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Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies
- Authors:
- KE Li-Shan, et al
- Journal article citation:
- Journal of Clinical Nursing, 24(15-16), 2015, pp.2057-2073.
- Publisher:
- John Wiley and Sons
Aims and objectives: To explore nurses' views regarding implementing advance care planning for older people. Background: Advance care planning is recommended as a way for older people to discuss their future care with family members and health professionals. Nurses play key roles in the process of advance care planning, including ensuring that patients are informed of their rights and that decisions are known to, and respected by, the health care team. Thus, understanding of nurses' experiences and perspectives regarding implementing advance care planning for older people is a significant topic for review. Design: Qualitative meta-synthesis. Methods: Four databases including CINAHL plus, Medline [EBSCOhost], EMBASE, and PsycINFO were searched, and 1844 articles were initially screened. Finally, 18 articles were critically appraised and a thematic synthesis was undertaken. Results: Four themes were identified regarding implementation of advance care planning: perceived disadvantages and advantages of advance directives; nurses' responsibility and roles; facilitators and barriers; and nurses' needs and recommendations. Nurses felt that advance directives provided more advantages than disadvantages. Nurses generally believed that they were well positioned to engage in advance care planning conversations. Nurses perceived barriers relating to older people, families, environment, time, culture, cost, language and knowledge of health care teams with regard to advance care planning. In nurses' needs, education and support were highlighted. Conclusions: This study provides useful knowledge for implementing advance care planning through illustrating nurses' experiences and perspectives. The results showed that nurses were more concerned about barriers in relation to working environment, teamwork, time and knowledge of health care team members than older people's characteristics, when implementing advance care planning. (Edited publisher abstract)
Nurses' and personal care assistants' role in improving the relocation of older people into nursing homes
- Authors:
- ELLIS Julie M., RAWSON Helen
- Journal article citation:
- Journal of Clinical Nursing, 24(13-14), 2015, pp.2005-2013.
- Publisher:
- John Wiley and Sons
Aims and objectives: This article presents findings from a study that explored nurses' and personal care assistants' role in improving the relocation of older people into a nursing home. Background: Suggestions for improving the relocation process for older people moving into a nursing home have been the outcomes of studies that have interviewed residents and their families. However, the views of nurses and personal care assistants working in nursing homes have not been previously explored. Design: An exploratory, descriptive qualitative research design. Methods: Individual interviews were conducted with 20 care staff (seven registered nurses, five enrolled nurses and eight personal care assistants) employed at four nursing homes. Findings: Using thematic analysis, two key themes were identified: ‘What it's like for them’ – highlighted staffs' awareness of the advantages, disadvantages and meaning of relocation, and focused on staffing and nursing care; other services provided and the environment. The second theme – ‘We can make it better’, revealed suggestions for improving the relocation process, and included spending time with new residents and the importance of a person-centred approach to care. Conclusion: Care staff have an important role in improving the relocation process of older people into a nursing home, as well as contributing to the discussion on this important clinical topic. Relevance to clinical practice: Challenging care staff to acknowledge the importance of their role in helping older people settle into a nursing home is a key requirement of nursing practice in aged care. Nursing practice guidelines, with a focus on person-centred care, on how to manage the relocation process for an older person and their family are required for this aspect of nursing home care. Education of staff on relocation policies and procedures is essential to ensure that residents and their families are supported through this process. (Publisher abstract)
A qualitative study of nurses’ clinical experience in recognising low mood and depression in older patients with multiple long-term conditions
- Authors:
- WATERWORTH Susan, et al
- Journal article citation:
- Journal of Clinical Nursing, 24(17-18), 2015, pp.2562-2570.
- Publisher:
- John Wiley and Sons
Aims and objectives: To explore how nurses’ recognise depression in older patients with multiple long-term conditions and the strategies they use to support the patient. Background: Depression decreases an older person's quality of life and sense of wellness, and increases functional impairment. The positive role of nurses working with patients with long-term conditions is now being recognised internationally; however, there is a gap in the research about how nurses recognise depression in older patients and how this impacts on their practice. Design: This is a qualitative study informed by a constructivist grounded theory approach. Methods: In-depth telephone interviews were conducted with 40 nurses working in geographically diverse areas in New Zealand. Results: Having the conversation with older patients about their low moods, or specifically about depression was not something that all the nurses had, or felt they could have. While some nurses knew they could provide specific advice to patients, others believed this was not their responsibility, or within the scope of their role. Conclusion: Faced with an increasing number of older people with long-term conditions, one of which maybe depression itself or as a result of living with other long-term conditions, ongoing monitoring and support pathways are necessary to prevent further decline in the older person's quality of life and well-being. Relevance to clinical practice: Nurses in primary health care can build on current knowledge and skills to increase their capability to promote ‘ageing well’ with older people who have long-term conditions and depression. (Publisher abstract)
The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians
- Authors:
- HYNNINEN Nina, SAARNIO Reetta
- Journal article citation:
- Journal of Clinical Nursing, 24(1-2), 2015, pp.192-201.
