The relationship between small-scale nursing home care for people with dementia and staff's perceived job characteristics

Background: Over the past few decades, new care models that are more resident-oriented and directed toward small-scale and homelike environments have been developed worldwide. The impact of these care models on the quality of life of residents has been studied. However, little research has been conducted to gain insight into how these new care models influence healthcare staff's work environment. This study focuses on the consequences of small-scale care on staff's perceived job characteristics. Methods: Data were derived from a sample of 136 Dutch living arrangements providing nursing home care for people with dementia (2008/2009), in which 1,327 residents and 1,147 staff participated. The relationship between two indicators of small-scale care (small-scale care characteristics and total number of residents with dementia in facility) and staff's job characteristics (job demands, decision authority, coworker and supervisor support) were studied with multilevel regression analyses. All analyses were adjusted for staff, resident, and living arrangement characteristics when needed. Results: Both indicators of small-scale care were associated with job demands; staff perceived less time and work pressure as more characteristics of small-scale care were integrated and the facility had less residents with dementia in total. Only one indicator was associated with decision authority. As more characteristics of small-scale care were integrated, staff's perceived decision authority was higher. No relationship was found with coworker and supervisor social support. Conclusions: Knowing that job demands and decision authority are important predictors of job appraisal and well-being, our findings show that small-scale care could have a beneficial impact on healthcare staff's work environment. Copyright © International Psychogeriatric Association 2014

The ideal application of surveillance technology in residential care for people with dementia

As our society is ageing, nursing homes are finding it increasingly difficult to deal with an expanding population of patients with dementia and a decreasing workforce. A potential answer to this problem might lie in the use of technology. However, the use and application of surveillance technology in dementia care has led to considerable ethical debate among healthcare professionals and ethicists, with no clear consensus to date. To explore how surveillance technology is viewed by care professionals and ethicists working in the field, by investigating the ideal application of surveillance technology in the residential care of people with dementia. Use was made of the concept mapping method, a computer-assisted procedure consisting of five steps: brainstorming, prioritizing, clustering, processing by the computer and analysis. Various participants (ranging from ethicists to physicians and nurses) were invited on the basis of their professional background. The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficul

Database 'Decision-making on palliative care after a severe CVA'

Aim: To gain insight in decision making on treatment options after a severe stroke. Design: ethnographic field research on 16 patients in three hospitals. Data: For each case there are verbatim written interviews and verbatim written family conversations. Restricted access: The data can only be reused if the legal representative of the patients grants permission to do so.Doel: Inzicht verwerven in de besluitvorming over het behandelbeleid in de post-acute fase van een ernstige beroerte. Design: etnografisch veldonderzoek naar 16 patiënten in drie ziekenhuizen. Data: Van elke casus bestaan verbatim uitgeschreven interviews en verbatim uitgeschreven familiegesprekken. Restricted access: De data komen alleen in aanmerking voor hergebruik als de wettelijk vertegenwoordiger van de patiënten daarvoor toestemming verleent

Surveillance technology: An alternative to physical restraints? A qualitative study among professionals working in nursing homes for people with dementia

Background: Working with surveillance technology as an alternative to traditional restraints creates obvious differences in the way care is organised. It is not clear whether professional caregivers find working with surveillance technology useful and workable and whether surveillance technology is indeed used to diminish restraint use. Objectives: The aim of this study was to obtain an insight into the view of Dutch dementia care professionals on the feasibility of surveillance technology as an alternative to physical restraints. Design: Qualitative study. Setting: The study was carried out in seven nursing homes for people with dementia in The Netherlands. Participants and methods Semi-structured interviews were held with nine key persons from seven nursing homes for people with dementia. Also, six focus group discussions were held with groups of nurses and two focus group discussions were held with multidisciplinary teams. Results: The dementia care professionals named three different ways in which surveillance technology can be used: to provide safety in general, to provide additional safety, and to provide more freedom for the residents. In addition to this, the dementia care professionals mentioned four limitations in the use of surveillance technology: it is unable to prevent falling, it cannot guarantee quick help, it does not always work properly, and it could violate privacy.Conclusion: Dementia care professionals consider surveillance technology supplemental to physical restraints, rather than as an alternative. Improvement of devices and education of care professionals might increase the support for using surveillance technology as an alternative to physical restraints. (aut. ref.

Thuis na een CVA: ‘Dan begint het pas’. Een kwalitatief onderzoek naar de behoefte aan nazorg van CVA-patiënten na terugkeer naar huis

Onderzoeksdoel Exploreren welke behoefte aan zorg CVA-patiënten hebben na terugkeer naar huis uit het ziekenhuis of het revalidatiecentrum. Methode Semigestructureerde interviews met twintig CVA-patiënten en hun partners in de regio Midden-Kennemerland. Resultaten ‘Dan begint het pas’: Thuis wordt het vaak pas duidelijk wat de consequenties van het CVA voor het dagelijks leven zijn. Gevolg hiervan is dat patiënten en hun mantelzorgers/partners na terugkeer naar huis (1) meer informatie en begeleiding hadden willen hebben en dat deze behoefte aan begeleiding langdurig blijft bestaan. Verder hadden ze (2) ook later de gelegenheid willen hebben om terug te vallen op nazorg (na aanvankelijk nee gezegd te hebben). Anderzijds zijn er ook (3) patiënten die geneigd zijn om zelf naar oplossingen te zoeken. Conclusies Patiënten die een CVA doorgemaakt hebben en hun mantelzorgers/partners kunnen thuis pas goed beoordelen waar hun behoefte aan nazorg ligt. De behoefte aan nazorg zou daarom pas na verloop van tijd na terugkeer naar huis beoordeeld moeten worden en langdurig toegankelijk moeten blijven. Omdat patiënten wat de neuropsychologische gevolgen betreft niet beseffen dat ze hier hulp voor kunnen krijgen, is het belangrijk dat het initiatief voor de nazorg bij de hulpverlener ligt

The experiences of people with dementia and intellectual disabilities with surveillance technologies in residential care

Background: Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy. Objective: To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy. Setting: Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual disabilities. Methods: Ethnographic field study. Ethical considerations: The boards representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee. Findings: Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.” Conclusion: Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. </jats:sec