Life In Residential Care Research Articles

The role of palliative care nurse practitioner in promoting end-of-life care in residential care facilities

Background and objective: The neglect of older people at the end of life in residential care documented in the Australian Royal Commission into Aged Care and Quality and Safety mandates urgent solutions to improve care. This integrative literature review aimed to explore the potential role of the palliative care nurse practitioner (PC-NP) in promoting quality end of life in residential care.Methods: Databases Medline, Emcare, PsychINFO and CINAHL were searched from January 2010 to April 2022. Full text of primary articles meeting inclusion criteria encompassing residents living in residential care settings, the role of the PC-NP in supporting quality dying were obtained and independently screened to determine final studies for review. Findings were thematically analysed. Two reviewers independently extracted data and assessed level of evidence and quality ratings for both quantitative and qualitative studies.Results: Of 12 articles meeting eligibility criteria, four specifically focused on the PC-NP or the palliative care nurse in residential care, seven examined the generic nurse practitioner role, and one the aged care nurse role in supporting palliative care. Themes common to all roles including positive patient outcomes, advance care planning, hospital avoidance, staff education and enhanced communication with families. Themes specific to the PC-NP included meeting end-of-life needs, end-of-life prescribing, and enhancing the role of the General Practitioner.Conclusions: Although reflected in only a handful of studies, this integrative review has provided preliminary insights into potential contributions of the PC-NP to quality end-of-life care for residential care residents.

Loneliness and boredom in residential care

OBJECTIVES: Older adults are more likely to experience loneliness and boredom in residential care. The purpose of this study is to extend the understanding of experiences of older adults in residential care and identify factors that residents believe contribute to loneliness and boredom. In addition, I aim to identify strategies used to cope with these experiences and provide recommendations to enhance the quality of life in residential care. METHODS: A phenomenological qualitative study was conducted through participant observation, in-depth interviews with 24 residents, and key informant interviews with 10 staff members. RESULTS: The findings emphasise the pervasiveness of loneliness and boredom despite facilities’ efforts to provide activities and support. Staff and family support helped to alleviate loneliness and boredom and participants employed individual coping strategies. DISCUSSION: Health professionals should recognise loneliness and boredom as issues in residential care and prioritise individual needs and preferences when designing activities.

“Sometimes I feel at home” adolescents’ narratives of everyday life in residential care

PurposeA residential care is home for children who live there and is simultaneously a workplace for employees aiming to safeguard the needs and development of children. Studies have shown that adolescents’ descriptions of life in residential care are connected to feelings of otherness and deviance. The purpose of this study is to explore how adolescents in residential care in Norway relate residential care as a home to their experiences of everyday life in this context and to their relationships with the employees.Design/methodology/approachThis study draws on individual, qualitative interviews with 19 boys and girls (aged 15–18 years) living in residential care homes in Norway. The interviews explored their narratives of everyday life in residential care. The adolescents were encouraged to tell about yesterday and were asked follow-up questions regarding everything that had occurred during encounters with employees. The Norwegian Center for Research Data approved the study.FindingsThe analysis shows tensions in the adolescents’ accounts between the institution as an abnormal context and their own subject position as normal. By drawing upon the terms “stigma” and “recognition” in the analysis, the study shows how recognising relationships between the youth and staff decreases the potential to experience stigma.Originality/valueThis study contributes to existing knowledge on social work in residential care. The paper shows how the institutional framework and employees’ practices impact adolescents’ self-understanding and their experiences of residential care as a home.

Older people's perceived autonomy in residential care: An integrative review.

Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people’s perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher’s Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people’s individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples’ autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people’s choices. Professionals’ characteristics, such as education and attitudes, and the older people’s living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people’s perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.

Children’s rights and residential care in Taiwan: An exploration of the tensions between global standards and culturally situated practices

This article examines the tension between the rhetoric of children’s rights and the realities of residential care for children in Taiwan. After reviewing Chinese and English literature, we present an empirical study of children’s experiences of life in residential care, drawing on participant observation, participatory arts-based activities and semi-structured interviews with 50 children in two homes. Breaking new ground, we reveal children’s accounts of happiness and unhappiness with institutional living, their strategies for developing resilience, and their understanding and experiences of children’s rights. We discuss the implications of these findings for social work policy, practice and research.

