Home Care Research Articles

Changing Trends in Job Satisfaction and Burnout for Care Aides in Long-Term Care Homes: The Role of Work Environment

ObjectivesThis study examined the association between care unit work environments in long-term care (LTC) homes and trends in care aides’ job satisfaction and burnout (exhaustion, cynicism, reduced professional efficacy) from 2014 to early 2020. DesignThis was a retrospective longitudinal study using data from care aide surveys collected by the Translating Research in Elder Care research program over 3 periods: September 2014–May 2015 (T1), May 2017–December 2017 (T2), and September 2019–March 2020 (T3). Settings and ParticipantsThe study included 631 care aides from a stratified random sample of 84 LTC homes in 3 Canadian provinces, who participated in data collection at all 3 time points. MethodsWe used mixed-effects linear regression with a “time by work environment” interaction to assess whether work environment is associated with trends in job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale) and burnout (Maslach Burnout Inventory-General Survey). We standardized the outcomes using z-scores. ResultsBetween T1 and T2, care aides in care units with less favorable work environments—characterized by less supportive leadership, weaker work culture, less effective team communication and feedback mechanisms, and insufficient structural resources and staffing—experienced a statistically significant decline in job satisfaction (B = −0.17, P < .01) and professional efficacy (B = −0.20, P < .01), along with an increase in exhaustion (B = 0.15, P < .05) and in cynicism (B = 0.27, P < .001). Those in more favorable work environments exhibited no statistically significant changes in these variables during the same period. Moreover, care aides in less favorable work environments continued to experience an increase in exhaustion from T2 to T3 (B = 0.16, P < .05). Conclusions and ImplicationsA positive work environment at the care unit level mitigated the deterioration in care aides’ job satisfaction and burnout over the period studied. Targeted interventions to improve work environments show promise in sustaining the resilience of the care aide workforce.

Effects of one-to-one music therapy in older adults with cognitive impairment: A randomized controlled trial.

This study investigated the effects of music therapy (MT), a nonpharmacological therapy, on cognitive, behavioral, and physiological outcomes in older adults with mild-to-moderate cognitive decline residing in care home settings. A randomized controlled trial design was employed, with 42 care home residents (Mage = 86.25 years) randomly assigned to either a one-to-one 16-week MT intervention or an active control group receiving storytelling. Experimental and control activities were matched on key aspects, and groups were equivalent at baseline concerning demographic factors, general health, cognitive-behavioral characteristics, and cognitive reserve levels. Pre/postintervention neuropsychological and behavioral measures were collected, alongside saliva samples for cortisol/dehydroepiandrosterone ratio and respiratory sinus arrhythmia analysis as indicators of overall stress and autonomic regulation. The MT group exhibited benefits in cognitive, behavioral, and physiological domains, suggesting potential advantages in maintaining cognitive functioning and reducing neuropsychiatric symptoms. Biomarkers indicated possible mechanisms underlying the effectiveness of MT. The 16 one-to-one interactive MT sessions-delivered over 5 months-had a positive impact on older adults with mild-to-moderate cognitive decline living in care home settings. The implications of these findings for healthy aging and suggestions for future research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Management of malignant pleural effusions and drainage care: a hospital in the home and palliative care service

Management of malignant pleural effusions and drainage care: a hospital in the home and palliative care service

Protective environment strategies for hematopoietic stem cell transplantation: progress and prospects.

With the progress of hematopoietic stem cell transplantation technology, the reduction of pretreatment intensity, the shortening of bone marrow suppression time and the reduction of infection risk, as well as the prominent physical and psychological stress for doctors and patients caused by rigorous protection procedures, the strategies for protective environment need to be reconsidered. Regardless of whether total environment protection is implemented, there is no significant difference in the outcomes of chemotherapy patients with neutropenia. The advantages and disadvantages of total environment protection have been weighed and reviewed for patients receiving hematopoietic stem cell transplantation. The protective environment strategies for hematopoietic stem cell transplantation patients have developed rapidly in the past two decades, from the initial replacement of laminar flow equipment by high-efficiency filtration devices to the development of home care after transplantation. In this article, the progress of protective environment strategies for hematopoietic stem cell transplantation patient was reviewed, and further reflections were posed, providing reference for future improvement.

