Development of a self-scan to evaluate and improve person-centered care in nursing homes:A Delphi study

Background and objective: Person centered care (PCC) has become the gold standard for providing care in nursing homes (NHs). Therefore, it is important for healthcare professionals in NHs to learn PCC-skills and to be supported to learn about- and improve the quality of PCC they provide. At this moment an instrument to support healthcare professionals in NHs to monitor and evaluate PCC is limited. The aim of the study was to develop a self-evaluation tool that provides healthcare professionals in NHs insight into the extent to which they provide PCC to residents, so that they can learn and further improve their current ways of working in a person-centered way. Methods: A three-round Delphi study with an expert panel (n = 25) in the domains of PCC, quality of NH care and education of caring staff. Findings were validated by residents and relatives during semi-structured interviews. Thematic analysis and descriptive statistics were used to analyze the data. Results: In the first round the experts did not provide measuring instruments, but we identified 18 key aspects of PCC. In the second round, three clusters were identified, and a scale was added, to enable assessment. In the third round, we deduplicated, restructured and used more clear language. This led to 14 key aspects of PCC, 24 measures, grouped into five clusters: knowing the resident, establishing relationship, a respectful approach, making decisions jointly and personal development. The result is a PCC self-scan for healthcare professionals in NHs. Residents and relatives, agreed with all aspects and stated that no aspects were missing. Conclusions: In this study we developed an accessible self-report learning tool for healthcare professionals that makes it possible to evaluate and improve their PCC-skills and improve the quality of PCC in NHs

Supporting autonomy for people with dementia living in nursing homes:A rapid realist review

Background For people with dementia living in nursing homes, autonomy is important. However, they experience difficulty with being heard as an autonomous person, as well as with expressing their preferences and choices. The question is how to support their autonomy. Objective Despite extensive efforts to support autonomy in daily care for people with dementia living in nursing homes, we do not know exactly what works for whom, in which context, how and why. The objective of this realist review is to explore what is known in literature on autonomy support interventions for people with dementia in nursing homes. Design A rapid realist review of literature. Review methods To understand how autonomy is supported, a realist approach was applied that entailed identifying the research question, searching for information, performing a quality appraisal, extracting data, synthesizing the evidence and validating the findings with a panel of experts. Causal assumptions were derived from articles found in four bibliographic databases (PubMed, PsychInfo, Cochrane and CINAHL) leading to context (C)–mechanism (M)–outcome (O) configurations. Results Data extraction from the included articles ultimately resulted in sixteen CMO configurations on four themes: a. preferences and choice: interventions for supporting autonomy in nursing homes and their results, b. personal characteristics of residents and family: people with dementia and their family being individuals who have their own character, habits and behaviors, c. competent nursing staff each having their own level of knowledge, competence and need for support, and d. interaction and relationships in care situations: the persons involved are interrelated, continuously interacting in different triangles composed of residents, family members and nursing staff. Conclusion The findings showed that results from interventions on autonomy in daily-care situations are likely to be just as related not only with the characteristics and competences of the people involved, but also to how they interact. Autonomy support interventions appear to be successful when the right context factors are considered

Live and let live:Residents' perspectives on alcohol and tobacco (mis)use in residential care facilities

Background Alcohol and tobacco use could cause health problems in older adults. Older adults who become in need of 24/7 care due to physical and/or neurological disabilities may need to move to a Residential Care Facility (RCF). RCFs aim to provide person-centred care (PCC) to enhance quality of life (QoL) of residents. Objectives This study aims to explore perspectives of residents on alcohol and tobacco use, which is essential to provide PCC. Methods A qualitative research design was chosen, and semi-structured interviews were conducted. Residents who use alcohol and/or tobacco and those who do not use these substances were purposively selected in two organisations on two types of units: psychogeriatric units and units providing care for residents with mainly physical disabilities. The results were analysed using thematic analysis. Results Thematic analysis resulted in five themes: Current use and self-reflection, knowledge and attitudes, addiction or habit, policies and availability, dependency versus autonomy. Conclusion Residents in this study value their autonomy regarding alcohol and tobacco use. They experience dependency on their (in)formal caregivers to use these substances and acknowledge that their use could cause a nuisance to others, challenging the ability of caregivers to implement PCC. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health and safety risks for all

