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Tendo-Bugondo C, Lieke O, Kasongo P, Diur B, Canagasabey DS, Thior I, Milenge PK, Kiluba JC. Facilitating person-centred care: integrating an electronic client feedback tool into continuous quality improvement processes to deliver client-responsive HIV services in the Democratic Republic of Congo. J Int AIDS Soc 2023; 26 Suppl 1:e26112. [PMID: 37408447 DOI: 10.1002/jia2.26112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Engaging communities in the design, implementation and monitoring of health services is critical for delivering high-quality, person-centred services that keep people living with HIV engaged in care. The USAID-funded Integrated HIV/AIDS Project in Haut-Katanga (IHAP-HK) integrated an electronic client feedback tool into continuous quality improvement (CQI) processes. We aimed to demonstrate this system's impact on identifying and improving critical quality-of-care gaps. METHODS Through stakeholder and empathy mapping, IHAP-HK co-designed a service quality monitoring system-comprising anonymous exit interviews and ongoing monitoring through CQI cycles-with people living with HIV, facility-based providers and other community stakeholders. IHAP-HK trained 30 peer educators to administer oral, 10- to 15-minute exit interviews with people living with HIV following clinic appointments, and record responses via the KoboToolbox application. IHAP-HK shared client feedback with facility CQI teams and peer educators; identified quality-of-care gaps; discussed remediation steps for inclusion in facility-level improvement plans; and monitored implementation of identified actions. IHAP-HK tested this system at eight high-volume facilities in Haut-Katanga province from May 2021 through September 2022. RESULTS Findings from 4917 interviews highlighted wait time, stigma, service confidentiality and viral load (VL) turnaround time as key issues. Solutions implemented included: (1) using peer educators to conduct preparatory tasks (pre-packaging and distributing refills; pulling client files) or escort clients to consultation rooms; (2) limiting personnel in consultation rooms during client appointments; (3) improving facility access cards; and (4) informing clients of VL results via telephone or home visits. Due to these actions, between initial (May 2021) and final interviews (September 2022), client satisfaction with wait times improved (76% to 100% reporting excellent or acceptable wait times); reported cases of stigma decreased (5% to 0%); service confidentiality improved (71% to 99%); and VL turnaround time decreased (45% to 2% informed of VL results 3 months after sample collection). CONCLUSIONS Our results showed the feasibility and effectiveness of using an electronic client feedback tool embedded in CQI processes to collect client perspectives to improve service quality and advance client-responsive care in the Democratic Republic of Congo. IHAP-HK recommends further testing and expansion of this system to advance person-centred health services.
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Affiliation(s)
| | - Oséé Lieke
- Independent Consultant, Lubumbashi, Democratic Republic of the Congo
| | | | - Baudouin Diur
- Union Congolaise des Organisations des Vivant avec VIH, Lubumbashi, Democratic Republic of the Congo
| | | | | | - Pascal K Milenge
- Independent Consultant, Lubumbashi, Democratic Republic of the Congo
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Van Graas R, Gobbens RJ. Learning and Developing Together for Improving the Quality of Care in a Nursing Home, Is Appreciative Inquiry the Key? Healthcare (Basel) 2023; 11:1840. [PMID: 37444674 PMCID: PMC10340465 DOI: 10.3390/healthcare11131840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
To investigate the impact of Appreciative Inquiry (AI) on learning and developing together for improving the quality of care in a nursing home, and to explore experiences following the four phases of the AI cycle, an AI was performed as part of participative action research. Interviews, group discussions, creative methods of storytelling, and reflections were used in the AI sessions. Staff members were interviewed to evaluate the AI process. All of the interviews were recorded and transcribed. Data were analyzed thematically using Maxqda and were discussed by the interviewers until consensus was reached. The sessions resulted in ten action proposals to improve healthcare. One proposal was worked out in agreements on cooperation. The evaluation revealed that the sessions have given a boost to the team spirit, and involvement at the location leading to more cooperation and communication during the shifts. The evaluation indicated that it is important to convert the action plans of the sessions into actions, which are then evaluated. AI was advised as a way of learning where everyone is involved, and mutual agreements are made. This study has shown that AI can be a valuable way to support learning and development to promote the quality of care in a nursing home.