- Publisher:
- John Wiley and Sons
Aims and objectives: The aim of this study is to describe the care of older people with dementia in surgical wards from the viewpoint of the nursing staff and physicians. Background: There has been little research on the impact of the increasing number of older people with dementia in surgical wards and the preparedness of multi-professional staff caring for them. Design: A qualitative, descriptive design was used. Methods: The data were collected using unstructured interviews with nursing staff (n = 19) and physicians (n = 9) who participate in caring for people with dementia in surgical wards. The collected data were analysed using inductive content analysis. Result: The nursing staff reported that caring for people with dementia was physically and mentally demanding. Physicians regarded memory disorder-related symptoms as primary causes of patients’ challenging behaviour, while in similar situations the nursing staff felt that such behaviour was related to their own personality or a deficiency in their nursing competence. The nursing staff commented that they had not received specific training in caring for people with dementia. Conclusion: The study highlights the importance of developing nurses’ skills to meet the current demands of their jobs. Thus, nursing staff urgently require additional training to safely care for this group of patients. In addition, the well-being of nursing staff needs further support, and working practices in the wards should be reviewed. Relevance to clinical practise: Education and up-to-date information related to patient care strongly improve the quality of nursing. The results can be applied to the development of competences related to the care of older people with dementia in surgical wards from a multi-professional standpoint. (Publisher abstract)
Pain in care home residents with dementia: an exploration of frequency, prescribing and relatives' perspectives
- Authors:
- BARRY Heather E., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(1), 2015, pp.55-63.
- Publisher:
- Wiley
Objectives: This study aims to determine pain frequency amongst care home residents with dementia, to investigate variables associated with pain, to explore analgesic use among residents and to seek residents' relatives' views on provision of care and management of pain by the care home. Methods: Structured face-to-face interviews were conducted with residents, nursing staff and relatives from nine dementia care homes in Northern Ireland, between May 2010 and March 2012. Demographic information was collected from participants, neuropsychiatric tests were used to assess residents' cognitive functioning, medication use was determined from care home records and residents' pain was assessed using a verbal descriptor scale. Relatives' views were sought on care provision and management of pain. Results: Forty-two residents, 16 nurses/care assistants and 35 relatives participated; the participation rate of residents was low (27.6%). Most residents were suffering moderate–severe dementia, and some residents (26.2%) were unable to provide a self-report of pain. A significantly higher proportion of relatives (57.1%) deemed residents to be experiencing pain at the time of the interview, compared with residents (23.8%, p = 0.005) and nurses/care assistants (42.9%, p = 0.035). Most residents (88.1%) were prescribed with analgesia; non-opioid analgesics were most commonly prescribed. High proportions of residents were prescribed with psychoactive medications. Antipsychotic drug use was associated with presence of pain (p = 0.046). Conclusions: This study has reinforced the challenge of assessing and managing pain in this resident population and highlighted issues to be addressed by long-term care providers and clinicians. Participation of people with dementia, and their families, in healthcare research needs to be improved. (Publisher abstract)
The state of the adult social care sector and workforce in England
- Author:
- SKILLS FOR CARE
- Publisher:
- Skills for Care
- Publication year:
- 2015
- Pagination:
- 104
- Place of publication:
- Leeds
The report uses the data from the National Minimum Data Set for Social Care (NMDS-SC) to give a picture of adult social care workforce, focusing on the size and structure of the sector and workforce, staff overview, workforce demographics, recruitment and retention, pay, qualifications and training and registered nurses. The main findings include: an estimated 17,300 organisations were involved in providing or organising adult social care in England as at 2013 - an increase of 1 per cent from 2012; around 214,000 adults, older people and carers received direct payments from councils’ social services departments as at 2013 and approximately 70,000 of these recipients were directly employing their own staff; the number of adult social care jobs was estimated to have increased by around 2 per cent between 2012 and 2013 and by 15 per cent since 2009; and since 2009 the workforce has continued to shift away from local authority jobs and towards independent sector jobs. The report concludes that if the sector is to meet the growing demands of an increasing older population then this type of information about the workforce is vital to help plan the future workforce effectively. (Edited publisher abstract)
Longitudinal prevalence and correlates of elder mistreatment among older adults receiving home visiting nursing
- Authors:
- FRIEDMAN Bruce D., et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 27(1), 2015, pp.34-36.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The objectives of this study were to identify elder mistreatment (EM) prevalence among a cohort of older adults receiving visiting nurse care in their homes, determine EM subtypes, and identify factors associated with EM. EM data were collected by nurses during monthly home visits for up to 24 months. It took the nurses a mean of 10.5 visits to discern EM. Fifty-four (7.4%) of 724 patients were identified as mistreated, of which 33 had enough information to subtype the EM. Of these 33, 27 were victims of neglect, 16 of psychological abuse, and 10 of financial exploitation, and 17 suffered more than one type. Among the entire sample, 11 variables were positively correlated with EM presence. Nurses visiting older adults in their homes should be aware that their patients are, as a group, vulnerable to EM, and that the factors identified here may be specific markers of greater risk. (Publisher abstract)
Addressing the burden of stroke caregivers: a literature review
- Author:
- JACKS Deborah
- Journal article citation:
- Journal of Clinical Nursing, 24(17-18), 2015, p.2376–2382.
