Advocating for a parent with dementia in a long-term care facility: the process experienced by daughters

"It's Akin to Standing Alone on the Platform": A Qualitative Analysis of Family Caregivers' Perceived Benefits of Conversations with Professional Dementia Caregivers

Family caregivers often face challenges in navigating care decisions and maintaining involvement after their relatives transition to long-term care facilities. This study explores family caregivers' perspectives on the benefits of engaging in conversations with professional caregivers in long-term dementia care. Semi-structured interviews were conducted with 17 family caregivers in Denmark. Using thematic and template analysis, five core themes were constructed, highlighting both emotional and practical motivations for communicating with healthcare professionals: (1) feeling disconnected and uninformed about their loved one's care, (2) managing emotional challenges while seeking reassurance, (3) leveraging professional expertise for guidance, (4) fostering collaboration through openness, and (5) achieving mutual understanding and perspective shifts. The findings underscore the critical role of open and ongoing communication among family and professional caregivers in building trust, addressing family caregivers' emotional and informational needs, and supporting them in navigating the shared caregiving roles of long-term dementia care. In addition, the findings point to the potential benefits of structured dialogues to promote family involvement and person-centered care in long-term dementia settings.

Family Involvement in the Care of Nursing Home Residents With Dementia: A Scoping Review

Family members are involved in the lives of older adults with dementia in complex ways. This scoping review synthesizes existing research on family involvement in the care of nursing home residents with advanced dementia. Using the Arksey and O'Malley scoping review framework, electronic searches of PubMed, EBSCO's CINAHL Complete, and APA PsychInfo on the Ovid platform were conducted. Twenty-eight studies met inclusion criteria. Emergent themes and definitions of involvement were obtained through thematic analysis, including: (1) contact (through visitation, calling, or writing letters); (2) engagement in care activities (instrumental/activities of daily living); (3) planning and monitoring care (being aware of health and treatment changes, partnership with care staff, ensuring adequate care, and decision-making); and (4) supporting the resident (advocacy, socioemotional support, and financial support). Moreover, limited psychometrically sound instruments exist to measure family involvement. These limitations stall the progression of research targeting family involvement.

The relationship at the heart of the experience of daughter caregivers of a parent with dementia: An interpretative phenomenological analysis

BACKGROUND

Parents with dementia require emotional, physical, psychological and financial support from their child caregivers to continue living at home. Daughter caregivers have been shown to be more involved in self-care and household tasks and to experience higher levels of distress than son caregivers.

OBJECTIVE

The aim of this study was to investigate the experience of daughter caregivers who provide informal care for a parent with dementia living in their own home.

METHOD

Semi-structured interviews were conducted with 11 daughter caregivers of a parent with Alzheimer's disease. Interviews were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three axes emerged from the analyses: [1] the before conditions the after: the quality of the previous relationship with the parent with Alzheimer's disease is a determining factor and allows the identification of three profiles of daughter caregivers: 'the grateful', 'the resentful' and 'the ambivalent', [2] when the relationship protects against the sense of burden: the feeling of being invaded by the caregiving situation is influenced by the quality of the relationship with the parent with Alzheimer's disease, and [3] alone or almost: the support network is desired when it is absent but kept at arm's length when it is present.

DISCUSSION

The results underline the importance of assessing the quality of attachment and supporting the relationship with the parent (especially when the relationship prior to the disease was difficult). Daughter caregivers should also be encouraged to delegate tasks and refocus their actions related to their values. Family mediation sessions may be planned to improve the organisation of care and set up an efficient collaboration.

Roles and experiences of informal caregivers of older adults in community and healthcare system navigation: a scoping review

OBJECTIVE

Informal caregivers are playing a vital role in improving the degree to which older adults access community and healthcare systems in a more seamless and timely manner, thereby fulfilling their complex needs. It is critical to understand their experiences and perspectives while navigating these systems. This review aimed to identify and organise the research findings on the roles and experiences of informal caregivers of older adults while navigating community and healthcare systems.

DESIGN

This scoping review was undertaken according to the Joanna Briggs Institute's Reviewer manual. Four databases were used: AgeLine, PsycINFO, CINAHL and Medline to capture literature with a focus on informal caregivers whose care recipients are aged 55 years or older. Articles were included if they focused on examining the experience, perspective and/or role of informal caregivers in providing care for their older care recipients, while articles were excluded if they only focused on healthcare professionals or older adults.

