Caregiving Staff Research Articles

Assessment of the acoustic environments in dementia care units: a case study

Dementia patients represent a particularly vulnerable group of people that are easily affected by their surroundings. Minor disturbances can lead to challenging behavior for the caregiving staff. Sensory stimulation is a critical factor in the treatment of these patients. At the same time, there is a challenge associated with it overstimulation as this can lead to social isolation, known as a factor that increases the risk of developing a dementia diagnosis. Therefore, a tailored sound environments is important to promote an inclusive environment for the patients to increase their well being and life quality. This study aims to discover the acoustical conditions at dementia care units in two hospitals, examine the impact of acoustic environment on patients and provide feedback about the existing standards and regulations for such buildings. In-depth interviews and measurements are combined to conduct both qualitative and quantitative feedback from the actual environment and users. The results can be used to develop acoustical design criteria for dementia units in the future.

Pilot study of the effectiveness and acceptability of an automatic toothbrush among residents in long-term care.

Reduced mobility and/or low cognitive functioning may make it difficult for residents with special care needs in long-term care homes to brush their own teeth every day. Demands on caregiving staff in these homes may also result in skipping essential toothbrushing tasks, resulting in poor oral health. This article provides the results of a 6-week pilot study that tested the effectiveness and acceptability of the Willo automatic toothbrush "robot" used among residents in long-term care compared to their regular toothbrush. Using a non-randomized delayed-start design with a convenience sample (age 38-82 years, mean=66.9), each study participant underwent biofilm assessments at three timepoints: (1) baseline as the study began (mean=2.33), (2) after using their regular toothbrush daily for 3weeks (mean=2.21), and (3) after using the Willo automatic toothbrush daily for 3weeks (mean=0.31). Using t-tests and repeated measures ANOVA, the Willo was significantly more effective than regular toothbrushing at reducing biofilm (p=.00004) and gingivitis (p=.002) over time. Participants also responded to brief weekly satisfaction surveys about their experiences using the two different brushes. The Willo was generally tolerated among participants, who largely reported that the brush was easy to use, not uncomfortable, and did not cause pain or bleeding. While approximately half of the study participants reported liking the Willo, the remainder did not want to replace their regular brush with the Willo, for a variety of reasons. We recommend more research on the effectiveness and acceptability of automatic toothbrushes with long-term care residents, caregivers, and others who may benefit from their use.

Dental care of disabled people: Descriptive cross-sectional study of social and medico-social establishments

The first objective of this study, concerning the intervention of a dentist in social and medico-social establishments (SMSE), was to diagnose the oral care needs of disabled people (DP). The second objective was to raise awareness of a prevention and follow-up protocol among caregiving staff. We carried out this descriptive cross-sectional study from October 2016 to October 2018, in twenty SMSEs in Essonne. It involved a cohort of 663 volunteer DP, i.e., over 81 percent of the DP accommodated in these establishments. We analyzed DP’s oral hygiene and health indicators, as well as changes in professional practices following simulation workshops, using Pearson’s Chi-square test and Cramer’s test to assess the existence of relationships between variables and their intensity, respectively. Of the 96 percent of DP who accepted a full screening, three-quarters had dental plaque and two-thirds had gingival inflammation, these pathologies being more frequent in the over-20s (p< 0.001 | Cramer’s V=0.26). Only 14 percent had good oral health. Six months later, seventeen SMSEs had recorded dental check-ups in their medical records, and eight SMSEs had introduced brushing after dinner and breakfast, compared with ten and seven respectively before the intervention. This study confirmed the need for SMSEs to carry out dental screening. The involvement of establishments in monitoring the oral hygiene of DP must be strengthened.

From 65 to 103, Older Adults Experience Virtual Reality Differently Depending on Their Age: Evidence from a Large-Scale Field Study in Nursing Homes and Assisted Living Facilities.

