Background: Pet robots have been employed as viable substitutes to pet therapy in nursing homes. Despite their potential to enhance the psychosocial health of residents with dementia, there is a lack of studies that have investigated determinants of implementing pet robots in real-world practice. This study aims to explore the determinants of implementing pet robots for dementia care in nursing...
(Edited publisher abstract)
Background: Pet robots have been employed as viable substitutes to pet therapy in nursing homes. Despite their potential to enhance the psychosocial health of residents with dementia, there is a lack of studies that have investigated determinants of implementing pet robots in real-world practice. This study aims to explore the determinants of implementing pet robots for dementia care in nursing homes, from the perspectives of healthcare professionals and organisational leaders. Methods: A descriptive qualitative study, conceptualised and guided using the Consolidated Framework of Implementation Research (CFIR), was conducted. We conducted semi-structured interviews with healthcare professionals and organisational leaders from nursing homes. Data was transcribed and analysed using Framework Analysis, based on the CFIR as an a priori framework. Results: A total of 22 participants from eight nursing homes were included. Determinants were mapped to constructs from all five CFIR domains. Determinants relating to the characteristics of pet robots include their design, realisticness and interactivity, affordability, cleanability, perceived evidence strength and comparative advantages to live pets. Determinants relating to external influences (outer setting) include national regulatory guidelines, funding and networks with other organisations. With regards to characteristics of nursing homes (inner setting), determinants include the relevance of pet robots in relation to the needs of residents with dementia, alignment with care processes, infection control mandates and their relative priority. In the domain 'characteristics of individuals', determinants were associated with individuals' beliefs on the role of technology, desires to enhance residents' quality of life, and differential attitudes on the use of robots. Finally, in the domain ‘implementation process', assessments and care planning were identified as determinants. Conclusions: Overall, while sentiments around determinants within CFIR domains of pet robots' characteristics, outer setting and implementation process were similar, participants' opinions on the determinants within the 'inner setting' and 'characteristics of individuals' were more varied. This could be due to different organisational structures, disciplinary differences and personal experiences of using pet robots. Many determinants in different domains were interrelated. Findings provide a springboard for identifying and designing implementation strategies to guide the translation of pet robots from research into real-world practice.
(Edited publisher abstract)
Background and Objectives: Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to (a) identify residents' opportunities for, and experiences...
(Edited publisher abstract)
Background and Objectives: Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to (a) identify residents' opportunities for, and experiences with, getting out; (b) understand the significance of getting out; and (c) explain influential factors. Research Design and Methods: Guided by grounded theory methods, we analyzed qualitative data collected over a 1-year period in 4 diverse assisted living communities. We followed 33 residents with dementia and their care partners. Data include detailed fieldnotes capturing 1,560 observation hours, 114 interviews with residents (where possible), assisted living staff, family members, and other visitors, and record review. Results: We identified the centrality of "being out in the world and negotiating connections," which characterizes residents' experiences with the outside world as a process of "working out" engagement with nature, others, and the community. Being out in the world was consequential to well-being and quality of life. Most residents got out at least occasionally; some lacked opportunities. Among residents who got out, most benefitted from ensuing connections. Yet, not all experiences were positive. Being out in the world varied over time and by individual-, care convoy-, assisted living community-, and neighborhood-level factors. Discussion and Implications: We discuss the implications of our findings for research and practice surrounding meaningful engagement among persons with dementia, including during crises such as the pandemic.
(Edited publisher abstract)
Subject terms:
Alzheimers disease, dementia, activities of daily living, leisure activities, day services, residents, user views, participation;
Health Expectations, 25(1), 2022, pp.80-90. Online only
Publisher:
Wiley
Background: Researchers often stress the necessity and challenge of integrating the positionings of residents, family members and nurses in order to realize each actor's involvement in long-term dementia care. Yet most studies approach user and family involvement separately. Aim: To explain how productive involvement in care provision is accomplished in triadic relationships between residents
(Edited publisher abstract)
Background: Researchers often stress the necessity and challenge of integrating the positionings of residents, family members and nurses in order to realize each actor's involvement in long-term dementia care. Yet most studies approach user and family involvement separately. Aim: To explain how productive involvement in care provision is accomplished in triadic relationships between residents, family members and nurses. Methods: An ethnographic study of identity work, conducted between 2014 and 2016 in a Dutch nursing home. Findings: this study identify four ideal-typical identity positionings performed by nurses through daily activities. The findings reveal how their identity positionings were inseparable from those of the residents and family members as they formed triads. Congruent, or 'matching', identity positionings set the stage for productive involvement. This systematic analysis of participants' identity work shows how-through embedded rights and responsibilities-their positionings inherently shaped and formed the triadic types and degrees of involvement observed within these relationships. Discussion and conclusion: This study both unravels and juxtaposes the interrelatedness of, and differences between, the concepts of user and family involvement. Accordingly, these findings display how residents, family members and nurses-while continuously entangled in triadic relationships-can use their identity positionings to accomplish a variety of involvement activities. To mirror and optimize the implementation of user and family involvement, this paper proposes a rights-based and relational framework based on these findings. Patient or public contribution: Conversations with and observations of residents; feedback session with the Clients' Council.
