Care Facilities Research Articles

Funkcjonowanie świetlic socjoterapeutycznych w czasie pandemii COVID-19 w Gdańsku, Poznaniu i Katowicach

Socio-therapeutic day-care facilities are specifically dedicated to the conduct of socio-therapeutic activities for children and adolescents from high-risk groups and those displaying difficulties in psycho-social functioning. During the pandemic, socio-therapeutic day facilities continued to aid their clients. The aim of this analysis is to describe the operation of socio-therapeutic day care facilities in Gdańsk, Katowice and Poznań. The data collection method for this project is a semi-structured telephone interview, while data is examined via a template analysis. The analyses concerned 30 socio-therapeutic day care facilities in Gdańsk, Katowice and Poznań. The data collected shows that socio-therapeutic day facilities could be an important source of support for the participants and their families. Elements of socio-therapeutic work were retained in contact with the clients to the highest possible degree via online communication. Online meetings enabled discussion of current difficulties, emotional respite and support. Topics discussed included those supporting health-promoting behavior in an epidemiological emergency. Many of the activities went beyond group work and were mainly supportive or crisis intervention. Staff members contacted parents, helped with children’s homework and even donated food parcels.

Cognitive training for Alzheimer’s disease

The article presents selected approaches to cognitive training for people with Alzheimer’s disease. Based on research findings, the combination of training and pharmacological treatment may delay the disease processes in dementia, ensuring that both patients and their caregivers enjoy longer lives and improved well-being. The Montessori Senior Method, recently gaining popularity in Poland, focuses on developing independence through adapted interactions, which can be particularly effective for elderly people. Instrumental Enrichment, on the other hand, uses learning mediation and prioritizes the creation of coping strategies that may be helpful in maintaining cognitive functions. Occupational therapy focuses on improving daily activities, which can be important for the quality of life of patients and their caregivers. This type of impact is usually holistic, encompassing both the patient and the caregiver. Errorless Learning and reality orientation training are other techniques that can be effective in maintaining cognitive functions, with easy adaptability to patients’ difficulties. These techniques allow working on a specific skill that is important to the patient. Computerised training and the use of virtual reality (Virtual Reality and Immersive Virtual Reality) also bring positive effects in terms of improving cognitive, sensory, motor, and emotional functions, but the costs and availability of equipment may pose a challenge for families, caregivers, and care facilities. A variety of training approaches may benefit patients with Alzheimer’s disease, both in terms of improvement of cognitive function and quality of life. It is important to continue research on the effectiveness of these methods and adapt them to the individual needs of patients.

The contribution of the charge nurse in integrated healthcare

Background: A charge nurse (CN) is defined as a nurse who holds a clinical-administrative management position. The role requires five essential skills: leadership; interpersonal communication; clinical-administrative caring; problem solving; and knowledge and understanding of the work environment. According to Plourde (2012), these skills can be divided into sub-skills that are needed in practice by CNs when upholding appropriate standards of quality of care in healthcare delivery. These skills are also essential for CNs when facilitating the process of integrated care within healthcare facilities. However, the scientific literature describes less-than-ideal work performance by CNs that relates to a lack of specialized and adapted training. Necessary skills are poorly addressed in the education of CNs, and they receive little formal support upon entry to practice. CNs play an essential role in coordinating processes surrounding integrated care in healthcare facilities, however the literature is scarce on this role of the CN. Objective: To demonstrate the extent to which the CN, by fulfilling their role, contributes to integrated care within healthcare facilities. Methods: A scoping review using the Joanna Briggs Institute (2020) framework was performed. Using a prepared search strategy, CINAHL, MEDLINE, Cairn, and grey literature databases were queried for articles written in French or English and published between 2000 and 2022. Articles mentioning at least one of the five CN skills named by Plourde (2012) were selected. Articles were analyzed according to “Leviers et obstacles au développement de l’ISS” by Longpré (2017) (Facilitators and barriers to the development of the integrated care model) which describes essential elements to consider in order to foster integrated healthcare. Results: 150 articles were retained and analyzed. These articles describe CN skills and how they are operationalized in practice. It was found that the skills and sub-skills of the CN are often addressed in articles describing integrated care, including for example the coordination of a patient's care during their hospitalisation. In addition, CNs allow for accessibility, continuity and integration of care. As such, CNs are key player in the implementation and development of better integrated care. Conclusion: This study illuminates the relevance of providing essential CN training that reinforces the CN skill set which in turn improves the quality and safety of integrated care in healthcare facilities.

