results of a mixed methods pilot study

Background ‘Kneipp Therapy’ (KT) is a form of Complementary and Alternative Medicine (CAM) that includes a combination of hydrotherapy, herbal medicine, mind-body medicine, physical activities, and healthy eating. Since 2007, some nursing homes for older adults in Germany began to integrate CAM in the form of KT in care. The study investigated how KT is used in daily routine care and explored the health status of residents and caregivers involved in KT. Methods We performed a cross-sectional pilot study with a mixed methods approach that collected both quantitative and qualitative data in four German nursing homes in 2011. Assessments in the quantitative component included the Quality of Life in Dementia (QUALIDEM), the Short Form 12 Health Survey (SF-12), the Barthel-Index for residents and the Work Ability Index (WAI) and SF-12 for caregivers. The qualitative component addressed the residents’ and caregivers’ subjectively experienced changes after integration of KT. It was conceptualized as an ethnographic rapid appraisal by conducting participant observation and semi-structured interviews in two of the four nursing homes. Results The quantitative component included 64 residents (53 female, 83.2 ± 8.1 years (mean and SD)) and 29 caregivers (all female, 42.0 ± 11.7 years). Residents were multimorbid (8 ± 3 diagnoses), and activities of daily living were restricted (Barthel-Index 60.6 ± 24.4). The caregivers’ results indicated good work ability (WAI 37.4 ± 5.1), health related quality of life was superior to the German sample (SF-12 physical CSS 49.2 ± 8.0; mental CSS 54.1 ± 6.6). Among both caregivers and residents, 89% considered KT to be positive for well-being. The qualitative analysis showed that caregivers perceived emotional and functional benefits from more content and calmer residents, a larger variety in basic care practices, and a more self-determined scope of action. Residents reported gains in attention and caring, and recognition of their lay knowledge. Conclusion Residents showed typical characteristics of nursing home inhabitants. Caregivers demonstrated good work ability. Both reported to have benefits from KT. The results provide a good basis for future projects, e.g. controlled studies to evaluate the effects of CAM in nursing homes

Complementary Medicine in Nursing Homes - Results of a Mixed Methods Pilot Study

BACKGROUND: ‘Kneipp Therapy’ (KT) is a form of Complementary and Alternative Medicine (CAM) that includes a combination of hydrotherapy, herbal medicine, mind-body medicine, physical activities, and healthy eating. Since 2007, some nursing homes for older adults in Germany began to integrate CAM in the form of KT in care. The study investigated how KT is used in daily routine care and explored the health status of residents and caregivers involved in KT. METHODS: We performed a cross-sectional pilot study with a mixed methods approach that collected both quantitative and qualitative data in four German nursing homes in 2011. Assessments in the quantitative component included the Quality of Life in Dementia (QUALIDEM), the Short Form 12 Health Survey (SF-12), the Barthel-Index for residents and the Work Ability Index (WAI) and SF-12 for caregivers. The qualitative component addressed the residents’ and caregivers’ subjectively experienced changes after integration of KT. It was conceptualized as an ethnographic rapid appraisal by conducting participant observation and semi-structured interviews in two of the four nursing homes. RESULTS: The quantitative component included 64 residents (53 female, 83.2 ± 8.1 years (mean and SD)) and 29 caregivers (all female, 42.0 ± 11.7 years). Residents were multimorbid (8 ± 3 diagnoses), and activities of daily living were restricted (Barthel-Index 60.6 ± 24.4). The caregivers’ results indicated good work ability (WAI 37.4 ± 5.1), health related quality of life was superior to the German sample (SF-12 physical CSS 49.2 ± 8.0; mental CSS 54.1 ± 6.6). Among both caregivers and residents, 89% considered KT to be positive for well-being. The qualitative analysis showed that caregivers perceived emotional and functional benefits from more content and calmer residents, a larger variety in basic care practices, and a more self-determined scope of action. Residents reported gains in attention and caring, and recognition of their lay knowledge. CONCLUSION: Residents showed typical characteristics of nursing home inhabitants. Caregivers demonstrated good work ability. Both reported to have benefits from KT. The results provide a good basis for future projects, e.g. controlled studies to evaluate the effects of CAM in nursing homes