There is growing interest in applications of virtual reality (VR) to improve the lives of older adults, but the limited research on older adults and VR largely treats older adults as a monolith, ignoring the substantial differences across 65 to 100+ year olds that may affect their experience of VR. There are also few existing studies examining the experiences and challenges facing those who facilitate VR for older adults (e.g., caregiving staff). We address these limitations through two studies. In study 1, we explore variation within older adults' experiences with VR through a field study of VR use among a large (N = 245) and age-diverse (Mage = 83.6 years, SDage = 7.9, range = 65-103 years) sample of nursing home and assisted living facility residents across 10 U.S. states. Age was negatively associated with the extent to which older adults enjoyed VR experiences. However, the negative relationship between age and older adults' attitudes toward VR was significantly less negative than the relationship between age and their attitudes toward other technologies (cell phones and voice assistants). In study 2, we surveyed caregiving staff (N = 39) who facilitated the VR experiences for older adult residents and found that the caregiving staff generally enjoyed the activity relative to other activities and felt it to be beneficial to their relationship with residents.

Exploring the gender gap in end-of-life care: ethical considerations for dementia patients

Abstract Background Dementia is a common, terminal disease that significantly reduces the quality of life. Home hospice services face ethical challenges when caring for patients in the final stages of the disease. While gender differences are known to exist in various aspects of care, limited research has explored gender variation in end-of-life care perceptions. This study aims to explore how home hospice staff consider gender, particularly regarding ethical issues. Methods The study used a phenomenological qualitative approach, conducting semi-structured interviews with 30 multi-professional home hospice staff members caring for dementia patients. Findings Caregivers tend to ignore gender when caring for elderly patients at the end of their lives. This non-gender-related approach is evident in their attitudes towards ethical issues, such as respecting patients, considering their welfare and dealing with communication difficulties. However, disregarding gender when caring for dementia patients within the home hospice framework raises questions regarding the dying person's perception of human dignity, their wishes, and their overall welfare. Conclusions Given that gender is a crucial component of a person's identity, the staff's non-gender-related approach towards end-of-life care reflects the non-gender-related social construction of the elderly. This raises concerns about the quality of care provided to end-of-life patients. To ensure that patients’ dignity is preserved in the final stages of their lives, it is necessary to provide training for caregiving staff on the importance of considering gender in end-of-life palliative care. Key messages • Home hospice staff tend to ignore gender when caring for dementia patients. Neglecting gender raises ethical concerns and questions about patient dignity and welfare. • Considering gender in end-of-life palliative care is crucial to ensure high-quality care for patients with dementia in the final stages of their lives.

Oral healthcare provision at long-term care facilities in eThekwini: Perspectives of coordinators.

The prevalence and impact of oral disease among long-term institutionalised residents highlight the need for a scale-up of preventive and promotional oral health services that include oral health education and training for caregiving staff. However, opportunities to improve oral healthcare services are met with challenges. This study was undertaken to establish coordinator perspectives on oral health provision. Seven long-term care facilities in the eThekwini district, South Africa. An in-depth exploratory study was conducted with 14 purposively selected coordinators (managers and nurses). Semi-structured interviews were conducted and focused on coordinators' experience and perspectives on oral healthcare. Data were analysed using thematic analysis. The following themes emerged from the study: A lack of comprehensive oral health care practices, inadequate support from the dental sector, insufficient oral health prioritisation, limited funding for oral health, and challenges associated with coronavirus disease (COVID-19). All respondents reported that no oral health initiatives existed. Plans for oral health training workshops presented with coordination and funding challenges. Oral health screening initiatives have ceased since COVID-19. The study findings indicated that prioritisation of oral health services was inadequate. There is a need for continual oral health in-service training for caregivers and support from coordinators in guiding the implementation of oral health training programmes.Contribution: It is envisaged that the findings of this study will bring about greater coordinator involvement and collaboration with the public and private dental sectors to improve oral healthcare at long-term care facilities.

The Collateral Effect of Enhanced Recovery After Surgery Protocols on Spine Patients With Neuromuscular Scoliosis.

