Involve Residents to Ensure Person-Centered Nursing Home Care During Crises Like the COVID-19 Outbreak

AbstractNursing homes aim to provide person-centered care and recognize residents as unique individuals with their own histories, life goals, and preferences. The life expectancy of nursing home residents is rather limited. Nursing homes have been hit hard by COVID-19 because of an increased risk of death and a total nursing home lockdown from March 19 until the end of May 2020. Although social relationships are a basic human need and the fulfillment of social needs is essential for both physical and mental health, nursing home residents were no longer allowed to meet their loved ones. This decision was taken without involving residents and their loved ones and without considering the psychosocial impact of such measures for residents and their loved ones. When visitors were again allowed in the nursing homes, this was valued highly. To enable decent decision-making, we call both the government and nursing homes to involve residents and their families in decision-making. It is essential to know how residents weigh the risk of a COVID-19 infection and the possible implication of them opposing social isolation. We have to adapt to a new common and need to stop talking about residents and their loved ones and start talking with them.

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The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review

Dementia ◽

10.1177/14713012211012606 ◽

2021 ◽

pp. 147130122110126

Author(s):

Alexandra E Harper ◽

Lauren Terhorst ◽

Marybeth Moscirella ◽

Rose L Turner ◽

Catherine V Piersol ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Scoping Review ◽

Informal Caregivers ◽

Nursing Home Care ◽

Person Centered Care ◽

People With Dementia ◽

Centered Care

Background Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers’ dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual’s care. However, little is known of the informal caregivers’ perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. Methods In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com , CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. Results We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. Conclusion Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers’ perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers’ satisfaction with nursing home care for residents with dementia.

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The Physical Environment of Nursing Homes for People with Dementia: Traditional Nursing Homes, Small-Scale Living Facilities, and Green Care Farms

Healthcare ◽

10.3390/healthcare6040137 ◽

2018 ◽

Vol 6 (4) ◽

pp. 137 ◽

Cited By ~ 11

Author(s):

Bram de Boer ◽

Hanneke Beerens ◽

Melanie Katterbach ◽

Martina Viduka ◽

Bernadette Willemse ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Physical Environment ◽

Well Being ◽

Nursing Home Care ◽

Small Scale ◽

People With Dementia ◽

Different Types ◽

Centered Care ◽

Green Care Farms

It is well recognized that the physical environment is important for the well-being of people with dementia. This influences developments within the nursing home care sector where there is an increasing interest in supporting person-centered care by using the physical environment. Innovations in nursing home design often focus on small-scale and homelike care environments. This study investigated: (1) the physical environment of different types of nursing homes, comparing traditional nursing homes with small-scale living facilities and green care farms; and (2) how the physical environment was being used in practice in terms of the location, engagement and social interaction of residents. Two observational studies were carried out. Results indicate that the physical environment of small-scale living facilities for people with dementia has the potential to be beneficial for resident’s daily life. However, having a potentially beneficial physical environment did not automatically lead to an optimal use of this environment, as some areas of a nursing home (e.g., outdoor areas) were not utilized. This study emphasizes the importance of nursing staff that provides residents with meaningful activities and stimulates residents to be active and use the physical environment to its full extent.

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Nurse-Patient Interaction: A Vital Salutogenic Resource in Nursing Home Care

Health Promotion in Health Care – Vital Theories and Research ◽

10.1007/978-3-030-63135-2_10 ◽

2021 ◽

pp. 117-136

Author(s):

Gørill Haugan

Keyword(s):

