Care Assistants Research Articles

Exploring Dementia-Friendly Environments in Long-Term Care Facilities: Perspectives from Multiple Stakeholders in Portugal

Current evidence suggests the importance of dementia-friendly environments in enhancing the well-being and quality-of-life of people living with dementia, particularly when they need to move out, either permanently or temporarily, of their own homes (e.g., long-term care facilities or hospitals). As dementia-specific regulations are currently absent in Portugal, most long-term care facilities are not designed to meet the needs of persons living with dementia. Also, this topic has not been the focus of attention by policymakers and researchers in Portugal and there is no recent scientific literature useful for planning new responses for dementia. To address this need, this study examines stakeholders’ perspectives on dementia-friendly environments in Portuguese long-term care facilities. Five stakeholder groups participated, including people living with dementia, caregivers, clinical and non-clinical staff, and experts. Through focus groups and interviews, participants discussed elements of a dementia-friendly environment considering autonomy, independence, mobility, stimulation, orientation, socialization, safety, and care assistance. Thematic analysis identified ten categories, emphasizing indoor (e.g. architectural elements, privacy, ambience, socialization, and safety) and outdoor components (e.g. surroundings, social spaces, and safety). These findings highlight collaborative design’s significance in enhancing the lives of people living with dementia and caregivers, providing comprehensive insights into creating purposeful long-term care environments.

Intersectorality in a conditional cash transfer programme: Actors, convergences and conflicts.

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

Evaluation of the Impact of Oral Health on the Daily Activities of Users of the National Health System.

the integration of dentistry services in the Unified Health System in Brazil (SUS) is essential in primary care assistance. we aimed to develop a tool for improving demand flowby evaluating the impact of oral health on the daily activities of users of the Family Health Unitusing the Oral Impacts of Daily Performance (OIDP)tool. In Barretos, Brazil, a cross-sectional study was conducted at a Family Health Unit (FHU)including patients over 12 years old. Oral health impact was assessed using the Oral Impacts of Daily Performance (OIDP) tool, and family risk was measured with the Coelho-Savassi scale. 430 participants, including 411 adults and 19 young people, were recruited. Of the adults, 31% had an average OIDP score of 16.61. For young people, 53% reported an impact (average OIDP score: 28.61). Family risk (R1) was prevalent in 57.9% of young people and 53.3% of adults. Among adults, different activities were affected by risk: smiling without embarrassment (risk level 2), enjoying contact with people (risk level 3), and performing one's job or social role (risk level 1). Emotional state (R3) had the lowest OIDP score (p = 0.029). implementation of the OIDP scale in clinical practice enhances healthcare planning and ensures better-quality and equitable services, thus emphasizing comprehensive oral healthcare within the SUS.

Ongoing Peritoneal Dialysis Training at Home Allows for the Improvement of Patients' Empowerment: A Single Center Experience.

Peritoneal dialysis (PD), as a home treatment, ensures better patient autonomy and lower intrusiveness compared to hemodialysis. However, choosing PD comes with an increased burden of responsibility that the patient may not always be able to bear, due to advanced age and deteriorating health condition. Various approaches have been explored to address this issue and mitigate its primary complications. In this study, we aim to present the ongoing PD training at-home program implemented by the Vicenza PD Center, and evaluate its impact on patients' prognoses. We enrolled 210 patients who underwent PD at Vicenza Hospital between 1 January 2019 and 1 January 2022 for a minimum of 90 days. Each patient was observed retrospectively for one year. We categorized the patients into three groups based on their level of autonomy regarding their PD management: completely independent patients; patients able to perform some parts of the PD method on their own, while the remaining aspects were carried out by a caregiver; and patients who required complete assistance from a caregiver, like in the assisted PD program (asPD). A total of 70% of the PD population were autonomous regarding their PD therapy, 14% had an intermediate degree of autonomy, and 16% were entirely dependent on caregivers. The PD nurses performed a median of four home visits per patient per year, with a tendency to make more visits to patients with a lower degree of autonomy. All the groups achieved similar clinical outcomes. At the end of the year of observation, only 6% of the patients witnessed a decline in their autonomy level, whereas 7% demonstrated an enhancement in their level of autonomy, and 87% remained stable. A home care assistance program ensures clinical support to a household with the purpose of improving the empowerment of the PD population and reducing the prevalence of assisted PD. Ongoing PD training at home helps patients to maintain a stable degree of autonomy and stay in their home setting, even though they present with relative attitudinal or social barriers.

