Icelandic Nursing Home residents : Their mortality, health, functional profile, and care quality, using the Minimum Data Set over time

To access full text version of this article. Please click on the hyperlink "View/open" at the bottom of this pageThe overall aim of this thesis was to investigate trends over time in residents‟ health status, functional profile and predictors of mortality at admission to Icelandic nursing homes and in addition to determine upper and lower thresholds for Minimum Data Set (MDS) Quality Indicators, to investigate the prevalence of quality indicators over time and their association with the health status and functional profile of residents in Icelandic nursing homes. Studies I and II included 2,206 persons assessed over 11 years (1996-2006). In study III a modified Delphi method and a panel of 12 members were used to determine the thresholds for Minimum Data Set Quality Indicators. Data from residents (N=2,247 representing 47 nursing homes) were analysed, applying the thresholds developed. In study IV the sample was 11,034 MDS assessments of 3,694 residents (2003-2009) and in the framework the sample was 11,912 MDS assessments of 3,704 residents (1999-2009). Study I showed that 28.6-61.4% of residents had intact cognitive performance and 42.5-68% were independent in ADL performance. A weak, but significant, linear trend over the eleven years was seen in residents' health becoming less stable, their cognitive performance improving, more pain being reported and greater participation in social activities. Study II showed that the median survival time was 31 months. No significant difference was detected in the mortality rate between cohorts. Age, gender (HR 1.52), place admitted from (HR 1.27), ADL functioning (HR 1.33-1.80), health stability (HR 1.61-16.12) and ability to engage in social activities (HR 1.51-1.65) were significant predictors of mortality. In study III upper and lower thresholds for 20 Minimum Data Set Quality Indicators were established. Residents not having a quality indicator present numbered from 32.5-99.3% depending on the indicator in question. The quality indicators with the median value above the upper threshold, indicating poor care, were: depression (49.4%); symptoms of depression without antidepressant (18.2%); use of 9 or more medications (63.8%); anti-anxiety or hypnotic drug use (69.2%); little or no activity (52.5%). Findings from study IV showed that 16 out of 20 quality indicators increased in prevalence, indicating a decline in quality of care (p< 0.05) over the study period. In 12 out of 20 indicators the prevalence was lower than 25%. One quality indicator showed improvement, i.e. „Bladder and bowel incontinence without a toileting plan‟ from 17.4% in 2003 decreasing to 11.5% in 2009 (p<0.001). Residents‟ health and functional status partially explained the increased prevalence of the quality indicators over time. At admittance many residents had a relatively high level of independence, the mortality rate did not change over the study period and health stability and ADL performance were strong predictors of mortality. More than 50% died within 3 years, and almost a third of the residents may have needed palliative care within a year of admission. Pain management, social engagement and palliative care are areas where more staff knowledge seems to be needed. The thresholds established aims for Icelandic nursing homes, uncovering areas of care requiring improvement. Icelandic nursing homes seem to be doing best in handling incontinence and nutritional care, and in several quality indicators the prevalence was quite low. The areas of care that indicated poor care and needed improvement included treatment of depression, number of medications and resident activity level. Quality Indicator results and trends over time can be used for improvement, planning of services and staff knowledge

