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To what extent is the work environment of staff related to person-centred care? a cross-sectional study of residential aged care
- Authors:
- SJOGREN Karin, et al
- Journal article citation:
- Journal of Clinical Nursing, 24(9-10), 2015, pp.1310-1319.
- Publisher:
- John Wiley and Sons
Aims and objectives: To explore the relationship between staff characteristics, perceived work environment and person-centred care in residential aged care units. Background: Person-centred care is often described as the model of choice in residential aged care and in the care of persons with dementia. Few empirical studies have reported on the relationship between how staff experience different aspects of their work and person-centred care. Design: The study had a cross-sectional quantitative design. Methods: Staff in 151 residential aged care units in Sweden (n = 1169) completed surveys which included questions about staff characteristics, valid and reliable measures of person-centred care, satisfaction with work and care, job strain, stress of conscience and psychosocial unit climate. Statistical analyses of correlations, group differences and multiple linear regression analysis estimated with generalised estimating equation were conducted. Results: Higher levels of staff satisfaction, lower levels of job strain, lower levels of stress of conscience, higher levels of a supportive psychosocial unit climate and a higher proportion of staff with continuing education in dementia care were associated with higher levels of person-centred care. Job strain and a supportive psychosocial climate, explained most of the variation in person-centred care. Conclusions: This study shows that the work environment as perceived by staff is associated with the extent to which staff perceive the care as being person-centred in residential aged care. These empirical findings support the theoretical postulation that the work environment is an important aspect of person-centred care. Relevance to clinical practice: Promoting a positive and supportive psychosocial climate and a work environment where staff experience balance between demands and control in their work, to enable person-centred care practice, seems to be important implications for managers and leaders in residential aged care. (Publisher abstract)
Effects of home-based stress management training on primary caregivers of elderly people with dementia in South Korea
- Authors:
- LEE Yoon-Ro, SUNG Kyu-taik, KIM Yang-E
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 11(2), March 2012, pp.171-179.
- Publisher:
- Sage
Concern about dementia among families caring for frail elderly is increasing in South Korea but clinical services for caregivers are said to be sparse. This study evaluated home-based stress management training aimed at reducing the physical and psychological vulnerability commonly associated with caring for a dementia sufferer. It used the multiple-method stress management programme developed by Whitney and Rose. The main difference between this and previous studies is that the intervention was implemented through individual counselling and took place in the client’s own home. The advantages are thought to be the ability to focus for longer on individual concerns and the counsellor being more involved with the whole family and able to more accurately gain insight into and analyse the situation. It also acknowledges Korean caregivers’ strong tendency to provide care for elderly people with dementia within the family setting. A total of 30 primary caregivers were recruited to the training programme (mean age 51 years, 10 female, 5 male in the intervention group). The programme included: relaxation training, cognitive restructuring, modelling sequence, and systematic problem solving. The stress level for the experimental group was significantly reduced, family relationships improved and satisfaction with life was greater. The practice implications and cultural relevance of this type of training are discussed.
Caregiver objective burden and assessments of patient-centered, family-focused care for frail elderly veterans
- Authors:
- ROSE Julia Hannum, et al
- Journal article citation:
- Gerontologist, 47(1), February 2007, pp.21-33.
- Publisher:
- Oxford University Press
There is a growing consensus that quality of care for frail elders should include family and be evaluated in terms of patient-centered, family-focused care (PCFFC). Family caregivers are in a unique and sometimes sole position to evaluate such care. In the context of caring for physically frail elders, this study examined the extent to which objective burden was associated with caregiver perceptions of PCFFC and the extent to which it mediated the influence of other variables on perceptions of PCFFC. In a study of frail elderly veterans receiving care in U.S. Department of Veterans Affairs ambulatory primary care clinics, informal caregivers assessed quality of care with 13 questions. Factor analysis of these items revealed an eight-item scale that specifically assessed PCFFC ( =.90). Regression analysis identified variables associated with caregiver (N = 210) assessments of PCFFC and the potential mediating effect of objective burden. Caregiver assessments of PCFFC were positively associated with care recipient instrumental activity of daily living limitations and perspectives on the quality of their own patient care. Greater objective burden was negatively associated with caregiver assessments of PCFFC and mediated (i.e., reduced) the relationship between care recipient perceptions of the quality of their own patient care and caregiver assessments of PCFFC (R2 =.06). These findings support recommendations for conducting caregiver assessments as part of routine care and highlight the importance of measuring objective burden and expectations for PCFFC in assisting physically frail elders. Primary care providers will require additional training in order to effectively implement and translate such caregiver assessments into clinical practice improvement.
