Measuring the quality of care in psychogeriatric wards

The influence of subliminal crosstalk in dementia narratives

Ethnographic audio-visual research data recorded in a busy dementia care environment were initially considered to be ‘contaminated’ by unwanted background noise. This included a variety of elements: ambient sound, mechanical noise, non-narrative vocalisation and narrative fragments from parallel conversation. Using the methodological lens of conversation analysis, we present an exploration of the striking temporal and sequential resonances between the narrative of one man with dementia and a group of care staff holding a separate conversation some distance away. We suggest that in this and similar settings, where random and intrusive background sounds and conversation form a ubiquitous backdrop, the presence of such ‘noise’ can have a detectable influence on the content and direction of situated narratives. We argue that rather than attempting to filter out these apparently intrusive sounds from micro-interactional data, interference elements can usefully be incorporated into the analysis of interactions.

Conversation analysis as a method for investigating interaction in care home environments

This article gives an outline of how the socio-linguistic approach of conversation analysis can be applied to the analysis of carer–patient interaction in care homes. A single case study from a routine encounter in a residential care home is presented. This is used to show how the conversation analysis method works, the kinds of interactional and communication features it can expose, and what specific contribution this kind of micro-interactional approach may make to improving quality of care in these environments.

Improving Work Satisfaction amongst Nursing Staff and Quality of Care for Elderly Patients with Dementia: Some Policy Implications

This paper discusses the policy implications for encouraging a high quality of service provision in hospital for elderly people with dementia. Contemporary policy is examined and the continuing need for long-stay beds is highlighted, particularly in Scotland. The measurement of the quality of care in nursing is reviewed and concern is expressed over whether the patients or only the audit score will benefit from any change in practice. Ways of improving both work satisfaction and the quality of care are recommended on the basis of a study of psychogeriatric wards in NHS hospitals in Scotland.

A different story: exploring patterns of communication in residential dementia care

This article reports findings from a three-year project on ‘Communication patterns and their consequences for effective care’ that explored communication in dementia-care settings. As the proportion of people with dementia living in British care-homes continues to grow, there is a need to understand better their care. Using a range of qualitative methods, the project set out to identify the constituent elements of dementia-care practice and the patterns that characterise day-to-day relations in care homes. The tightly prescribed and standardised nature of the interactions between staff and residents is described: it raises questions about the capacity for dementia care to be truly person-centred. The project found that people with dementia are both capable of communication, and invest much effort in seeking to engage those around them, but are excluded from the monitoring, planning and provision of care in ways that we argue are discriminatory. The case is made for promoting and supporting communication as key skills and competencies for care workers. The value of measuring the level and quality of communication as a means to evaluate care is demonstrated. The authors question the priorities that currently guide care practice and argue that we need to listen to people with dementia and rethink what lies at the heart of dementia care.

Perceptions on individualized approaches to mental health care

Ways of working on acute psychiatric units have come under intense scrutiny in order for service users to receive modern care and treatment. This has led to various ways not only to improve the therapeutic milieu on psychiatric wards, but also to develop standardized approaches to care. This paper reports on a study on the development of a care pathway for people diagnosed with schizophrenia, with the aim of standardizing the care process. Action research was used to develop the care pathway and views were collected, and observations made from a range of mental health professionals. Not all respondents were in agreement with a care pathway and this led to clinicians defending the individualized nature of psychiatric care. Implementation of a care pathway may help not only to rekindle the therapeutic purpose of psychiatric care, but also to build in the individualized approach to carrying out hospital care. Limitations of the study have also been briefly reported.

Nursing Needs of Hospitalized Older Adults Consumer and Nurse Perceptions

The proportion of older adults is increasing in Australia, and the proportion of older adults requiring medical care is expected to increase in the future. At the same time, budget restrictions are a reality for Australia's health system. Increasing need and decreasing resources suggest the need to focus on the quality aspect of treatment and care for older adults. Little research has been conducted in the area of perceived nursing needs of elderly patients during hospitalization. This is an important area of research because it is increasingly recognized that elderly patients have specialized needs and are the major consumers of health care. Even less research has compared patient and carer perceptions with those of nursing staff. This article is a literature review and an investigation of the quality of care elderly patients receive, and of patient and nurse perceptions of the importance of various nursing activities. Quality of care is reviewed in terms of perceptions of nursing care priorities and elderly patients' satisfaction with the quality of nursing care they receive. Research examining nurses' perceptions related to why they are unable to consistently provide quality nursing care to all elderly patients is also reviewed. By identifying the nursing needs of elderly patients and educating nursing staff about these needs, professional practice can be guided and improvements in quality of care, patient satisfaction, and patient outcomes may occur.

"Individualised care" from patients', nurses' and relatives' perspective--a review of the literature

This paper provides an overview of the empirical research literature on individualised care. It offers a description of the methods that have been used in studies of individualised care over the years, and then discusses the meaning and realisation of individualised care from patients', nurses' and relatives' points of view in order to highlight needs for further research. The review focuses on empirical articles retrieved from the MEDLINE database published between 1973 and June 1999. It draws attention to the complexity of individualised care, which at first sight may look like a relatively straightforward nursing activity. It is shown that a wide range of methods have been used to study individualised care in the current literature. There is a lack of research where patients' experiences of the individuality of care in hospital settings are concerned.