Care-related Case Management and the experienced burden of informal caregivers: empirical study

Care-related Case Management and the experienced burden of informal caregivers: empirical study Abstract. Background: Informal caregivers are responsible for the majority of home care in Germany. Their experience of stress is becoming more and more relevant given the tense staffing situation in outpatient professional care in rural areas. Case management as an innovative approach to caring in peripheral areas also focuses on the burden experienced by informal caregivers. Aim: The question arises as to whether care-related case management can have a positive influence on the burden experienced by informal caregivers. Methods: In a mixed-method approach, the influence of case management on the experience of stress is analyzed quantitatively (N = 251) and qualitatively (N = 40) using a pre-post design with a control group. Group difference tests based on the HPS-scale and content analysis of the interviews are conducted. Results: The analyses suggest that case management can have a positive influence on the experience of burden. From a quantitative perspective, there was a stabilizing influence on the experience of burden in the intervention group, while burden increased in the control group. Qualitatively, there was an influence on subjective burden. In particular, the role of the case manager as a central contact person in matters regarding the care situation is relevant. Conclusions: By providing new resources and coping strategies, case management can effectively alleviate the burden experienced by informal caregivers.

Assesment of anxiety and depression in pregnant women in home care management

This study aims to identify factors associated with depressive and anxious symptomatology in pregnant women hospitalized during the antepartum period in home care management (Hospitalisation à domicile). This is a quantitative, single-center, observational, and descriptive study that included all French-speaking women hospitalized in the HAD of AP-HP between September 2022 and February 2023. Anxious and depressive symptoms were assessed using the self-administered HADS (Hospital Anxiety and Depression Scale) questionnaire. Analyses were conducted according to two distinct groups, comparing patients with an anxiety or depression scores below 8 on the HADS to those with a score of 8 or above (the threshold set on the questionnaire corresponding to intermediate symptomatology). A second questionnaire created for the study detailed maternal history, pregnancy experience, and lifestyle. A total of sixty-four women were included from September 20, 2022, to February 15, 2023. Eighteen women (28%) evaluated had anxious symptomatology and thirteen women (20%) had depressive symptomatology. Factors significantly associated with anxiety were poor pregnancy experience (p = 0.04), the need for psychological follow-up during pregnancy (p<0,01), country of birth (p = 0.022), as well as psychiatric history such as previous consultations with a mental health specialist (p = 0.015) and previous psychotropic treatment (p = 0.028). Additionally, a history of violence (respectively, p = 0.034 and p<0.01) and the women's belief that a consultation with a psychologist would benefit them were also associated with anxious and depressive symptomatology (respectively, p<0,01 and p <0.01) Conclusion: Our results highlight the importance and necessity of enhancing the screening and prevention of various mental disorders during pregnancy. It would be interesting to implement organized screening for anxiety, similar to depression, in pregnant women hospitalized at home and for the entire obstetric population.

Surrogate-based approach of predicting and optimising building performance by integrating daylighting, thermal comfort, and costs - A case study of community care homes

Surrogate-based approach of predicting and optimising building performance by integrating daylighting, thermal comfort, and costs - A case study of community care homes

How aged care home staff and health care professionals understand the Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE tool)? A cognitive interview study