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Affiliation(s)
- Regula Van Graas
- Faculty of Health, Sports, and Well-Being, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands;
| | - Robbert J. Gobbens
- Faculty of Health, Sports, and Well-Being, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Tranzo Academic Centre for Transformation in Care and Welfare, Faculty of Behavioural and Social Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands
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van Corven C, Bielderman A. Promoting empowerment for people living with dementia in nursing homes: Development and feasibility evaluation of an empowerment program. DEMENTIA 2022; 21:2517-2535. [PMID: 36063815 PMCID: PMC9583290 DOI: 10.1177/14713012221124985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This article describes the development and feasibility evaluation of an empowerment program for people living with dementia in nursing homes. METHODS Development and feasibility evaluation of the empowerment program was guided by the British Medical Research Council's (MRC) framework. In the developmental phase, we used intervention mapping to develop the theory- and evidence-based intervention. During the feasibility phase, two care teams utilised the program from September to December 2020. We evaluated the feasibility in terms of demand, acceptability, implementation, practicality, integration and limited efficacy. FINDINGS This study showed that, according to healthcare professionals, the program was feasible for promoting empowerment for people living with dementia in a nursing home. Healthcare professionals mentioned an increased awareness regarding the four themes of empowerment (sense of identity, usefulness, control and self-worth), and greater focus on the small things that matter to residents. Healthcare professionals experienced challenges in involving family caregivers. CONCLUSION An important step is to take into account the implementation prerequisites that follow from our findings, and to further investigate feasibility, as the use of the program and data collection was hindered by the COVID-19 pandemic. Subsequent research could investigate the effects of the empowerment program.
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Affiliation(s)
- Charlotte van Corven
- Department of Primary and Community Care, Radboud University Medical
Center, Radboud Institute for Health Sciences, Radboud Alzheimer
Center, Nijmegen, The Netherlands
| | - Annemiek Bielderman
- Department of Primary and Community Care, Radboud University Medical
Center, Radboud Institute for Health Sciences, Radboud Alzheimer
Center, Nijmegen, The Netherlands
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Rutten JER, Backhaus R, Tan F, Prins M, van der Roest H, Heijkants C, Hamers JPH, Verbeek H. Work environment and person-centred dementia care in nursing homes-A cross-sectional study. J Nurs Manag 2021; 29:2314-2322. [PMID: 34053141 PMCID: PMC8597031 DOI: 10.1111/jonm.13386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/05/2022]
Abstract
Aim This study aims to explore the relationship between work environment, job characteristics and person‐centred care for people with dementia in nursing homes. Background Person‐centred care approaches have become a dominant indicator for good quality of care in nursing homes. Little is known about the relationship between work environment, job characteristics and person‐centred care in nursing homes. Method(s) Cross‐sectional data from the LAD study were used. Direct care staff (n = 552) of nursing homes (n = 49) filled an online questionnaire about work environment characteristics and person‐centred care. To examine relationships, multilevel linear regression analyses were conducted. Results Associations were found between a higher transformational leadership style, less social support from a leader, a higher unity in philosophy of care, higher levels of work satisfaction, more development opportunities, better experienced teamwork and staff‐reported person‐centred care. Conclusion(s) In a complex nursing home environment, person‐centred care is influenced by organisational and work characteristics, shared values and interpersonal relationships. Implications for Nursing Leaders may consider facilitating collaboration and creating unity between care staff, clients and family members in order to provide person‐centred care. Therefore, a transformational leadership style, educational programmes and coaching for leaders are recommended.
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Affiliation(s)
- Johanna E R Rutten
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Ramona Backhaus
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Frans Tan
- Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Marleen Prins
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
| | - Henriette van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
| | - Ceciel Heijkants
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Ho P, Cheong RCY, Ong SP, Fusek C, Wee SL, Yap PLK. Person-Centred Care Transformation in a Nursing Home for Residents with Dementia. Dement Geriatr Cogn Dis Extra 2021; 11:1-9. [PMID: 33790933 PMCID: PMC7989831 DOI: 10.1159/000513069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
Background Conventional nursing homes in Singapore adopt an institutional and medical model of care with a focus on safety and risk management. As such, less regard is placed on upholding the dignity and autonomy of the resident, which compromises quality of care and the well-being of the resident. Today, person-centred care (PCC) has become synonymous with high-quality care that sustains the well-being and personhood of the care recipient. Objectives To describe the model of PCC adopted by a nursing home, Apex Harmony Lodge (AHL), with a logic model and evaluate outcomes on residents' well-being, care quality, and staff attrition by comparing pre-PCC initiation (2015) to post-implementation (2016). Methods Male residents in a 30-bed assisted living facility for persons with dementia in AHL were assessed using Dementia Care Mapping. Residents' well-being and staff attrition were measured before and after PCC implementation. Results There were statistically significant improvements in resident well-being (Δ = 0.44, p = 0.029), Positive Engagement Potential (Δ = 0.17, p = 0.002), and Occupational Diversity (Δ = 0.12, p = 0.014) in 2016. Withdrawal and Passive Engagement in the residents were reduced significantly as were Care Detractors. There was also a 55% reduction in staff attrition rates post-PCC. Conclusions Post-PCC implementation, the outcomes indicate a superior quality of care, enhanced resident well-being, and better staff retention. The AHL PCC model could serve as a roadmap for other nursing homes aspiring to raise the quality of care and influence long-term care standards and regulations for policy makers and legislators.