The intersection of abandonment, HIV-positive status and residential care for a group of perinatally infected adolescents

Although anti-retroviral treatments have significantly reduced the incidence of mother-to-child transmission of HIV and AIDS, there remains, for the foreseeable future, a group of adolescents who have been perinatally infected. Noting the paucity of information regarding the impact of paediatric AIDS and its intersection with residential care, this paper investigates the lived realities of 20 South African adolescents who were vertically infected with HIV and AIDS, were abandoned, and have been raised in residential care. The exploratory study highlights that for these youth the dimensions of their adolescence, HIV-positive status and associated abandonment as well as life in residential care are mutually reinforcing and interconnected. Issues of race and class also interact with these social dimensions. Ultimately, these dimensions intersect to create a particular form of social exclusion. Intentional, critical intervention is required on the micro level to support these teens develop a coherent identity. On the meso level, the residential facility should actively facilitate community integration, particularly with the adolescents’ communities (and where possible, families) of origin. Governments need to strengthen intersectoral, rights-based responses and in particular, address the consequences of cognitive impairment associated with perinatal transmission.

Research-based Reflections on How the Educational, Economic and Social Circumstances Faced by Some Children and Young People Can Lead to Significant Disadvantage and Vulnerability

Abstract The paper provides detailed reflections on the educational, economic and social circumstances that impact on the lives of many disadvantaged and vulnerable children and young people. Drawing largely on primary research data collected in Romania, Germany and the United Kingdom, three illustrative case studies are presented for consideration focusing on: life in residential care and youth offending institutions; experiences of educational vulnerability; and human trafficking. The methodological approach adopted across the research projects explored, was shaped by the demands and expectations of the United Nations Convention on the Rights of the Child (UNCRC). All of the reported data reflects the views of children and young people who were interviewed as part of three research projects. It is argued that the difficult and challenging circumstances that many children and young people find themselves in, place them at significant disadvantage and increased vulnerability in terms of their social and educational development and life chances.

Personal characteristics of bullying victims in residential care for youth

Purpose – This research examined some personal characteristics of victims of bullying in residential care for youth. The paper aims to discuss these issues. Design/methodology/approach – A total of 601 young people aged 11-21 from 22 residential facilities in Croatia completed an anonymous self-reported bullying questionnaire, the Big Five Personality Inventory, the Basic Empathy Scale and the Rosenberg Self-esteem Scale. Findings – The results demonstrated that male and female victims lacked self-esteem, presented with neurotic personality traits and were likely to believe that bullying was just part of life in residential care. Female victims also presented with lower levels of agreeableness and conscientiousness, while male victims were young and had a history of victimisation during their previous placement, in school and at the beginning of their current placements. Practical implications – Victims in care might benefit from programmes addressing their low self-esteem, high neuroticism and attitudes ...

P-279: ‘Having something meaningful to do’ is correlated with Quality of Life in residential care ... or not?

P-279: ‘Having something meaningful to do’ is correlated with Quality of Life in residential care ... or not?

Potential Benefits to Staff from Humor Therapy with Nursing Home Residents

Life in residential care can be challenging for residents and staff. Bringing humor into this setting may benefit residents, creating a more productive, enjoyable work environment for staff. The potential effect of exposure to humor therapy on staff, both as active and incidental participants, as part of a randomized controlled trial of the effect of humor therapy for aged care residents was investigated in the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE). The intervention involved a humor program with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine 2-hour sessions over 12 weeks. Methods included a staff survey at three time points, interviews with LaughterBosses, and a satisfaction rating by facility managers. There were significant positive findings for some staff subgroups, including assistants in nursing/personal care assistants and staff older than 45. LaughterBoss interviews and intervention group manager ratings of staff work enthusiasm were positive.

End of Life in Residential Care from the Perspective of Care Aides

We explored contextual features shaping end-of-life (EOL) care in residential care facilities by drawing on the perspectives of 11 resident care aides (RCAs) in one Western Canadian urban centre. RCAs characterized EOL care as "providing comfort", including physical and emotional comfort. Concerns with time and workload challenges dominated accounts and generated guilt, sadness, and frustration. RCAs tried to "find the time" by taking it from themselves or other residents, and by relying on the commitment of co-workers and on families. Findings emphasize the importance of the RCA role (particularly in emotional comfort), yet call for attention to interpretations of what is involved in this work, and to definitions of scopes of practice and training requirements. Findings reiterate the importance, among Canadian RCAs, of appropriate workloads to facilitate quality EOL care, and raise concerns about how time constraints shape EOL care practice and the meanings infusing this practice.

