Family involvement with communication-impaired residents in long-term care settings

A family involvement and patient-tailored health management program in elderly Korean stroke patients' day care centers

PURPOSE

This study aimed to examine the effects of a family involvement and functional rehabilitation program in an adult day care center on elderly Korean stroke patients' perceived health, activities of daily living, instrumental activities of daily living, and cost of health services, and on family caregivers' satisfaction.

DESIGN

Using one-group pre- and posttest design, dyads consisting of 19 elderly stroke patients and family caregivers participated in 12-week intervention, including involvement of family caregivers in day care services and patient-tailored health management.

FINDINGS

Outcomes of patients and caregivers were significantly improved (all p < .001). However, the cost of health services did not decrease significantly.

CONCLUSIONS

This program improved functional levels and health perception of elderly stroke patients and caregivers' satisfaction. However, results must be interpreted with caution, because this was only a small, single-group pilot study.

CLINICAL RELEVANCE

This program may be effective for elderly stroke patients and their caregivers.

'Making it better': self-perceived roles of family caregivers of older people living in care homes: a qualitative study

BACKGROUND

With growing numbers of frail older people making the move to a care home, family carers are increasingly finding themselves in the position of assisting with this transition and establishing a new caring role within this context. However, the nature of the family caregiving role within the care home setting is poorly understood.

AIMS AND OBJECTIVES

This paper draws on data from a study, which sought to better understand the experience of nursing home placement from the viewpoint of relatives. The focus here is on the self-perceived contribution of family carers to life within the home.

METHODS

A constructivist methodology was used. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a care home.

FINDINGS

Data analysis revealed three phases to the transition from the relatives' perspective. This paper reports on the findings which relate to the final phase: 'making it better', which documents experiences of establishing a new caregiving role within the care home. Relatives described three main aspects to their role: maintaining continuity, which involves helping the older person to maintain their sense of identity through the continuation of loving family relationships and through helping staff to get to know the resident as an individual; keeping an eye, by monitoring the care received, providing feedback to staff and filling any gaps, and contributing to community through interacting with other residents, relatives and staff, taking part in social events and generally providing a link with the outside world.

RELEVANCE TO CLINICAL PRACTICE

Findings suggest that the potential contribution of relatives to promoting the well-being of both residents and staff is under-developed. Staff in care homes should seek to identify the role that relatives would like to perform and support them to achieve this.

'Making the move': relatives' experiences of the transition to a care home

Despite a growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the caregiving career, relatively few studies in the UK have explored this experience in depth. The research on which the present paper is based sought to better understand experiences of nursing home placement from the viewpoint of relatives. The study was informed by a constructivist perspective. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Data analysis revealed three phases of the transition from the relatives' perspective: 'making the best of it'; 'making the move'; and 'making it better'. The relatives' experiences across these phases were understood in terms of five continua, reflecting the extent to which they felt they were: operating 'under pressure' or not; 'working together' or 'working alone'; 'supported' or 'unsupported', both practically and emotionally; 'in the know' or 'working in the dark'; and 'in control of events' or not. This paper reports on the findings which relate to the second phase of the transition, 'making the move', which relates to experiences around the time of relocation to the care home environment. The findings suggest that health and social care practitioners have enormous potential to influence relatives' experiences of nursing home entry. Experiences are enhanced if family carers perceive that they are able to work in partnership with care staff in order to ease the transition for the older person.

Family and Staff Partnerships in Long-Term Care: A Review of the Literature

Working with the family in aged care to provide the best care possible is consistent with modern nursing philosophy, which espouses holistic care. The quality and enjoyment of the experience, however, is frequently fraught with problems and challenges for both the family and the staff involved. In residential aged care, partnerships are a complex mix of interactions among the older adult resident, the family, and the caregiving staff. To understand how family involvement in this environment can be made more meaningful, nurses need to be cognizant of how family members experience the caregiving role and how they are perceived by nursing home staff and residents. The relevant literature of the past 20 years is reviewed and key issues central to an understanding of "family care" in the nursing home from the perspective of the family, the nursing home resident, and the nursing home staff are highlighted in this article.

Resident and family perspectives. The first year in a long-term care facility

The purpose of this longitudinal study was to explore perspectives, needs, and expectations of residents (N = 6) and family members (N = 3) of the resident's first year in a long-term care facility. The narrative method and a semi-structured interview guide were used to obtain participants' views at 2 and 6 weeks, and 3, 6, 9, and 12 months after admission. During data analysis, six themes emerged, which suggest implications for gerontological nursing education and practice. The authors conclude that by listening to residents and family members, nurses can use this information to improve life for residents and dignify them as individuals.

A conceptual framework for achieving high-quality care in nursing homes

Nursing home care accounts for 12% of healthcare expenditures in the United States, yet serious concerns remain about the quality of care provided in these settings. This article describes a comprehensive systems model that views organizational environments as consisting of four interacting dimensions: organizing arrangements, social factors, technology, and physical setting. This model is then used as a conceptual framework (vis-à-vis an extensive literature review) to identify factors that contribute to poor-quality care in nursing homes and to highlight previous research efforts. The literature review also provides a useful framework to guide nursing home administrators and healthcare quality professionals in their implementation of quality improvement processes and serves to help direct future research in this very important arena.

Satisfaction with nursing home care of a relative: does inviting greater input make a difference?

This study examined whether a formal invitation to have greater involvement in the nursing home care of their relatives resulted in increased satisfaction in former care-givers. The conceptual framework guiding the study was based on Roy's Adaptation model of Nursing (Roy 1984, 1989), since it was believed that the intervention might aid the adaptation of family members to the institutionalisation of a close friend or relative. Increased satisfaction with care was measured as evidence of adaptation. In the study, 31 former care-givers were randomly assigned to two groups, one of which was offered greater involvement in care. Of the participants in the experimental group, the four who accepted this opportunity all had relatives admitted in the past 6 months. After 6 weeks there was no significant difference between the groups. Trends suggest that similar programs may be most useful in the early months following admission, while care-givers are in the process of adapting to their new circumstances. It appears that nursing staff must be sensitive to the different needs for involvement in the care of relatives.

The role of gerontological advanced practice nurses in geriatric care

GAPNs have a significant role to play in the care of older people. They provide focused health screening, counseling, crisis intervention, and comprehensive care to this population. They serve as important advocates in directing appropriate utilization of resources and making referrals that promote continuity of care geared to the needs of older adults. GAPNs provide essential educational services to older clients, their families, and other nursing and health care professionals involved in their care. They are innovators in the field of gerontological nursing and geriatric care and initiate or collaborate in research aimed at improving the health status of older persons. GAPNs are true providers of geriatric care, with great potential for serving an increasingly aging society.