Starfsfólk og íbúar á hjúkrunarheimilum

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSamskipti hafa mikil áhrif á líðan okkar óháð því á hvaða aldursskeiði við erum og hvaða hlutverkum við gegnum. Samskipti eru álitin einn af áhrifaþáttum heilbrigðis. Löngum hefur verið sagt að maður sé manns gaman, en tækni og hraði nútímans breyta samskiptaháttum og breikka bilið á milli þeirra sem þurfa að hefta straum of mikilla samskipta og þeirra sem sitja hjá, einmana mitt í hringiðu annríkis og offramboðs. Í grein þessari verður fjallað um mikilvægi góðra samskipta við umönnun aldraðra og byggt á niðurstöðum tveggja nýrra rannsókna sem voru lokaverkefni til meistaragráðu við Hjúkrunarfræðideild Háskóla Íslands. Annars vegar er um að ræða rannsókn Ingibjargar Hjaltadóttur (2001) um lífsgæði á hjúkrunarheimilum og hins vegar rannsókn Sigrúnar Gunnarsdóttur (2000) um líðan starfsmanna á sjúkrahúsum. Rannsóknirnar voru báðar eigindlegar og byggðu á viðtölum við þátttakendur auk þátttökuathugana. Líf á hjúkrunarheimilum einkennist af því að það er bæði heimili og vinnustaður. Við hugleiðum oft hvernig öldruðu heimilisfólki líður á hjúkrunarheimilinu en hugsum ekki eins til þess hvernig starfsfólkinu líður. Líðan starfsfólksins hefur áhrif á samskipti þess við skjólstæðingana og þá umönnun sem það veitir. Þannig hefur líðan starfsfólks á hjúkrunarheimilum bein áhrif á líðan aldraðra sem dvelja þar. Áður en vikið verður að rannsókn Ingibjargar um lífsgæði á hjúkrunarheimilum verður fjallað stuttlega um niðurstöður rannsóknarinnar um líðan starfsmanna á sjúkrahúsum

Prevalence of diabetes as well as general health status of Icelandic nursing home residents 2003-2012

Vísindasjóður Félags íslenskra hjúkrunarfræðingaInngangur: Sykursýki er vaxandi vandamál meðal eldra fólks og einn af áhættuþáttum fyrir flutning á hjúkrunarheimili. Ennfremur er sjúkdómabyrði og lyfjanotkun þeirra sem eru með sykursýki oft meiri. Tilgangur rannsóknarinnar var að skoða algengi sykursýki á íslenskum hjúkrunarheimilum yfir árin 2003-2012 og gera samanburð á heilsufari, færni, lyfjanotkun og sjúkdómsgreiningum íbúa með eða án sjúkdómsgreiningarinnar sykursýki sem bjuggu á hjúkrunarheimili árið 2012. Efniviður og aðferð: Rannsóknin var afturskyggn og mælitækið Gagnasafn um heilsufar og hjúkrunarþörf íbúa á öldrunarstofnunum var notað við gagnasöfnun (N=16.169). Nánari tölfræðileg greining var gerð á gögnum frá 2012 (n=2337). Niðurstöður: Á rannsóknartímabilinu var meðalaldur frá 82,3 (sf 9,1) til 85,0 ár (sf 8,4) og hlutfall kvenna frá 65,5 til 68,0%. Hlutfall þeirra sem voru skráðir með sjúkdómsgreininguna sykursýki hækkaði úr 10,3% árið 2003 í 14,2% árið 2012 (p≤0,001). Meðalaldur íbúa með sykursýki árið 2012 var 82,7 ár en annarra 85 ár. Íbúar með sykursýki höfðu meiri húðvandamál, notuðu fleiri lyf, vitræn geta var betri og þátttaka í virkni var meiri. Þeir sem voru með sykursýki voru frekar með háþrýsting, hjartasjúkdóm vegna blóðþurrðar, heilaáfall, nýrnabilun, oflæti/þunglyndi, sjónukvilla vegna sykursýki og aflimun, en voru síður með kvíðaröskun, Alzheimer-sjúkdóm og beingisnun. Ályktun: Íbúar með sykursýki á hjúkrunarheimilum eru yngri en aðrir og betur á sig komnir andlega, en hins vegar getur meðferð þeirra verið margslungin og hana þarf að sérsníða að hverjum einstaklingi. Sykursýki er vaxandi vandi inni á hjúkrunarheimilum og því þarf að tryggja að starfsfólk hafi þekkingu á hvernig best er að meðhöndla sykursýki hjá öldruðum.Introduction: Diabetes is an increasing problem among old people as well as being a contributing factor in their need for institutional care. Comorbidity and use of medication is often greater among people with than without diabetes. The aim of this study was to investigate the prevalence of diabetes in Icelandic nursing homes over the period 2003- 2012. Additionally we compared health, functioning, medication use and medical diagnoses of residents with diabetes to those without diabetes, living in nursing homes in 2012. Material: Retrospective study of 16.169 Minimum Data Set 2.0 assessments, further analysis conducted for data from the year 2012 (n=2337). Results: Mean age from 82.3 (SD 9.1) to 85.0 years (SD 8.4) and women were 65.5% to 68.0%. Number of residents with diabetes increased from 10.3% in the year 2003 to 14.2% in 2012 (p≤0,001). Mean age of residents with diabetes in the year 2012 was 82.7 compared to 85 years for others. Residents with diabetes had more skin problems, used more medication, their cognitive performance was better and their involvement in activities greater. They were more likely to have hypertension, arteriosclerotic heart disease, stroke, renal failure, manic depressive disorder, diabetic retinopathy or amputation. They were however, less likely to have an anxiety disorder, Alzheimer’s disease or osteoporosis. Conclusion: Residents with diabetes are younger than other residents and their cognitive performance is better, their care and treatment may however be complicated and needs to be adapted to each individual. Diabetes is an increasing problem in nursing homes and therefore an area where more knowledge among staff is needed