Perceptions of care-dependent older people in nursing homes about their oral health and oral care

Background: Oral health is associated with general health but often remains neglected in residential care settings. Integration of oral care into general care is necessary, but literature shows that appropriate oral care is hampered by multiple barriers. Among older people, attitudes towards oral health and oral care are poor, as they are often unaware of the importance of oral health. The lack of ability to perform their own oral care, due to ageing, is also a perceived barrier. This study is part of research on the implementation of the new Oral Health Section (OHS) in the interRAI assessment of general care needs of nursing home residents. The aim of the study is to identify older people’s experiences with their own oral health, with the oral care performed, their perception of the importance of oral care, as well as their meaning about the assessment of their oral health using. 
 Setting and participants: Care-dependent older people living in 3 Flemish nursing homes. 
 Methods: In-depth interviews were performed and the Oral Health-Related Quality of Life 14 (OHIP-14) instrument was completed. This validated instrument measures the degree of self-rated oral health and satisfaction with the oral health status. The OHS was also filled out, which assesses whether they need assistance with daily oral hygiene care (Oral Hygiene CAP) and whether they need to be referred to a dentist (Dentist CAP). Interviews were coded, validated and discussed by 2 researchers and analysed in the software Nvivo1.7.
 Results: A total of 22 care-dependent older people were interviewed. The mean age of the sample was 84.5 (± 8.2 SD) and 63.6% were female. A total of 11 participants (50%) had no teeth but wore dentures; the others still had their natural teeth. The mean score of the OHIP-14 was 3.9 (range 0-56), indicating good scores for oral health-related quality of life. All older people who still had their natural teeth found it important to keep them in the future. Most older people were satisfied with their own oral health (81.8%), although, according to the results of the CAPs, 86.4% of them scored poorly on the assessment of oral hygiene and 68.2% needed immediate referral to a dentist. This shows that older people tend to overestimate their own oral health and are often satisfied, despite having several oral health problems.
 Conclusions/implications: The study provided information about the perceptions and experiences of older people regarding their oral health and oral care. Learning about their experiences and perceptions can help to identify their wishes and needs, making it possible to improve daily oral care and proactively develop strategies to provide effective dental care for the future older population. Policy makers can use these results to foster the integration of oral care guidelines into care protocols within nursing homes, as well as support collaboration with dentists and dental hygienists within care facilities.

Pandemic Patient Engagement Success: Maintaining Family Presence Through Partnership

This presentation is relevant for patients of hospitals and residents of long-term care facilities, their loved ones and essential partners in care, and staff and leadership of healthcare facilities.
 A painful pandemic challenge for patients, families and staff in hospitals was the absence of loved ones or essential care partners through Family Presence/Visitor Policy restrictions. Leadership at Kingston Health Sciences Centre (KHSC) worked proactively with the Patient and Family Advisory Council and a small, diverse group of Patient Experience Advisors to plan for possible restrictions and consider how best to approach ongoing changes and challenges to the policy expected in the face of the pandemic. The group continues to work together at this time of uncertainty.
 An initial meeting of eight advisors and leaders took place prior to the World Health Organization’s official announcement of the pandemic. Due to growing concern about hospital infections, the meeting venue was a local coffee shop, hence the group became known throughout the hospital as The Balzac’s Group. Synchronous virtual meetings and asynchronous communication were employed by the group to address concerns and create family presence opportunities on a rapid response basis. Group collaboration remains evident as new concerns arise with the ongoing ebb and flow of COVID-19 hospitalizations, staff shortages and less restrictive family presence policies. This partnership has been pivotal to the organization’s pandemic planning and response, enabling family presence while respecting government directives, organizational challenges, and patient/family priorities.
 This collaboration informed several new and sustained initiatives including: a virtual visits process, ePostcards, a Care Partner Program, expanded cell phone use in restricted areas, resources for loved ones traveling distances, careful and measured increases in family presence and a family presence policy Exceptions Committee.
 An unexpected outcome was an increased level of respect and strengthened patient engagement. Factors influencing this success were transparency and trust in sharing sensitive or confidential information, mutual decision-making, frank and honest sharing of both personal and professional perspectives, and active listening. Many KHSC advisors increased their patient partnership activities during the pandemic and felt an enhanced sense of agency in their efforts to improve the patient experience in healthcare.
 