RESULTS

A total of 24 studies were identified that met the study inclusion criteria. This review elucidated the roles of caregivers as a primary system navigator and as an advocate for older adults. Numerous challenges/barriers in system navigation were uncovered, such as lack of consistency in fragmented systems, as well as facilitators, including interface/coordination roles. Finally, recommendations for better system navigation such as caregiver engagement and integration of continuity of care services were identified.

CONCLUSION

The need to raise the visibility of the roles and experiences of informal caregivers in system navigation was highlighted. Further research needs to focus on implementing interventions for informal caregivers incorporating a care coordinator to fill the care gap within community and healthcare systems. This review has the potential to foster greater integration of community and healthcare systems.

Supporting the "hallway residents": a qualitative descriptive study of staff perspectives on implementing the Namaste Care intervention in long-term care

BACKGROUND

Long-term care (LTC) settings are becoming home to an increasing number of people living with advanced or late-stage dementia. Residents living with advanced dementia represent some of society's most vulnerable and socially excluded populations and are thus at an increased risk of social isolation. A multisensory intervention tailored to this population, Namaste Care, has been developed to improve quality of life for residents living with advanced dementia in LTC homes. To date, limited research has explored the perspectives of staff in implementing the Namaste Care program with an emphasis on social inclusion of residents in Canadian LTC homes. This study aimed to describe the perspectives of LTC staff on the implementation facilitators and barriers of Namaste Care as a program to support the social inclusion of residents living with advanced dementia.

METHODS

Using a qualitative descriptive design, semi-structured interviews (n = 12) and focus groups (n = 6) were conducted in two LTC homes in Southern Ontario, Canada, over a 6-month period. Convenience sampling was used to recruit LTC home staff from the two participating sites. Thematic analysis was used to analyze data.

RESULTS

LTC staff (n = 46) emphasized the program's ability to recognize the unique needs of residents with advanced dementia, and also stated its potential to facilitate meaningful connections between families and residents, as well as foster care partnerships between staff and families. Findings indicated staff also perceived numerous facilitators and barriers to Namaste Care. In particular, providing staff with dedicated time for Namaste Care and implementing volunteer and family participation in the program were seen as facilitators, whereas the initial perception of the need for extra staff to deliver Namaste Care and identifying times in the day where Namaste Care was feasible for residents, families, and staff, were seen as barriers.

CONCLUSIONS

LTC staff recognized the need for formalized programs like Namaste Care to address the biopsychosocial needs of residents with advanced dementia and offer positive care partnership opportunities between staff and family members. Although staffing constraints remain the largest barrier to effective implementation, staff valued the program and made suggestions to build LTC home capacity for Namaste Care.

Keeping the Connection Alive With Tender Care and Common Sense: A Phenomenological Study on Daughters' Experiences of Having a Mother in a Nursing Home

The relationship between mother and daughter is exceptional when it comes to closeness and its impact on their whole life. Thus, a mother's move to a nursing home is pivotal for both of them. The aim of this interpretative phenomenological study, using the Vancouver School of Doing Phenomenology, was to explore daughters' experience of having a mother in a nursing home, its impact on the maternal relationship, and the daughters' need for education and support. Data were collected by 21 semi-structured interviews with 12 women who had mothers living in a nursing home. Keeping the connection alive with tender care and common sense encapsulates the interrelation between the daughters' urge to hold on to the mother-daughter relationship and the rare consideration of education and support from health professionals. Responsibility and sense of duty paired with relief because the mother is in a safe place were accompanied by the daughters' need for confirmation that the mother is well taken care of.

Residents' and Relatives' Experiences of Acute Situations: A Qualitative Study to Inform a Care Model

Background and Objectives

As new models of care aiming to reduce hospitalizations from nursing homes emerge, their implementers must consider residents’ and relatives’ needs and experiences with acute changes in the residents’ health situations. As part of the larger INTERCARE implementation study, we explored these persons’ experiences of acute situations in Swiss nursing homes.