Recreational activities in nursing homes

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenTilgangur og markmið rannsóknarinnar var að lýsa virkni til dægrastyttingar hjá heimilismönnum hjúkrunarheimila með tilliti til bakgrunns þeirra og líkamlegrar og andlegrar færni. Aðferð. Úrtakið (N=1825) voru heimilismenn hjúkrunarheimila á landinu sem voru metnir með RAI-matstækinu haustið 2004. Þetta er þversniðsrannsókn og við gagnavinnslu var notuð bæði lýsandi og skýrandi tölfræði. Niðurstöður sýndu að 26,1% heimilismanna voru virkir í daglegum athöfnum. Í 45,9% tilvika var meðaltími í virkum athöfnum mikill eða þó nokkur. Eftirlætisvistarvera þegar fólk tekur sér eitthvað fyrir hendur var eigið herbergi en eftirlætistómstundir til dægrastyttingar voru samræður, tónlist og að hlusta á útvarp og horfa á sjónvarp. Í ljós kom að því minni sem geta heimilismanns var til að sinna athöfnum daglegs lífs (ADL) því minni var virkni hans og einnig að því meiri sem vitræn skerðing var því minni var virknin. Tónlistin skar sig úr sem dægrastytting að því leyti að allir kusu hana, burtséð frá ADL-færni eða vitrænni getu. Ályktanir. Niðurstöður rannsóknarinnar benda til að sá hópur, sem þarf sérstaklega að horfa til varðandi það að auka dægrastyttingu á hjúkrunarheimilum, eru þeir sem eru með mikla vitræna skerðingu og þeir sem þurfa mikla aðstoð við athafnir daglegs lífs (ADL). Hjúkrunarheimili ættu að ýta með markvissum hætti undir að heimilismenn stytti sér stundir og starfsfólk að hvetja til og skipuleggja dægrastyttingu á hjúkrunarheimilum með áherslu á samskipti, samveru og tónlist. Lykilorð: Virkni, vitræn skerðing, athafnir daglegs lífs, dægrastytting, aldraðir, hjúkrunarheimili.Aim. The purpose of this study was to describe the recreational activities of nursing home residents in relation to their background and physical and cognitive abilities. Method. The sample consisted of Icelandic nursing home residents (N=1825) who were assessed with the RAI instrument in the autumn of 2004. This was a cross-sectional study and descriptive and bivariate statistics were used to analyse the data. Results. 26.1% of the residents were actively involved in the activities of the nursing home. 45.9% spent high or average time in nursing home activities. The most preferred activity setting was the resident’s own room, and the most preferred activities were participating in conversation, listening to radio and music, and watching TV. The results showed that those who needed much help in performing activities of daily living (ADL), and those who were severely cognitively impaired, were less active. Music differed from other activities in that everyone seemed to prefer it regardless of their cognitive impairment, and the help they needed in performing activities of daily living. Conclusions. The findings indicate that nursing home staff needs to pay special attention to how to increase the activity of those who are severely cognitively impaired and those who need more help with activities of daily living. For this group of residents, the emphasis should be on developing recreational activities that are important to them like social interaction, being together, and music. Nursing homes should offer recreational activities systematically and nursing home staff should encourage and organize such activities

