and outcomes of care.     

Attitudes toward dementia‐related aggression among staff in Japanese aged care settings

Aim and objective. This study investigated attitudes of Japanese aged care staff toward aggression by people with dementia. Relationships between staff attitudes, professional characteristics and clinical practice were explored. Background. Aggressive behaviour is often demonstrated by people with dementia and may be influenced by many factors including an inability by the individual to appropriately express their needs, difficulties with assessment, as well as organisational and practice issues. Design. Survey. Method. Twenty‐seven facilities/organisations located in the western and middle parts of Japan were surveyed. Staff (n = 675) employed in these facilities provided personal and professional information and completed the Attitudes Towards Aggression Scale. Results. Staff who were older, had more clinical experience, higher education and/or a higher position reported more positive attitudes towards patient aggression. Staff with negative attitudes towards patients who are aggressive reported using chemical and/or physical restraint more often than staff with positive attitudes. Conclusions. Dementia education as well as restraint policy will be useful in addressing negative staff attitudes, in particular it may help to reverse the myth that restraint is necessary for staff protection. Furthermore, staff counseling may help to reduce stressors and to change staff negative attitudes towards people with dementia who display aggression. Relevance to clinical practice. The findings show that negative staff attitudes may adversely affect clinical decision making and patient care. Measuring attitudes can identify areas requiring education or skill development and enable changes in attitudes to be monitored over time.     

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.     

机构养老护理员对老年人态度及相关影响因素分析

【】目的 调查浦东新区医疗机构养老护理员对老化知识掌握现状和对老年人态度。方法 以整群抽样方法,采用Palmore老年知识量表(FAQ)和Kogan老年人态度量表(KAOP)对187名医疗机构养老护理员进行问卷调查。结果 共回收有效问卷143份,其中男10人,女133人;年龄39岁～62岁(51.66岁±4.54岁);养老护理员对FAQ量表总分(10.89±2.42),答题正确率为(43.55±9.70)%,处于较低水平;KAOP量表总分为(145.33±21.66),消极分量表得分为(59.34±16.57)分,积极分量表得分为(86.08±13.96)分,总体态度偏向正向和积极;养老护理员对开设继续教育课程需求总分为(4.12±1.10)分,对开设继续教育课程有强烈的意愿。不同特征养老护理员的FAQ得分差异均无统计学意义(P＞0.05);不同年龄、不同职称KAOP总分差异有统计学意义(P＜0.05),其中≤49岁及50-59岁年龄组KAOP总分和KAOP＋得分均高于≥60岁(P＜0.05);中级职称KAOP总分高于初级职称和无职称者,中级职称KAOP＋得分高于无职称者(P＜0.05);KAOP-得分方面,工龄6-10年高于11年以上、护理院高于老年科,非独生子女高于独生子女(P＜0.05)。不同工龄的养老护理员在开设继续教育课程需求得分上差异有统计学意义(P＜0.05),其中6年以上工龄高于5年以内者(P＜0.05);小学及以下学历高于初中学历者(P＜0.05)。养老护理员的FAQ得分与KAOP总分(r=-0.013,P=0.879)、KAOP+(r=-0.011,P=0.893)、KAOP-(r=-0.028,P=0.736)均无相关性;养老护理员对开设继续教育课程的需求得分与KAOP总分(r=-0.195,P=0.019)、KAOP+(r=-0.178,P=0.034)和FAQ(r=-0.206,P=0.014)均呈负相关,与KAOP-(r=-0.106,P=0.207)无相关性。结论 养老护理员对老化知识普遍缺乏;绝大部分养老护理员对老年人表现出正向和积极的态度;养老护理员对开设继续教育课程的意愿较高。应积极探索养老护理员的继续教育课程开发和规范化培训模式,全面提高养老护理员的服务素质、服务技能和服务态度,最大限度满足老年人的服务需求,提高老年人的生活质量和获得感。     

The evolution of palliative care and the relevance to residential aged care: Understanding the past to inform the future

Improving the experience of dying in residential aged care units became a significant project of the Australian Government’s National Palliative Care Program in 2004. This initiative resulted in an expectation that residential aged care facilities would adopt the recommended palliative approach to underpin service delivery. Recognising palliative care as a specialist area of health care practice is a recent development which has influenced the expectations of community and government. This paper traces the global history of palliative care and how historical factors influenced its development in Australia. This discussion presents an overview of the positioning of dying and death within society, explaining how with the shifting emphasis on care of the dying accordingly has been the focus on palliative care specialists. Care of the dying in residential aged care units has largely been overlooked in the context of specialist involvement. This paper acknowledges dying and death as occurring in residential aged care facilities, illuminating the advantages of adopting a palliative approach and offers recommendations.