An exploration of hydration care for nursing home residents living with dementia

Background/aims Older adults residing in nursing homes are vulnerable to dehydration. Residents living with dementia can experience additional challenges, making it difficult to independently consume sufficient fluids. The aim of this study was to describe the experience of hydration care for nursing home residents living with dementia. Methods Observations of hydration care were conducted between 06:00 and 22:45 on one care home unit. Twenty-two residents with dementia were eligible for observation. Conversations with staff and relatives provided further insights. The data were analysed using thematic analysis. Findings Hydration care provision was highly routinised with little flexibility. Residents received limited support to express individual choices, and staff missed opportunities to provide drinks. More fluid was consumed when care staff developed strategies to encourage fluid intake. Conclusions Key factors to optimise hydration care include providing individual support to encourage fluid intake and expression of choice, flexible care routines, and focus on communication and teamworking.

NRC is taking a positive approach to the future

Adrian Ashurst, Consultant Editor of NRC, outlines an exciting future for Nursing and Residential Care.

Helping nurses help themselves with change

Change is an inevitable part of living. Some changes are embraced and others are rejected or resented. In the case of the latter, life can become difficult for staff members and those who work with them, especially if organisational change is challenging. This difficulty can lead to dissatisfaction with work, poor work performance, low morale and increased staff turnover. In order to help nurses understand the emotions surrounding change, this article looks at the Bridges Transition Model and Fisher's Personal Transition Curve. To help nurses better manage change when they are subject to it, four practical tools are explored that can be used to help individuals make change work for them.

An exploration of hydration practices in Maltese residential care homes for older people

Background/aims The integral relationship between adequate hydration and good health is widely recognised. Older people with complex needs and frailty can struggle to maintain adequate hydration, with residents in care home settings being at an increased risk of dehydration. The aim of this study was to explore current hydration practices in residential care homes in Malta. Methods An exploratory qualitative approach was adopted to explore staff's views and approaches in supporting residents' hydration. Data was collected via semi-structured, individual and small group interviews with staff from two care homes from the central and southern region of Malta. A process of open coding, followed by axial coding, was used to analyse the data. Peer debriefing was performed throughout, until agreement was reached among the research team about the final themes and sub-themes. Results Three themes emerged from the data: culture of promoting fluid intake; challenges in supporting older people to achieve optimum hydration; hydration practices and approaches. Conclusions A hydration promotion culture was demonstrated through various practices adopted in the care homes. The strong focus on water intake, in response to concerns about consuming sugary beverages, has implications for the promotion of a person-centred approach to hydration care. Inconsistencies in monitoring of fluids and daily recommended targets highlights the importance of policies or guidelines to guide hydration practice. Challenges related to refusal of fluids and language barriers among non-native staff were evident and justify further research is this area.

A hard winter ahead

The Care Quality Commission's annual report on the state of care in England gives cause for concern for the foreseeable future, starting with the immediate issue of winter pressures. Amanda Halliwell reports.