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Calling the question of "possible dying" among nursing home residents: triggers, barriers, and facilitators
- Author:
- BERN-KLUG Mercedes
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 2(3), 2006, pp.61-85.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as "dying" can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of "possible dying" by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; non-compliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Let people loose
- Author:
- LLOYD Mark
- Journal article citation:
- Community Care, 26.10.06, 2006, pp.32-33.
- Publisher:
- Reed Business Information
This article provides a comparison of older care in Finland and the UK, based on a study visit by staff from Kent Community Housing Trust to the combined health and social services department in the Espoo region. The article concentrates on lessons to be learned for older care – particularly residential – in the UK. It focuses on the benefits of nursing and social care combined services, contrasting Finland’s guiding principle that “regulation stifles the soul” in older care, with the UK approach of overregulation.
Assessing and comparing physical environments for nursing home residents: using new tools for greater research specificity
- Authors:
- CUTLER Lois D., et al
- Journal article citation:
- Gerontologist, 46(1), February 2006, pp.42-51.
- Publisher:
- Oxford University Press
The authors developed and tested theoretically derived procedures to observe physical environments experienced by nursing home residents at three nested levels: their rooms, the nursing unit, and the overall facility. Illustrating with selected descriptive results, in this article we discuss the development of the approach. On the basis of published literature, existing instruments, and expert opinion about environmental elements that might affect quality of life, the authors developed separate observational checklists for the room and bath environment, unit environment, and facility environment. The authors trained 40 interviewers without specialized design experience to high interrater reliability with the room-level assessment. The authors used the three checklists to assess 1,988 resident room and bath environments, 131 nursing units, and 40 facilities in five states. From the data elements, they developed quantitative indices to describe the facilities according to environmentally relevant constructs such as function-enhancing features, life-enriching features, resident environmental controls, and personalization. The authors reliably gathered data on a large number of environmental items at three environmental levels. Environments varied within and across facilities, and the authors noted many environmental deficits potentially relevant to resident quality of life. Implications: This research permits resident-specific data collection on physical environments and resident-level research using hierarchical analysis to examine the effects of specific environmental constellations.
A reality check on virtual communications in aged care: pragmatics or power?
- Authors:
- KING Christopher, WORKMAN Barbara
- Journal article citation:
- Ageing International, 31(4), 2006, pp.253-262.
- Publisher:
- Springer
- Place of publication:
- New York
This article reports on the use of videoconferencing technologies to deliver specialist pain management services to frail older nursing home residents in Australia. Observational and client satisfaction data indicated that participants readily adapted to using the technology, and expressed preference for virtual consultations over-face-to-face consultations. These data suggest a need to revisit the assumptions about the use of technologies in aged care; how the technologies should be used, and who should be making these decisions, the belief that technology cannot and should not replace face-to-face health consultations, and the role of technology in doctor-patient interactions. The theoretical and practical implications for aged care are explored, including the design of IT systems for aged care and policy principles that encourage the view of older people as passive recipients of health services.
Role of the social worker in old versus new culture in nursing homes
- Author:
- MEYERS Sandy
- Journal article citation:
- Social Work: A journal of the National Association of Social Workers (NASW), 51(3), July 2006, pp.273-277.
- Publisher:
- Oxford University Press
The author argues that social workers play a crucial role in the lives of people living in nursing homes. It is discussed how many social workers are trying to change the prevailing nursing home culture from one of delivering services to sustain life to one of infusing life with the joy of living it. The article discusses how social workers should actively listen and help people grow based on their individual needs and interests, and not to those of the nursing home.
Moving from a victim blaming to an appreciative inquiry: exploring quality of life in care homes
- Authors:
- MEYER Julienne, et al
- Journal article citation:
- Quality in Ageing, 7(4), December 2006, pp.27-36.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
This article highlights the need for researchers to work across disciplinary boundaries in order to capture the complexity that care practitioners have to engage with everyday in care home settings. Drawing on findings from a literature review on the complexity of loss in continuing care institutions for older people, the case is made for less victim blaming and more appreciative approaches to research. The way this thinking informed the development of a further literature review on quality of life in care homes is discussed. Findings from this second study are shared by illustrating key messages with quotes from older residents, relatives and staff living, visiting and working in care homes. These best practice messages focus on: transition into a care home; working to help residents maintain their identity; creating community within care homes; shared decision-making; health and health services; end-of-life care; keeping the workforce fit for purpose, and promoting positive culture. The importance of collaborative working in both research and practice is discussed.