Older Adults ◽

Health Promotion ◽

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Patient Interaction ◽

Health Promoting ◽

To Come

AbstractWe are now witnessing a major change in the world’s population. Many people globally grow very old: 80, 90, and 100 years. Increased age is followed by an increased incidence of functional and chronic comorbidities and diverse disabilities, which for many leads to the need for long-term care in a nursing home. Quality of life and health promotive initiatives for older persons living in nursing homes will become ever more important in the years to come. Therefore, this chapter focuses on health promotion among older adults living in nursing homes. First, this chapter clarifies the concepts of health, salutogenesis, and pathogenesis, followed by knowledge about health promotion. Then insight and knowledge about the nursing home population is provided; what promotes health and well-being in nursing home residents?Health promotion in the health services should be based on integrated knowledge of salutogenesis and pathogenesis. The salutogenic understanding of health is holistic and considers man as a wholeness including physical, mental, social, and spiritual/existential dimensions. Research indicates that various health-promoting interventions, specifically the nurse–patient interaction, influence on older adults in nursing homes as a wholeness of body–soul–spirit, affecting the whole being. Hence, dimensions such as pain, fatigue, dyspnea, nausea, loneliness, anxiety, and depressive symptoms will be influenced through health-promoting approaches. Therefore, two separate studies on the health-promoting influences of nurse–patient interaction in nursing home residents were conducted. In total, nine hypotheses of directional influence of the nurse–patient interaction were tested, all of which finding support.Along with competence in pain and symptom management, health-promoting nurse–patient interaction based on awareness and attentional skills is essential in nursing home care. Thus, health care workers should be given the opportunity to further develop their knowledge and relational skills, in order to “refine” their way of being present together with residents in nursing homes. Health professionals’ competence involves the “being in the doing”; that is, both the doing and the way of being are essential in health and nursing care.

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Challenges in Current Nursing Home Care in Rural Germany and How They Can Be Reduced by Telehealth - an Exploratory Pre-post Study

10.21203/rs.3.rs-498775/v1 ◽

2021 ◽

Author(s):

Susann May ◽

Kai Jonas ◽

Thomas Zahn ◽

Martin Heinze ◽

Felix Mühlensiepen

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Rural Areas ◽

Qualitative Content Analysis ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Alternative Form ◽

Supporting Evidence ◽

Existing Structures

Abstract BackgroundTelemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. ObjectiveThe goal was to assess the effect of implement medical video consultations into nursing home care addressing the following research questions:- How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? - How can video consultations be used to reduce difficulties arising in everyday care? - How does implementation of video consultations impact day-to-day nursing home care delivery?MethodsTwenty-one guided interviews (pre-implementation n=13; post-implementation n=8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis.ResultsChallenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly.ConclusionsTelehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.

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Racial and Ethnic Disparities in Pain Management for Nursing Home Residents: A Scoping Review

Innovation in Aging ◽

10.1093/geroni/igab046.3194 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 885-885

Author(s):

Cassandra Dictus ◽

Youngmin Cho ◽

Tamara Baker ◽

Anna Beeber

Keyword(s):

Nursing Home ◽

Pain Management ◽

Nursing Homes ◽

Racial Disparities ◽

Racial Differences ◽

Racial Bias ◽

Nursing Home Residents ◽

Ethnic Disparities ◽

Nursing Home Care

Abstract Within nursing homes, residents commonly experience pain that unfortunately goes underrecognized and undertreated, having a dramatic negative impact on residents' quality of life. Nursing homes are becoming more racially and ethnically diverse, and there is concerning evidence documenting disparities in the quality of nursing home care. In other healthcare settings, people of diverse race groups often receive less optimal pain management, but the evidence regarding racial disparities has not been synthesized for nursing homes. Thus, the purpose of this review was to investigate what is known about racial disparities related to pain management (e.g. assessment, treatment, preferences) in US nursing homes. We completed a scoping literature review using PRISMA-ScR guidelines and searching PubMed, CINHAL, and Scopus for peer-reviewed, empirical studies. Most studies were older large retrospective cohort studies of administrative data documenting that White residents were more likely than residents of diverse race groups to have pain documented and treated. Only a few studies looked at possible reasons to explain the disparities; differences were not found to be related to nursing staff racial bias nor differences in pain-related diagnoses. However, there was evidence of racial differences in resident behavior and attitudes related to pain management. None of the studies examined systemic factors related to differences among nursing homes, which has been implicated in studies looking at other outcomes including COVID-19. More research is needed which examines the causal mechanisms behind the documented racial disparities in pain management so that gaps in care can be reduced.