IntroductionHigh use of psychotropic medications continues to be common in residential aged care homes despite the risk of harm and limited efficacy in people living with dementia. Research has shown that the organizational culture of aged care homes influences psychotropic medication use in residents with dementia. The PRACTICE (Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence) tool was developed to evaluate the organizational culture of aged care homes specific to the use of psychotropic medications. ObjectivesTo evaluate the comprehensibility, relevance, and comprehensiveness of the PRACTICE tool among end-users. MethodCognitive interviews were conducted with participants representing a broad range of health disciplines across Australia. Interviews were performed using a combination of the think-aloud technique and verbal probing. Interviews were transcribed and content coded for participants’ perceptions of the PRACTICE tool. Items were modified based on findings from the cognitive interviews, participants’ suggestions for rewording of items and discussions with the research team. ResultsA total of 20 cognitive interviews were conducted. Based on the cognitive interviews, 48 out of 63 items were modified. Reasons for modification were categorized into three themes: 1) Items changed to align with the aged care home staff’s scope of practice; 2) Items adjusted to prevent unintended blame from reading the items; and 3) Items modified to prevent potential misinterpretation of their intended meaning. Three items were added to improve the comprehensiveness of the tool. Most participants reported that they understood the items and considered them as relevant and acceptable for the evaluation of organizational culture and use of psychotropic medication in aged care homes. ConclusionThis study confirms that the PRACTICE tool is a comprehensive tool appropriate for the assessment of organizational culture specific to psychotropic medication use and is important for aged care settings.

Temporomandibular Disorders in Children and Adolescents

Temporomandibular disorder (TMD) is characterized by pain, dysfunction, and distress in the masticatory muscles and/or temporomandibular joints and associated structures. Despite its high prevalence in children and adolescents, exceeding 20%, TMD has not been extensively studied. Therefore, this review aimed to establish an overview of TMD in children and adolescents and describe its diagnosis and treatment. TMD more predominantly occurs in girls and has multifactorial etiologies, with several risk factors interacting differently at the individual level. TMD is associated with poor oral health-related quality of life and abnormal facial growth. The Diagnostic Criteria for TMD (DC/TMD) assessment protocol is used to diagnose TMD in young patients, and TMD can be effectively managed with conservative therapies such as patient education, home care, physical therapy, occlusal appliance therapy, and pharmacotherapy. During routine dental checkups, pediatric dentists can identify TMD in children and adolescents to reduce the occurrence of complications due to its chronic progression.

An analysis of the efffects of the income level of the family caregivers for the recipients using LTC home care services on the willingness to pay : A cross-sectional study

Purpose: This study aimed to determine how income level affects the willingness to pay out-of-pocket payments for those who bear the cost of home care services to use better services. Method: We analyzed data from 1,189 family caregivers who used home care services in the Co-payment for LTC Insurance in 2021. The Chi-square and Cochran-Mantel-haenszel tests was conducted to confirm the relationship between the family caregiver’s income level and willingness to pay out-of-pocket payments. The logistic regression analysis was performed to analyze the effect of income level on willingness to pay. Result: We found that 58.6% of family caregivers in home care services were willing to pay out-of-pocket payments for better long-term care service. After adjusting home care benefit types, the higher the family caregivers’ income level , the higher the willingness to pay additional out-of-pocket payments(p&lt;.001). In addition, as family caregivers’ income level increased, the odds ratio of the willingness to pay additional payments tended to increase(p&lt;.001). Conclusion: Family caregivers who are responsible for the payment of home care services by recipients are willing to pay additional out-of-pocket payments for better service use by recipients. We found that the higher the income level, the higher the willingness to pay. It is necessary to consider the additional cost sharing along with introducing the new home care services and improving the quality of home care services.

THE INFLUENCE OF SELF-CARE NURSING THEORY DEVELOPMENT IN PRENATAL HOME CARE SERVICES WITH HEALTH EDUCATION AND GIVING OF DATES PALM JUICE TOWARD ANEMIA CASE

Indonesia has the fourth-highest anemia rate in Southeast Asia, at 30%. Prenatal home care nurses can manage anemia using a self-care approach that includes giving dates juice and health education. The purpose of this study was to determine the effect of developing self-care nursing theory in prenatal home care services with health education and the provision of date palm juice on anemia at the Batujajar Public Health Center assisted area. This study method is a pre-experiment with a one-group pre and post-test without a control group design. The sample studied was 20 people using a purposive sampling technique using the marginal homogeneity and Wilcoxon statistical tests. The results of the study with the Marginal Homogeneity test obtained p-value = 0.001 &lt; α (0.05), and the Wilcoxon test results obtained the result ρ = 0.000 &lt; α (0.05). This study concludes that the development of self-care nursing theory in antenatal home care services, along with health education and giving date palm juice to anemia cases at Batujajar Health Center assisted area, influences it. This study is expected to be the basis for the method of developing self-care nursing theory in providing health education and interventions to overcome anemia, especially in pregnant women.Keywords: Anemia, dates palm juice, health education, self care nursing theory.