Working towards a 'new culture of activity provision in care homes - helping residents to 'live life'
- Authors:
- KNOCKER Sally, SILVER Sylvie
- Journal article citation:
- Journal of Care Services Management, 1(1), September 2006, pp.34-42.
- Publisher:
- Taylor and Francis
This article explores a positive way of looking at activity provision in care home settings, focusing on individual planning and a whole-day approach rather than traditional structured group activities and entertainment. Practical examples and direct quotes from residents interviewed in care homes are offered by the authors who both have extensive experience of delivering activities in innovative ways in care homes. It is concluded that while shifts in attitudes and approaches are needed, it can and should be an achievable goal for all older people in care settings to live life whatever their frailty or level of dementia.
Quality of life, quality of care and resident satisfaction in care homes
- Authors:
- BOLDY Duncan, DAVIES Sue, GRENADE Linda
- Journal article citation:
- Journal of Care Services Management, 1(1), September 2006, pp.66-80.
- Publisher:
- Taylor and Francis
Recent years have seen a growing interest in the study and measurement of both quality of life (QOL) and quality of care (QOC). 'Satisfaction' is often used as a primary indicator of QOL and/or QOC, although the way in which it is conceptualised and measured varies according to factors such as context and study population. In this article a number of issues relating to the assessment and quality of life and quality of care in care homes for older people are discussed, with a particular focus on resident satisfaction as a key indicator. The results of an Australian study of resident satisfaction in care homes and its relevance to the UK context are then discussed.
Care homes: through the eyes of the consumer
- Author:
- P&G PROFESSIONAL
- Publisher:
- English Community Care Association
- Publication year:
- 2006
- Pagination:
- 5p.
- Place of publication:
- London
This report has been commissioned to provide the care sector with invaluable insights into long-term residential care. By evaluating the views of those directly affected by long-term care and listening to the personal experiences of the participants, the study aims to provide a platform for debate surrounding the issues currently present within the sector and to specifically identify the key factors that determine care home choice for residents, staff and relatives. The study was designed to achieve the following objectives: Provide insightful new information of value to care home operators and those working within the sector; Provide a voice for the residents, relatives and staff who make use of long-term care services for older people; Highlight to operators the factors that affect the selection of their services.
Assisting cognitively impaired nursing home residents with bathing: effects of two bathing interventions on caregiving
- Authors:
- HOEFFER Beverly, et al
- Journal article citation:
- Gerontologist, 46(4), August 2006, pp.524-532.
- Publisher:
- Oxford University Press
When cognitively impaired nursing home residents exhibit agitated and aggressive behaviours during bathing, nursing home caregivers are in a unique position to improve residents' experience. This article addresses whether certified nursing assistants (CNAs) who received training in a person-centred approach with showering and with the towel bath showed improved caregiving behaviours (gentleness and verbal support) and experienced greater preparedness (confidence and ease) and less distress (hassles) when assisting residents with bathing. The research used a crossover design and randomized 15 nursing homes into two treatment groups and a control group of 5 facilities each. In one treatment group, CNAs received person-centred training, first with showering for 6 weeks (Time 1) and then with the towel bath for 6 weeks (Time 2). The treatment order was reversed in the other treatment group. Control group CNAs used usual showering procedures without person-centred training. Observational and self-report data was collected at baseline and at the end of Time 1 and Time 2 on five caregiving outcomes. Data was analysed from 37 CNAs assisting 69 residents by using 3 x 2 repeated measures analyses of variance to compare the three groups on change from baseline. Compared with the control group, treatment groups significantly improved in the use of gentleness and verbal support and in the perception of ease. It is concluded that a person-centred approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents.