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;
Health and Social Care in the Community, 30(3), 2022, pp.e668-e676.
Publisher:
Wiley
Carers of people with dementia can experience reduced health and well-being, but little is known about how best to support them. There is some evidence to suggest that case management may improve outcomes for carers but less evidence about the features of case management services that can effectively support carers of people with dementia. Admiral Nursing operates a case management approach...
(Edited publisher abstract)
Carers of people with dementia can experience reduced health and well-being, but little is known about how best to support them. There is some evidence to suggest that case management may improve outcomes for carers but less evidence about the features of case management services that can effectively support carers of people with dementia. Admiral Nursing operates a case management approach staffed by specialist nurses and is the only service of its kind in the United Kingdom dedicated to helping people with dementia and their carers. This paper reports qualitative findings from a mixed methods study of Admiral Nursing. For the qualitative strand of the project, data were collected in focus groups and in-depth interviews with carers of people with dementia (n = 35) and analysed thematically using the framework approach. The aim of this analysis was to understand differences between the experiences of the carers in our sample with and without Admiral Nursing, applying Freeman's model of continuity of care (Freeman et al., Continuity of care, 2000). Participants who had received Admiral Nursing were recruited from two geographical locations and carers without experience of this service were recruited from two different areas. We found that carers in our sample felt 'supported' in circumstances where they received an ongoing service from an Admiral Nurse or other professional with expertise in dementia who was able to develop a meaningful relationship with them over time. We conclude that ongoing support, expertise in dementia and a meaningful relationship are key features of relationship continuity common in carers' reports of feeling supported. Specialist nurses are well placed to provide this continuity.
(Edited publisher abstract)
Subject terms:
carers, nursing, nurses, dementia, qualitative research, comparative studies, service provision, case management, carer views, staff views;
...an intergenerational project in East London, supporting dementia carers; working with homecare staff and their managers to develop an enhanced service, about spotting ill-health early, and escalating only the right patients to the right clinician with the right data; offering an Apprentice Nursing Associate pathway; digital technology.
(Edited publisher abstract)
This document brings together some stories and themes from across many partnership projects, delivered by partners of Care City, an innovation centre for healthy ageing and regeneration. It explores what we should do to support care staff to develop clinical skills and work as partners with health colleagues, and how we can open up new career routes into nursing and AHP roles. The stories cover an intergenerational project in East London, supporting dementia carers; working with homecare staff and their managers to develop an enhanced service, about spotting ill-health early, and escalating only the right patients to the right clinician with the right data; offering an Apprentice Nursing Associate pathway; digital technology.
(Edited publisher abstract)
Subject terms:
good practice, innovation, adult social care, intervention, older people, dementia, staff development, digital technology, nurses, care workers, social care professionals, training;
Quality in Ageing and Older Adults, 22(1), 2021, pp.56-67.
Publisher:
Emerald
Purpose: Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use...
(Edited publisher abstract)
Purpose: Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting. Design/methodology/approach: A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis. Findings: Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes. Research limitations/implications: The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research. Originality/value: In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.
(Edited publisher abstract)
Subject terms:
nurses, emotions, hospitals, patients, dementia, wellbeing, person-centred care, staff views;
Dementia: the International Journal of Social Research and Practice, 20(1), 2021, pp.188-212.
Publisher:
Sage
Person-centred care is widely advocated when caring for people with dementia. When a person with dementia is admitted for hospital care, hospital wards are obliged to not only address the cause for admission but also provide dementia-specific care during the hospital stay. Research has shown that the delivery of person-centred care to people with dementia is often inadequate or absent...
(Edited publisher abstract)
Person-centred care is widely advocated when caring for people with dementia. When a person with dementia is admitted for hospital care, hospital wards are obliged to not only address the cause for admission but also provide dementia-specific care during the hospital stay. Research has shown that the delivery of person-centred care to people with dementia is often inadequate or absent in the hospital setting. Moreover, whilst registered nurses often wish to improve the in-hospital care of patients with dementia, there is evidence of experienced barriers. This study aimed to describe registered nurses’ experiences of facilitators for the delivery of person-centred care to inpatients with dementia. By way of systematic searches in the databases PubMed, CINAHL and PsycINFO, qualitative studies (n = 19) reporting registered nurses experience of caring for inpatients with dementia were identified. Relevant content was analysed using a method of thematic synthesis. Three main categories and nine subcategories were presented, internal facilitators (experience and knowledge; values and beliefs; professional identity; empathy), external facilitators (physical environment; organisational culture and structure) and facilitating actions (forming a holistic picture; establishing trust; adjusting routines and interventions). While facilitators did exist in the hospital setting, the findings indicate that care received by inpatients with dementia is dependent on individual registered nurses knowledge, personal aptitude and ability to compensate for structural flaws. In order to minimise arbitrary outcomes of care for patients with dementia, consistent organisational support in the form of educational interventions and allocation of resources is crucial.