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Affiliation(s)
- Peiyan Ho
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Siew Pei Ong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Carol Fusek
- Alzheimer's Disease Association, Singapore, Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Philip Lin Kiat Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
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Autonomy Support of Nursing Home Residents With Dementia in Staff-Resident Interactions: Observations of Care. J Am Med Dir Assoc 2020; 21:1600-1608.e2. [PMID: 32553488 DOI: 10.1016/j.jamda.2020.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES People with dementia living in nursing homes benefit from a social environment that fully supports their autonomy. Yet, it is unknown to what extent this is supported in daily practice. This study aimed to explore to which extent autonomy is supported within staff-resident interactions. DESIGN An exploratory, cross-sectional study. SETTING AND PARTICIPANTS In total, interactions between 57 nursing home residents with dementia and staff from 9 different psychogeriatric wards in the Netherlands were observed. METHODS Structured observations were carried out to assess the support of resident autonomy within staff-resident interactions. Observations were performed during morning care and consisted of 4 main categories: getting up, physical care, physical appearance, and breakfast. For each morning care activity, the observers consecutively scored who initiated the care activity, how staff facilitated autonomy, how residents responded to staff, and how staff reacted to residents' responses. Each resident was observed during 3 different mornings. In addition, qualitative field notes were taken to include environment and ambience. RESULTS In total, 1770 care interactions were observed. Results show that autonomy seemed to be supported by staff in 60% of the interactions. However, missed opportunities to engage residents in choice were frequently observed. These mainly seem to occur during interactions in which staff members took over tasks and seemed insensitive to residents' needs and wishes. Differences between staff approach, working procedures, and physical environment were observed across nursing home locations. CONCLUSIONS AND IMPLICATIONS The findings of this study indicate that staff members support resident autonomy in more than one-half of the cases during care interactions. Nonetheless, improvements are needed to support resident autonomy. Staff should be encouraged to share and increase knowledge in dementia care to better address residents' individual needs. Especially for residents with severe dementia, it seems important that staff develop skills to support their autonomy.
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Prins M, Willemse BM, Heijkants CH, Pot AM. Nursing home care for people with dementia: Update of the design of the Living Arrangements for people with Dementia (LAD)-study. J Adv Nurs 2019; 75:3792-3804. [PMID: 31566778 PMCID: PMC6900200 DOI: 10.1111/jan.14199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of the current study is to describe the extended design of the Living Arrangements for people with Dementia (LAD)-study. BACKGROUND The demand for long-term care in care homes increases with the growing number of people with dementia. However, quality of care in care homes needs improvement. It is important to monitor quality of care in care homes for the purposes of conducting scientific research, providing input for policy, and promoting practice improvement. DESIGN The Living Arrangements for people with Dementia -study monitors changes in - quality of - care in care homes since 2008. With its extended design, the Living Arrangements for people with Dementia -study now also focuses on additional topics that are considered to improve quality of care: implementation of person-centred care, involvement of family carers and volunteers and reducing psychotropic drugs and physical restraints using a multidisciplinary approach. METHODS The data collection of the Living Arrangements for people with Dementia -study entails an interview with the manager and questionnaires are completed by care staff, family carers, volunteers, and multidisciplinary team members. This study is partly funded by the Dutch Ministry of Health, Welfare and Sports, grant number 323,088 and partly funded by the participating care homes. DISCUSSION Results of the Living Arrangements for people with Dementia -study will shed more light on variables related to quality of care in care homes for people with dementia. IMPACT Based on the obtained information, appropriate efforts to improve quality of care can be discussed and implemented. Furthermore, the results of this study guide policy making, because it expands knowledge about the effects of changing policies and exposes topics that need further attention. TRIAL REGISTRATION Not applicable. This article does not report the results of a healthcare intervention on human participants.
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Affiliation(s)
- Marleen Prins
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Clinical, Neuro & Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernadette M Willemse
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ceciel H Heijkants
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical, Neuro & Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Optentia, North-West University, Johannesburg, South Africa.,School of Psychology, University of Queensland, Brisbane, Qld., Australia
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Smith-MacDonald L, Venturato L, Hunter P, Kaasalainen S, Sussman T, McCleary L, Thompson G, Wickson-Griffiths A, Sinclair S. Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers. BMC Geriatr 2019; 19:128. [PMID: 31060500 PMCID: PMC6503362 DOI: 10.1186/s12877-019-1135-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/11/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION This paper details a subset of the findings from a participatory action research project exploring a palliative intervention in long-term care sites across Canada. The findings presented in this paper relate to understanding compassion within the context of a palliative approach to long-term care. METHODS Findings presented are drawn from qualitative interviews and focus groups with residents, family members, healthcare providers, and managers from 4 long-term care sites across 4 provinces in Canada. In total, there were 117 individuals (20 residents, 16 family members, 72 healthcare providers, and 9 managers) who participated in one of 19 focus groups. Data was analyzed by multiple members of the research team in accordance with thematic analysis. Individual concepts were organized into themes across the different focus groups and the results were used to build a conceptual understanding of compassion within Long Term Care . FINDINGS Two themes, each comprised of 5 sub-themes, emerged from the data. The first theme 'Conceptualizing Compassion in Long-Term Care generated a multidimensional understanding of compassion that was congruent with previous theoretical models. 'Organizational Compassion: resources and staffing', the second major theme, focused on the operationalization of compassion within the practice setting and organizational culture. Organizational Compassion subthemes focused on how compassion could support staff to enact care for the residents, the families, one another, and at times, recognizing their pain and supporting it through grief and mourning. CONCLUSIONS Results suggest that compassion is an essential part of care and relationships within long-term care, though it is shaped by personal and professional relational aspects of care and bound by organizational and systemic issues. Findings suggest that compassion may be an under-recognised, but essential element in meeting the promise of person-centred care within long-term care environments.
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Affiliation(s)
- Lorraine Smith-MacDonald
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Lorraine Venturato
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.,Dementia and Cognitive Impairment NeuroTeam, Hotchkiss Brain Institute, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Paulette Hunter
- St. Thomas More College, University of Saskatchewan, 1437 College Drive, Saskatoon, SK, S7N 0W6, Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, 845 Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada
| | - Lynn McCleary
- Department of Nursing, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | | | - Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Compassion Research Lab, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N1N4, Canada.
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Boltz M, Lee KH, Shuluk J, Secic M. Development of the Care Environment Scale-Long-Term Care. Clin Nurs Res 2018; 29:169-176. [PMID: 30227722 DOI: 10.1177/1054773818801485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A critical dimension of Quality Assurance and Performance Improvement (QAPI) activity in long-term care is an analysis of the care environment, that is, the way care and services are organized. The purpose of this study was to develop and pilot test a psychometrically sound tool that long-term care staff could use to assess the care environment and guide performance improvement activity. Focus groups with 57 interdisciplinary participants in five nursing homes developed initial items, with excellent content validity (item content validity index = 1.0) evaluated by an expert panel. Pilot testing of internal consistency of the Care Environment Scale-Long-Term Care (CES-LTC) was conducted in a web-based administration of the items by 425 interdisciplinary staff members in 30 nursing homes and four assisted living facilities. The CES-LTC is internally consistent (Cronbach's alpha = .90) and accounts for approximately 71.6% of the total variance. The three factors extracted from the exploratory factor analysis are Institutional Values (k = 6), Access to Resources (k = 10), and Person-Centered Approaches (k = 12). Intrarater reliability in a subsample of 66 registered nurses revealed good test-retest results (overall intraclass correlation coefficients [ICC] = 0.78). The CES-LTC appears to be a valid and reliable measure of staff perceptions of the care environment and may be used to actively engage staff in QAPI endeavors including root cause analyses and improvement activity.
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Affiliation(s)
- Marie Boltz
- The Pennsylvania State University College of Nursing, University Park, PA, USA
| | | | - Joseph Shuluk
- University of Florida College of Medicine, Jacksonville, FL, USA
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Boscart VM, Davey M, Ploeg J, Heckman G, Dupuis S, Sheiban L, Luh Kim J, Brown P, Sidani S. Psychometric Evaluation of the Team Member Perspectives of Person-Centered Care (TM-PCC) Survey for Long-Term Care Homes. Healthcare (Basel) 2018; 6:E59. [PMID: 29882833 PMCID: PMC6023483 DOI: 10.3390/healthcare6020059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 11/17/2022] Open
Abstract
Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes. This study aimed to evaluate the psychometric properties of an 11-item Team Member Perspectives of Person-Centered Care (TM-PCC) survey, adapted from White and colleagues (2008). In a cross-sectional study, 461 staff from four long-term care homes in Ontario, Canada, completed the TM-PCC. Construct validity and internal consistency of the TM-PCC were examined with a principal component analysis and Cronbach’s alpha coefficient. Findings revealed a three-component structure with factor 1, Supporting Social Relationships; factor 2, Familiarity with Residents’ Preferences; and factor 3, Meaningful Resident⁻Staff Relationships. The TM-PCC, as compared to the original survey, presented with less components (i.e., did not address Resident Autonomy, Personhood, Comfort, Work with Residents, Personal Environment, and Management Structure), yet included one new component (Meaningful Resident⁻Staff Relationships). The TM-PCC has a similar internal consistency (Cronbach’s alpha coefficient 0.82 vs. White et al. 0.74⁻0.91). The TM-PCC can be used to assess PCC from the staff’s perspective in long-term care homes.
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Affiliation(s)
- Veronique M Boscart
- Schlegel Centre for Advancing Seniors Care, 299 Doon Valley Drive, Kitchener, ON N2G 4M4, Canada.
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada.
- Schlegel Villages, 325 Max Becker Dr, Kitchener, ON N2E 4H5, Canada.
| | - Meaghan Davey
- Schlegel Centre for Advancing Seniors Care, 299 Doon Valley Drive, Kitchener, ON N2G 4M4, Canada.
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada.
| | - George Heckman
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada.
- Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L3G1, Canada.
| | - Sherry Dupuis
- Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L3G1, Canada.
| | - Linda Sheiban
- Schlegel Centre for Advancing Seniors Care, 299 Doon Valley Drive, Kitchener, ON N2G 4M4, Canada.
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada.
| | - Jessica Luh Kim
- Schlegel Villages, 325 Max Becker Dr, Kitchener, ON N2E 4H5, Canada.
| | - Paul Brown
- Schlegel Villages, 325 Max Becker Dr, Kitchener, ON N2E 4H5, Canada.
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University350 Victoria St, Toronto, ON M5B 2K3, Canada.
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Gilmore-Bykovskyi AL, Rogus-Pulia N. Temporal Associations between Caregiving Approach, Behavioral Symptoms and Observable Indicators of Aspiration in Nursing Home Residents with Dementia. J Nutr Health Aging 2018; 22:400-406. [PMID: 29484354 PMCID: PMC5830143 DOI: 10.1007/s12603-017-0943-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Dysphagia, or impaired swallowing, is common in nursing home (NH) residents with dementia and contributes to malnutrition and diminished quality of life. Dysphagia also commonly leads to aspiration or passage of food or fluids into the airway, which can result in aspiration pneumonia-a leading cause of death for people with dementia. Currently available interventions for dysphagia aim to modify the risk of aspiration events primarily by modifying diet and positioning to improve the safety of an individual's swallow. However other potentially modifiable contextual factors relevant to mealtime care within NH settings that may influence the occurrence of aspiration events, such as the nature of caregiving interactions or occurrence of dementia-related behavioral symptoms, have not been examined. To address this gap, we examined the temporal associations between caregiving approach and behavioral symptoms as antecedents to observable indicators of aspiration among nursing home (NH) residents with dementia. DESIGN Secondary analysis of coded, timed-event behavioral data from 33 video-recorded observations of mealtime interactions between NH residents with dementia and caregivers. SETTING/PARTICIPANTS Residents with dementia who required assistance with mealtime care (n=12) and nursing assistants (n=8) from Memory Care Units (MCU) in 2 Midwestern NHs. RESULTS Observable indicators of aspiration were significantly more likely to occur during or following task-centered caregiver actions than person-centered actions (12% likelihood; Yule's Q 0.89; OR 95% CI 12.70-23.75) and 15-30 seconds after a behavioral symptom (5% likelihood; Yule's Q 0.65; OR 95% CI 4.18-8.57). CONCLUSIONS These findings provide compelling preliminary evidence that caregiver approach may influence the occurrence of aspiration. Provided the urgent need for more approaches to mitigate the complications associated with dysphagia in people with dementia, even a moderate reduction in aspiration events may be clinically meaningful. Further, well-designed observational studies with individuals with well-characterized dysphagia are needed to better understand and characterize these relationships, their temporal structures and their impacts on other relevant outcomes such as eating performance and malnutrition.
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Affiliation(s)
- A L Gilmore-Bykovskyi
- Andrea Gilmore-Bykovskyi, PhD, RN, UW-Madison School of Nursing, 3173 Cooper Hall, 701 Highland Avenue, Madison, WI 53705, Phone: (608) - 262-3057, E-mail:
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Roberts TJ, Gilmore-Bykovskyi A, Lor M, Liebzeit D, Crnich CJ, Saliba D. Important Care and Activity Preferences in a Nationally Representative Sample of Nursing Home Residents. J Am Med Dir Assoc 2017; 19:25-32. [PMID: 28843525 DOI: 10.1016/j.jamda.2017.06.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/24/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Person-centered care (PCC), which considers nursing home resident preferences in care delivery, has been linked to important outcomes such as improved quality of life, resident satisfaction with care, and mood and reduced behavioral symptoms for residents with dementia. Delivery of PCC fundamentally relies on knowledge of resident preferences. The Minimum Data Set (MDS) 3.0 Preference Assessment Tool (PAT) is a standardized, abbreviated assessment that facilitates systematic examination of preferences from a population of nursing home residents. However, it is unknown how well the PAT discriminates preferences across residents or items. The purpose of this study was to use MDS 3.0 PAT data to describe (1) overall resident preferences, (2) variation in preferences across items, and (3) variation in preferences across residents. DATA Data from admission MDS assessments between October 1, 2011 and December 31, 2011 were used for this study. SAMPLE A nationally representative sample of 244,718 residents over the age of 65 years who were able to complete the resident interview version of preference, cognition, and depression assessments were included. MEASUREMENTS Importance ratings of 16 daily care and activity preferences were the primary outcome measures. Resident factors including function (MDS Activities of Daily Living-Long Form), depression (Patient Health Questionnaire-9), cognitive impairment (Brief Interview for Mental Status), and sociodemographics (age, race, sex, and marital status) were used as predictors of important preferences. ANALYSIS Overall preferences were examined using descriptive statistics. Proportional differences tests were used to describe variation across items. Logistic regression was used to describe variation in preferences across residents. RESULTS The majority of residents rated all 16 preferences important. However, there was variation across items and residents. Involvement of family in care and individualizing daily care and activities were rated important by the largest proportion of residents. Several resident factors including cognitive impairment, depression, sex, and race were significant predictors of preferences. CONCLUSIONS Findings demonstrate the PAT captures variation in preferences across items and residents. Residents with possible depression and cognitive impairment were less likely to rate preferences important than residents without those conditions. Non-Caucasian and male residents reported some preferences differently than Caucasian and female residents. Additional assessment and care planning may be important for these residents. More research is needed to determine the factors that influence preferences and the ways to incorporate them into care.
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Affiliation(s)
- Tonya J Roberts
- William S. Middleton Veteran Affairs Hospital, Madison, WI; University of Wisconsin-Madison, School of Nursing, Madison, WI.
