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Perspectives on the delirium experience and its burden: common themes among older patients, their family caregivers, and nurses
- Authors:
- SCHMITT Eva M., et al
- Journal article citation:
- Gerontologist, 59(2), 2019, p.327–337.
- Publisher:
- Oxford University Press
Background and Objectives: While there are qualitative studies examining the delirium-related experiences of patients, family caregivers, and nurses separately, little is known about common aspects of delirium burden among all three groups. This study describes common delirium burdens from the perspectives of patients, family caregivers, and nurses. Research Design and Methods: Semi-structured qualitative interviews about delirium burden were conducted with 18 patients who had recently experienced a delirium episode, with 16 family caregivers, and with 15 nurses who routinely cared for patients with delirium. This study recruited participants from a large, urban teaching hospital in Boston, Massachusetts. Interviews were recorded and transcribed. This study used interpretive description as the approach to data analysis. Results: This study identified three common burden themes of the delirium experience: Symptom Burden (Disorientation, Hallucinations/Delusions, Impaired Communication, Memory Problems, Personality Changes, Sleep Disturbances); Emotional Burden (Anger/Frustration, Emotional Distress, Fear, Guilt, Helplessness); and Situational Burden (Loss of Control, Lack of Attention, Lack of Knowledge, Lack of Resources, Safety Concerns, Unpredictability, Unpreparedness). These burdens arise from different sources among patients, family caregivers, and nurses, with markedly differing perspectives on the burden experience. Discussion and Implications: The findings advance the understanding of common burdens of the delirium experience for all groups and offer structure for instrument development and distinct interventions to address the burden of delirium as an individual or group experience. This work reinforces that no one group experiences delirium in isolation. Delirium is a shared experience that will respond best to systemwide approaches to reduce associated burden.
Organizational characteristics associated with staff turnover in nursing homes
- Authors:
- CASTLE Nicholas D., ENGBERG John
- Journal article citation:
- Gerontologist, 46(1), February 2006, pp.62-73.
- Publisher:
- Oxford University Press
The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey). The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of nursing staff. Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between nursing homes, based on their organizational characteristics.
Factors associated with and impact of burnout in nursing and residential home care workers for the elderly
- Authors:
- HARRAD R., SULLA F.
- Journal article citation:
- Acta BioMedica, 89(7S), 2018, pp.60-69.
- Publisher:
- Mattioli 1885
- Place of publication:
- Italy
Background and aim of the work: Numbers of elderly people worldwide continue to grow. Increasingly these individuals require nursing and residential care to meet their needs. Nursing is an occupation associated with burnout amongst its workforce, associated with increases of emotional exhaustion, depersonalisation and decreases in personal accomplishment. This review of literature provides a more detailed picture of the associations and predictors of burnout within this setting, and also considers the implications this holds for patient care, before providing recommendations for managers of such settings. Methods: Literature searches were conducted across a range of academic databases with a series of relevant keywords. Results: Examination of search results suggested several factors relating to staff burnout including occupational aspects, types of setting, staff perceptions, coping strategies, education and training and the impact of burnout on care delivery. Conclusions: Studies from across the globe suggest that burnout is prevalent amongst staff working in nursing and residential homes caring for elderly people, with implications for the patients, staff and homecare providers. Factors associated with burnout appear to include perceptions of job stress and occupational aspects, as well as the types of coping mechanisms staff employ. Managing grief associated with death of patients at work, as well as staff perceptions of both clients and their illnesses also appear related to burnout as well as the specific type of healthcare setting. (Edited publisher abstract)
Intentions to quit work among care staff working in the aged care sector
- Authors:
- KARANTZAS Gery C., et al
- Journal article citation:
- Gerontologist, 52(4), August 2012, pp.506-516.