The quality of nursing home care: do the opinions of family members change after implementation of emotion-oriented care?

OBJECTIVE

The present study focuses on opinions on the quality of nursing home care of family members of nursing home residents with dementia. Furthermore, we examined whether family members' appreciation of the care increased as a result of the implementation of emotion-oriented care.

DESIGN

Randomized clinical trial.

INSTRUMENT

An 18-item questionnaire was developed. The following subjects were addressed: communication activities between staff and family members; satisfaction regarding contacts with staff; the extent to which family members can participate in care; the contact that family members experience with the person with dementia, and opinions about the way in which nursing staff treat residents.

RESULTS

Most family members already had a positive opinion on the nursing home care prior to the implementation of emotion-oriented care. The most positive assessment concerned the way in which nursing staff treated residents. The lowest scores concerned communication activities between ward staff and family members. Comparison of the first and end measurements showed that in general opinions on the quality of care did not change.

STUDY LIMITATIONS

A large number of incomplete questionnaires made it impossible to conduct factor analysis on the classification of the questions in various sections and therefore allowed us only to make statements at the item level.

CONCLUSIONS

For the most part family members had a positive opinion on the nursing home care. In general, implementation of emotion-oriented care did not lead to a more positive assessment. Despite the generally accepted notion that involving family members in care is important, family members were regularly treated as outsiders. This demonstrates that there is room for improvement in the communication by nursing home staff with family members (e.g. more frequent contacts and information about the illness).

Developing and testing an instrument for the measurement of individual care

This paper describes a preliminary study in which an instrument was developed for the measurement of individual care in adult patients and in which the reliability and validity of the instrument were evaluated. Individual care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The purpose here is to describe the process by which the individual care instrument (IC) was developed, the preliminary testing of the instrument and psychometric evaluation of the instrument in a sample of adult patients discharged from a Finnish general Hospital (n=203). Item analyses showed an acceptable level of internal consistency reliability and homogeneity in each scale of the IC, and Cronbach alpha values were high in every measurement. Exploratory factor analysis supported a three-factor solution. The psychometric evaluations suggested that the instrument is worthy of further development.

Individualized care in a Finnish healthcare organization

This paper reports the findings of a study exploring the provision of individualized care in a regional hospital in Finland. Individualized care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The data were collected from hospitalized patients (n = 203) using a questionnaire specially developed for this study. The response rate was 89%. A strong support to facilitate patient participation in decision-making was reported. Most shortcomings concerning the provision of individualized care related to consideration of the patient's cultural background and the involvement of the patient's family in the planning of care. Patients' age and the type of ward were associated with the provision of individualized care: patients aged 65 or over were more satisfied than younger age groups with the way in which their personal life situation had been taken into account. Patients from the gynaecological ward thought, more than patients from the surgical ward, that their situation had been taken into account during hospitalization.

The delivery of quality nursing care: a grounded theory study of the nurse's perspective

This grounded theory study explored and described the delivery of quality nursing care from the perspective of nurses. Data were gathered by tape recorded interviews, published literature and some participant observation. Ten registered nurses from an acute-care public hospital located in Perth, Western Australia were interviewed. Twelve additional transcripts from interviews conducted by postgraduate students were also used. Quality nursing care was perceived to relate to the degree to which patients' physical, psychosocial, and extra care needs were met. The consequences of quality care were interpreted as 'therapeutic effectiveness', where the therapy provided by nurses was perceived to positively affect patients' healing. This was gauged by the patient's psychosocial and physical response to illness, safety, and satisfaction. Therapeutic effectiveness was facilitated by the development of positive relationships between nurses and patients, nurse's positive attributes and competent practices, as well as a functional nursing team. The problem of nurses' inability to consistently provide quality nursing care to all patients was identified. Insufficient time (caused by a lack of human and physical resources) was perceived as the main reason for this. Dissatisfaction and stress in nurses was related to this problem. To deal with this, nurses used a process named 'selective focusing'. Work was planned to most effectively utilize the time available, within the parameters of safety. Implications for nursing practice, education and management are discussed, and directions for further research are provided.

Educating nursing home staff in the reduction of pressure sores

Care-related work within continuing care settings is often perceived as being of low status and requiring little skill. In reality, however, creating a positive long-term care environment requires imagination and creativity. Education and training are a key element in any effort to improve the quality of care in nursing homes and similar settings, yet recent evidence suggests that opportunities for continuing education and training for staff in such environments are limited. This article considers the context of continuing education for nurses and care assistants employed in nursing homes, and uses a pilot evaluation of an educational package aimed at reducing the incidence of pressure sores as a case example to raise important issues. The difficulties in providing sufficient opportunities for education are highlighted and the need to embed any educational programme within a well-developed staff support structure is stressed.

Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.