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Prevalence of Behavioural and Psychological Symptoms of Dementia in Nursing Homes in Berlin

European Psychiatry ◽

10.1016/s0924-9338(09)70723-0 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

T. Majic ◽

J.-P. Pluta ◽

T. Mell ◽

A. Decker ◽

A. Heinz ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Caregiver Burden ◽

Psychological Symptoms ◽

Drug Prescription ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Cross Sectional ◽

Psychiatric Hospitalizations

Background:Behavioral and Psychological Symptoms of Dementia (BPSD) include agitation, apathy, hallucinations, and depression. These symptoms are a challenge to professional nursing care, resulting in frequent psychiatric hospitalization, which incur high costs to the national healthcare systems.Objective:To estimate the prevalence of BPSD in nursing home residents in 16 representative nursing homes in Berlin, Germany.Methods:In a cross-sectional clustered cohort study, BPSD were assessed using the Dementia Mood Assessment Scale (DMAS), the Neuropsychiatric Inventary (NPI) and the Cohen-Mansfield Agitation Inventory (CMAI). Dementia stage severity was measured by Functional Assessment Staging (FAST) and the Mini-Mnetals State Examination (MMSE). Furthermore, the patients" history recording psychotropics and number of psychiatric hospitalizations were registered. The prevalence and incidence rates of BPSD as well the duration of hospitalization and the quantity of drug prescription were estimated.Results:BPSD are common above all in nursing home residents with dementia, exhibiting prevalence rates of above 60% of all nursing home residents suffering from dementia. The severity of BPSD was related to number of psychiatric hospitalizations, the amount of psychotropics prescribed, and caregiver burden (p < .05).Conclusion:The high prevalence rate of BPSD reflects a significant problem in nursing home care, and is related to negative health outcomes and caregiver burden. Thus, nursing home care could be improved by minimizing the severity of BPSD, as well as the amount of drugs prescribed and the frequency of demented patients" hospitalization.

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Nursing home care quality: a cluster analysis

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-12-2015-0145 ◽

2017 ◽

Vol 30 (1) ◽

pp. 25-36 ◽

Cited By ~ 2

Author(s):

Vigdis Abrahamsen Grøndahl ◽

Liv Berit Fagerli

Keyword(s):

Cluster Analysis ◽

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Well Being ◽

Care Quality ◽

Nursing Home Care ◽

Healthcare Personnel ◽

Content Type ◽

Quality Perceptions

Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients’ perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents (n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ2 tests and one-way between-groups ANOVA were performed to characterise the clusters (p<0.05). Findings Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents’ care quality perceptions.

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THE SUPPORT OF AUTONOMY FOR NURSING HOME RESIDENTS WITH DEMENTIA: OBSERVATION OF MORNING CARE

Innovation in Aging ◽

10.1093/geroni/igz038.285 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S73-S73

Author(s):

Linda J Hoek ◽

Hilde Verbeek ◽

Erica De Vries ◽

Jolanda C Van Haastregt ◽

Ramona Backhaus ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Relational Autonomy ◽

Staff Members ◽

People With Dementia ◽

Centered Care ◽

Field Notes ◽

Almost All ◽

Physical Care

Abstract People with dementia in nursing homes need their social environment in supporting their autonomy. This study explored how this relational autonomy is supported by staff for residents with dementia during morning care in nursing homes. Structured observations (n=1815) were carried out to assess how resident choice is supported within staff-resident interaction. Observation of morning care consisted of four main categories: ‘getting up’, ‘physical care’, ‘physical appearance’ and ‘breakfast’. In addition, qualitative field notes were taken to support observations. In total, 55 residents with dementia were included from eight nursing home wards in The Netherlands. Results indicated that resident autonomy during morning care was only limitedly supported. Individual staff members took over tasks, regardless of resident’s individual capabilities to make a choice. Staff controlled resident’s choice for almost all observed categories. The findings of this study implicate that person-centered care during morning routine can be improved by addressing individual needs

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Nurse-Patient Interaction and Self-Transcendence: Assets for a Meaningful Life in Nursing Home Residents?