‘What Troubled Children Need’ Constructions of Everyday Life in Residential Care

This article argues that key values of child protection work are not the appropriate point of departure for contemplating the welfare of children in professional care. Central values, such as ‘comfort’, ‘recognition’ or ‘appreciation’ say very little about the social practices of residential care. Using data from an ethnographic study in Denmark, the article demonstrates that ideas about the needs of troubled children are realised in dissimilar ways, creating highly different living environments for institutionalised children. The principles behind these construction processes are explored, and the profound ambiguity of values in childcare is discussed as an effect of residential care’s being an ‘institutional’ or ‘human service’ type of organisation.

Regulating life in residential care: the unassuming authority of the timetable

AbstractThis paper highlights the various roles and influences of a particular text form: the timetable pasted unassumingly on the wall of a residential home for children. It provides examples of literacy events that take place around the ubiquitous timetable and how through these events, the social dynamics of its residents and those around them are constructed and enforced. An important aspect of institutional life, the timetable “regulates the home's residents' daily patterns by structuring their time so that they move from one set of skills to another throughout the day”. In addition, it becomes the ‘invisible monitor’ in the absence of the home's supervisor, as though ‘empowered’ with authority to dictate the children's actions. In other words, the timetable proves to have dominant control over the daily practices of those living in residential care.

Resident perspectives of the determinants of quality of life in residential care in Ireland

This paper is a report of a study conducted to identify the determinants of quality of life for older people living in residential care, including exploration of mediating factors at personal and institutional levels and to construct a model of these. The quality of life of older people living in residential care is an under-researched area. The focus in the gerontology literature has been on quality of care rather than quality of life for these people. There is emerging consensus, however, that quality of life for older people is a complex, multidimensional concept, incorporating both subjective and objective elements, whether people live at home or in residential care. A grounded theory study was conducted in 2005-2006. A total of 101 interviews were undertaken with older people across 12 sites, representing different types of residential care in Northern Ireland. The constant comparative technique was used to analyse data. Four themes having an impact on the quality of life of residents were identified: ethos of care; sense of self and identity; connectedness; and activities and therapies. Mediating and facilitating and/or constraining factors for quality of life were also identified. The core category was conceptualized as 'maximizing potential'. Achieving optimal quality of life for older people in residential care will remain elusive unless all the factors which affect on it are taken into account by practitioners and policy-makers. Improving the quality of life of older people in residential care will require action in respect of all of the domains identified in this paper.

Residential life today, Government rhetoric and individual rights, a match for reality?

This paper explores the position of older people in influencing and negotiating their own living and care arrangements, with a particular focus on residential care. Firstly it outlines the factors that have lead to the current position with regard to key social policies impacting on the lives of older people, both in the broad sphere of service user and community participation and in the area of residential care itself. The paper then examines recent research into the experiences of life in residential care and the extent to which older people's rights through various items of legislation, government guidance and other influential 'good practice' publications have been realised. This is considered at both strategic and individual levels. A discussion of some of the tensions manifest in this situation suggest possible areas upon which future attention should be focussed.

Perceptions of Hong Kong Chinese elders on adjustment to residential care

While there is an increasing number of elders moving into residential care homes in Hong Kong, very little is known about how they adjust to the changes associated with living in such homes. A grounded theory study was therefore conducted to explore the processes through which Chinese elders adjust following a move to residential care. Audiotaped in-depth interviews were conducted with 18 elders one week after residential home admission and then every month until no new information about their adjustment experiences could be discovered. Constant comparative analysis of data revealed that newly admitted elders adjust through the four stages of orienting, normalizing, rationalizing and stabilizing as they struggle to regain normality in a life that is as close to that lived before admission as possible. The purpose of this paper is to report on Chinese elders' normalizing experiences in the second stage of adjustment. It found that a number of experiences suggested in the literature, as barriers to residential living, such as living with rules and regulations, lack of privacy and autonomy, are not regarded as important by Chinese elders. However, establishing relations with other residents and staff appears to be a particular challenge. It concludes that the life experience and socio-cultural values of Chinese elders have to be addressed when trying to effectively help Chinese elders adjust to life in residential care. The findings also highlight the need for better collaboration between nursing and social work staff in their efforts to promote elders' adjustment.