Easing the Burden on Caregivers- Applications of Artificial Intelligence for Physicians and Caregivers of Children with Cleft Lip and Palate.

Many caregivers of children with cleft lip and palate experience a high level of anxiety throughout their child's medical and surgical care. We aim to evaluate artificial intelligence (AI) as a tool to mitigate these feelings and can aid clinicians in the development of robust pediatric educational materials for caregivers and families. Thirteen of the most common postoperative questions following cleft lip and/or palate repair were developed by an expert panel of senior Pediatric Plastic Surgeons and were posed to ChatGPT. Professional answers from the expert panel were provided and compared to responses from ChatGPT. A literature review was also conducted to generate a new support model for caregivers with children undergoing a surgical procedure. Department of Pediatric Plastic Surgery at a metropolitan Children's Hospital. Senior Pediatric Plastic Surgeons at a metropolitan Children's Hospital. None. The primary outcome was to determine the ability of ChatGPT to respond to common postoperative questions and to develop a model for AI assistance in family-centered perioperative care. ChatGPT had a postoperative question response accuracy rate of 69% when compared with subject matter expert responses, with its greatest errors being information errors. An extensive literature search revealed that AI can assist in multiple traditional perioperative strategies to reduce caregivers and patient anxiety. Artificial Intelligence can help to reduce the burden of generating patient education materials as well as support caregivers in multiple aspects and perioperative care.

Circuito dos Cuidados Psicossociais: sistematização de intervenção na crise psíquica no atendimento pré-hospitalar móvel

An experience report that aims to present the systematization of care for the management of psychic crises developed by the SAMU-DF Mental Health Center. The methodology, based on the steps of the Maguerez’s Arch, allowed both the identification of professionals’ difficulties regarding psychic crises management and the construction of the system called “Psychosocial Care Circuit’’ to guide the assistance of the mobile pre-hospital care. The Circuit has as mnemonic AEIOU, and each letter corresponds to an element evaluated as necessary for the psychic crisis intervention. Therefore, it is possible to affirm that the permanent education in health enables the transformative action of professionals, in addition to transforming the reality in which they are inserted, and that the systematization has accelerated the consolidation of the necessary skills for psychic crises care.

Grasping the meaning of perinatal palliative care for the multiprofessional team.

To grasp the meaning of perinatal palliative care for the multidisciplinary team. This is a qualitative study guided by content analysis. The study included 56 health professionals working in maternal and child units of a public university hospital. A semi-structured interview was conducted, which was recorded and subsequently fully transcribed. The collection took place from June 2018 to May 2019. Data were entered and exported to Atlas ti: The Qualitative Date Analysis & Research Software, version 23.1.1.0. Four thematic categories emerged from the data analysis: palliative care and eligible public in the view of professionals; communication between family and team in decision-making; assistance in palliative care; humanized care. The professionals think of palliative care in Perinatology in a similar way and perceive the difficulties of communication with the family and decision-making. They agree that it is necessary to provide greater support to the family, and to provide comfort measures, either for the non-viable fetus or for the baby eligible for palliative care.