(Edited publisher abstract)
Subject terms:
hospitals, dementia, person-centred care, nurses, staff-user relationships;
International Journal of Geriatric Psychiatry, 35(4), 2020, pp.405-413.
Publisher:
Wiley
Objectives: To explore current practice and the role of UK care homes and Admiral Nurses in helping people living with dementia and their family carers prepare for end‐of‐life. Methods: The researchers conducted an online survey with all UK Admiral Nurses (59% response rate) and a random sample of Gold Standards Framework accredited care homes in England and Wales (38% response rate...
(Edited publisher abstract)
Objectives: To explore current practice and the role of UK care homes and Admiral Nurses in helping people living with dementia and their family carers prepare for end‐of‐life. Methods: The researchers conducted an online survey with all UK Admiral Nurses (59% response rate) and a random sample of Gold Standards Framework accredited care homes in England and Wales (38% response rate). The researchers used descriptive statistics to report survey findings. Results: While respondents commonly discussed the progressive nature of dementia with people living with dementia and family carers, they less frequently spoke to people with dementia or carers about the nature of dementia as life shortening, terminal, or a disease you can die from. Admiral Nurses highlighted that where service models reduced continuity of care, opportunities for ongoing discussion and developing relationships that supported these discussions were reduced. Admiral Nurses and care homes raised concerns about conversations being left too late, when the person with dementia no longer had capacity to engage. There was a high level of agreement with all European Association of Palliative Care and National Institute for Health and Care Excellence (NICE) statements presented regarding end‐of‐life care planning and discussions. Conclusions: The survey of care homes and Admiral Nurses, combined with findings from the previous survey of UK memory services, increases understanding of how services help people with dementia and family carers prepare for end‐of‐life. The study found fragmentation across the service system, lack of continuity, and tensions regarding when these conversations should be initiated and by whom.
(Edited publisher abstract)
Subject terms:
dementia, nurses, care homes, end of life care, carers, advance care planning, care workers, families, communication;
International Journal of Care Coordination, 23(1), 2020, p.14–23.
Publisher:
Sage
Introduction: There are numerous effective transitional care interventions yet they are not routinely implemented. Furthermore, few interventions exist for older adults with dementia. A first step in developing effective interventions for dementia patients and increasing intervention uptake for all patients is to understand the current delivery process of transitional care. Methods: A mixed...
(Publisher abstract)
Introduction: There are numerous effective transitional care interventions yet they are not routinely implemented. Furthermore, few interventions exist for older adults with dementia. A first step in developing effective interventions for dementia patients and increasing intervention uptake for all patients is to understand the current delivery process of transitional care. Methods: A mixed methods study using an explanatory multiphase design was conducted. Guided by provider interviews, medical charts were reviewed to collect information on the day-to-day transitional care being delivered to older adults. Then providers were interviewed again to assess the accuracy of those results and provide context. Results: The medical charts of 210 older adults (126 with dementia and 84 without) were reviewed and nine providers representing various professional roles including social work, nursing, and case management were interviewed. Social workers and case managers were primarily involved in discharge planning, communicating with providers outside the hospital, advanced care planning, providing social and community supports, and making follow-up appointments. Registered nurses were the primary providers of patient education and medication safety while physicians were primarily involved in ensuring that necessary information was available in the discharge summary and that it was available in the chart. Discussion: This study found distinct patterns in the delivery of transitional care, including the unique roles nursing, social work, and case management have in the process. Furthermore, these patterns were found to differ between patients with and without dementia. These findings are both consistent and inconsistent with the existing literature on transitional care interventions.
(Publisher abstract)
Subject terms:
dementia, older people, intervention, social workers, discharge planning, nursing, social work, nurses, professional role, case management, hospital discharge;
Dementia: the International Journal of Social Research and Practice, 19(6), 2020, pp.2090-2113.
Publisher:
Sage
...as a wide range of caregiver and environmental facilitators to optimizing dementia mealtime care. Findings can inform the development and implementation of multifaceted innovative mealtime assistance and staff training programs to promote resident eating performance while fostering person-centered individualized mealtime care practice.