 This initiative may be a source of new ideas, inspiration, and encouragement for patient partners and hospital leaders to actively partner in co-design and delivery of compassionate person-centred policies and care, especially during times of crisis.
 The group continues to be the “go-to” group for family presence policy questions. The strengthened relationship with Patient Advisors has had a spillover effect more broadly into other hospital initiatives and increased awareness of the value of their input. We hope to continue to share this success story broadly to encourage other healthcare facilities to partner with the precious resource of patients, families, and patient advisors, at all levels of health care. We are considering a Patient Advisor led publication in the future.

Is the quality of public health facilities always worse compared to private health facilities: Association between birthplace on neonatal deaths in the Indian states.

The role of place of delivery on the neonatal health outcomes are very crucial. Although the quality of care is being improved, there is no consensus about who is the better healthcare provider in low and middle-income countries (LMICs), public or private facilities. The aim of this study is to assess the differentials in neonatal mortality by the type of healthcare providers in India and its states. We used the data from the fourth wave of the National Family Health Survey 2015-16 (NFHS-4). Information on 259,627 live births to women within the five years preceding the survey was examined. Neonatal mortality rates for state and national levels were calculated using DHS methodology. Multi-variate logistics regression was performed to find the effect of birthplace on neonatal deaths. Propensity score matching (PSM) was used to evaluate the relationship between place of delivery and neonatal deaths to account for the bias attributable to observable covariates. The rise in parity of the women and purchasing power influences the choice of healthcare providers. Increased neonatal mortality was found in private hospital delivery compared to public hospitals in Punjab, Rajasthan, Chhattisgarh, Madhya Pradesh, Bihar, Jharkhand, Odisha, Goa, Maharashtra, Andhra Pradesh and Karnataka states using propensity score matching analysis. However, analysis on the standard of pre-natal and post-natal care indicates that private hospitals generally outperformed public hospitals. The study observed a significant variation in neonatal mortality among public and private health care systems in India. Findings of the study urges that more attention be paid to the improve care at the place of delivery to improve neonatal health. There is a need of strengthened national health policy and public-private partnerships in order to improve maternal and child health care in both private and public health facilities.

General and orofacial symptoms associated with acute and long COVID in 80- and 90-year-old Swedish COVID-19 survivors

ObjectivesTo describe acute and long COVID-19 symptoms among older elderly Swedes and to find predictive factors for the development symptoms associated with acute and long COVID. Material and methodsA questionnaire about general and oral health was mailed to all 80-year-olds (born 1942, n = 6299) and 90-year-olds (born 1932, n = 1904) in two Swedish counties. Participants reporting COVID-19 were asked to complete an additional questionnaire. ResultsOverall response rate was 66 % (n = 5375). Affirmative responses to having been sick/tested positive for COVID-19 were reported by 577 persons. Response rate to the COVID-19 questionnaire was 49 %. The majority (88 %) reported some general symptoms during the acute stage while 44 % reported orofacial symptom/s. Reporting of any form of long-COVID general symptoms was 37 and 35 % for orofacial symptoms. Predictive factors for contracting COVID-19 (based on self-report from 2017) were living in elderly housing/senior care facility (OR 1.6, CI 1.0–2.3), large number (>10) of weekly social contacts (OR 1.5, CI 1.3–1.9), being married (OR 1.4, CI 1.1–1.7) and high school/university education (OR 1.3 CI 1.1–1–6). The highest odds ratio for general symptoms of long-COVID were a single complete denture (OR 5.0, CI 2.0–12.3), reporting bad breath (OR 3.7, CI 1.9–7.2) and daytime dry mouth (OR 2.2, CI 1.1–4.2). Regarding long-COVID orofacial symptoms, the highest risk factors were bad breath (OR 3.8, CI 1.9–7.5) and a single complete denture in one jaw (OR 3.4, CI 1.2–9.8). ConclusionLong-COVID general and orofacial symptoms are common among older elderly COVID-19 survivors Clinical significanceOral microorganisms may be responsible for development of long-COVID symptoms. Health personnel managing COVID-19 patients should carefully examine dental status, especially in those having acrylic-based removable dentures, for oral signs and symptoms. If found, rigorous oral hygiene procedures should be carried out including cleaning/disinfection of the denture.