Comparison of Health Status, Function, Symptoms, and Advance Directives of Nursing Home Residents in Iceland According to Estimated Life Expectancy

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesTilgangur: Á síðustu árum hefur dvalartími íbúa á íslenskum hjúkrunarheimilum styst og því hafa margir þeirra þörf fyrir líknarmeðferð og umönnun við lífslok fljótlega eftir flutning þangað. Mikilvægt er að þekkja breytingar á heilsufari og einkennum sem verða þegar nær dregur lífslokum svo að íbúarnir fái viðeigandi umönnun og líði sem best. Tilgangur rannsóknarinnar var að varpa ljósi á heilsufar, færni, einkenni og meðferðarmarkmið íbúa á hjúkrunarheimilum, sem hafa hálfs árs lífslíkur eða minni, og bera saman við aðra íbúa. Aðferð: Rannsóknin var lýsandi þversniðs- og samanburðarrannsókn byggð á fyrirliggjandi RAI-gögnum (e. Resident Assessment Instrument) frá íbúum allra hjúkrunarheimila á Íslandi. Kvarðar og breytur, sem lýsa heilsufari, færni, einkennum og meðferðarmarkmiðum, byggðust á síðasta mati ársins 2012 (N=2337). Lífslíkur íbúa voru áætlaðar í sama mati og flokkaðar í annars vegar hálft ár eða minna og hins vegar meira en hálft ár. Niðurstöður: Meðalaldur var 84,7 ár (sf=8,2; spönn=20–106 ár) og hlutfall kvenna var 65,6%. Heilsufaríbúa með minni lífslíkur var verra en annarra íbúa. Vitræn geta mæld á vitrænum kvarða (0–6) var að meðaltali 5,0 (sf=1,3) meðal íbúa með minni lífslíkur en hálft ár, en annarra 3,3 (sf=1,8), p<0,001. Færni þeirra var einnig verri, meðaltal á löngum ADL-kvarða (0-28) var 26,3 (sf=3,0) samanborið við 16,5 (sf=8,3), og byltur voru einnig algengari (27,9%) en meðal annarra íbúa (12,8%), p<0,001. Íbúar með minni lífslíkur voru með meiri verki og önnur erfið einkenni heldur en aðrir íbúar. Hlutfallslega helmingi fleiri voru með verki daglega (61,3%) og þeir voru einnig oftar með slæma eða óbærilega verki (42,7%) en aðrir (14,8%), p<0,001. Ályktanir: Niðurstöðurnar staðfesta mikla umönnunarþörf og erfið einkenni þeirra sem dvelja á hjúkrunarheimilum, einkum þeirra sem eru með skemmri lífslíkur. Leggja þarf áherslu á fræðslu og þjálfun starfsfólks, ásamt breyttu mönnunarfyrirkomulagi í samræmi við heilsufar og þarfir þessa hóps.Aim: As length of stay has shortened in Icelandic nursing homes, many residents are in need of palliative care. It is important to recognize changes in symptoms and health status as death approaches in order to provide adequate care. The aim of this study was to compare the health status, function, symptoms, and advanced directives in residents with estimated life expectancy of six months or less with other residents. Method: This was a descriptive, cross-sectional, comparison study, based on ResidentAssessment Instrument data (RAI)from all nursing home residentsin Iceland. Data on health status, function,symptoms, and advanced directives, from the latest assessment in the year 2012 were used (N=2337). Life expectancy was categorized during this data collection into six months or less (shorter) or longer. Results: The mean age of participants was 84.7 (SD=8.2; range=20- 106) and women were 65.6%. The health status of residents with shorter life expectancy was worse than in other residents. Mean score on the Cognitive Performing Scale (0–6) was 5.0 (SD=1.3) in those with shorter life expectancy compared to others (3.3, SD=1.8), p<0.001. Their functional status was also worse, mean score on the long-ADL scale (0–28) was 26.3 (SD=3.0) compared to 16.5 (SD=8.3) in other residents, and frequency of falls was higher (27.9%) than in other residents (12.8%), p<0.001. Pain and othersymptoms were more prevalent in residents with shorterthan longer life expectancy, more than half had daily pain (61.3%), and a higher proportion had severe or unbearable pain (42.7%) than residents with longer life expectancy (14.8%), p<0.001. Conclusion: Nursing home residents have many difficult symptoms and need substantial care-giving, particularly those with shorter life expectancy. There is a need for education and training of nursing staff, as well as changes in staffing, to meet the needs of Icelandic nursing home residents.Rannsóknin var styrkt af B-hluta vísindasjóðs Félags íslenskra hjúkrunarfræðinga og Öldrunarráði Íslands