(Edited publisher abstract)
Subject terms:
dementia, family members, long term care, nursing homes, residents, nurses, staff-user relationships, user participation;
Journal of Gerontological Nursing, 48(1), 2022, pp.29-33.
Publisher:
Healio
Long-term care facility (LTCF) residents have been disproportionately affected by coronavirus disease 2019 (COVID-19), from increased mortality and restrictive public health measures. The current study aims to describe the experiences of residents relocating between LTCFs at the onset of the COVID-19 pandemic. Emphasis was placed on residents' sense of home and how the pandemic and ensuing isolation affected their transition. This qualitative study follows the principles of constructivist grounded theory. Seven of 10 residents interviewed had cognitive impairment (mean age = 84 years). Four primary themes were elicited from the interviews focusing on residents' perceptions of their environment and highlights the value placed on privacy and control, the multifaceted feeling of loss during the pandemic, the importance of relationships as a source of comfort and pleasure, and resilience shown by residents in times of hardship. Our study indicates that residents experienced dichotomy and paradox during the pandemic, attempting to strike a balance between isolation and camaraderie, infection risk and mental health, and loss and resilience. The need for familial contact and socialization must be balanced against infection control measures.
(Edited publisher abstract)
Long-term care facility (LTCF) residents have been disproportionately affected by coronavirus disease 2019 (COVID-19), from increased mortality and restrictive public health measures. The current study aims to describe the experiences of residents relocating between LTCFs at the onset of the COVID-19 pandemic. Emphasis was placed on residents' sense of home and how the pandemic and ensuing isolation affected their transition. This qualitative study follows the principles of constructivist grounded theory. Seven of 10 residents interviewed had cognitive impairment (mean age = 84 years). Four primary themes were elicited from the interviews focusing on residents' perceptions of their environment and highlights the value placed on privacy and control, the multifaceted feeling of loss during the pandemic, the importance of relationships as a source of comfort and pleasure, and resilience shown by residents in times of hardship. Our study indicates that residents experienced dichotomy and paradox during the pandemic, attempting to strike a balance between isolation and camaraderie, infection risk and mental health, and loss and resilience. The need for familial contact and socialization must be balanced against infection control measures.
(Edited publisher abstract)
Subject terms:
service transitions, older people, Covid-19, long term care, nursing homes, care homes, cognitive impairment, dementia, qualitative research, user views, residents;
International Journal of Older People Nursing, early cite 24 June 2021, p.e12394.
Publisher:
John Wiley & Sons, Ltd
Place of publication:
West Sussex
Background: Many people residing in nursing or residential care homes (also called long-term care facilities) live with physical or cognitive difficulties. Staff working in these environments often help residents (particularly those with more advanced dementia) with their personal care needs, including maintaining mouth care and health. Poor oral health is associated with many difficulties
(Edited publisher abstract)
Background: Many people residing in nursing or residential care homes (also called long-term care facilities) live with physical or cognitive difficulties. Staff working in these environments often help residents (particularly those with more advanced dementia) with their personal care needs, including maintaining mouth care and health. Poor oral health is associated with many difficulties, including increased risk of respiratory problems, pain and discomfort. Yet, concerns have been raised that staff may not have the knowledge and skills to effectively support residents with oral care and health. There is therefore an important gap between what is known about the importance of maintaining oral health (scientific evidence) and daily practice in long-term care environments. Objectives: To work with care home staff: (1) to create a learning culture to address how to promote mouth care for residents, particularly when a resident resists support with this aspect of care; and (2) to effect mouth care practice changes (if required) using participatory and inclusive research cycles. Methods and results: This study conducted a participatory research project to address this important area of care. Four participatory research ‘cycles’ were conducted. Cycle one explored existing literature to develop accessible guidance on strategies that staff could use to support residents to maintain and improve oral care, particularly when a resident may resist such care. Cycle two built on this review to determine knowledge levels within the care team. This highlighted deficiencies in staff knowledge, skills and competence for providing mouth care and their need for training to address this. Cycle three identified evidence-based strategies to develop staff understanding and knowledge. Cycle four brought together experts from nursing, dentistry, behaviour change, systematic reviews and care homes research to develop a grant application to progress this work further. Conclusion: This paper provides an example of the processes undertaken in a participatory research project, bringing together science and practice to improve an essential area of care. Implications for practice: Using participatory research approaches in this setting can allow the effective translation of uncertainties in care and practice into questions that can be addressed by research, leading to meaningful outcomes for those living and working in care homes.