The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial
- Authors:
- FINNEMA Evelyn, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(4), April 2005, pp.330-343.
- Publisher:
- Wiley
The aim was to examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants. A multi-site randomized clinical trial with matched groups was performed, and measurements taken at baseline and after seven months. Sixteen psychogeriatric wards in fourteen nursing homes in the Netherlands were examined. One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer (DAT) type, mixed DAT and vascular dementia, and dementia syndrome (NAO) and 99 nursing assistants participated. The following measurements were used. Demented elderly: Behaviour and mood related to adaptation to the illness and the institutionalization. Nursing assistants: General health as measured by feelings of stress, stress reactions, feeling of competence and illness. Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks: maintaining an emotional balance (less anxiety) and preserving a positive self-image (less dissatisfaction). In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training. Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia. For the severely demented elderly we did not find this surplus value. This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes. With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them.
Doing it well: seven steps to dignity and compassion in caring for older people. Guidance for those who care
- Author:
- WARING Amanda
- Publisher:
- Beth Johnson Foundation
- Publication year:
- 2018
- Pagination:
- 52
- Place of publication:
- Stoke-on-Trent
This resource explores how older people living in care homes can be better looked after, taking account of their individuality, what they think and want, and their feelings. It focuses on helping those who are directly responsible for the care of older people to do their job as well as possible. Emphasis is on a person-centred approach that highlights dignity, compassion and respect. The resource covers seven steps that can help improve the quality of care for older people. Each step introduces topics that can be expanded upon within your own care setting. The steps cover: dignity awareness; recognising ageism; understanding dementia; addressing stress and burnout; growing a meaningful activity and relationships; and spiritual and emotional care. For each of the seven steps, the guide includes discussion points, issues to consider, and exercises. The guidance can best be used as part of a blended approach to learning in the workplace, supported by coaching, supervision and mentoring. It can be used by groups of staff or individuals who can take themselves through some of the exercises as an aid to learning. It will be relevant for health care and social services professionals, managers, nursing staff and care workers, whether working in care homes and hospices or in private domiciliary care. (Edited publisher abstract)
A retrospective study of a multicomponent rehabilitation programme for community-dwelling persons with dementia and their caregivers
- Authors:
- CORNELIS Elise, et al
- Journal article citation:
- British Journal of Occupational Therapy, 81(1), 2018, pp.5-14.