10.21203/rs.2.13599/v1 ◽

2019 ◽

Author(s):

Gørill Haugan ◽

Britt Moene Kuven ◽

Wenche Mjanger Eide ◽

Siw Eriksen Tåsen ◽

Eva Rinnan ◽

...

Keyword(s):

Older Adults ◽

Nursing Home ◽

Nursing Homes ◽

Meaning In Life ◽

Nursing Home Residents ◽

Well Being ◽

Nursing Home Care ◽

Patient Interaction ◽

Self Transcendence

Abstract Background. Today, we face a shift to an older population worldwide and its consequences; a noteworthy part of older adults will need 24-hours nursing home care at the end of life. Finding new and alternative approaches to increase wellbeing among nursing home residents is highly warranted. Knowledge about nurse-patient-interaction, self-transcendence and meaning-in-life seems vital in order to guide clinical practice in how to best and efficiently boost wellbeing among older adults in nursing homes. Methods In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH patients representing 27 NHs responded to the nurse-patient interaction, self-transcendence, and the purpose-and-meaning-in-life scales. Inclusion criteria were: (1) municipality authority’s decision of long-term NH care; (2) residential time three months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations (five hypotheses) between the latent constructs were tested by means of structural equation modelling (SEM) using Stata 15.1. Results The SEM-model yielded a good fit (χ2=146.824, p=0.021, df=114, χ2 /df=1.29 RMSEA=0.040, p-close 0.811, CFI=0.97, TLI=0.96, and SRMR=0.063), showing significant relationships between the constructs of nurse-patient interaction, inter- and intra-personal self-transcendence and meaning-in-life. Nurse-patient interaction significantly relates with both inter- and intra-personal self-transcendence and meaning in NH patients. Self-transcendence revealed a fundamental influence on perceived meaning, while nurse-patient interaction demonstrated a significant influence on meaning, mediated by self-transcendence Conclusion According to the rapidly growing number of people over 65 in the world, and the growing segment of people 80-100, the present results are significant in their suggestions that nurse-patient-interaction is a crucial resource in relation to nursing home residents’ wellbeing. Knowledge of how nurse-patient-interaction, self-transcendence and meaning relate to each other among older adults in NHs is important for researchers, nurses, caregivers, nursing educators, and clinicians. Health professionals in nursing homes should learn how to competently use the nurse-patient interaction as a health promoting asset for self-transcendence, meaning and thus well-being. Nursing home nurses should be given more time for interacting with the residents, continuity and mutuality in nurse-patient relationships should be prioritized and facilitated.

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Challenges in current nursing home care in rural Germany and how they can be reduced by telehealth - an exploratory qualitative pre-post study

BMC Health Services Research ◽

10.1186/s12913-021-06950-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Susann May ◽

Kai Jonas ◽

Georgia V. Fehler ◽

Thomas Zahn ◽

Martin Heinze ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Rural Areas ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Alternative Form ◽

Supporting Evidence ◽

List Type ◽

Existing Structures

Abstract Background Telemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. The goal was to assess the effect of implementing medical video consultations into nursing home care addressing the following research questions: How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? How can video consultations be used to reduce difficulties arising in everyday care? How does implementation of video consultations impact day-to-day nursing home care delivery? Methods Twenty-one guided interviews (pre-implementation n = 13; post-implementation n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis. Results Challenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly. Conclusions Telehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.

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