(Edited publisher abstract)
Subject terms:
participatory research, care homes, oral health, residents;
European Journal of Social Work, 24(5), 2021, pp.828-851.
Publisher:
Taylor and Francis
User participation has been one of the central guiding principles in health and social services for decades, but there are many obstacles in practice, especially when service users’ have difficulties in exercising their autonomy. Many residents with dementia in nursing homes belong to this group. This article is based on a critical interpretive review of the factors affecting user participation...
(Edited publisher abstract)
User participation has been one of the central guiding principles in health and social services for decades, but there are many obstacles in practice, especially when service users’ have difficulties in exercising their autonomy. Many residents with dementia in nursing homes belong to this group. This article is based on a critical interpretive review of the factors affecting user participation for residents with dementia living in nursing homes. The search yielded 1555 articles; in total 82 full-text articles were retrieved, of which 38 met the inclusion criteria. Six broad analytical themes were identified; characteristics of the residents, staff, co-residents, relatives, tools for promoting participation and socio-material context, which indicates that user participation for this group and this context is multifactorial. Another interesting finding is that very few of the included articles question to whether the residents have real power in influencing the provision of individual services; moreover user participation on collective level with the overall aim of influencing service delivery in nursing homes was non-existent. An open question is whether residents with dementia in nursing homes are primarily considered patients more than fellow citizens.
(Edited publisher abstract)
Subject terms:
user participation, residents, nursing homes, dementia, literature reviews, citizenship;
Health and Social Care Delivery Research, 9(19), 2021, Online only
Publisher:
National Institute for Health Research
Place of publication:
London
Design: mixed-methods study. Setting: care homes for older adults in England. Findings: This study found that care home quality ratings were related to working conditions for staff and positively associated with quality-of-life outcomes for residents. This study found a positive relationship between care quality and both staff wages and staff being trained in dementia and person-centred care. Homes...
(Edited publisher abstract)
Background: Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. This study developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. The study also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them. Objectives: were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator (Care Quality Commission) quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes. Design: mixed-methods study. Setting: care homes for older adults in England. Findings: This study found that care home quality ratings were related to working conditions for staff and positively associated with quality-of-life outcomes for residents. This study found a positive relationship between care quality and both staff wages and staff being trained in dementia and person-centred care. Homes that were short-staffed or struggled to keep staff tended to be of poorer quality. The research shows that care home quality is important to the quality of life of residents, especially those who have higher care and support needs. One way in which care homes can improve care quality, and, therefore, improve residents’ quality of life, is by investing in their care workforce through leadership, training, and better pay and working conditions. Conclusions: The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.
(Edited publisher abstract)
Subject terms:
quality of life, care homes, staffing levels, residents, quality assurance, performance management, anxiety, depression, pain, outcomes;
Background and Objectives: Mealtime engagement is defined as verbal and nonverbal assistance provided by caregivers to guide and motivate care recipients in eating. Quality mealtime engagement is critical to improve mealtime difficulties and intake among older adults with dementia requiring eating assistance. Few tools are feasible and valid to measure mealtime engagement. This study developed...