Research Design and Methods

3 focus groups were conducted with residents and their relatives and analyzed via reflexive thematic analysis.

Results

The first theme, the orchestra plays its standards, describes experiences of structured everyday care in nursing homes, which functions well despite limited professional and competency resources. The second theme, the orchestra reaches its limits, illustrates accounts of acute situations in which resources were insufficient to meet residents’ needs. Interestingly, participants’ perceptions of acute situations went well beyond our own professional view, that is, changes in health situations, and included situations best summarized as “changes that might have negative consequences for residents if not handled adequately by care workers.” Within the third theme, the audience compensates for the orchestra’s limitations, participants’ strategies to cope with resource limitations in acute situations are summarized.

Discussion and Implications

Our findings suggest differences between care providers’ and participants’ perspectives regarding acute situations and care priority setting. Alongside efforts to promote staff awareness of and responsiveness to acute situations, care staff must commit to learning and meeting individual residents’ and relatives’ needs. Implications for the development and implementation of a new nurse-led model of care are discussed.

Family involvement with care homes following placement of a relative living with dementia: a review

This review updated a previous review [Gaugler JE (2005) Family involvement in residential long-term care: a synthesis and critical review. Aging and Mental Health9, 105–118] and focused on dementia. Fourteen years of development in family involvement with care homes following placement of a relative was explored. The review aimed to investigate two questions: (1) What types of involvement do families have with care homes following placement of people living with dementia? (2) Which factors influence family involvement with care homes? PsycINFO, MEDLINE and CINAHL Plus were searched for publications between January 2005 and December 2018. Thirty-three papers representing 30 studies were included. Papers were appraised using a quality rating tool designed for use with mixed study designs. Studies were of a reasonable quality though some weaknesses included single-site samples, high attrition rates and poor reporting. Twenty-eight papers highlighted types of involvement including collaboration, family–staff relationship development, decision making and visiting. Twenty-five papers pertained to factors influencing involvement, which included outcome of care quality evaluation, wish for recognition and sense of integration into the care team. Type of family involvement has changed over time with increased emphasis on families’ desire for partnership, to be active rather than passive advocates, and to focus on care monitoring and evaluation. Seven themes of family involvement activities are featured and a non-linear process is proposed. When compared to patient and family-centred care principles, an analysis of family involvement types found good fit overall and potential for framework improvements. Over 30 diverse factors influence inter-family variation in the level and nature of family involvement. Consideration of these factors and resolution of the gaps in evidence, including intergenerational and cultural concerns, can improve care home facilitation of family participation. This dementia-specific review is a comprehensive timely complement to Gaugler's seminal work about older adults in care.

Facilitators and barriers to implement nurse-led interventions in long-term dementia care: a qualitative interview study with Swiss nursing experts and managers

Background

To support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in long-term dementia care.

Methods

We conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples’ perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant’s choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants’ perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript.

Results

Six dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n = 12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in long-term dementia care: «A common attitude and cohesion within the organization», «Commitment on several levels», «A needs-oriented implementation», «The effect and the public perception of the intervention», «A structured and guided implementation process», «Supporting knowledge and competencies», as well as «Resources for implementing the intervention».

Conclusions

To support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is necessary that the value of the intervention is perceptible.Commitment-building is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents and relatives. Furthermore, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia, thus. Therefore, it is important to support dementia-specific competencies in long-term care. Findings indicate that the barrier is determined by the intervention and its implementation – and not by the behaviour of the person with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02120-1.

"It's Pure Panic": The Portrayal of Residential Care in American Newspapers During COVID-19

Background and Objectives

This study examines the discursive construction of residential care during the COVID-19 pandemic in three leading American newspapers: The New York Times, USA Today, and The New York Post.

Research Design and Methods

A total of 54 news articles between 21 January and 8 May 2020 were identified from the LexisNexis academic database for analysis. The articles were analyzed using both a critical discourse analysis approach and a thematic analytical framework.

Results

Findings indicate that residents’ voices are excluded and superseded by others, namely their family members. Literary elements were used to portray residential care as shockingly dangerous, deceptive, and problematic. Blame was often assigned to an individual or group according to the political tendency of the newspaper.