CHINESE AMERICAN FAMILY CAREGIVERS’ PERCEPTIONS OF HOME CARE AND FACILITY CARE FOR LOVED ONES WITH ADRD

Abstract Cognitive decline and impairment among older adults are significant public health concerns because they lead to increased disability, caregiver burden, and healthcare costs associated with the treatment of declining cognitive function. The Chinese American population, the largest Asian group in the US, is aging rapidly, and it is expected that older Chinese Americans and their caregivers will increasingly need ADRD care planning for home care and facility care. Therefore, the goal of this study is to examine the beliefs and attitudes of Chinese American family caregivers regarding home care and facility care for their loved ones with ADRD. In our study, N=17 Chinese American caregivers were recruited to participate in the study interview through a partnership with the Alzheimer’s Program at the Chinese American Service League. The mean age of the caregivers was 49.6 years, and the majority were female, married, had college degrees or higher, and reported being in good health. Results indicated that most ADRD patients needed medium or high levels of care and were cared for at home. Chinese American caregivers were reluctant to place their loved ones in facilities, such as nursing homes or memory care centers, due to high costs, poor quality of care, language barriers, and Chinese filial piety. Additionally, most Chinese caregivers lacked knowledge regarding the types of home care and facility care and the services provided. Therefore, future development of culturally and linguistically targeted interventions for ADRD care planning is necessary for Chinese American patients with ADRD and family caregivers.

THE IMPACT OF THE COVID-19 PANDEMIC ON FAMILY CARE PARTNERS OF PERSONS WITH DEMENTIA IN ASSISTED LIVING FACILITIES

Abstract Background The Covid-19 pandemic affected persons living with dementia and their family care-partners. Family care-partners are diverse, including spouses, children, and friends. Care-partners may live with the care recipient, or apart from them. Covid-19 policies and priorities isolated care-partners living at home, while banning others from supporting their loved ones in assisted living facilities (ALF). Purpose: The purpose of this study was to examine the impact the covid-19 pandemic had on family care-partners of persons living with dementia. Methods This study used an online survey of 133 family care-partners (89 living in ALF, 44 living in the community). Results Among family care-partners, 34.8% of those who lived in an ALF reported a severe change in routine compared to 38.6% of those living in the community. 78.7% of ALF care-partners reported that they were unable to visit their loved one in a care facility, compared to 31% of care-partners living in the community. 67.4% of ALF care-partners were separated from the person with dementia that they cared for, compared to 22.7% of care-partners living in the community. 70.5% of CPs in the community reported they had to spend a lot more time taking care of a family member with dementia compared to 13.5% of ALF CPs. Conclusion Unique differences exist in how the pandemic impacted the lives of family care-partners of community-based or ALF-based persons living with dementia. Understanding these differences can help tailor policies and healthcare priorities to best support family care-partners living in community or ALF settings.

GENDER-BASED VIOLENCE IN HOMICIDE–SUICIDE EVENTS: A CALL FOR ADHERENCE TO THE CDC DEFINITION FOR “MERCY KILLING”

Abstract Intimate partner homicide suicide (IPHS) events are overwhelmingly male perpetrated (90%). Gender-based violence (GBV) prevention requires ‘best practices’ for media reporting. Consider the following: In a patient room of a busy hospital, an overwhelmed man (71) suicided after firing shots at his wife (70) who had survived a stroke. The gunfire caused trauma among witnesses. Media reports used the term ‘mercy killing,’ but critical ingredients were missing. The CDC’s NVDRS (2022) defines ‘mercy killing’ as “…Killed, at the victim’s request…to end…pain or distress…Do not assume…murder/suicide by a sick, elderly couple is mercy killing.” Evidence of a clear wish to die, is needed “due to a hopeless or terminal condition.” Our IPHS, news surveillance study was updated 1999-2022 and used content analysis to identify GBV rationalizations, based upon 2219 events and over 5000 fatalities across young (n=987), middle aged (n=699), and older 60+ (n=533) categories. Only the 60+ group had claims of ‘mercy killing,’ mostly without adherence to the CDC definition. Older men who are suicidal may also harm an unsuspecting partner. For women, end of life decision-making is lost in ‘safe spaces,’ like homes or care facilities, which is made worse by rationalized excuses. Women are rarely suicidal and use passive methods (i.e., drugs). When women care for an ailing partner, they don’t commit IPHS. Older men are more suicidal and utilize more lethal firearm methods (similar to the IPHS patterns). Media best practices involve valuing persons with disabilities, publicizing services and recognizing violence is a public health problem.