Quality improvement and measuring quality of care in home nursing using interRAI-HC quality indicators: intervention study

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnÖldruðum fer fjölgandi og hefur þörfin fyrir þjónustu í heimahúsi aukist í takt við það. Krafan um að heilbrigðisstofnanir veiti góða þjónustu og fé sé vel varið eykst stöðugt. Með tilkomu matstækisins interRAI-Home Care (interRAI-HC) og tilheyrandi gæðavísa opnast möguleikar á að meta gæði heilbrigðisþjónustu í heimahúsum. Tilgangur þessarar rannsóknar var að athuga hvort hægt væri að hafa áhrif á gæði þjónustu heimahjúkrunar með fræðslu til starfsfólks og notkun á gæðavísum interRAI-HC. Rannsóknin var megindleg íhlutunarrannsókn sem fylgdi fyrir-eftirrannsóknarsniði án samanburðarhóps. Gögnin voru byggð á upplýsingum úr mati sem framkvæmt var í interRAI-HC frá 31 skjólstæðingi heimahjúkrunar á Selfossi. Starfsfólk tók þátt í ákvörðunum varðandi val á þremur interRAI-HC gæðavísum sem stefnt var á að bæta með íhlutun í formi fræðslu. Að auki var fylgst með stöðu tíu gæðavísa sem íhlutunin beindist ekki sérstaklega að. Þátttakendur í rannsókninni voru á aldrinum 60 til 94 ára (meðalaldur 79,2 ár), hlutfall kvenna var 64,5% og bjuggu 51,6% skjólstæðinga einir. Starfsmenn ákváðu að beina íhlutun að gæðavísum um byltur, félagslega einangrun og ófullnægjandi verkjastillingu þeirra. Á rannsóknartímanum lækkaði hlutfall þeirra sem hlutu byltu úr 22,6% í fyrra mati í 0% í seinna mati (p = 0,012). Hinir tveir gæðavísarnir, sem íhlutun beindist sérstaklega að, lækkuðu hlutfallslega þó að munurinn væri ekki marktækur. Sjö af þeim tíu gæðavísum, sem íhlutun beindist ekki að, sýndu breytingar í átt til hins betra. Niðurstöður benda til að með fræðslu til starfsfólks sé hægt að bæta þjónustu við skjólstæðinga heimahjúkrunar. Starfsfólk var áhugasamt og vildi taka þátt og hafa áhrif á sína vinnu til hins betra. Niðurstöður benda einnig til að notkun interRAI-HC-matstækisins og gæðavísa þess sé gagnleg í umbótavinnu og geti nýst fleiri heilsugæslustöðvum.The need for home care is increasing as the elderly population is growing. Furthermore the demand for quality and efficiency in health care services is increasing. The interRAI-Home Care (interRAI-HC) instrument and the additional quality indicators open possibilities to evaluate quality in home care service. The aim of the study was to investigate if it was possible to influence the quality of home care service by improving staff knowledge and the use of interRAI-HC instrument. The study was a quantitative intervention study with before-after research design without a comparison group. The data were from the interRAI-HC assessments from 31 home nursing clients in the Selfoss area. The staff participated in selecting three interRAI-HC quality indicators needing an intervention in the form of lectures. Ten additional quality indicators were studied before and after the intervention. The mean age of the participants was 79.2 years (min. 60; max. 94), females were 64.5% and 51.6% lived alone. The quality indicators the staff selected for intervention were falls, social isolation and inadequate pain control. Over the research period the percentage of clients that had a fall decreased from 22.6% to 0% (p = 0.012). The other two quality indicators selected also decreased but not significantly. Seven of the 10 quality indicators not selected for improvement work also decreased, however not significantly. The findings indicate that by increasing staff knowledge, services to home care clients can be improved. The staff were very enthusiastic and wanted to participate and improve their work. Moreover, the findings indicate that the use of the interRAI-HC instrument and the quality indicators is valuable in quality improvement work and may be useful for other home care agencies