(Edited publisher abstract)
Background and Objectives: Mealtime engagement is defined as verbal and nonverbal assistance provided by caregivers to guide and motivate care recipients in eating. Quality mealtime engagement is critical to improve mealtime difficulties and intake among older adults with dementia requiring eating assistance. Few tools are feasible and valid to measure mealtime engagement. This study developed and tested the Mealtime Engagement Scale (MES). Research Design and Methods: Items were developed based on literature review and expert review and finalized based on content validity and corrected item-total correlation. A secondary analysis of 87 videotaped observations capturing 18 nursing home staff providing mealtime care to residents with dementia was conducted. Internal consistency, interrater reliability, and intrarater reliability were assessed. Concurrent and convergent validity were examined through correlation (rs) with the Relational Behavior Scale (RBS) and the Mealtime Relational Care Checklist (M-RCC), respectively. Results: The 18-item MES was developed with adequate content validity (Scale-content validity index [CVI] = 1.00; Scale-CVI/Average = 0.962–0.987). Each item is scored from 0 (never) to 3 (always). The total scale score ranges from 0 to 54. Higher scores indicate greater mealtime engagement. The MES had very good internal consistency (Cronbach’s α = 0.837), outstanding interrater reliability (interclass correlation = 0.920), outstanding intrarater reliability (interclass correlation = 0.956), adequate concurrent validity based on strong correlation with the RBS (rs = 0.821, p < .001), and fair convergent validity based on weak correlation with the M-RCC (rs = 0.219, p = .042). Discussion and Implications: Findings provide preliminary psychometric evidence of MES to measure mealtime engagement. Future testing is needed among more and diverse samples in different care settings to accumulate psychometric evidence.
(Edited publisher abstract)
Subject terms:
instruments, carers, dementia, meal services, nutrition, nursing homes, residents, activities of daily living, user participation;
Background and Objectives: Nursing homes (NHs) care for 70% of Americans dying with dementia. Many consider deaths in NHs rather than hospitals as preferable for most of these residents. NH characteristics such as staff teamwork, communication, and other components of patient safety culture (PSC), together with state minimum NH nurse staffing requirements, may influence location of death...
(Edited publisher abstract)
Background and Objectives: Nursing homes (NHs) care for 70% of Americans dying with dementia. Many consider deaths in NHs rather than hospitals as preferable for most of these residents. NH characteristics such as staff teamwork, communication, and other components of patient safety culture (PSC), together with state minimum NH nurse staffing requirements, may influence location of death. This study examined associations between these variables and place of death (NH/hospital) among residents with dementia. Research Design and Methods: Cross-sectional study of 11,957 long-stay NH residents with dementia, age 65+, who died in NHs or hospitals shortly following discharge from one of 800 U.S. NHs in 2017. Multivariable logistic regression systematically estimated effects of PSC on odds of in-hospital death among residents with dementia, controlling for resident, NH, county, and state characteristics. Logistic regressions also determined moderating effects of state minimum NH nurse staffing requirements on relationships between key PSC domains and location of death. Results: Residents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death. This effect was stronger in NHs located in states with higher minimum NH nurse staffing requirements. Discussion and Implications: Promoting communication openness in NHs across nursing disciplines may help avoid unnecessary hospitalization at the end of life, and merits particular attention as NHs address nursing staff mix while adhering to state staffing requirements. Future research to better understand unintended consequences of staffing requirements is needed to improve end-of-life care in NHs.
(Edited publisher abstract)
Subject terms:
nursing homes, residents, dementia, safety, death, hospitals, end of life care, mortality;
European Journal of Social Work, early cite 15 August 2021,
Publisher:
Taylor and Francis
User participation has been one of the central guiding principles in health and social services for decades, but there are many obstacles in practice, especially when service users’ have difficulties in exercising their autonomy. Many residents with dementia in nursing homes belong to this group. This article is based on a critical interpretive review of the factors affecting user participation...
(Edited publisher abstract)
User participation has been one of the central guiding principles in health and social services for decades, but there are many obstacles in practice, especially when service users’ have difficulties in exercising their autonomy. Many residents with dementia in nursing homes belong to this group. This article is based on a critical interpretive review of the factors affecting user participation for residents with dementia living in nursing homes. The search yielded 1555 articles; in total 82 full-text articles were retrieved, of which 38 met the inclusion criteria. Six broad analytical themes were identified; characteristics of the residents, staff, co-residents, relatives, tools for promoting participation and socio-material context, which indicates that user participation for this group and this context is multifactorial. Another interesting finding is that very few of the included articles question to whether the residents have real power in influencing the provision of individual services; moreover user participation on collective level with the overall aim of influencing service delivery in nursing homes was non-existent. An open question is whether residents with dementia in nursing homes are primarily considered patients more than fellow citizens.
(Edited publisher abstract)
Subject terms:
user participation, nursing homes, dementia, residents, literature reviews;