a cross-sectional study

Abstrakt Einleitung: Naturheilkundliche Anwendungen sind bislang in der geriatrischen Pflege wenig verbreitet, obwohl sie möglicherweise die konventionelle Pflege sinnvoll ergänzen würden. Zu den wenigen Einrichtungen, in denen Naturheilkunde angewendet wird, gehören so genannte Kneipp- Senioreneinrichtungen. Ziel des Forschungsprojektes war die Evaluation des Gesundheitszustandes der Bewohner und die Untersuchung der Arbeits- und Gesundheitssituation der Mitarbeiter. Die Kneippanwendungen sollten erfasst und durch Mitarbeiter und Bewohner beurteilt werden. Methodik: Von September bis Oktober 2011 wurde eine Querschnittstudie in allen vier bis dahin zertifizierten Kneipp-Senioreneinrichtungen durchgeführt. Es wurden Mitarbeiter, die regelmäßig Kneippanwendungen durchführten, und Bewohner, die regelmäßig Kneippanwendungen erhielten, befragt. Daten wurden mit Hilfe von validierten Fragebögen und standardisierten Fragen einmalig erhoben. Ergebnisse: Insgesamt konnten die Datensätze von 64 Bewohnern (53 weiblich, 83,2 ± 8,1 Jahre (MW ± SD)) und 29 Mitarbeitern (29 weiblich, 42,0 ± 11,7 Jahre) erhoben werden. Bei den Bewohnern wurden durchschnittlich 8 ± 3 Diagnosen gestellt, sie nahmen 8 ± 3 Medikamente täglich ein. 42% der Bewohner litten unter einer manifesten Demenz. Die gesundheitsbezogene Lebensqualität anhand des Short-Form 12 zeigte vergleichsweise hohe Durchschnittswerte für die psychische Summenskala und niedrige Werte für die körperliche Summenskala (psychische Summenskala 56,9 ± 8,2, körperliche Summenskala 43,2 ± 8,1). Die Alltagskompetenz anhand des Barthel-Index und des Fragebogens „Instrumentelle Aktivitäten des täglichen Lebens“ (IADL) war deutlich eingeschränkt (Barthel- Index 60,8 ± 24,4). Kneippanwendungen wurden von 89% als positiv für das Wohlbefinden bewertet. Die Arbeitsfähigkeit der Mitarbeiterinnen anhand des Work Ability Index (WAI) fiel mit durchschnittlich 37,4 ± 5,1 Punkten in die Rubrik „gut“. Die gesundheitsbezogene Lebensqualität ergab für die körperliche (49,2 ± 8,0) und die psychische Summenskala (54,1 ± 6,6) des SF-12 bessere Werte im Vergleich mit den Referenzwerten der deutschen Normstichprobe. Die Evaluation der psychischen Belastung am Arbeitsplatz, gemessen mit dem Copenhagen Psychosocial Questionnaire (COPSOQ), ergab im Vergleich zu vergleichbaren Kollektiven bessere Ergebnisse für die Bereiche „soziale Beziehungen“ und „Führungsqualität am Arbeitsplatz“, „Arbeitsplatz- Unsicherheit“ und „allgemeine Lebenszufriedenheit“. 96% beschrieben naturheilkundliche Maßnahmen als günstig für die eigene Gesundheit und das Wohlbefinden. 90% gaben an, dass sich durch die Anwendung von Kneippmaßnahmen ihr Verhältnis zu den von ihnen betreuten Bewohnern positiv verändert habe. Schlussfolgerung: Die Ergebnisse zeigten multimorbide, polypharmazierte und in ihren Alltagsfähigkeiten deutlich eingeschränkte Bewohner. Mitarbeiterinnen zeigten teilweise eine hohe allgemeine Lebenszufriedenheit und eine gute Arbeitsfähigkeit. Beide Gruppen schätzten die Kneippanwendungen für das Wohlbefinden. Um Effekte des Kneippkonzeptes beurteilen zu können, sollten prospektive kontrollierte Studien durchgeführt werden.Abstract Background: Complementary and alternative medicine (CAM) may complement conventional geriatric nursing in useful ways. The so-called Kneipp nursing homes are among the few institutions that use CAM in form of naturopathy named Kneipp Therapy (KT) in Germany. This study evaluated the health status of residents and the working conditions and health status of caregivers in Kneipp nursing homes. Further, we documented attitudes and preferences of residents and caregivers towards KT. Methods: We performed a cross-sectional study in 2011 in four certified Kneipp nursing homes. We included caregivers who regularly applied KT and residents who regularly received it. Data was gathered once through validated questionnaires and standardized questions. Results: We analyzed the data of 64 residents (53 female, 83.2 ± 8.1 years (mean and SD)) and 29 caregivers (29 female, 42.0 ± 11.7 years). The residents had an average of 8 ± 3 diagnoses and took 8 ± 3 drugs daily. Forty-two percent suffered from manifest dementia. The health- related quality of life showed comparably high average values on the Short Form 12 Health Survey (SF-12) mental component summary scale (56.9 ± 8.2) and low average values on the physical component summary scale (43.2 ± 8.1). Residents’ ability to cope with everyday problems was considerably restricted according to the Barthel Index (60.8 ± 24.4) and the Instrumental Activities of Daily Living questionnaire. Eighty-nine percent evaluated KT as having a positive impact on their wellbeing. Caregivers’ work ability was classified as “good”, with an average of 37.4 ± 5.1 points according to the Work Ability Index. The health-related quality of life, evaluated with the SF-12, showed better results compared to the German caregivers norm, both on the physical component summary scale (49.2 ± 8.0) and the mental component summary scale (54.1 ± 6.6). The evaluation of psychological strain at the workplace, measured with the Copenhagen Psychosocial Questionnaire, showed better results than similar collectives in the categories “social support”, “quality of leadership”, “insecurity at work” and “satisfaction with life”. 96% reported KT as beneficial to their health and wellbeing and 90% percent stated that applying KT had improved their relationships with residents. Conclusion: The results focus on residents characterized by multimorbidity, polypharmacy and considerably restricted abilities. Caregivers indicated a relatively high satisfaction of life and good work ability. Residents and caregivers appreciated KT for their wellbeing. Prospective controlled studies should be carried out to assess the effects of KT in nursing homes