Enhanced recovery after surgery (ERAS) protocols are often specific to a specific type of surgery without assessing the overall effect on the ward. Previous studies have demonstrated reduced length of stay (LOS) with ERAS protocols in patients with adolescent idiopathic scoliosis (AIS), although the patients are often healthy and with few or no comorbidities. In 2018, we used ERAS principles for patients undergoing AIS surgery with a subsequent 40% reduced LOS. The current study aims to assess the potential collateral effect of LOS in patients surgically treated for neuromuscular scoliosis admitted to the same ward and treated by the same staff but without a standardized ERAS protocol. All patients undergoing neuromuscular surgery 2 years before and after ERAS introduction (AIS patients) with a gross motor function classification score of 4 to 5 were included. LOS, intensive care stay, and postoperative complications were recorded. After discharge, all complications leading to readmission and mortality were noted with a minimum of 2 years of follow-up using a nationwide registry. Forty-six patients were included; 20 pre-ERAS and 26 post-ERAS. Cross groups, there were no differences in diagnosis, preoperative curve size, pulmonary or cardiac comorbidities, weight, sex, or age. Postoperative care in the intensive care unit was unchanged between the two groups (1.2 vs 1.1; P = 0.298). When comparing LOS, we found a 41% reduction in the post-ERAS group (11 vs 6.5; P < 0.001) whereas the 90-day readmission rates were without any significant difference (45% vs 34% P = 0.22) We found no difference in the 2-year mortality in either group. The employment of ERAS principles in a relatively uncomplicated patient group had a positive, collateral effect on more complex patients treated in the same ward. We believe that training involving the caregiving staff is equally important as pharmacological protocols.

A post-market cluster randomized controlled trial of the effect of the TENA SmartCare Change Indicator™ on urinary continence care efficiency and skin health in older nursing home residents

BackgroundUrinary continence care for residents of nursing homes who are unable to communicate their toileting needs usually involves care aides manually checking continence products (pads) to determine the level of urine saturation prior to changing. The TENA SmartCare Change Indicator is a medical device which estimates urine saturation and notifies caregivers of the optimal time for pad changes. This study will seek to examine the effect of the TENA SmartCare Change Indicator on urinary continence care efficiency and skin health, in comparison to usual care.MethodsThis cluster randomized controlled trial (NCT05247047) involving older nursing home residents with urinary incontinence unable to consistently indicate their toileting needs, and their care aides, will compare technology-based and usual continence care over a period of 8 weeks. Co-primary endpoints of superiority in continence care efficiency and non-inferiority in the maintenance of skin health will be assessed. Secondary outcomes will examine the resident quality of life, sleep quality, responsive behaviours, changes in pad use and leakage episodes outside the pad. Change in care aide work engagement, job satisfaction and rushed tasks will be assessed. Benefits and challenges with the use of the device for continence care will be identified from the perspectives of the care staff.DiscussionUrinary continence assessment and care in nursing homes is reported as suboptimal and threatening to dignity. Data on the utility and effect of technological solutions for improving urinary continence care are few and conflicting. If shown effective, this technological solution has the potential to improve the care for older residents and improve the working lives of caregiving staff who look after this most vulnerable section of the population.Trial registrationClinicalTrials.gov NCT05247047. Registration date is Feb 18, 2022

Assisted eating as a communicative activity

Background: This study aims to further the understanding of communication involving people with late-stage dementia by highlighting assisted eating as an interactive joint activity. Assisted eating is, on the surface, primarily a care activity with the purpose of feeding the assisted person and thereby facilitating nutritional uptake. Helping someone to eat requires, nevertheless, fine-grained communication and co-ordination of both attention and embodied actions. Method: Using video recordings where a person with late-stage dementia is provided with assistance to eat, we show how assisted eating is sequentially organized into smaller, local communicative projects, and how each project’s completion is contingent upon the temporal co-ordination of the participants’ attention and embodied actions. Results: The analysis shows how actions necessary to carry out the eating (e.g., manipulating the food, bringing the food to the mouth) are also inherently communicative and achieved through an embodied participation framework. Discussion/conclusion: Our findings show that while the caregiving staff perform most of the actions required in the assisted eating, the person with dementia is a central agent whose actions – displays of engagement and disengagement – are decisive for the progression of the eating activity and play central roles in the interactive achievement of the activity.