THE RELATIONSHIP BETWEEN LONG-TERM CARE OMBUDSMAN PROGRAM SPENDING AND NURSING HOME OUTCOMES

Abstract As part of the Older Americans Act, State Long-term Care Ombudsman Programs (LTCOP) serve older adults in nursing homes (NHs) and board and care facilities. The National Academies of Science, Engineering, and Medicine called for increased LTCOP funding to improve NH quality. We hypothesized that increases in spending on LTCOP would be associated with a lower prevalence of NH residents with low-care needs who could be cared for in the community and fewer residents taking antipsychotics. We conducted a secondary analysis using the National Ombudsman Reporting System, NH facility-level data from LTCfocUS.org for 15,592 US NHs (2011-2018), and the Area Health Resource File. Using a two-way fixed effects model with standard errors clustered at the facility-level, we examined the relationship between LTCOP spending per LTC bed at the state-level and outcomes, controlling for year, state, facility, and market characteristics. Increased LTCOP spending was associated with a lower proportion of residents in NHs with low-care needs and a lower percent of residents receiving antipsychotics (p < .0001). In 2011, the average share of low-care NH residents (weighted by bed size) was 13.34%, and the share of residents on antipsychotics was 25.95%. For every $25 annual change in LTCOP funds, there was a .84 percentage point decrease in the prevalence of low-care residents for the average NH, and a .80 percentage point decrease in the share of residents receiving antipsychotics. States that have increased funding for their LTCOP observe better outcomes. This documents the need to increase funding to support LTCOP.

FROM COMFORT TO PROFITABILITY: RELATIONSHIP BETWEEN CARE QUALITY AND FINANCIAL PERFORMANCE IN US HOSPICES

Abstract Hospice care is a critical aspect of end-of-life care in the United States, providing comfort and support to individuals with life-limiting illnesses. Quality of care is a key concern for hospice facilities, as it can impact both patient outcomes and financial sustainability. Poor quality of care can lead to negative patient experiences, increased hospitalizations, and even legal issues. It can also result in financial penalties or reduced reimbursement from payers. However, there is limited research on the relationship between quality of care and financial performance in hospice facilities. Employing a cross-sectional observational design, we examined the relationship between Hospice and Palliative Care Composite Process Measure (lagged by 1 year) and the total margin of hospice facilities across the United States. We used secondary data from Nursing Home Compare, Healthcare Cost Report Information System Dataset, and the American Community Survey for the period 2017-2021. We found a positive association between quality process measures and financial performance in hospice facilities after controlling for organizational and community factors that may influence financial performance, such as facility size and location. Specifically, a 10-unit increase in quality measure was associated with a 2% increase in total margin. The findings of this study have important implications for the management and financing of hospice facilities. Investments in quality improvement initiatives may lead to improved financial performance. Policymakers should consider these findings when designing payment systems for hospice care, and administrators of hospice facilities should prioritize quality improvement initiatives to ensure both high-quality care and financial viability.