Exploring communication challenges in dementia care: Insights from home healthcare nurses

ObjectivesCare for people living with dementia predominantly takes place at home and is often characterized by multiple hospitalizations throughout the lengthy disease trajectory. Care transitions from the hospital often involve home health care. The purpose of this study was to explore communication challenges experienced by home health nurses to inform communication training needs for home-based dementia care. MethodsSeven audio-recorded focus group discussions were held with home health nurses (n = 31) from a large home care agency serving rural and urban counties. Focus group transcripts were thematically analyzed. ResultsWe identified the following themes highlighting communication challenges for home health nurses: addressing potential risk for harm or injury, patient vulnerability, care partner needs, shifting decision-making to surrogate, and discrepancy in home health goals and family needs. These themes identified specific care transition conversation topics and communication content imperative for dementia-specific staff training. ConclusionsTopics for communication skills training to improve person-centered dementia care were identified. These findings inform the future development of a home health staff communication curriculum for dementia care. Advanced communication skills are necessary to ensure these conversations take place and are engaged with sensitivity. Practice implicationsOur study informs the development of communication training on key communication topics in nurse-delivered and home healthcare interventions aimed at improving dementia care.

자립준비청년의 자립 경험에 대한 국내 연구동향

This study aims to examine trends in the Korean literature on the experiences of young adults who aged out of the child welfare system. We analyzed 86 studies including 56 peer-reviewed journal articles and 30 master's theses and dissertations published up to August 2024. The first related study appeared in 2002, and about 55% of the studies were published in the past five years. The term referring to the young adults varied in the literature, but the official term “youth preparing for independence” has been used since the policy announcement in 2021. Most studies focused on leaving out of foster care facilities, followed by foster care homes and group homes. In terms of research methods, more qualitative studies were published than quantitative studies.. In-depth interviews were the most commonly used method of data collection in qualitative research, and other methods such as focus group interviews and qualitative meta-analysis were also used. In quantitative research, both primary and secondary data were commonly used. We classified the topics of research into seven themes: independent living, emotions, relationships, support services, career paths, employment, and health. We suggest that future research focus on specific topics in more depth, converge research across academic disciplines, and attempt to diversify research methods.

(+)-Nootkatone, the flavor of grapefruit

Nootkatone is one of the most valuable citrus flavors. Originally isolated from the heartwood of the Nootka cypress (Callitropsis nootkatensis), it was probably the identification of nootkatone as a minor component of grapefruit oil that catapulted this sesquiterpene into the focus of flavor research and made it a highly sought-after citrus aroma in recent decades. The odors of ( +)-nootkatone and (−)-nootkatone are perceptible in the air at threshold concentrations of 30 ppm and 66,000 ppm of saturated vapor, respectively. While ( +)-nootkatone embodies a strong grapefruit scent and has a bitter taste, (−)-nootkatone has a faint woody vetiver note and is virtually tasteless. In 2020, nootkatone was registered by the US Environmental Protection Agency as an insect repellent and natural insecticide that may repel and kill mosquitoes, fleas, ticks, mites, lice, and termites. Moreover, numerous pharmacological activities of nootkatone have been thoroughly investigated. As expected, a wealth of synthetic approaches, which are essentially based on the oxidation of valencene and on total syntheses, have been published in the last 60 years since its discovery. However, in addition to extraction from natural sources (e.g., grapefruit peel), the enzymatic oxidation of valencene and fermentative processes are the preferred production technologies today. The market is expected to grow considerably over the next 10 years, not least owing to the wide range of potential applications in the pharmaceutical, personal, and home care sector.How the reader may benefit: learn more about the total synthesis of natural products, allylic oxidation, and Robinson annulation, gain deeper insights into the biosynthesis of sesquiterpenes and finally discover how enantiopure compounds, such as ( +)-nootkatone, are produced at an industrial scale.Graphical