(Edited publisher abstract)
Background and Objectives: Cognitively impaired individuals are at increased risk for functional and behavioral difficulties at mealtimes, leading to compromised eating performance, low food and fluid intake, and negative functional and nutritional outcomes. Nursing assistants are the most critical front-line care staff and best positioned to manage the personal and environmental factors that influence resident eating performance. Identifying nursing assistants’ perceptions of barriers and facilitators to engaging residents in eating will provide important experientially based foundation for developing and testing evidence-driven interventions to promote mealtime care. Methods: A qualitative descriptive study was conducted in three sites: two nursing homes and one hospital gero-psychiatric inpatient unit. Six focus groups were conducted with a purposive sample of 23 nursing assistants who regularly provided mealtime care to residents with cognitive impairment. Interview questions addressed barriers and facilitators at resident, caregiver, environmental (facility), and policy levels in optimizing mealtime care. Audio recordings of focus groups were transcribed and analyzed using qualitative descriptive content analysis. Both barriers and facilitators were organized into a hierarchical taxonomy based on similarities and differences framed by the Social Ecological Model. Results: The majority of barriers and facilitators were at the caregiver level. Caregiver-level barriers included lack of preparation and training, competing work demands, time pressure, and frustration. Caregiver-level facilitators included caregiver preparation and motivational, technical, informational, and instrumental assistance. Environmental-level barriers and facilitators related to the physical, social, and cultural environment and facility practices. Only barriers to optimizing mealtime care were identified at resident and policy levels. Conclusions: Nursing assistants identified multilevel barriers as well as a wide range of caregiver and environmental facilitators to optimizing dementia mealtime care. Findings can inform the development and implementation of multifaceted innovative mealtime assistance and staff training programs to promote resident eating performance while fostering person-centered individualized mealtime care practice.
(Edited publisher abstract)
Updated guidance which sets out five principles to support people working in health and care settings to apply five principles for improving the quality of care and support for people with dementia and their carers. The five SPACE principles cover: Staff who are skilled and have time to care; partnership working with carers; Assessment, early identification of dementia and post diagnostic support...
(Edited publisher abstract)
Updated guidance which sets out five principles to support people working in health and care settings to apply five principles for improving the quality of care and support for people with dementia and their carers. The five SPACE principles cover: Staff who are skilled and have time to care; partnership working with carers; Assessment, early identification of dementia and post diagnostic support; Care and support plans which are person-centred and individual; and Environments that are dementia friendly. Each principle includes information on what will support its implementation and considerations for training and education. It is recommended that the principles are used them to support the development of practice in a systematic way to support improvement. The principles can be used by nurses and other health and social care staff, as well as senior managers.
(Edited publisher abstract)
Subject terms:
dementia, nurses, care workers, managers, carers, good practice, nursing, training materials;
University of Kent. Personal Social Services Research Unit
Publication year:
2019
Pagination:
184
Place of publication:
Canterbury
Annual report providing unit costs for a range of health and social care services, community-based health and care staff and hospital-based health care staff. The report details cost at the level of individual service users for: services for older people; services for people with mental health problems; services for people who misuse drugs or alcohol; services for people requiring learning disability support; services for adult requiring physical support; services for children and their families; hospital and related services; and care packages, including support for children, young adult, people with disabilities and older people. It also provides unit cost information for different grades of staff working in a range of settings, including community-based health care and social care staff, and hospital-based staff. It also includes two guest articles, on of uses data collected as part of a study of clinical medication reviews in care homes for older people to see whether two different methods of collecting primary and social care resource use data produce similar costs.
(Edited publisher abstract)
Annual report providing unit costs for a range of health and social care services, community-based health and care staff and hospital-based health care staff. The report details cost at the level of individual service users for: services for older people; services for people with mental health problems; services for people who misuse drugs or alcohol; services for people requiring learning disability support; services for adult requiring physical support; services for children and their families; hospital and related services; and care packages, including support for children, young adult, people with disabilities and older people. It also provides unit cost information for different grades of staff working in a range of settings, including community-based health care and social care staff, and hospital-based staff. It also includes two guest articles, on of uses data collected as part of a study of clinical medication reviews in care homes for older people to see whether two different methods of collecting primary and social care resource use data produce similar costs.
(Edited publisher abstract)
Subject terms:
alcohol misuse, care homes, care workers, childrens social care, costs, dementia, doctors, extra care housing, general practitioners, health care, health professionals, home care, hospitals, learning disabilities services, mental health services, multidisciplinary teams, nurses, residential care, nursing homes, older people, social care, social care provision, social care staff, social workers, staff, substance misuse;