Initial Assessment of Trauma Patients

Introduction: The initial assessment of trauma patients is a critical and time-sensitive phase in the realm of emergency medicine. This presentation outlines the fundamental components and principles of conducting an effective initial assessment, which is essential for promptly identifying life-threatening injuries and ensuring timely interventions for patient stabilization.
 The primary objective of the initial assessment is to swiftly detect and address imminent life-threatening conditions. This process adheres to a structured approach, often following established protocols such as Advanced Trauma Life Support (ATLS).
 Commencing with the evaluation of the patient's airway, breathing, and circulation (ABCs), healthcare providers prioritize the maintenance of a patent airway, adequate respiration, and a stable circulatory system. Any life-threatening issues identified during this phase demand immediate intervention.
 Simultaneously, healthcare providers perform a concise yet comprehensive patient history and physical examination, gathering information about the injury's mechanism, the patient's medical background, and any pertinent details. This collected data serves as the foundation for subsequent assessments and treatment plans.
 The secondary survey, a more detailed and systematic examination, follows the initial assessment. This phase involves a thorough head-to-toe evaluation aimed at detecting injuries that may have been initially overlooked. Diagnostic procedures, including imaging studies and laboratory tests, may be initiated during this phase to further assess and diagnose injuries.
 The initial assessment places specific emphasis on identifying and managing conditions with rapid and potentially lethal deterioration, such as tension pneumothorax, cardiac tamponade, and massive hemorrhage.
 Throughout the assessment process, effective communication among the trauma team members is paramount to ensure a coordinated and efficient response. This includes making triage decisions and facilitating swift patient transport to the most appropriate care facility, all of which contribute to optimal trauma patient management.
 In conclusion, the initial assessment in trauma patients is a dynamic and systematic process designed to swiftly identify and address life-threatening injuries. By recognizing these injuries promptly, initiating timely interventions, and gathering critical patient information, healthcare providers and emergency responders play a vital role in ensuring the best possible outcomes for trauma patients. Training in these procedures is essential to equip healthcare teams with the skills and knowledge needed for successful trauma patient management.

A Facility-Level Analysis of Nursing Home Compare's Five-Star Rating and Maryland's Family Satisfaction with Care Survey.

Nursing facilities care for individuals with cognitive and/or physical disabilities. Poor quality is associated with greater disease and mortality. Quality comprises many factors and different stakeholders value different factors. This study aimed to compare two care quality frameworks, one based on observable factors and one on family satisfaction. We merged publicly available 2021 Maryland nursing facility data. The Maryland Health Care Commission surveys long-term care residents' family satisfaction across seven domains. Centers for Medicare and Medicaid Services' (CMS) 5-star ratings aggregate inspections, staffing, and quality measures. We used univariate and bivariate statistics to compare the frameworks. The data set included 220 facilities and 4,610 survey respondents. The average facility rating was 7.70/10 and overall 77% of respondents would recommend the facility. Eighty-six percent of respondents from 5-star facilities, 79% from 4-star facilities, and 76% from 3-star facilities would recommend the facility compared to 65% from 1-star facilities (p < .001, p < .01, and p < .05, respectively). Four or 5-star facilities received significantly higher ratings (8.33, p < .001; 7.75, p < .05, respectively) than 1-star facilities (7.07). Our results corroborated earlier findings of strong associations between CMS ratings and satisfaction at the extremes of the 5-star system. These associations are inconsistent across family-reported domains. This suggests overlap between the frameworks. CMS ratings address care quality; family satisfaction measures quality of life and care quality. High satisfaction is associated with high care quality and quality of life; lower satisfaction is associated with lower care quality.

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention

BackgroundNursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. ObjectiveTo assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. MethodsThis study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. DiscussionAlternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community. Trial registrationNCT05605392.

Caring for persons with Dementia: a qualitative study of the needs of carers following care recipient discharge from hospital

BackgroundA randomised clinical trial titled the Carer End of Life Planning Intervention (CELPI) in people dying with dementia evaluated the effect of carer education and support about palliative care on care recipient outcomes. We present a pre-planned qualitative analysis of data collected during the CELPI trial in which needs of carers randomised to the study intervention group were assessed using a novel instrument (Carer Needs Directed Assessment in Dementia (CANDID). This tool aimed to identify carers’ perceptions of their own and their care-recipients’ needs and is an important step in identifying support provision for dementia-specific, palliative cares services upon hospital discharge.MethodsThe CANDID tool was designed to identify the needs and experiences of primary carers and of their care recipients during the last twelve months of the care recipient’s life. The tool consisted of 33 open-ended questions evaluating: symptom management, emergency contacts, advance care planning, carer’s perception of the care recipient’s future needs, carer’s current needs, and a proposed current and future care plan. The researcher’s philosophical assumption of interpretative phenomenology informed the study and approach to data collection and analysis. Qualitative data collected during interviews using this tool were thematically analysed in five steps: compiling, disassembling, reassembling, interpreting and concluding. An interpretation of participants’ reality emerged from their common experiences and the subjective meanings assigned to actions attached to the phenomena studied.ResultsThirty carer participants were included. Analysis identified three major themes: Carers’ perceived stressors, systemic barriers to care provision, and future planning. Issues identified included barriers to accessing supports, carer health and division between roles, financial burden, familial conflicts, adquate care in hospital and aged care facilities, concern about future needs, and end-of-life discussions.ConclusionThe CANDID tool enabled an evaluation of carer needs and concerns. Identifying those needs may inform a referral to palliative care services where the level of management required may be benenficial for both the person living with dementia and their primary carer.Trial RegistrationAustralian Clinical Trials Registration: (ACTRN12619001187134).