Functioning and needs of elders waiting for in-hospital respite care

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Tilgangur þessarar rannsóknar var að fá lýsandi mynd af líkamlegri, andlegri og félagslegri færni og þörfum aldraðra sem biðu eftir hvíldarinnlögn á öldrunarsviði Landspítala vorið 2007. Einnig var leitast við að kanna væntingar aldraðra og aðstandenda til þjónustunnar. Rannsóknin var megindleg með lýsandi sniði. Úrtakið var 24 einstaklingar sem bjuggu á eigin heimilum og voru á biðlista fyrir hvíldarinnlögn á öldrunarsviði Landspítala. Tekin voru viðtöl við þátttakendur eða aðstandendur þeirra. Notað var RAI-HC-matstæki sem greinir þarfir og styrkleika einstaklinga á ýmsum sviðum og er ætlað heilbrigðis- og félagsþjónustu. Niðurstöður sýndu að allir þurftu aðstoð við böðun og almennt var mikil þörf fyrir aðstoð við daglegar athafnir. Hjá 16 af 24 hafði orðið afturför í sjálfsbjargargetu við daglegar athafnir síðustu mánuði. Um helmingur þátttakenda var með minnisskerðingu og þurftu margir aðstoð og eftirlit allan sólarhringinn. Af 24 þátttakendum töldu 16 þeirra töldu heilsufar sitt vera lélegt eða sæmilegt. Meðal þátttakenda var andleg vanlíðan, einangrun og einmanaleiki algeng og þátttaka í félagslífi lítil. Álykta má út frá niðurstöðum að þessi hópur aldraðra þarfnist mikillar aðstoðar og að hún sé að miklu leyti veitt af nánasta aðstandanda. Þar sem mikið álag er á aðstandendum er þörf á aukinni heilbrigðis- og félagsþjónustu fyrir þennan hóp. Hjúkrunarfræðingar og annað heilbrigðisstarfsfólk gegnir mikilvægu hlutverki við mat á þjónustuþörf þess aldraða og umönnunaraðila hans sem og að leiðbeina um hugsanleg þjónustuúrræði.The aim of this study is to receive a descriptive picture of the physical, mental, and social functioning and needs of elders waiting for in-hospital respite care at the Division of Geriatric Medicine, Landspitali-University Hospital in the spring of 2007. Furthermore the aim was to explore the expectations of the elders and their relatives to the service. The research was quantitative with a descriptive design. The sample was 24 persons who live in private homes and were on a waiting list for in-hospital respite care. Participants or their relatives were interviewed. The RAI-HC instrument was used as it evaluates needs and strengths of individuals and is intended for health and social services. The findings showed that participants were severely burdened with health problems. All needed some assistance when bathing and most of them needed help in their activities of daily living. Their main caregivers were therefore under a lot of stress. Sixteen out of 24 participants had in the last months experienced a decline in their ability to take care of themselves. Half of the participants had dementia and many of them needed assistance and supervision 24 hours a day. Poor emotional condition was prevalent, isolation and loneliness were common and social participation restricted. The participants were in great need of assistance, most of which came from their closest relative. Increased health and social services are needed for this group. Nurses and other health care workers play an important role in assessing the need of elderly people and their caregivers for service as well as informing about available services