Discussion and Implications

A cultural model of panic and dishonesty begins to take shape through the COVID-19 pandemic. Fearmongering and the portrayal of residential care as lacking transparency will likely create future mistrust of the industry. The depiction of vulnerability and the illusion of resident inclusion in the news coverage enable paternalistic decision-making and care practices in the name of supposed protection.

Interventions to foster family inclusion in nursing homes for people with dementia: a systematic review

BACKGROUND

Family inclusion in nursing homes is central to the provision of individualized care for people with dementia. Although positive effects can be recognized, barriers have been identified that hamper family inclusion in nursing homes. Specifically for people with dementia, insight into the content of interventions to foster family inclusion is lacking.

METHODS

A systematic review was performed by systematically searching the databases PubMed, Cinahl, PsycInfo and Embase. Studies were eligible if they examined (1) nursing home settings, (2) interventions to foster the inclusion of family members from people with dementia, (3) were original research articles in which effects/experiences of/with these interventions were evaluated, and (4) were written in English, Dutch or German. Findings were summarized systematically.

RESULTS

Twenty-nine studies were included. Two interventions were targeted at creating family-staff partnerships from a two-way perspective. Other interventions focused on single components, such as including family members in formal decisions (n = 9), enabling them to make better informed decisions and/or participate more actively (n = 7), or providing psychoeducation for family members (n = 3). Within the interventions, family and staff members are often treated differently. Effects on actual increase in family inclusion remain unclear.

CONCLUSIONS

Very few interventions exist that try to enhance equal family-staff partnerships in nursing homes. Future interventions should pay specific attention to mutual exchange and reciprocity between family and staff. As little is known about promising (components of) interventions to foster family inclusion in nursing homes for people with dementia, more effectiveness research is needed.

[The method of "town hall talks": a study protocol]

BACKGROUND AND AIM

Society is responsible for strengthening "caregiver-sensitive" communities based on the principle of social services to the public and are thus oriented towards the appreciation of caring relatives (CR) of people with dementia (PwD), their capability for self-care and participation. This requires methods to emphasize the social value of informal care and to re-evaluate existing support services. The article aims to present the method of "town hall talks".

METHOD

In 20 communities throughout Germany a public town hall talk in which CR, actors in the community (AC) and the citizens enter into a dialogue, was conducted. In three moderated discussion groups the question of communal responsibility for the provision of resources was addressed. These resources should encourage the CR ability of self-care as well as strategies for their support. In order to make a statement regarding the success of the project planning, three pilot town hall talks were evaluated.

PREVIOUS RESULTS

The recruitment of the population sample and the organization of the town hall talks in particular are administratively and logistically challenging. The project can only be successful through networking and intensive cooperation between scientists and the communities. In terms of content and logistics, the project planning of the pilot town hall talks was successful. The method received excellent ratings from the majority of the CR and AC.

CONCLUSION

Regarding the creation of caregiver-sensitive communities the town hall talks promise great potential. The specific benefit of the method for the CR and the community will be examined.

A Survey of the Characteristics and Administrator Perceptions of Family Councils in a Western Canadian Province

Family Councils are independent, self-determining groups composed of family members (inclusive of friends) who have assembled with the main purpose of protecting and improving the quality of life of those living in long-term care (LTC) homes. This study aimed to describe the prevalence and characteristics of Family Councils in British Columbia, Canada. We conducted a cross-sectional survey with administrators of 259 homes and received 222 usable surveys. Of the 151 LTC homes that had Family Councils, it was most common for the homes to be larger (>50 residents), accredited, privately owned, and located in urban areas. Perceived barriers to Family Councils included lack of interest, tendency to focus on individual complaints, and the transitory nature of families. Perceived benefits of Family Councils included enhanced communication between staff and families, peer support, and collective advocacy. Recommendations focus on enhancing accessibility, information sharing, and meaningfulness of Family Councils to improve family engagement.

Partnerships in nursing homes: How do family caregivers of residents with dementia perceive collaboration with staff?

Background

Partnerships between family and nursing staff in nursing homes are essential to address residents’ needs and wishes. Collaboration is needed to create partnerships; nonetheless, challenges exist.

Aim

This study aimed to gain insights into the experiences of families collaborating with staff.