Antecedents of patient health engagement in the radiotherapy service (evidence from Indonesia).

Private radiotherapy (RT) facilities in emerging countries are growing with cancer incidence. Private healthcare providers must provide better care based on patient perspectives to reach more patients. This study investigated the relationship between antecedents of patient health engagement (PHE) with revisit intention (RVI) and intent to recommend (ITR) in private RT facilities. The survey was conducted in a private hospital with a RT service in Central Java province, Indonesia. A quantitative, cross-sectional design with a purposive sampling method was used. Patient questionnaire survey modified from validated self-administered radiotherapy experience (RTEQ) and PHE questionnaire were used to collect data. Partial least squares-structural equation modelling was used to analyse the data. In this study, 173 respondents consented to participate, which demonstrated that seven of the eight experience antecedents of PHE measured by reliable and valid RTEQ and were significantly related to PHE (p-value <0.05). At the same time, the degree of PHE has a significant relationship with RVI and ITR (p-value <0.05). Patient informational needs elements from the patient experience, followed by situational repose, were shown to have a prominent relation to PHE. The management of private RT facilities needs to focus more on these elements to encourage PHE to establish hospital performance. The findings denote that six elements of RTEQ relate to PHE and further hospital outcomes. Hospital management could utilise this approach to improve the quality of care in RT facilities, specifically in private hospitals in emerging countries.

Heterogeneous effects of national health insurance scheme on healthcare utilisation: evidence from Ghana

PurposeThis paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth.Design/methodology/approachThe study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership.FindingsGenerally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries.Originality/valueTo the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330

The Experiences of Nursing Managers in Implementing Palliative Care in Long-Term Care Facilities.

The purpose of this study was to explore the experiences of nursing managers in implementing palliative care in long-term care facilities and to provide recommendations for managers who plan to introduce palliative care into their facilities. This study used semi-structured interviews and grounded theory methodology, with purposive sampling. A total of 11 long-term care facilities in eastern Taiwan that had implemented palliative care were selected, and 11 facility nursing managers participated in in-depth, face-to-face interviews. The introduction of palliative care in long-term care facilities can be divided into four stages: (1) the opportunity for change, (2) playing a supportive role, (3) a new collaboration model, and (4) facility transformation. The core category shared by the participants may be summed up as "the palliative care captain in the facility". It reflects the spirit of the successful implementation of palliative care by managers in long-term care facilities. The study reveals that during the initial phases of implementing palliative care, the palliative care teams assume a crucial leadership role, while the facilities play a supportive role. At this stage, managers should focus on personnel training and addressing internal issues within the facilities to facilitate successful collaboration with the palliative care teams. In the later stages, the facilities transition from a supportive role to one of independence, marking a critical juncture for the facilities' potential stable development. During this period, managers are tasked not only with establishing the facilities' own palliative care team but also with facilitating the transformation of staff from learners to instructors. Finally, even after successful implementation, managers must contemplate how to innovate and set more ambitious goals.

Support for children and families, including those arriving in the face of the war from Ukraine, offered in specialist day care facilities in Bialystok

Abstract Day care centres provide families with assistance in the care and upbringing of their children. Various forms of classes, from pedagogy of play to specialist therapeutic help, planned in the annual calendar of the institutions constitute a great support for families. Classes, free time activities, trips are free of charge, which is important in the case of families struggling with life and financial difficulties. Specialist day-care centres are a bridge between educational institutions and the family house. Such places constituted a mainstay for children coming to Białystok from a war-torn country, from Ukraine. This article is a summary of methodological activities that took place in specialized day care facilities with the participation and great commitment of students of the Faculty of Education of the University of Bialystok. The article presents good practices that can also be promoted in other institutions in the country.