| | - Andrea Gilmore-Bykovskyi
- William S. Middleton Veteran Affairs Hospital, Madison, WI; University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Maichou Lor
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Daniel Liebzeit
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Christopher J Crnich
- William S. Middleton Veteran Affairs Hospital, Madison, WI; University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI
| | - Debra Saliba
- VA Greater Los Angeles Healthcare System, Geriatric Research Education and Clinical Center, Los Angeles, CA; UCLA/JH Borun Center for Gerontological Research, Los Angeles, CA
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Bangerter LR, Van Haitsma K, Heid AR, Abbott K. "Make Me Feel at Ease and at Home": Differential Care Preferences of Nursing Home Residents. THE GERONTOLOGIST 2016; 56:702-13. [PMID: 26035895 PMCID: PMC4944536 DOI: 10.1093/geront/gnv026] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/13/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY Assessing and honoring older adults' preferences is a fundamental step in providing person-centered care in long-term care facilities. Researchers and practitioners have begun to develop measures to assess nursing home (NH) residents' everyday preferences. However, little is known about how residents interpret and conceptualize their preferences and what specific clinical response may be needed to balance health and safety concerns with preferences. DESIGN AND METHODS We used content analysis to examine interview responses on a subset of eight open-ended items from the Preferences of Every-day Living Inventory for Nursing Home (PELI-NH) residents with 337 NH residents (mean age 81). We considered how residents self-define various preferences of care and the associated importance of these preferences. RESULTS Residents identified preferences for interpersonal interactions (greetings, staff showing care, and staff showing respect), coping strategies, personal care (bathroom needs, setting up bedding), and healthcare discussions. Respondents highlighted specific qualities and characteristics about care interactions that are necessary to fully meeting their everyday preferences. IMPLICATIONS Results contribute to an emergent body of research that utilizes patient preferences to achieve the goals of person-centered care. The complexity of these responses substantiates the use of qualitative inquiry to thoroughly assess and integrate NH resident preferences into the delivery of person-centered care.
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Affiliation(s)
- Lauren R Bangerter
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park.
| | | | - Allison R Heid
- The New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
| | - Katherine Abbott
- The Department of Sociology and Gerontology, Miami University, Oxford, Ohio
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Calkins M, Brush J. Honoring Individual Choice in Long-Term Residential Communities When It Involves Risk: A Person-Centered Approach. J Gerontol Nurs 2016; 42:12-7. [DOI: 10.3928/00989134-20160531-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Graham ME. From wandering to wayfaring: Reconsidering movement in people with dementia in long-term care. DEMENTIA 2015; 16:732-749. [PMID: 26519452 DOI: 10.1177/1471301215614572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The movement of people with dementia in long-term care continues to be an issue of concern among clinicians, caregivers and families. This article will examine the social construction "wandering" and its association with pathology, risk discourse and surveillance technologies. Further, the article will explore the recent shift from the term "wanderer" to the phrase "people who like to walk" in person-centred dementia care. Engaging with Ingold's concept of movement as wayfaring, an alternative becoming-centred understanding of movement and its significance for people with dementia will be presented and illustrated through a case study. The paper concludes that depathologizing movement opens the possibility to see movement in people with dementia as an intention to be alive and to grow, rather than as a product of disease and deterioration. Suggestions for future research and implications for care interventions are discussed.
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Bunn D, Jimoh F, Wilsher SH, Hooper L. Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review. J Am Med Dir Assoc 2014; 16:101-13. [PMID: 25499399 DOI: 10.1016/j.jamda.2014.10.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities. DESIGN Systematic review of intervention and observational studies. DATA SOURCES Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked. ELIGIBILITY CRITERIA Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally. REVIEW METHODS Two reviewers independently screened, selected, abstracted data, and assessed risk of bias from included studies; narrative synthesis was performed. RESULTS A total of 4328 titles and abstracts were identified, 325 full-text articles were obtained and 23 were included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at the resident, institutional, or policy level. Overall, the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment. Reported findings from 6 of the 9 intervention studies investigating the effect of multicomponent strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, and increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, P = .01. Two smaller studies reported positive effects: one on fluid intake in 9 men with Alzheimer disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages, and mode of delivery (straw vs beaker; prethickened drinks vs those thickened at the bedside) were inconclusive. Two large observational studies with good internal validity investigated effects of ownership; in Canada, for-profit ownership was associated with increased hospital admissions for dehydration; no difference was seen in dehydration prevalence between US for-profit and not-for-profit homes, although chain facilities were associated with lower odds of dehydration. This US study did not suggest any effect of staffing levels on dehydration prevalence. CONCLUSIONS A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management, and care staff, but these require further investigation using more robust study methodologies. The review protocol was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003100).
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Affiliation(s)
- Diane Bunn
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK.
| | - Florence Jimoh
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Stephanie Howard Wilsher
- School of Psychology, Faculty of Social Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Lee Hooper
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
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