Effects of changes in staff mix in a specialized dementia ward

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenTilgangur rannsóknarinnar var að skoða áhrif breytinga á samsetningu mönnunar á gæði hjúkrunar, starfsánægju og upplifun starfsmanna. Rannsóknin fór fram á annarri af tveimur deildum fyrir sjúklinga með heilabilun á öldrunarsviði Landspítalans. Sjúkraliðar með framhaldsnám og hjúkrunarfræðingar á tilraunadeildinni fengu breytt starfssvið. Þátttakendur voru sjúklingar og starfsmenn á rannsóknardeildinni og einnig hjúkrunarfræðingar af báðum deildum. Rannsóknin var unnin samkvæmt hugmyndafræði starfendarannsókna og fjórar rannsóknaraðferðir notaðar til að fá fram mismunandi sjónarhorn á viðfangsefnið. Gögnum um gæði hjúkrunar var safnað með stöðluðu megindlegu mælitæki (RAI) og innbyggðir gæðavísar skoðaðir. Gögnum um starfsánægju var safnað með skriflegum spurningalista og gögnum um upplifun starfsmanna af breytingunum var safnað með viðtölum við rýnihópa og dagbókarskrifum. Gagnasöfnun fór fram fyrir og við upphaf breytinga og svo aftur þegar breyting var vel á veg komin. Niðurstöður rannsóknarinnar gáfu vísbendingar um að gæði hjúkrunar og starfsánægja hefðu haldist stöðug. Í rýnihópum og dagbókum komu fram þrjú meginþemu: Breytt hlutverk, togstreita og ný tækifæri. Það tók á fyrir alla að skilgreina ný hlutverk og breytt fagleg samskipti. Einnig var átak að breyta viðteknum vinnuvenjum á deildinni og togstreita kom fram á milli stétta. Sjúkraliðar með framhaldsnám í öldrunarhjúkrun fundu fyrir ákveðinni fyrirstöðu en jafnframt að hjúkrunarfræðingarnir vildu styðja við bakið á þeim og leiðbeina inn í þetta nýja hlutverk sem hafði í för með sér ný tækifæri. Niðurstöður þessa rannsóknarverkefnis varpa ljósi á hvernig hægt er að nýta betur menntun sjúkraliða með framhaldsnám í öldrunarhjúkrun og um leið þróa nýjar leiðir í starfi hjúkrunarfræðinga. Rannsóknin er því mikilvægt innlegg í umræðu um hvernig starfskraftar sjúkraliða með framhaldsnám verða nýttir í öldrunarþjónustu í framtíðinni.The purpose of this study was to examine the effects of changes in staff mix model on quality of care, staff satisfaction, and staff perception of this change. The study was conducted in one of two specialized dementia wards at the Division of Geriatric Medicine at the Landspitali University Hospital. Geriatric-Licensed Practical Nurses (G-LPNs) and registered nurses (RNs) gained different roles on the ward. Patients and staff from the study ward and RNs from the other specialized dementia ward participated in the study. The theoretical framework of the study was Action Research and four methods were used to obtain different views on the issue. Data on quality of care were collected using a quantitative instrument (RAI) and inherent quality indicators observed. Data on job satisfaction were collected using a questionnaire and data regarding staff experience were obtained by discussions in focus-groups and diaries. Data were gathered before and after changes and finally after changes had been in place for awhile. Findings indicated that the quality of care as well as staff satisfaction remained constant. In focus groups and diaries three main themes emerged: Role change; conflict and new opportunities. It required a great effort for everyone to define new roles and changes of professional interaction. Changing the usual way of working in the ward was stressful as well because of conflicts between professions. The G-LPNs encountered certain barriers but also realized that the RNs were ready to provide support and guidance into their new role. The altered role had also the potential for new opportunities. The study results illuminate how the G-LPNs´ further education can be utilized as well as how new roles for RNs can be developed. The study findings are important for the discussion on the role G-LPNs will have in care of the elderly in the future