Percepciones y sentimientos de mujeres embarazadas con toxoplasmosis en seguimiento ambulatorio

Introduction: Toxoplasmosis persists as a neglected disease and poses a challenge to public health, especially due to the risk of vertical transmission, which can lead to countless biological complications for the newborn and to psychological and emotional repercussions for the mother. Objective: To understand the perceptions and feelings of pregnant women affected by toxoplasmosis undergoing outpatient follow-up. Materials and Methods: A qualitative and exploratory study developed with 12 women with gestational toxoplasmosis undergoing specialized outpatient follow-up in a municipality from the state of Paraná, Brazil. The data were collected through semi-structured individual interviews and subjected to content analysis, supported by descending hierarchical classification. Results: The pregnant women experienced situations ranging from diagnosis and treatment to preventing the disease in the child and family. These experiences generated fear, distress and uncertainty about the disease, which were not adequately addressed during prenatal assistance in primary care. However, the pregnant women emphasized the importance of the multiprofessional team at the secondary level in monitoring and health education. Discussion: Although the pregnant women felt confident about the treatment and its implications for the child's health, discovering the diagnosis impacted their everyday lives and those of their families, especially due to lack of reliable information about toxoplasmosis and to the absence of emotional support at the primary level. Conclusions: There was a temporary scenario of disinformation among these women, who were not properly guided and supported. However, the guidelines offered in secondary health care were essential for improving knowledge and practices in health.

Navigating late-stage dementia: A perspective from the Alzheimer's Association.

Alzheimer's disease (AD) is the most common cause of dementia, a general term for memory loss and decline in other cognitive abilities enough to interfere with daily life. AD accounts for 60% to 80% of dementia cases. The late stage of AD tends to be the shortest stage and, on average, lasts 1 to 2 years. As this stage of the condition progresses, it requires continuous intensive long-term care and around-the-clock intensive care. The Alzheimer's Association stands firm in its commitment to supporting individuals living with AD and other dementia, their care partners, and their health-care providers as they navigate treatment and care decisions across the continuum of the disease. This article is a direct response to recently published works that run counter to the Association's viewpoint. It outlines the Association's perspective on crucial factors for consideration during late-stage dementia care, including advanced directives, palliative care, nutrition, and legal considerations. It explores diverse perspectives from the field, differing from the Alzheimer's Association's stance. Last, it underscores resources available through the Alzheimer's Association, aiming to present a comprehensive perspective on late-stage care for support and assistance to all involved.

Human Body As Legal Phenomenon

The following research is devoted to the reasoning of the body as a legal phenomenon. After all, despite the fact that the body is ontologically the closest thing to us, from the legal point of view it is one of the most mysterious legal phenomena. In other words traditional jurisprudence usually divides all legal beings into subjects of law (the state, individuals and legal entities, the nation etc.) and objects of legal relations (estate, material evidence, objects of dispute, etc.). However the body cannot be identified within these criteria. On the one hand the body itself is not a subject of law. After all, purely disembodied, abstract entities, such as legal entities or the state, are subjects of law, sometimes without any material "embodiment". On the other hand purely corporeal existence does not guarantee legal personality, since, for example, the presence of a dead body as such indicates its absence. The similar conditions are fully reflected in the national legislation of Ukraine. Its analysis shows that the human body is not defined as an independent object of legal regulation and there is no corresponding legal regime. The most symptomatic manifestation of the total disregard for the legal issues of the body is the absence of a corresponding term even in special medical legislation regulating organ transplantation, health care and medical assistance. Therefore the phenomenon of the body currently remains outside the attention of lawyers. This leads to the lack of a conceptual reasoning of the body as a legal phenomenon and uncertainty of legal regulation of the human body as such. So it is worth to conclude that the phenomenon of the body needs to be comprehended from a philosophical and legal point of view. The result of such comprehension is the identification of the following ontological features of the body as a legal phenomenon: syncretism, liminality and intentionality of the body. This, in turn, creates certain grounds to assert that normativity is immanently present in the body, when the body itself is a hypothesis and disposition for others, and the impossibility of communication with it is a sanction. As a result the author concludes that the inviolability of the body should be enshrined in law and the relevant amendments should be made to the Civil and Criminal Codes of Ukraine.