- Publisher:
- John Wiley and Sons
Aims and objectives: To examine the empirical literature regarding the risk of burden experienced by the older adult caregiver of the stroke survivor. The scope of this review was limited to older adult family members caring for older adult stroke survivors as evidenced in the literature written between the years of 2009–2014. Background: This article will explore published research within the past five years (2009–2014) that addresses the issue of burden among older adult caregivers of stroke survivors in addition to the implication for the changes needed within the nursing profession to mitigating the burden experienced by the caregiver. Many stroke survivors are in their 6th decade of life or older, with caregivers approximately the same age. This literature review specifically focuses on the role of nursing and the issue of caregiver burden. Design: Literature Review. Methods: A review of the literature published between 2009–2014 related to the lived experience of caregivers of stroke survivors and the role of nursing related to mitigating caregiver burden. Results: Numerous factors impact the lived experience of caregivers providing care for the stroke survivor. Assuming the role of caregiver has an inherent risk which can result in health compromises for the caregiver. It is the responsibility of the nurse to assess, design interventions and provide education to prepare the caregiver for the demands of the role. Conclusions: The literature review has shown that research regarding the risk of caregiver burden and the resulting health compromise is scarce. In addition, there is a lack of evidence-based nursing interventions aimed at assuaging the risk of caregiver burden. Relevance to clinical practice: Caregiver stress culminating in burden is commonly a reason for the eventual institutionalisation of the stroke survivor. Critically assessing and providing for the physical, psychosocial and educational support needs of stroke caregivers will assist in mitigating the daily burden experienced by the caregiver. Caregiver burden often results in psychological and physical health compromise for the caregiver. This literature review will address the role of the caregiver and the responsibilities of nursing to meet the needs of the caregiver. (Publisher abstract)
Resident-to-resident aggression in nursing homes: social worker involvement and collaboration with nursing colleagues
- Author:
- BONIFAS Robin Patchell
- Journal article citation:
- Health and Social Work, 40(3), 2015, pp.e101-e109.
- Publisher:
- Oxford University Press
Resident-to-resident aggression (RRA) is the most common form of abuse occurring in nursing homes. A staff referral to the facility social worker is a common intervention approach used to manage this behaviour, yet studies are nonexistent regarding how nursing home social workers respond to such referrals or how their efforts link with interprofessional team members. The purpose of this study was to identify assessment and intervention strategies social workers use to address RRA and how they collaborate with nursing colleagues in the RRA management process. Semi-structured interviews were completed with social services and nursing personnel (n = 90) from 10 nursing homes. Interview questions focused on the participants' role in addressing RRA and associated interprofessional partnerships. Thematic analysis of three a priori categories, social work assessment, intervention, and collaboration, identified that (1) assessment approaches include gathering information, applying knowledge of causal factors, and determining psychosocial impact; (2) intervention approaches comprise determining appropriate interventions, applying preventive approaches, and delivering psychosocial interventions; and (3) collaborative strategies include mutual assessment consultations, joint intervention planning, tandem intervention delivery, and maximising professional strengths. Findings illustrate social workers' extensive involvement in responding to RRA incidents and the importance of social worker-nurse collaboration, especially with direct care workers. (Publisher abstract)
Medicare constrains social workers' and nurses' home care for clients with Alzheimer's disease
- Author:
- CABIN William D.
- Journal article citation:
- Social Work: A journal of the National Association of Social Workers (NASW), 60(1), 2015, pp.75-83.
- Publisher:
- Oxford University Press
The Medicare home health prospective payment system (PPS) has existed for 13 years, yielding significant profits to providers. However, studies indicate many unresolved questions about whether PPS improves patient quality of care, is cost-effective, and reduces patient levels of unmet need. In addition, PPS has undermined the provision of social work home health services. The article presents the views of 29 home health care nurses regarding the impact of PPS on their care decisions for people with Alzheimer's disease and their caregivers. The nurses identify Alzheimer's disease symptom management and psychosocial needs as phantoms, omnipresent below the surface but not attended to by home care clinicians. The interviews support the greater involvement of social workers to more adequately address the psychosocial needs of Medicare home health patients. The article contends that the current failure to simultaneously address the cost, needs, and quality-of-life issues of people with Alzheimer's disease who are cared for at home is analogous to the end-of-life care situation before passage of the Medicare Hospice Benefit. A collaborative demonstration project - social work and nursing - is proposed to determine how PPS might better address quality of life and costs of home-based people with Alzheimer's disease and their caregivers. (Publisher abstract)