Method

Semi-structured interviews were held with 30 family caregivers of nursing home residents with dementia.

Findings

Data reflected three themes, which shaped collaboration with staff from families’ perspective, ‘communication’, ‘trust and dependency’ and ‘involvement’.

Discussion

Good communication appeared to be a requisite condition for having trust in staff and quality of involvement in residents’ life. Good communication was described as having informal contact with staff, which enabled family and staff to build a personal connection. Consequently, this seemed to increase trust and satisfaction regarding involvement.

Conclusion

Findings suggest that increasing informal contact and building a personal connection should be a priority for staff in order to improve collaboration and to create partnerships with families.

From Family Involvement to Family Inclusion in Nursing Home Settings: A Critical Interpretive Synthesis

The provision of care work by families plays an integral role in the quality of life of older adults living in a nursing home setting. This critical interpretive synthesis examines family members' perceptions of their roles and responsibilities in nursing home settings and interrogates the structural and relational barriers and enablers to family involvement as they relate to fostering an inclusive environment. Electronic databases and published literature were searched for empirical studies that were conducted in a nursing home setting and described involvement from the perspective of family members. Thirty-two articles published between 2006 and 2016 were included in the review. Although involvement comprised a variety of roles and responsibilities, it was grounded in family-resident relationships, influenced by family-staff relationships, and deeply affected by broader sociopolitical factors. We conclude that involvement should be understood as a democratic process with supporting policies and programs to encourage family inclusion in facility life.

Staff Factors Contributing to Family Satisfaction with Long-Term Dementia Care: A Systematic Review of the Literature

OBJECTIVE

The aim of the present review was to critically evaluate empirical evidence regarding staff factors that contribute to families' satisfaction with ongoing care provision for their relatives with dementia in long-term care.

METHODS

Four databases were systematically searched using search terms informed by the aim of the present systematic review. The resulting 14 relevant articles comprised both qualitative and quantitative studies.

RESULTS

The findings highlighted three broad areas relating to staff factors that appeared to contribute to families' satisfaction with care provision: family related factors, relating to staff interaction with families; staffing related factors, focusing on staffing organization and composition; and client related factors, focusing on staff interaction with clients and the quality of care provided.

CONCLUSIONS

The findings have important implications for care staff and managers working in such settings regarding staffing organization, staff training, recruitment and retention. Future research directions are discussed.

CLINICAL IMPLICATIONS

Families want consistent, knowledgeable staff that interact well and respond appropriately to the needs of their relative as well as their own needs as family members. Staff training in such settings should therefore focus not only on staff education but also on the importance of establishing effective relationships with both clients and families.

Extending "Continuity of Care" to include the Contribution of Family Carers

BACKGROUND

Family carers, as a "shadow workforce", are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty's model of continuity of care to explore the contribution of family carers' to the provision of care and support for an older family member's chronic condition within the context of health service delivery.

METHODS

We analysed data from interviews of 13 family carers in a case study of primary health care in New Zealand - a Maori Provider Organisation - to determine the alignment of family caregiving with the three levels of continuity of care (relational continuity, informational continuity, and management continuity).

RESULTS

We found alignment of family caregiving tasks, responsibilities, and relationships with the three levels of continuity of care. Family carers 1) partnered with providers to extend chronic care to the home; 2) transferred and contributed information from one provider/service to another; 3) supported consistent and flexible management of care.

DISCUSSION

The Maori Provider Organisation supported family carer-provider partnership enabled by shared Maori cultural values and social mandate of building family-centred wellbeing. Relational continuity was the most important level of continuity of care; it sets precedence for family carers and providers to establish the other levels - informational and management - continuity of care for their family member cared for. Family carers need to be considered as active partners working alongside responsive primary health care providers and organisation in the implementation of chronic care.

Episodic memories of relationship quality, procedural knowledge of attachment scripts, and the experience of daughters caring for a parent with dementia

A caregiver's attachment history with their parents may affect the thoughts, feelings, and behavior they now have as they care for a parent with dementia. Participants were 77 daughters of a parent with dementia. The nature of participant conscious episodic memories of their parental figures and unconscious procedural knowledge of caregiving processes (secure base script knowledge) were identified as two aspects of the caregiver's relationship history that may impact their involvement in care, relationship conflict, critical attitudes, and strain. Our findings indicated that the nature of episodic memories of the caregiver relationship history with parental figures were significantly associated with stress and criticism of their parent. Greater unconscious procedural knowledge of the secure base script was associated with caregiver report of less conflict and less involvement in the caregiving tasks. Potential clinical implications of this pattern are also discussed.