The role of therapeutic recreation in long-term care culture change: a comparative case study from Alberta, Canada

ABSTRACT Historically, long-term care (LTC) homes have operated under a biomedical model, with a fairly institutional atmosphere. The culture change movement has challenged this approach, advocating for person-centred care and more homelike environments. We conducted a multi-site comparative case study at three rural LTC homes to examine the role therapeutic recreation (TR) services play in contributing to culture change and in creating a homelike environment in LTC. Three factors emerged that enabled TR staff to actively contribute to LTC culture change: 1) prioritizing the value of leisure experiences for improved quality of life, 2) being valued, supported, and empowered by management, and 3) being welcomed as essential and collaborative members of the care team. We discuss the implications of these findings and conclude with several recommendations for how LTC homes can better utilize TR services to improve quality of life and advance the aims of the culture change movement.

The Challenge of Actualising Research in Practice: Implementing the Charter of Lifelong Rights in Childhood Recordkeeping in Out of Home Care

This paper addresses the challenges encountered when actualising research in practice, using the implementation of the Charter of Lifelong Rights in Childhood Recordkeeping in Out of Home Care as an illustrative example. We begin with overviews of the recordkeeping failures of the past and present, and the development of the Charter to address them. We imagine transformed recordkeeping and archiving systems engaging children, young people and Care leavers as creators and decision-makers about their records. We identify challenges and barriers to implementation and discuss the strategies designed to engage major stakeholders in implementing the Charter. The paper concludes by challenging recordkeeping regulators, recordkeeping and archival institutions, current records creators and holders, and the recordkeeping and archival profession to play their essential role in enabling the realisation of this goal and identify the broader relevance of reconceptualising person-centric recordkeeping.

The CURTAIN feasibility study: Exploring a food-themed reminiscence theatre intervention to improve the nutrition of older adults living in residential care homes

Reminiscence theatre (RT), an applied drama technique, is an effective tool for improving health-related outcomes for older adults in clinical settings. However, no research has explored the potential for a food-themed RT intervention to improve the nutrition, health and wellbeing of this population. Therefore, the current study explored the feasibility and acceptability of such an intervention – the CURTAIN intervention – in residential care-homes. Two care-homes, their residents and staff were recruited to a cluster randomised crossover feasibility study with post-hoc interviews. Over two months, participants (n = 42) took part in the CURTAIN activity and a control activity before consuming their lunch, with momentary hunger, activity/meal enjoyment, and food intake measured around each activity. Continuation to a full-scale trial was assessed against progression criteria for data-collection-sheet completion and residents' enjoyment of the intervention. The intervention was highly enjoyed by residents (median score = 8/10), with only 1% of data-collection cells blank. Attrition rate was 5% and preliminary data suggest CURTAIN has the potential to improve residents’ appetite and energy intake. Aspects of evaluation design and recruitment strategy to optimise sample diversity require some amendments; however, overall, the CURTAIN intervention is feasible and acceptable to care-home residents and staff, and a full intervention evaluation is warranted.

A qualitative study on the experiences of caregivers of children undergoing surgery for congenital heart diseases

ObjectiveThis study explores the experiences of caregivers of pediatric cardiac surgery patients, aiming to deepen understanding of their role and improve the caregiving process. MethodsA qualitative, phenomenological approach was employed using individual, semi-structured interviews with a heterogeneous sample of caregivers (both mothers and fathers) of children who had undergone surgery for congenital heart disease. Interviews were conducted face-to-face from June 2023 to May 2024, following Creswell's interview techniques. Data collection and analysis were performed simultaneously using MAXQDA software. ResultsParticipants included caregivers of children aged 2 months to 17 years, with caregivers themselves aged 25 to 50 years. Most children had undergone surgery for congenital heart valve disease, with surgeries ranging from one to three. Three main themes and nine sub-themes were identified: (1) “Comprehensive health journey” described caregivers' experiences from diagnosis through treatment and their interactions with healthcare professionals; (2) “Challenges” encompassed social isolation, financial strain, work-life balance issues, and the impact on the education process; and (3) “Uncertainty” captured caregivers' anxiety about the future and concerns regarding home care. ConclusionThe findings offer valuable insights into the challenges and needs of caregivers in the pediatric cardiac surgery context, highlighting areas where support services and interventions could be beneficial. Implications to practiceThe study emphasizes the importance of healthcare professionals providing caregivers with clear information and empathetic support, which can enhance both caregiver well-being and patient outcomes.