Criteria deemed important by ICU patients when designating a reference person

BackgroundWe investigated the criteria that hospitalized patients in intensive care units (ICUs) deem important when designating relatives who are best qualified to interact with the caregiving staff. MethodsWe conducted an exploratory, observational, prospective, multicenter study between March 1, 2018, and October 31, 2018, within two ICUs. A 12-item questionnaire was distributed to patients in the ICUs by the investigating physicians. Patients were considered eligible if they had a good understanding of the French language and if they had not officially designated surrogates before ICU admission. ResultsSeventy-one patients whose average age was 63.9± 17.3 years, of whom 21 (29.5%) were females, completed the questionnaire. The average Charlson comorbidity score was 2.5 ± 2.4, and the average Simplified Acute Physiology Score (SAPS II) was 39.8 ± 16.5. The main etiology was respiratory infection (40.8%), followed by sepsis (23.9%). The most important criteria identified by patients when selecting reference persons were a good knowledge of the patient's wishes and values, an emotional attachment to the patient, and being a family member. ConclusionOur findings reveal that ICU patients considered the following criteria to be critical when designating reference persons: knowledge of their wishes and the existence of emotional and family attachments.

Oral-care adherence. Service design for nursing homes - initial caregiver reactions and socio-economic analysis.

Background: Lack of proper oral care among elderly people in nursing homes is associated with increased morbidity and hospitalisation. The ability of the individual to maintain sufficient oral self-care is difficult for caregivers to assess, and thus, caregivers often risk providing suboptimal oral care. Sensor-based tools exist that can support the caregiving staff in achieving a better understanding of who among the elderly are able to perform proper self-care, and who cannot and thus need additional assistance from caregivers. How such systems should be designed and deployed in nursing homes, and how they will be perceived by caregivers has not been investigated sufficiently yet.Objectives: The aim of this study was to gain a better understanding of how caregiving staff perceives the introduction of sensor-based systems that allow the caregivers to automatically discover who among the elderly residents are able to adhere to the given recommendation on daily oral self-care, and who among them are in need of further assistance, as well as whether there is potential for saving costs.Methods: In a mixed methods qualitative study, we visited three nursing homes where we had recently deployed, or were about to deploy, electrical toothbrushes and a basic oral-care adherence aid system. Nursing home staff was interviewed during the field studies about their initial reactions to introducing such a system as part of their daily workflow. The field study was supported by a literature review.Results: Caregiving staff welcomed the introduction of a sensor-based oral-care adherence aid system, which would identify any elderly who could no longer achieve a sufficient level of oral self-care. Improving oral care for the elderly may not only prevent serious consequential diseases, but also generate considerable savings with a return on investment of at least 1:2.5.Conclusion: Sensor-based oral-care adherence aid systems that monitor oral-care adherence, meaning the ability of the individual elderly to properly perform teeth and/or denture brushing as part of normal self-care efforts, appear useful and relevant to introduce. More work is needed to provide a better understanding of the long-term user experience of both caregiving staff and elderly. There is also a need for more high-quality long-term clinical studies of further preventive effects of oral hygiene measures and their economic benefit.

A qualitative assessment of factors affecting nursing home caregiving staff experiences during the COVID-19 pandemic.

BackgroundA large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes.MethodsBased on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel.ResultsThroughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups.ConclusionsAddressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.

Telepsychiatry to Provide Mental Health Support to Healthcare Professionals during the COVID-19 Crisis: A Cross-Sectional Survey among 321 Healthcare Professionals in France.