Family Involvement in Nursing Homes: Are Family Caregivers Getting What They Want?

The provision of person-centered care for nursing home residents with dementia suggests the need for family caregiver involvement. In this article, we argue that optimal family involvement differs by family caregiver and therefore depends on the degree to which family caregivers consider their own involvement to be important. In this Canadian study, we compare the importance that 135 family caregivers of residents with dementia place on 20 kinds of involvement with the degree to which they perceive opportunities for involvement. Family Involvement Congruence Scores are calculated in three ways: those for whom involvement is important, those for whom involvement is not important, and an overall congruence score. Congruence scores varied by involvement type. These scores show promise for use in future research on family caregiver involvement and as tools for use by facilities as they endeavor to meet family caregiver expectations for involvement.

End-of-life care communications and shared decision-making in Norwegian nursing homes--experiences and perspectives of patients and relatives

BACKGROUND

Involving nursing home patients and their relatives in end-of-life care conversations and treatment decisions has recently gained increased importance in several Western countries. However, there is little knowledge about how the patients themselves and their next-of-kin look upon involvement in end-of-life care decisions. The purpose of this paper is to explore nursing home patients' and next-of-kin's experiences with- and perspectives on end-of-life care conversations, information and shared decision-making.

METHODS

The study has a qualitative and explorative design, based on a combination of individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 33 relatives. The data was analysed applying a "bricolage" approach". Participation was based on informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics.

RESULTS

Few patients and relatives had participated in conversations about end-of-life care. Most relatives wanted such conversations, while the patients' opinions varied. With some exceptions, patients and relatives wanted to be informed about the patient's health condition. The majority wanted to be involved in the decision-making process, but leave the final decisions to the health professionals. Among the patients, the opinion varied; some patients wanted to leave the decisions more or less completely to the nursing home staff. Conversations about end-of-life care issues are emotionally challenging, and very few patients had discussed these questions with their family. The relatives' opinions of the patient's preferences were mainly based on assumptions; they had seldom talked about this explicitly. Both patients and relatives wanted the staff to raise these questions.

CONCLUSION

Nursing home staff should initiate conversations about preferences for end-of-life care, assisting patients and relatives in talking about these issues, while at the same time being sensitive to the diversity in opinions and the timing for such conversations. As the popularity of advance care planning increases in many Western countries, discussions of patients' and relatives' perspectives will be of great interest to a broader audience.

A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care

AIM

Involving people in decisions about their care is good practice and ensures optimal outcomes. Despite considerable research, in practice family involvement in decision making can be challenging for both care staff and families. The aim of this review was to identify and appraise existing knowledge about family involvement in decision making for people with dementia living in residential aged care.

METHODS

The present Joanna Briggs Institute meta-synthesis considered studies that investigate involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this article presents the qualitative findings. A comprehensive search of studies was conducted in 15 electronic databases. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as relevant for this review; 16 were qualitative papers reporting on 15 studies. Two independent reviewers assessed the studies for methodological validity and extracted the data using the standardized Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The findings were synthesized using JBI-QARI.

RESULTS

The findings related to the decisions encountered and made by family surrogates, family perceptions of, and preferences for, their role/s, factors regarding treatment decisions and the collaborative decision-making process, and outcomes for family decision makers.

CONCLUSION

Results indicate varied and complex experiences and multiple factors influencing decision making. Communication and contacts between staff and families and the support available for families should be addressed, as well as the role of different stakeholders in decisions.

Family caregiver strategies to encourage older relatives with dementia to use social services

AIM

To elicit the strategies used by Japanese family caregivers in the community to encourage older relatives with dementia to use adult daycare and respite stays.

BACKGROUND

Older adults with dementia often require adult daycare and respite stays for their family caregivers to gain respite from care-giving. However, persons with dementia often face difficulty in new environments and timely access to sufficient services may be difficult to achieve. Few studies have examined how family caregivers encourage their service use.

