Caretakers' views on responsibilities for the care of the demented elderly

Relationships between the characteristics of oncohematology services providing palliative care and the sociodemographic characteristics of caregivers using health indicators: social support, perceived stress, coping strategies, and quality of work life

OBJECTIVE

The aim of this study was to analyze the relationships between the characteristics of the management of oncohematology services and the psychosocial determinants of caregivers' health at work including social support, stress, and coping strategies.

DESIGN

Investigation using questionnaires was carried out about nurses and nurse aides in hematology and oncology services.

SETTING

All hematology and oncology services of Western France were requested. Five questionnaires concerning sociodemographic characteristics, measurements of quality of work life, of social support, of perceived stress, and of coping strategies and quality of work life were delivered among health professionals.

PARTICIPANTS

Five hundred seventy-four questionnaires from 53 different services were analyzed. There were 57.4% nurses and 42.6% nurse aides. Some 94.1% were female and 33.5% were older than 40 years.

RESULTS

Several characteristics of oncohematology services were significantly linked to health indicators, as the need for time and recognition, the importance of training (in palliative care, pain management, and help relationship), the care of patients and their families, the interdisciplinary efficiency, and external interventions (psychologists and volunteers). We showed that participative management which includes implementation of service projects and of multidisciplinary staff influence the quality of work life of health professionals. We showed also how much the characteristics of services organized around an effective social support (need for recognition) favor a better quality of work life among caregivers, influencing their perceived stress and their coping strategies.

CONCLUSION

To our knowledge, it is the first study showing a relationship between participative management (including multidisciplinary staffs, approach with a service project, and internal training) and the quality of work life in the domain of health care. The implementation of this model should be promoted in health care services.

The ethics of autonomy and dignity in long-term care

Efforts to address the “paradox of autonomy in long-term care” attempt to salvage an ethic of autonomy by redefining the central concept, and then applying it to the long-term care environment. Such attempts are critiqued, and an alternative ethic of dignity for long-term care is developed. Autonomy, it is argued, is crucial to certain aspects of dignity, but should not be confused with the whole of it. Indeed, long after the capacity for autonomy has diminished or vanished, basic dignity continues to exert normative force.

Moral reasoning among professional caregivers in nursing homes

This article examines the responses from a sample of Swedish nursing home staff workers to a hypothetical ethical conflict highlighting the issue of restraint. The responses were analyzed in two ways: first, Piaget's theory of moral development was used to differentiate between "autonomous" and "heteronomous" awareness, and second, the responses were analyzed from the perspective of ethical principles, that is, autonomy, beneficence, nonmaleficence, and justice. The findings indicate that autonomous ethical awareness took precedence over heteronomous ethical awareness. The dominant moral values were the principle of beneficence, followed by the principle of autonomy.

Staff burnout in dementia care--relations to empathy and attitudes

Sixty nursing staff in geriatric and psychogeriatric care (RNs, LPNs and nurse's aides) were selected to be studied on two occasions with an interval of one year regarding the relationships between their experience of burnout, empathy and attitudes towards demented patients. A semistructured interview was performed on the second occasion to learn more about their work experience and to relate the ratings of burnout, empathy and attitudes to their experience at work. The staff's experience of burnout changed from a mean score of 2.7 in 1987 to 2.5 in 1988. Their empathic ability was moderately high and increased from 398 (m) in (1987) to 450 (m) in 1988. The attitudes of staff remained unchanged from 1987 to 1988 and no differences were found regarding the staff's age, place of work or time at present place of work. As for the staff's empathy, there was no difference with respect to sex, category of staff or place of work. RN's showed the most positive attitudes towards demented patients both in 1987 and 1988 and differed compared to the nurse's aides and LPN's. Burnout correlated with lower empathy and less positive attitudes in the staff. Regression analysis showed that 'experience of feed-back at work' and 'time spent at present place of work' were the most important factors when explaining burnout among the staff. Staff with high empathy experienced "a close contact with the patient" as the most stimulating factor at work while staff with low empathy experienced "improvement of the patient's health" and "contact with colleagues" as the most stimulating factors. The importance of counteracting burnout in the care of demented patients is stressed.

Food refusal amongst nursing home patients as conceptualized by nurses' aids and enrolled nurses: an interview study

One hundred and forty-three nurses' aids and 48 enrolled nurses at nursing homes in Sweden were interviewed about food refusal among patients. It became evident that their concepts of 'food refusal' and 'forced feeding' were very vague. This could partly be explained by the lack of knowledge among staff of how to interpret the frequent ambiguous eating behaviours among demented patients. It has been suggested that concept clarification and ethical analysis might reduce anxiety among staff caring for patients with severe eating problems.