Pandemics are difficult times for the mental health of healthcare professionals, who are more likely to present with PTSD-like symptoms. In the context of a highly contagious communicable disease, telemedicine is a useful alternative to usual care, and should be considered as a means to support healthcare professionals’ mental health. This is a multicenter (n = 19), cross-sectional study, based on a 27-item questionnaire, aiming to investigate the acceptability to healthcare workers of a telepsychiatry service as a means of providing mental health support during the COVID-19 pandemic. Between October and December 2020, 321 responses were received, showing that women, caregiving staff, and those directly involved in the care of COVID-19 patients are less favorable to the idea of receiving remote support. In our population, barriers were related to the clinical setting or ethics, and most of the respondents would not accept a drug prescription by telepsychiatry. Although telepsychiatry should be a part of the armamentarium of mental health management, it is not suitable as a stand-alone approach, and should be combined with conventional face-to-face consultations.

Where were you during the Queen's visit? Using photographs to facilitate collective storytelling, resident identity and positive care relationships in aged care.

This paper explores the potential of photographs as a tool to facilitate storytelling, reminiscence and social connections for older residents living in residential aged care and caregiving staff. Fourteen residents and three staff attended two sessions in which residents brought and shared personal photographs. Narrative enquiry was used to elicit individual and collective stories. Narrative analysis of residents' selected photographs overwhelmingly showed a younger self (n=6), highlighting relationships (n=6) and achievements (n=6). Sharing images with other residents and staff enhanced new connections and personal communications. This research highlights the communicative value of photographs in aged care. Residents were able to reflect upon shared personal and global events-from the role of pets in their lives to public events such as the Queen's visit to Australia-and through discussion build a collective shared narrative. This enabled new connections and sharing of stories between staff and residents.

Exploring gaps in positive solitude perceptions: older adults vs. gerontology professionals

The aim of this study was to explore old persons' experiences of positive solitude (PS) and the gaps between their experience and professional caregivers' perceptions of older adults' experiences of PS. Moreover, we attempt to understand the basic mechanism that may explain these gaps. A qualitative method was used. Fourty-one older adults (aged 65-103 years) and 2 groups of professionals: 16 occupational therapists with a specialization in gerontology and 41 gerontology graduate students from other occupations. Four open-ended questions about PS were asked. The older adults described their views on PS and experiences during solitude. The two caregiver groups, who are familiar with older adults, answered the questions twice, referring once to themselves and once to older adults in general. A. Gaps exist between old peoples' and caregivers' perceptions and experience of PS. B. The caregivers believe that older adults cannot easily enjoy PS. C. Caregivers believe that there are certain preconditions for older adults' experience of PS. D. Differences in attitude toward older adults between the caregiver groups were found. Although old people occasionally prefer PS, culture and age bias may prevent caregivers from accepting older adults' need for PS. Practical implications include the need to raise awareness of age bias among caregiving staff, in particular regarding their acceptance of older adults' PS experiences. This may improve the staff's willingness to enable older adults to experience PS without interruption.

Elderly care in the time of coronavirus: Perceptions and experiences of care home staff in Pakistan.

ObjectiveThe highly contagious and deadlycoronavirus disease 2019 (COVID‐19) has caused significant disruption in the small care sector of Pakistan. This study accordingly explores the perceptions and experiences of staff providing direct caregiving services to the elderly residents at three care homes during the time of the coronavirus pandemic in Karachi, Pakistan.DesignUsing a qualitative approach, 27 digitally recorded, semi‐structured, face‐to‐face interviews were performed with current and former caregiving staff members. The data were analyzed through qualitative content analysis.ResultsAnalysis highlights various kinds of challenges that were faced by the caregivers and their families during the pandemic. The main theme class identified from the data was “living in anxiety and fear.” The work‐related decisions made by caregivers at that time were mainly influenced by their familial demands and responsibilities.ConclusionCaregivers were at risk of catching the lethal virus through inhalation of or physical contact with infectious particles, but despite that most of them continued to render elderly care services. This study's findings could be used by government leaders and care home administrations when making coronavirus containment policies, designing economic relief packages, and formulating caregiving training programs in Pakistan or other countries in the world.

