The effect of Orem's self-care model on nursing care in a nursing home setting

Self-, Informal and Formal Care: Partnerships in Community-Based and Residential Long-Term Care Settings

Un accent croissant est mis sur le besoin de regrouper les efforts des personnes âgées, de leur famille et des fournisseurs de services constitués dans un contexte de collaboration ou de partenariat en ce qui a trait aux soins de longue durée, que ce soit en établissement ou dans la communauté. Il est donc nécessaire d'établir de quelle façon ces relations sont actuellement structurées. L'auteur procède à un examen systématique des résultats des études réalisées entre 1985 et 1998 sur les relations entourant les soins personnels, l'assistance formelle et l'assistance informelle dans ces deux environnements. Les résultats tendent à démontrer que les soins formels ne viennent pas remplacer les services informels mais qu'ils sont plutôt utilisés en supplément ou en complément des soins assurés par le réseau informel, et ce tant en établissement que dans la collectivité. La structure exacte de ces partenariats et la relation entre les soins personnels et les soins assurés par les systèmes formels ou non apparaissent moins clairs. Les résultats montrent qu'il faut recentrer l'attention sur des préoccupations plus larges de soutien des partenariats déjà en place plutôt que sur la création de partenariats et la protection contre les substitutions inutiles.

The relationship between disability and self-care agency of Turkish people with rheumatoid arthritis

AIM

This study aims to determine the relationship between disability levels and self care agency scores in Turkish patients with rheumatoid arthritis and to investigate the factors affecting them.

BACKGROUND

Self-care agency is the complex acquired ability to meet one's constant requirements for care that regulates life processes, maintains or promotes the integrity of human structure, functioning and development, and promotes well-being.

DESIGN AND METHODS

Forty-three consecutive patients with Rheumatoid Arthritis (M/F: 11/32; mean age 49.53 +/- 13.37 years; disease duration 118.32 +/- 76.55 months), being followed up by Ege University Rheumatology Outpatient Department and all fulfilling ACR 1987 criteria were included in this study. Data collection instruments used in this study were Informative-Demographic Data Form, Health Assessment Questionnaire (including disability index and pain scale) and Self-as-Carer Inventory.

RESULTS

The mean disability index, the mean pain score and the mean self-care agency score of patients were 0.53 (SD 0.45), 1.48 (SD 0.74) and 80.95 (SD 27.80) were respectively. Self-care agency of patients found moderate level. It was found that a positive correlation between the disability index and the self-care agency scores (r = 0.488; p < 0.01). It was found that in male (t = 0.907; p = 0.000), in patients graduate from university (F = 0.271; p = 0.001), the self-care agency was better than other patients.

CONCLUSION

In conclusion we found that in Turkish patients with Rheumatoid Arthritis, the higher the disability rate was, the lower the self-care agency score was.

RELEVANCE TO CLINICAL PRACTICE

Disability, pain and their impact on self-care agency should be focused on in everyday care for Rheumatoid Arthritis patients. These areas are most important in nursing care and should be considered while organizing the medical treatment and rehabilitation programme.

Beyond the basics. Effects of the Eden Alternative model on quality of life issues

In Life Worth Living, Thomas (1996) proposed that in long-term care facilities for elderly individuals, loneliness, helplessness, and boredom are out of control and are steadily decaying the residents' spirits, adversely affecting quality of life. While Thomas' contention appeals to common sense, no empirical evidence is offered in its support. The purpose of this quasi-experimental study was to assess the impact of implementation of the Eden Alternative model on levels of loneliness, boredom, and helplessness of older residents of a long-term care facility. The model was introduced into the experimental facility on May 1, 1998. The final sample for the experimental group included 21 cognitively intact older adults from a state veterans home (13 men, 8 women, mean age = 76.1). The final control group was composed of 13 residents in a private long-term care facility (11 women, 2 men, mean age = 85.7). A Background Data Sheet, the Geriatric Depression Scale (includes yes or no questions related to helplessness and boredom), and the UCLA Loneliness Scale (Version 3) were administered by an interviewer at baseline and 1-year post-implementation of the Eden Alternative model. Data analysis from the post-implementation phase revealed significant differences between the groups on levels of boredom (z = -2.6, p = .01) and helplessness (z = -2.2, p = .03). Lower levels of distress were found in the experimental group on both boredom and helplessness, but not loneliness. Findings suggest health care professionals and researchers have an opportunity to take a leading role in impacting services related to quality-of-life issues for this important, but often overlooked, population.

A review of older people's experiences with residential care placement

BACKGROUND

Transition to the care and environment of a residential home has been identified in the literature as the most significant relocation affecting older people. However, little effort has been made systematically to review and synthesize the body of knowledge relating to older people's experiences with such placement. This has led to lack of concerted effort in the development of strategies to help elders adjust to such placement with dignity and success.

AIM

This paper presents a critical review of the literature related to older people's experiences with residential care placement, with an attempt to identify how knowledge in this area could be moved forward.

CONCLUSIONS

It is concluded that, while understanding of older people's pre and postplacement experiences was abundant, there was a dearth of literature on the actual experiences involved as older people made their day to day adjustment after placement. There is a need for future research to identify the dynamic processes of how older people come to terms with residential living. Future research should also focus on developing an accurate understanding of the adjustment experiences of elders with different ethnic background.

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.

Self-care in nursing home residents

The investigator observed four residents to explore the nature of self-care in the nursing home. The three themes identified showed that residents performed self-care and acted assertively but not to their full potential. Timing of care events and whether nurse or resident performed them were unpredictable, and residents demonstrated lack of information about scheduling and other routines. Residents not only frequently waited for events to occur but (also) both nurses and residents provided clues that nurse permission was necessary before proceeding. Residents expressed frustration due to lack of control.

Quality of life: its meaning to the long-term care resident

1. While the physical and recreational environments have been shown to be important to the mental health of the long-term care resident, human relationships and social contact have been described as being far more important in determining quality of life. 2. This study identified two new findings as contributing to quality of life--caring for oneself and the importance of helping others. 3. Failure to accurately assess a resident's ability to provide self-care may lead to excess disability, a situation in which a resident may become more functionally disabled, in part, due to the staff performing more care than is actually needed.

Nurses' assessment of elderly patients in hospital

Nurses' assessment of patients' mobility in hospital provided the focus for an inductive qualitative study which examined how an everyday aspect of nursing practice was carried out. The study described assessment practices in both long-term care and acute care wards for elderly patients as a situated activity. Interviews with nurses, as well as observation of their activities and records, resulted in explanations of their behaviour as deriving from their conceptions of ward functions. These conceptions arose from their adoption of the values of cure and discharge and so, in the different types of ward, assessment held different meanings and was carried out in different ways. The findings have implications for nursing practice in different settings but also for the care of elderly and chronically ill patients, where cure is an inappropriate end goal of care. This example of developing explanatory theory inductively also has implications for the development of mid-range nursing theory and suggestions are made for its extension.