How do practically trained (student) caregivers in nursing homes learn?:A scoping review

Background and objective: Practically trained (student) caregivers (further: caregivers) make up the majority of care staff in nursing homes (NHs). To keep up with the fast-changing healthcare environment and ensure a high quality of care, it is important to know how to stimulate continuous work-based learning (WBL) among this group. The purpose of the study was to systematically study the scientific literature published to date on (1) how caregivers learn in NHs and (2) what facilitates or impedes their learning. Methods: A scoping review was carried out, systematically searching six scientific databases. A total of 35 studies published from January 2009 to February 2021 were included. Study characteristics, learning mechanisms, facilitators, and barriers to learning were extracted and synthesized. Results: None of the studies specifically focused on how caregivers learn. Yet, we identified various learning mechanisms, and found that learning by theory or supervision was most frequently engaged in. Most learning mechanisms used among the groups in the included studies were planned and formal and developed and initiated by others out of the context. Three main themes were identified among the facilitators and barriers of WBL: individual learning, collective learning, and resources for learning. An interdependency between (sub)themes was found. Conclusions: The way caregivers in NHs learn is understudied. Moreover, both their informal learning and the support they receive to be(come) active learners has been overlooked. As WBL provides caregivers with opportunities to learn within a real-life setting, we suggest more research on informal learning mechanisms

Health impact of the first and second wave of COVID-19 and related restrictive measures among nursing home residents:A scoping review

Abstract Background and objectives COVID-19 disproportionally affects older adults living in nursing homes. The purpose of this review was to explore and map the scientific literature on the health impact of COVID-19 and related restrictive measures during the first and second wave among nursing home residents. A specific focus was placed on health data collected among nursing home residents themselves. Research design and methods In this study, best practices for scoping reviews were followed. Five databases were systematically searched for peer-reviewed empirical studies published up until December 2020 in which data were collected among nursing home residents. Articles were categorized according to the type of health impact (physical, social and/or psychological) and study focus (impact of COVID-19 virus or related restrictive measures). Findings were presented using a narrative style. Results Of 60 included studies, 57 examined the physical impact of COVID-19. All of these focused on the direct impact of the COVID-19 virus. These studies often used an observational design and quantitative data collection methods, such as swab testing or reviewing health records. Only three studies examined the psychological impact of COVID-19 of which one study focused on the impact of COVID-19-related restrictive measures. Findings were contradictory; both decreased and improved psychological wellbeing was found during the pandemic compared with before. No studies were found that examined the impact on social wellbeing and one study examined other health-related outcomes, including preference changes of nursing home residents in Advanced Care planning following the pandemic. Discussion and implications Studies into the impact of the first and second wave of the COVID-19 pandemic among nursing home residents predominantly focused on the physical impact. Future studies into the psychological and social impact that collect data among residents themselves will provide more insight into their perspectives, such as lived experiences, wishes, needs and possibilities during later phases of the pandemic. These insights can inform policy makers and healthcare professionals in providing person-centered care during the remaining COVID-19 pandemic and in future crisis periods

"Precious time together was taken away":Impact of COVID-19 restrictive measures on social needs and loneliness from the perspective of residents of nursing homes, close relatives, and volunteers

