Clinical prioritizations and contextual constraints in nursing homes – a qualitative study

Scand J Caring Sci; 2010; 24; 533–540
Clinical prioritizations and contextual constraints in nursing homes ‐ a qualitative study Aim: The aim of the study was to describe nurses’ and physicians’ experiences of prioritization factors in nursing homes. Background: What are the experiences of health care personnel when prioritizing treatment and care for elderly residents in nursing homes? Little research has been done in this area, yet with the growing elderly population and limited health care budgets there can be little doubt about its relevance. Method: The study was conducted through semi‐structured interviews with 13 physicians and nurses in six nursing homes. The interviews were analysed by manifest content analysis based on first‐ and second‐level categories describing relevant factors. The categories were developed after preliminary readings of the texts. Results: This study revealed that there was a complex set of contextual constraints which influenced the care provided. There were three main findings: (i) some overall challenges related to providing good care to nursing home residents; these in turn influenced (ii) prioritizing dilemmas and (iii) factors influencing prioritization decisions. Discussion: Contextual constraints and higher level prioritizations seem to play a key role in clinical prioritizations in nursing homes. The combination of implicit rationing and the factors described as most predominant in the clinical prioritizations in nursing homes may result in inadequate and unjust health care services for some of the nursing home residents. In particular, those patients who do not speak up or do have comprehensive needs are at risk of being neglected.     

护理干预对老年痴呆患者日常生活自理能力的影响

目的 探讨积极的护理干预对老年痴呆患者日常生活自理能力的影响.方法 对33例老年痴呆患者采取日常生活的护理、自我照顾能力的训练、认知训练及安全管理、心理护理.6个月后采用χ2检验评估护理干预效果.结果 33例老年痴呆患者日常生活能力较护理干预实施前有显著改变.结论 积极的护理干预对老年痴呆患者日常生活自理能力有显著改善作用.     

护理干预对老年痴呆患者日常生活自理能力的影响

目的探讨积极的护理干预对老年痴呆患者日常生活自理能力的影响。方法对33例老年痴呆患者采取日常生活的护理、自我照顾能力的训练、认知训练及安全管理、心理护理。6个月后采用Χ^2检验评估护理干预效果。结果33例老年痴呆患者日常生活能力较护理干预实施前有显著改变。结论积极的护理干预对老年痴呆患者日常生活自理能力有显著改善作用。     

A model for using the VIPS framework for person-centred care for persons with dementia in nursing homes: a qualitative evaluative study

røsvik j., kirkevold m., engedal k., brooker d. & kirkevold ø . (2011) A model for using the VIPS framework for person‐centred care for persons with dementia in nursing homes: a qualitative evaluative study. International Journal of Older People Nursing 6 , 227–236 doi: 10.1111/j.1748‐3743.2011.00290.x Background. The ‘VIPS’ framework sums up the elements in Kitwood’s philosophy of person‐centred care (PCC) for persons with dementia as values, individualised approach, the perspective of the person living with dementia and social environment. There are six indicators for each element. Aim. To conduct an initial evaluation of a model aimed at facilitating the application of the VIPS framework. Design. Qualitative evaluative study. Methods. A model was trialled in a 9‐week pilot study in two nursing homes and evaluated in four focus groups using qualitative content analysis. Results. Five themes emerged: (1) Legitimacy of the model was secured when central roles were held by nurses representing the majority of the staff; (2) The model facilitated the staff’s use of their knowledge of PCC; (3) Support to the persons holding the internal facilitating roles in the model was needed; (4) The authority of the leading registered nurse in the ward was crucial to support the legitimacy of the model and (5) Form of organisation seemed to be of importance in how the model was experienced. Conclusion. The model worked best in wards organised with a leading registered nurse who could support an auxiliary nurse holding the facilitating function.     

Sexual behaviour of institutionalised residents with dementia – a qualitative study

Aims. The purpose of this study was to explore the characteristics of and the contexts related to sexual behaviours among institutionalised residents with dementia. Background. Institutionalised residents with dementia are frequently unable to manage their sexual needs properly resulting in caregivers having a more conservative and passive attitude toward residents with dementia than those with higher cognitive status. Design. A grounded theory study. Methods. The participants in this study were institutionalised older people with dementia and their formal caregivers. Data were collected using in‐depth, face‐to‐face interviews of 12 formal caregivers and by observing 12 institutional older people with dementia for three days. All observations were recorded and interview data were tape recorded and transcribed verbatim. Results. The results indicated that the predisposing factors included having opportunity, presence of a cooperative target and personal space without privacy. The sexual expressions of institutionalised older people with dementia included: physically intimate touch, sexual expression without touching others and sexual talk. Responses by individuals to sexual behaviour from another resident included neutral response, negative response and positive response. Conclusion. To provide better care, it is recommended that an inventory regarding sexual expression for clinical and research usage be constructed from the research results. Relevance to clinical practice. The findings of this study can provide the basis to develop on‐the‐job training programmes for sexual education of residents with dementia in institutions. Regular seminars on sexual care for the residents with dementia might be beneficial for managing sexual issues among residents and to decrease caregivers’ burden.     

Prevalence of dementia syndromes in persons living in homes for the elderly and in nursing homes in southern Sweden

The prevalence of dementia syndromes was studied in individuals aged 70 and over living in institutions integrated into primary care within a limited area in southern Sweden. The populations studied were all persons living in homes for the elderly in the city of Lund (n = 471) and all persons living in nursing homes in the Lund health service district (n = 384). In the former, 30% were moderately demented and 6% severely demented. The corresponding figures for patients in nursing homes were 33% and 36%. Among the various psychiatric symptoms which are common in dementia, confusion was most prevalent. In the homes for the elderly, 32% of the subjects were moderately or severely confused, while the corresponding figure in the nursing homes was 62%. The consumption of sedatives and hypnotics was greater in homes for the elderly than in nursing homes. The presence of moderate or severe dementia was associated with greater use of sedatives and hypnotics in nursing homes. Prevalence studies of this type might be used to study organizational changes in the care of the elderly within a health service district.     

Quality of care in Norwegian nursing homes – deficiencies and their correlates

Background: Quality of care (QoC) in nursing homes has many aspects and various proxies have been used to evaluate it. In only a few studies several proxies for quality have been combined into a common variable. Objective: To explore which variables are associated with low QoC in few and several areas respectively. Methods: A structured interview of the patients’ primary carer of 1926 patients in 251 wards was carried out. Questions about different kinds of quality deficiencies during the last 7 days were recorded. Eight main types of quality deficiencies were used to construct a linear outcome variable called number of quality deficiencies (NQD) with values from zero to eight. Patient characteristics such as sex, age, function in activities of daily living (ADL), behaviour and mental capacity were recorded. Type of ward, staffing, size of ward, type of institution and formal education of the staff, were also recorded. Results: More than half of the patients in Norwegian nursing homes experienced two or more quality deficiencies in the care during 1 week. The variables that were strongest associated with NQD, were present of aggressive behaviour, low level of functioning in ADL and moderate‐to‐severe dementia. Staffing level and type of ward had also a significant influence on the model.