Factors Associated with Good Birth Preparedness and Complication Readiness among Pregnant Women in Malang District, Indonesia

Indonesia has a high maternal mortality rate, despite the prevalence of antenatal care and delivery assistance by competent birth attendants. This study aims to identify factors associated with good Birth Preparedness and Complication Readiness (BPACR) among pregnant women in Malang District. An observational study with a cross-sectional design was conducted, involving 60 pregnant women. Factors examined include socioeconomics, cultural beliefs, obstetric characteristics, and knowledge of BPACR. The participants had a mean age of 26.3 years and a mean gestational age of 26.4 weeks; 51.5% were in their second pregnancy, 53.3% had completed high school or higher education, and 83.3% were housewives. Additionally, 50% reported cultural beliefs or prohibitions against certain activities that could impede labor, while 51.7% adhered to food taboos perceived to affect labor. Of the participants, 91.7% had a Maternal and Child Health (MCH) handbook, 31.7% had read the entire handbook, and 21.7% were aware of at least two danger signs during pregnancy, childbirth, and the postpartum period. Good BPACR was defined as meeting at least three of four criteria, namely identifying a competent birth attendant, choosing a health facility for delivery, saving funds, and arranging transport. Reading the entire MCH handbook (aOR: 7.225) and holding certain cultural beliefs or prohibitions (aOR: 6.359) were significantly associated with good BPACR. These beliefs reflect a positive attitude toward recognizing obstetric danger signs.

Identification of formation mechanism and key elements of quality geriatric care behavior of nursing assistants in nursing homes: a grounded theory study.

This study aimed to identify the key elements and develop a formation mechanism model of quality geriatric care behavior for nursing assistants. This qualitative research employed the strategy of grounded theory proposed by Strauss and Corbin. Furthermore, the data was collected by participatory observation and semi-structured interviews. A total of 12 nursing managers, 63 nursing assistants, and 36 older people from 9 nursing homes in 6 cities were interviewed, whereas for the observatory survey, participants were recruited from 2 nursing homes. The comparative and analysis process revealed 5 key elements of quality geriatric care behavior, including holistic care, personalized care, respect, positive interaction, and empowerment. Based on the Capability-Opportunity-Motivation-Behavior (COM-B) model, key elements and the 3 stages of quality geriatric care behavior (negative behavior cognition stage, practice exchange run-in stage, and positive behavior reinforcement stage), the theoretical framework of the formation mechanism was established. The results indicated that nursing assistants' capabilities, motivation, and organizational and environmental support are vital for quality care behaviors. The theoretical framework established in this study provides theoretical support and practical reference to policymakers, institutional administrators, and healthcare professionals for improving nursing assistant's care behaviors.

Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model

ObjectivesThis study aimed to evaluate the prospective cost-effectiveness of the Identification and Referral to Improve Safety plus (IRIS+) intervention compared with usual care using feasibility data derived from seven UK...

Short Communication on Improving the Sociological, Mental, and Somatic Health Comprising Cases Study: Overview on Seminar Women [Through the Aging Process - The Next Frontiers towards Gender Equality, San Diego, US - January 2024

This short communication provides a descriptive analysis of the seminar titled Women through the Aging Process - The Next Frontiers towards Gender Equality & quot; held in San Diego in January 2024. The seminar aimed to address the sociological, mental, and somatic health issues faced by women as they age and explore strategies for improving gender equality in this context. Key topics discussed included the importance of preventive and curative measures, inclusion of older women in the social community, gender-specific caregiving roles, emotional support and personal care assistance, health advocacy and social engagement, education and training for caregivers, and developing specialized programs for aging women. The seminar emphasized the need to respect autonomy and choice while ensuring the safety and well-being of aging women. In conclusion, the seminar provided valuable insights and recommendations for promoting gender equality in the aging process.

Clinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort.

To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility. This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score. A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance. Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.