Palliative Home Care Based on Clinically Relevant Scientific Measures: A Cross-Sectional Study.

Introduction: Measuring palliative care needs of patients with multiple complex illnesses and their family, is essential for providing quality clinical care. The integrated palliative care outcome scale (IPOS) is a scientifically verified measure of patients' physical, emotional symptoms, and their palliative care communication and practical needs. The patients in this study require palliative care due to both their end-of-life heart failure (HF) and vascular dementia. Purpose: The purposes are to describe and compare home palliative care needs measured by the family caregivers (N = 20) and patients (N = 20) IPOS scores and to examine whether the patient IPOS total score can predict patient HF health status and caregiving burden scores. Methods: This study uses explanatory research design with rigorous methods for obtaining information from multiple sources. Descriptive, Cohen's Kappa (k) statistics comparing patient and caregiver IPOS scores and regression analyses to examine the patient IPOS scores impact on patient HF health status and caregiving burden scores were used. Results: There was significant agreement between patient and caregiver ratings on 16 out of 17 IPOS items (k = .34 to .80). Regression analyses found that the patient IPOS total score significantly predicted patients' HF health status (β = -.50, P < .05), and caregiving burden scores (β = .57, P < .01). Conclusion: Patients' and their caregivers' IPOS scores agreement indicates palliative care needs can be consistently identified. The patient IPOS total scores can predict patients' HF health status and caregiving burden. These measures provide information directly applicable for health professionals guiding palliative home care.

A comprehensive experience-based framework of actionable priorities to enhance Canada’s health and social care system: discussions with older persons, clinicians, managers, and decision-makers using nominal group technique

BackgroundExisting frameworks of older persons’ experiences in health and social care systems are usually based on single stakeholder perspectives and focused on limited aspects that are independent from one another. This study aimed to describe such experiences from the perspective of diverse stakeholders and develop a comprehensive experience-based framework for actionable priorities to enhance Canada’s health and social care system.MethodsWe adapted a nominal group technique with a qualitative approach. We formed four groups of stakeholders (4 older persons, 7 clinicians, 5 managers, 4 decision-makers) in the province of Quebec. First, participants individually completed a questionnaire to rank the six domains of an international set of metrics of quality of care for older persons in terms of their importance. Then, we conducted a remote discussion with each stakeholder group, obtained consensus on the priority domains, and explored personal/professional experiences explaining prioritization processes and what changes are needed. An inductive-deductive thematic analysis was conducted to develop a framework for actionable health and social care priorities.ResultsThe framework included six key categories revolving around a core category of ‘health equity’. (1) ‘Access to services and care’ focused on improved accessibility of healthcare navigators, primary and home care services, and end-of life care. (2) ‘Respect for older persons’ involved individuality and uniqueness, daily needs, advocacy in defence of vulnerability, and decision-making valuing care preferences. (3) ‘Involvement of family and friends’ encompassed formal recognition, responsibilities, and trajectories associated with caregiving. (4) ‘Communication and education’ consisted of adaptive communication between older persons, caregivers, and professionals and societal-level education and awareness-raising. (5) ‘Coordination and integration of care’ comprised health and social services organization, cross-sectoral approaches, and interdisciplinary collaboration. (6) ‘Responsiveness to evolving needs’ of older persons involved timely response to health transitions and promoting holistic approaches.ConclusionsThis study illustrates the complex challenges of caring for older persons. The framework suggests several areas for improvement in care practices and policies for older persons and caregivers. Proposed intervention targets include public healthcare system navigators, standardized goals of care practices respecting persons’ wishes, formal recognition of caregiver contributions, society-level education, cross-sectoral initiatives, and holistic approaches.