DESIGN

A qualitative method.

METHODS

Semi-structured interviews were conducted with 16 family caregivers who were caring for relatives with dementia at home between 2005-2007. Data were analysed qualitatively.

RESULTS

Family caregivers used various strategies to encourage older relatives to use services, allowing the older adult to decide whether to use the service, yearning and searching for the least harmful service, tailoring the service to the older adult, persuading the older adult to use the service, conforming the older adult to the service and coercing the older adult to use the service. Different strategies were used depending on factors such as desperation in needing respite, willingness to do what is best for the older adult, confidence in taking care of the older adult and the anticipated response of the older adult to services.

CONCLUSION

Nurses should carefully assess caregivers' strategies in their attempts to encourage service use and should provide adequate assistance in accordance with those strategies.

Staff–Family Relationships in Residential Aged Care Facilities

The aim of the study was to examine staff and family members’ perceptions of each other’s roles and responsibilities in the Australian residential aged care setting. Data was collected by interview and focus group from 27 staff and 14 family members at five residential aged care facilities in the state of Victoria, Australia. Findings highlight “communication” as the core category supporting the formation of constructive staff–family relationships, as described by three main themes; “building trust,” “involvement,” and “keeping the family happy.” Staff attitudes, mutual cooperation, meaningful engagement, and shared expectations lay the foundation for relationships. Findings suggest that further efforts to establish and sustain good relationships with families are required by facilities. Characteristics, roles, and expectations of staff and family that can both promote and hinder the formation of constructive staff–family relationships are discussed.

Caregivers' desired patterns of communication with nursing home staff- just TALKKK!

Individuals with cognitive impairment often represent a significant percentage of the residents in a nursing home nurse's care. With years of experience caring for their placed family members, caregivers of these residents are often experts in knowing the resident's needs, habits, behaviors, and moods. Caregivers often wish to convey this insider knowledge to nursing home staff. Furthermore, communication with caregivers promotes trust that personalized, safe, and effective care occurs when they are not there. Based on an interpretive study of the experiences of caregivers who place a family member with Alzheimer's disease in the nursing home, six preferred patterns of communication are presented in this article. The six patterns are represented by the acronym TALKKK (tell them; ask them; listen to them; know their family member by relating and communicating; be knowledgeable about dementia, its progression, dementia-specific care, and commonly used medications; and share that knowledge with them).

Informal caregivers of persons with dementia, their use of and needs for specific professional support: a survey of the National Dementia Programme

Background

This paper describes both the use of and needs for informal caregivers of people with dementia, based on a questionnaire survey organized within the National Dementia Programme in the Netherlands. The National Dementia Programme is a quality collaborative of the Dutch Alzheimer's Association, the Institute of Quality of Healthcare (CBO) and the Knowledge Centre on Ageing (Vilans), instigated by the Ministry of Health, Welfare and Sport, to improve integrated care for people with dementia and their informal caregivers. The support needs of informal caregivers are important to improve caregiver well-being and delaying institutionalization of the person with dementia.

Methods

In the period April 2006 - January 2007, the National Dementia Programme questionnaire was completed by 984 informal caregivers. Descriptive statistics were used to analyze the use of and needs for additional professional support by informal caregivers. Chi-square tests were used to assess the relationships between characteristics of the caregivers (spouses, sons/daughters, sons/daughters in-law) and support needs on one hand and to assess the relationship between the living situation of the person with dementia (living at home or living in a nursing home or home for the elderly) and support needs on the other hand.

Results

Almost all informal caregivers (92.6%) received some professional support. However, two thirds (67.4%) indicated they had one or more needs for additional professional support. Informal caregivers often need additional professional advice about what to do when their relative is frightened, angry of confused. Spouses reported different needs than sons or daughters (in-law): spouses relatively often need emotional support and sons or daughters (in-law) more often need information and coordination of dementia care.

Conclusions

Most of the informal caregivers report that they need additional information and advice, e.g. about how to cope with behavioral problems of their relative, about the progression of the illness trajectory, emotional support and coordination of dementia care. Future support programmes, e.g. in the field of case management, should address the specific needs of informal caregivers.