Stroke survivors' experiences with rebuilding life in the community and exercising at home: A qualitative study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAim: This study aimed to explore how stroke survivors deal with stroke-related impairments when rebuilding their lives in the community and their experiences of exercising at home. Design: An explorative and descriptive qualitative study. Methods: A purposive sample of ten stroke survivors residing at home was recruited to explore experiences of rebuilding their lives in the community and exercising at home. One focus group interview was conducted followed by semi-structured interviews. Data were analysed using thematic analysis. Results: Three main themes were identified: "Framing exercise within the context of everyday life" describes how stroke survivors integrate exercise in everyday activities with varying success and the social importance of exercising; "Managing the challenges of physical impairment" describes the taxing undertakings in daily living, loss of concentration and identity; "Long-term challenges of everyday life" describes how the stroke survivors manage depression and live with a sense of uncertainty. Keywords: home rehabilitation; qualitative research; rehabilitation; stroke patients; stroke rehabilitation.NordForsk programme on Health and Welfar

Changes in home care clients’ characteristics and home care in five European countries from 2001 to 2014 : comparison based on InterRAI - Home Care data

Funding Information: The doctoral project was funded partly by the University of Iceland Research Fund and The Foundation of St. Josef’s Hospital in cooperation with The Icelandic Gerontological Research Center, National University Hospital of Iceland. Funding Information: The author gratefully thanks Kristin Bjornsdottir for her supervision and the directors and coworkers at the Home Care center at the Capital Area Primary Care in Reykjavik. Publisher Copyright: © 2021, The Author(s).Background: Policymakers advocate extended residence in private homes as people age, rather than relocation to long-term care facilities. Consequently, it is expected that older people living in their own homes will be frailer and have more complex health problems over time. Therefore, community care for aging people is becoming increasingly important to facilitate prevention of decline in physical and cognitive abilities and unnecessary hospital admission and transfer to a nursing home. The aim of this study was to examine changes in the characteristic of home care clients and home care provided in five European countries between 2001 and 2014 and to explore whether home care clients who are most in need of care receive the care required. Methods: This descriptive study used data from two European research projects, Aged in Home Care (AdHOC; 2001–2002) and Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care (IBenC; 2014–2016). In both projects, the InterRAI-Home Care assessment tool was used to assess a random sample of home care clients 65 years and older in five European countries. These data facilitate a comparison of physical and cognitive health and the provided home care between countries and study periods. Results: In most participating countries, both cognitive (measured on the Cognitive Performance Scale) and functional ability (measured on the Activities of Daily Living Hierarchy scale) of home care clients deteriorated over a 10-year period. Home care provided increased between the studies. Home care clients who scored high on the physical and cognitive scales also received home care for a significantly higher duration than those who scored low. Conclusion: Older people in several European countries remain living in their own homes despite deteriorating physical and cognitive skills. Home care services to this group have increased. This indicates that the government policy of long-term residence at own home among older people, even in increased frailty, has been realised.Peer reviewe