- Publisher:
- Sage
Introduction: This study determined whether the multicomponent rehabilitation programme of a memory clinic had positive outcomes on ameliorating everyday functioning, quality of life, mood and behavioural disturbances of persons with dementia and reducing distress and burden of caregivers. Method: A retrospective pre-test–post-test study without control group was conducted on the first cohort of persons with dementia (n = 30) and their caregivers (n = 30), who participated in a programme lasting for a maximum of 1 year with 25 1-hour counselling sessions. The assessment contained an evaluation of everyday functioning in basic, instrumental and advanced activities of daily living, cognition, mood, emotional and behavioural disturbances, quality of life and caregiver burden. Results: Eight participants dropped out prematurely. For persons with dementia (n = 22), participating in the programme did not improve everyday functioning and cognition but ameliorated quality of life significantly (Z = –2.7, p = 0.006, 95% CI (.003–.005)) and stabilised mood, emotional and behavioural disturbances for 60% or more of them. For caregivers (n = 22), the mild to moderate burden of care remained stable or got better for 63.6% of the caregivers. Conclusion: This programme appears to be promising and valuable, and might reduce institutionalisation rates. Future explorations are recommended to research how participants evolve and to investigate which participants responded in a positive way. (Edited publisher abstract)
Fragile foundations: exploring the mental health of the social care workforce and the people they support
- Author:
- GATHERUM Becca
- Publisher:
- Scottish Care
- Publication year:
- 2017
- Pagination:
- 36
- Place of publication:
- Ayr
This report looks the mental health support for older people living in care homes and accessing care at home and housing support services. It covers individuals who have lived with mental health challenges throughout their lives, as well older people who are experiencing mental health issues for the first time. It is based on focus group research with 43 care staff working across the independent social care sector in Scotland. The focus groups discussed care staff’s personal and professional experiences of mental health and the ways in which mental health issues impact upon them in their care roles and their ability to support individuals. The report examines the factors which comprise and impact upon care workers’ mental health and wellbeing. It also examines the pressures and expectations that are placed on them in carrying out their roles, often acting as a link between many individuals and services. The report shows that staff are increasingly losing their capacity and resilience to cope with these pressures, which are preventing staff from delivering compassionate care. The report provides recommendations to promote a person-centred, rights-based system of care in Scotland. These include an increased recognition of older people’s mental health issues as a human rights issue, increased recognition of the contribution of the social care workforce to supporting older people's mental health; and extending mental health and well-being support to the social care workforce. (Edited publisher abstract)
The influence of individual and organizational factors on person-centred dementia care
- Authors:
- HUNTER Paulette V., et al
- Journal article citation:
- Aging and Mental Health, 20(7), 2016, pp.700-708.
- Publisher:
- Taylor and Francis
Objectives: Although some individual and organisational contributors to person-centred care or quality of care have been studied, they have rarely been examined together. The authors' goal was to investigate the association of personal and organisational–environmental characteristics with self-reported person-centred behaviours in long-term residential care settings. Method: 109 long-term care staff from two Canadian long-term care homes were asked to complete scales assessing self-reported person-centred care, organisational support for person-centred care, beliefs about personhood in dementia, and burnout. Independent variables included four employee background characteristics (age, gender, occupation, and years of education), beliefs about personhood in dementia, burnout, and three aspects of organisational support for person-centred care (the physical environment of residents, collaboration on care, and support from management). Dependent variables included five aspects of person-centred care: autonomy, personhood, knowing the person, comfort care, and support for relationships .The authors used multiple linear regression analysis and changes in R2 to test variable associations. Results: Including organisational variables in regression models resulted in statistically significant (p < .05) changes in R2 for each of the five dependent variables. Including personal variables resulted in statistically significant changes in R2 for some dependent variables, but not others. In particular, including employee background characteristics resulted in a statistically significant change in R2 for comfort care, and including beliefs about personhood and burnout resulted in statistically significant changes in R2 for personhood but not for other dependent variables. Conclusion: Organisational characteristics are associated with several aspects of person-centred dementia care. Individual characteristics, including gender, beliefs about personhood, and burnout, appear to be more important to some aspects of person-centred dementia care (e.g., respect for personhood and comfort care) than others. (Edited publisher abstract)
Care-giving in dementia: research and applications: volume 3
- Editors:
- JONES Gemma M.M., MIESEN Bere M.L., (eds.)
- Publisher:
- Brunner-Routledge
- Publication year:
- 2004
- Pagination:
- 437p.
- Place of publication:
- Hove
Key themes in Volume 3 include: personal construct psychology and person-centred care; living in lifestyle groups in nursing homes; music therapy for people with dementia; support programmes for caregivers of people with dementia; coping in early dementia; stress and burden on care-givers; the Alzheimer Café concept and new support groups for people with dementia; ethical issues in the care of elderly people with dementia in nursing homes.