- Publisher:
- Oxford University Press
The stability of staff in facilities providing care for the elderly is generally poor and this high turnover has implications for the quality of care provided and the financial costs to care agencies. The authors applied a model of intention to quit to identify the contextual and personal factors that shape aged care staff’s intention to quit. A sample of 208 aged care staff, including nurses, personal care assistants, allied health professionals, and managers recruited from across care services in Melbourne completed a self-report questionnaire. The data gathered assessed intention to quit, organisational commitment, job satisfaction, self-esteem, stressors, stress, and supervisor support. The findings largely supported the model. Specifically, job commitment, job satisfaction, and work stressors directly influenced intentions to quit, although work stressors and supervisor support demonstrated numerous indirect associations on quitting intentions. The findings suggest that aged care service providers can modify aged care workers’ intentions to quit by reducing job stressors and increasing supervisor support.
Effects of guided care on family caregivers
- Authors:
- WOLFF Jennifer L., et al
- Journal article citation:
- Gerontologist, 50(4), August 2010, pp.459-470.
- Publisher:
- Oxford University Press
Guided Care (GC) for multi-morbid older people is provided by a registered nurse who works with the patients’ primary care physician (PCP). This study determined whether GC improves patients’ primary caregivers’ depressive symptoms, strain, productivity, and perceptions of the quality of care recipients’ chronic illness care. A randomised controlled trial of GC was conducted within 14 PCP teams. Participants included 196 primary caregivers who completed baseline and 18-month surveys and whose care recipients remained alive and enrolled in the GC study for 18 months. Caregiver outcomes included the following: depressive symptoms; strain; the quality of care recipients’ chronic illness care; and personal productivity. Findings revealed that between-group differences in depression, strain, work productivity, and regular activity productivity were not statistically significant after 18 months, but GC caregivers reported the overall quality of their recipients’ chronic illness care to be significantly higher. Quality was significantly higher in 4 of 5 Patient Assessment of Chronic Illness Care subscales, reflecting goal setting, coordination of care, decision support, and patient activation. The authors concluded that GC improved the quality of chronic illness care received by multi-morbid care recipients but did not improve caregivers’ depressive symptoms, affect, or productivity.
A comparative study of stress and burnout among staff caregivers in nursing homes and acute geriatric wards
- Authors:
- COCCO Enmio, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(1), January 2003, pp.78-85.
- Publisher:
- Wiley
A cross-sectional survey was conducted in three nursing homes (total of 522 beds, 270 caregivers) and nine geriatric sections of general hospitals (total of 371 beds, 280 caregivers). Staff caregivers were asked to answer a four-part questionnaire made up of socio-demographic data, the General Health Questionnaire (GHQ-12), the Maslach Burnout Inventory (MBI) and the Stressful Events Questionnaire (SEQ). Results appear to show that levels of stress and burnout among staff caregivers are moderate in acute geriatric wards, but significantly higher than in nursing homes.
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)
The effects of relocation on elderly people with dementia and their nursing staff
- Authors:
- McAUSLANE Louise, SPERLINGER David
- Journal article citation:
- International Journal of Geriatric Psychiatry, 9(12), December 1994, pp.981-984.
- Publisher:
- Wiley
The effects of relocating 19 patients with dementia and their nursing staff from an old long-stay hospital ward to a community nursing home were evaluated. Compared with patients who were remaining in hospital, those relocated patients who were still alive at the time of follow-up showed no evidence of changes in behavioural dependency or the number of problem behaviours. Nursing staff who were being moved, compared to their colleagues, may have helped to minimize the impact of the move on the patients, but this study draws attention to the importance of providing support for staff undergoing such changes.
The unconscious at work: individual and organizational stress in the human services
- Editors:
- OBHOLZER Anton, ROBERTS Vega Zagier
- Publisher:
- Routledge
- Publication year:
- 1994
- Pagination:
- 242p.,bibliog.
- Place of publication:
- London
Aimed at people managing and working in the human services, including consultants, trainers and students of organisational behaviour. Offers employees new ways of looking at their own experiences of stress at work, and of increasing understanding of the processes which can undermine effectiveness and morale. Part 1 contains the conceptual framework and examines the unconscious aspects of organisational life from psychoanalytical and from open systems theory perspectives. Part 2 looks at the stress involved in working with people and includes sections on working in a special baby care unit, with damaged children, disabled children, older people, and with dying people. Parts 3 and 4 deal with organisations and their effects on the people who work in them.