Enhancing healthcare professional and caregiving staff informedness with data analytics for chronic disease management

An important area in healthcare to which data analytics can be applied is chronic disease management. The chronic care model is mostly patient-centric, so patients have been considered as the end users of data analytics. The information needs of healthcare providers have been overlooked. Drawing upon the theory of informedness and the transtheoretical model of health behavior change, we use a multicase study approach to investigate the information needs of different caregiving stakeholders in the spectrum of chronic diseases, and how data analytics can be designed to meet the varying needs of professionals and staff to support their informedness.

Criteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU.

We investigated the criteria that patients' relatives deem important for choosing, among themselves, the person best qualified to interact with the caregiving staff. Exploratory, observational, prospective, multicentre study between 1st March and 31st October 2018 in 2 intensive care units (ICUs). A 12-item questionnaire was completed anonymously by family members of patients hospitalized in the ICU 3 and 5days after the patient's admission. Relatives were eligible if they understood French and if no surrogate had been appointed by the patient prior to ICU admission. More than one relative per patient could participate. In total, 87 relatives of 73 patients completed the questionnaire, average age of relatives was 58±15years, 46% were the spouse, 30% were children/grandchildren. Items classed as being the most important attributes for a reference person were: good knowledge of the patient's wishes and values; an emotional attachment to the patient; being a family member; and having an adequate understanding of the clinical status and clinical history. This study identifies the attributes considered by relatives to be most important for designating, among themselves, a reference person for a patient hospitalized in the ICU.

Acceptability and Feasibility of a Multicomponent Telehealth Care Management Program in Older Adults With Advanced Dementia in a Residential Memory Care Unit.

The aim of the current study was to examine the acceptability and feasibility of a multicomponent care management program in older adults with advanced dementia in a long-term memory care unit. Eighteen older adults with moderate to severe dementia were asked to wear an activity monitor (Fitbit Charge 2 HR) and participate in a once monthly telehealth intervention via iPads over a 6-month period. Activity monitor data were used to assess compliance. Acceptability was assessed through qualitative interviews conducted with the caregiving staff on the memory unit. The care management program was acceptable to residents and their caregivers. Results indicated that the care management program is feasible in older adults with advanced dementia although activity monitor adherence was better during the day than at night. Telehealth session compliance was excellent throughout the study. A long-term multicomponent dementia care program is acceptable and feasible in individuals with advanced dementia. Future studies should aim to evaluate whether data received from activity monitors can be used in a dementia care intervention program.

Improving relationship quality in group care settings: The impact of implementing the CARE model

The current study examined the effects of implementing a new program model on the quality of relationships between direct care providers and residents in group care agencies. Children and Residential Experiences (CARE), an organization-wide program model that involves a range of structural change and staff-development activities, was implemented in 13 group care agencies in one Southeastern state. CARE implementation lasted three years and involved the application of six evidence-informed principles throughout the organization in order to create more therapeutic environments and improve the quality of care for children.We used a stepped-wedge design in which one cohort of agencies began CARE immediately and a second cohort waited 12 months before beginning, allowing them to serve as a comparison group during the waiting period. Children in each agency were surveyed annually about the perceived quality of their relationships with staff using a new instrument developed for this study. Results of a linear mixed model indicated that after accounting for clustering at the agency and cottage levels and controlling for several important covariates, child perceptions of relationship quality increased significantly in the three years after CARE implementation began. The strength of the CARE effect was stronger for residents with several previous placements, but did not differ by age, gender, race, length of stay, DSS referral, or problem behavior. Results provide evidence that supports the effectiveness of CARE as an intervention to help group care agencies improve the quality of children's daily interactions with caregiving staff, a critical aspect of their experience while living in care. The process requires a long-term commitment and an organization-wide focus on serving the best interests of children.