During the COVID-19 outbreak in March 2020, restrictive measures (e.g., prohibiting physical visits and group activities) were introduced in nursing homes to protect older residents. Although the importance of social contacts and social activities to fulfill social needs and avoid loneliness is known, these were challenged during the pandemic. This qualitative study specifically focused on how residents, close relatives, and volunteers in nursing homes experienced the restrictive measures in retrospect and gained insights into the impact of the restrictive measures on social needs and loneliness, and the lessons that could be learned. Thirty semi-structured, face-to-face interviews with residents and close relatives, and one online focus group with ten volunteers, were conducted. Recruitment took place at psychogeriatric and somatic units in the Northern, Eastern and Southern regions of the Netherlands and Flanders, Belgium. The interviews and focus group were transcribed verbatim, and an open, inductive approach was used for analysis. Alternative ways of social contact could not fully compensate for physical visits. Generally, participants reported that it was a difficult time, indicated by feelings of loneliness, fear, sadness, and powerlessness. A great diversity in loneliness was reported. The most important reasons for feeling lonely were missing close social contacts and social activities. The diversity in the impact of restrictive measures depended on, e.g., social needs, coping strategies, and character. Restrictive COVID-19 measures in nursing homes resulted in negative emotions and unmet social needs of residents, close relatives, and volunteers. During future outbreaks of the COVID-19 virus or another virus or bacterium, for which restrictive measures may be needed, nursing homes should actively involve residents, close relatives, and volunteers to balance safety, self-determination, and well-being

Including personal boundaries scale: development and psychometric properties of a measurement for nurses' self-efficacy toward intimate and sexual behavior in dementia care

BackgroundPerson-centered nursing home care recognizes the intimate and sexual needs of residents with dementia but lacks guidance for nurses to address them while effectively respecting their personal boundaries. The Including Personal Boundaries (IPB) scale was developed to complement clinical and scientific efforts to support both nurse and resident wellbeing.MethodsThrough a co-creative process, theoretical principles, day-to-day experiences, and expert knowledge were integrated into an initial nineteen-item version of the IPB scale. The pilot sample comprised 297 Dutch (vocational) nurses in dementia nursing care.ResultsAfter Principal Component Analysis, nine items with strong factor loadings (>0.6) were retained. Internal reliability measures supported the item selection, such as high internal consistency (α = 0.866) and adequate corrected item-total correlations (0.532–0.781).ConclusionThe presented IPB scale, a nine-item scale, is a short, robust measure to assess nurses' self-efficacy in their capabilities to include personal boundaries (physical and emotional) when confronted with the intimate and sexual behaviors of residents with dementia. Further validation is recommended. The IPB scale could provide valuable insights for research, clinical practice, and education

Patients' experiences of the quality of long-term care among the elderly: comparing scores over time

Contains fulltext : 108999.pdf (publisher's version ) (Open Access)BACKGROUND: Every two years, long-term care organizations for the elderly are obliged to evaluate and publish the experiences of residents, representatives of psychogeriatric patients, and/or assisted-living clients with regard to quality of care. Our hypotheses are that publication of this quality information leads to improved performance, and that organizations with substandard performance will improve more than those whose performance is relatively good. METHODS: The analyses included organizational units that measured experiences twice between 2007 (t(0)) and 2009 (t(1)). Experiences with quality of care were measured with Consumer Quality Index (CQI) questionnaires. Besides descriptive analyses (i.e. mean, 5(th) and 95(th) percentile, and 90% central range) of the 19 CQI indicators and change scores of these indicators were calculated. Differences across five performance groups (ranging from 'worst' to 'best') were tested using an ANOVA test and effect sizes were measured with omega squared (omega(2)). RESULTS: At t0 experiences of residents, representatives, and assisted-living clients were positive on all indicators. Nevertheless, most CQI indicators had improved scores (up to 0.37 change score) at t(1). Only three indicators showed a minor decline (up to -0.08 change score). Change scores varied between indicators and questionnaires, e.g. they were more profound for the face-to-face interview questionnaire for residents in nursing homes than for the other two mail questionnaires (0.15 vs. 0.05 and 0.04, respectively), possibly due to more variation between nursing homes on the first measurement, perhaps indicating more potential for improvement. A negative relationship was found between prior performance and change, particularly with respect to the experiences of residents (omega(2) = 0.16) and assisted-living clients (omega(2) = 0.15). However, the relation between prior performance and improvement could also be demonstrated with respect to the experiences reported by representatives of psychogeriatric patients and by assisted-living clients. For representatives of psychogeriatric patients, the performance groups 1 and 2 ([much] below average) improved significantly more than the other three groups (omega(2) = 0.05). CONCLUSIONS: Both hypotheses were confirmed: almost all indicator scores improved over time and long-term care organizations for the elderly with substandard performance improved more than those with a performance which was already relatively good