Stakeholder Perspectives on Implementation of Continuous Care by Maternity Care Assistants During Labor in The Netherlands

Stakeholder Perspectives on Implementation of Continuous Care by Maternity Care Assistants During Labor in The Netherlands

Awareness of Dementia Care Amongst the Staff Working at Day-care Centers and Nursing Homes in Macao.

The staff working at day-care centers and nursing homes are in a key frontline for early detection of older people living with dementia, however, whether the staff were well prepared and if they were appropriately trained were still little known. A cross-sectional survey was conducted and the validated questionnaires exploring the awareness of dementia care, in terms of knowledge, attitude and preventive practice domain, were given to the staff working at day-care centers and nursing homes in Macao. 272 samples were approached and scores of knowledge was 76.23 ± 19.62, attitude was 80.05 ± 8.92 and preventive practice was 75.59 ± 13.88, among which knowledge and preventive practice were positively related to attitude, and knowledge, attitude and preventive practice were negatively related to age. Health care assistants' knowledge were less than social workers, managers, health professionals and clerk. Attitude of health care assistants were less positive than social workers and health professionals. Health care assistants and older staff had less knowledge and less positive attitude. Trainings to improve knowledge, attitude and preventive practice amongst health care assistants and older staff were recommended strongly.

Spiritual Care in Hong Kong Home Care Nursing

Florence Nightingale Home Health & Nursing (FNHHN) was founded by a group of experienced nurses in Hong Kong in the year of 2020 with a strong intention to provide holistic nursing care to the elderly at home apart from assisted care required with the following identified values.

Prevalence Rates of Diabetic Retinopathy and Undiagnosed Diabetes Among Delaware Nursing Home and Assisted Living Facility Residents.

Objectives: To determine the prevalence of diabetic retinopathy and undiagnosed diabetes among Delaware nursing home and assisted care facility residents. Methods: This cross-sectional study involved the statistical analysis of comprehensive eye examination records of 2,063 nursing home residents residing in 18 facilities and 4 assisted living facilities in Delaware from 2005 to 2009. Descriptive statistical analyses were conducted to identify the rates of retinal dot and blot hemorrhages and existing systemic diabetes diagnoses. Results: The mean age of nursing home and assisted care facility residents was 77 years (range 9-104), and 64.4% were over the age of 80. Most residents were female (61.1%) and white (72.5%). 3.6% of the 2,063 nursing home residents had blot or dot hemorrhages in one or both eyes. 32.8% had a type 1 or type 2 diabetes diagnosis. Of the ones with a positive dot and blot hemorrhage finding, 56.8% had a diagnosis of diabetes, and 43.2% did not. Discussion: There was a high prevalence of dot and blot hemorrhages without a systemic diagnosis of diabetes, indicating a need for regular eye care among residents.

Moral Distress Healthcare Providers in Spain: Observational Study.

To evaluate the moral distress (MD)in health professionals of pediatric and adult units to show how the complexity of care in the pediatric field causes the professionals who carry out their activity in these units to present a higher level of moral distress and a worse climate ethical. Observational study with health professionals who currently work in Spanish Hospitals. A 58-item questionnaire was electronically distributed which included sociodemographic and employment characteristics, the Spanish version of the Measure of Moral Unrest for Healthcare Professionals (MMD-HP-SPA) and the Hospital Ethical Climate Survey (HECS). A total of 169 health professionals completed the questionnaire. The moral distress was significantly higher among nurses than among physicians and nursing assistant care technicians. Focusing on the type of unit, moral distress it was only significantly higher for those physicians treating adult patients compared to those treating pediatric patients. Regarding the total score of the HECS survey, the medical group shows higher scores compared to the nursing group. Statistically significant differences have been found only in the medical group that treats adult patients, presenting a higher level of moral unrests than the pediatrician group. The MMD-HP-SPA questionnaire is a valid and useful instrument to detect MD in our hospital units in order to be able to implement strategies/interventions that improve the ethical climate and other factors that can mitigate and prevent this MD.