Morning Care Research Articles

Analysis of poor work postures during morning care operations of intensive care unit nurses: a field research

BackgroundPoor working postures in morning care operations contribute significantly to work-related muscle fatigue and low back pain among ICU (Intensive Care Unit, ICU) nurses. However,there are few field studies on the relationship between Poor working postures and work-related muscle fatigue, low back pain among ICU nurses.ObjectiveThis study aims to assess the frequency and degree of posture hazards associated with poor working postures during morning care operations of ICU nurses.MethodsTwo ICUs in a Grade-A tertiary hospital in Hunan Province were randomly selected for the field study in May–June 2021 research. The image data of the participating nurses’ morning care work postures were collected by observation method and image recording method, and the postural hazard level was assessed by the two-person interpretation method of the work posture analysis system. The mean and standard deviation, frequency and percentage were used for the basic statistical description, and the general linear model multivariate Hotelling’s T2 test was used to calculate the Hotelling’s T2 and F statistics to explore the pattern of change in the postural hazard score curves.ResultsA total of 45 nurses were observed during morning care operations, resulting in 47.8 h of video data and 34,428 effective static operation posture pictures. Among these pictures, 21,166 (61.5%) depicted poor working postures. Nurses spent up to 7 min and 30 s maintaining a challenging posture during oral care, with the highest postural hazard score (M = 2.2, SD = 0.3) observed during defecation care. Each patient requires a total of 25–30 min of oral care per day.The Hotelling’s T2 test indicated that the change curve of the postural hazard score in each step revealed the largest second-order F value, F = 52.931, P < 0.001.DiscussionICU nurses frequently adopt poor working postures during morning care operations. Further research should focus on optimizing safe working postures to prevent or minimise detrimental occupational hazards resulting from poor working postures.Research on occupational low back pain among ICU nurses can help them work more efficiently, and thereby improving their nursing level.

Metabolic load during morning care and active bed exercises in critically ill patients: An explorative study

BackgroundTo avoid overexertion in critically ill patients, information on the physical demand, i.e., metabolic load, of daily care and active exercises is warranted. ObjectiveThe objective of this study was toassess the metabolic load during morning care activities and active bed exercises in mechanically ventilated critically ill patients. MethodsThis study incorporated an explorative observational study executed in a university hospital intensive care unit. Oxygen consumption (VO2) was measured in mechanically ventilated (≥48 h) critically ill patients during rest, routine morning care, and active bed exercises. We aimed to describe and compare VO2 in terms of absolute VO2 (mL) defined as the VO2 attributable to the activity and relative VO2 in mL per kilogram bodyweight, per minute (mL/kg/min). Additional outcomes achieved during the activity were perceived exertion, respiratory variables, and the highest VO2 values. Changes in VO2 and activity duration were tested using paired tests. ResultsTwenty-one patients were included with a mean (standard deviation) age of 59 y (12). Median (interquartile range [IQR]) durations of morning care and active bed exercises were 26 min (21–29) and 7 min (5–12), respectively. Absolute VO2 of morning care was significantly higher than that of active bed exercises (p = 0,009). Median (IQR) relative VO2 was 2.9 (2.6–3.8) mL/kg/min during rest; 3.1 (2.8–3.7) mL/kg/min during morning care; and 3.2 (2.7–4) mL/kg/min during active bed exercises. The highest VO2 value was 4.9 (4.2–5.7) mL/kg/min during morning care and 3.7 (3.2–5.3) mL/kg/min during active bed exercises. Median (IQR) perceived exertion on the 6–20 Borg scale was 12 (10.3–14.5) during morning care (n = 8) and 13.5 (11–15) during active bed exercises (n = 6). ConclusionAbsolute VO2 in mechanically ventilated patients may be higher during morning care than during active bed exercises due to the longer duration of the activity. Intensive care unit clinicians should be aware that daily-care activities may cause intervals of high metabolic load and high ratings of perceived exertion.

Peningkatan Pengetahuan Perawat tentang Oral Hygiene di Ruang Rawat Inap HCU Penyakit Dalam RSUP Dr. M. Djamil Padang

Personal hygiene is a person's effort to maintain cleanliness and health. One of the activities during morning care regarding patient personal hygiene that nurses often forget is performing oral hygiene. The results of interviews conducted with the patient's family indicated that oral hygiene treatment was rarely carried out. Therefore, it was necessary to provide education to increase nurses' knowledge about oral hygiene—the activity aimed at helping nurses to understand the importance of performing oral hygiene care. The implementation of the activity was carried out directly by the nurse by conducting a pre-test, giving material, and ending with a post-test. The results of the pre-test were the level of knowledge of nurses about oral hygiene care before being given education; namely, seven families had good knowledge (23%), ten families had sufficient knowledge (33%), and 13 families had poor knowledge (44%). The post-test results were the family knowledge level in the HCU Internal Medicine ward at RSUP Dr M. Djamil Padang after being given education; 25 families had good knowledge (83%), and five families had sufficient knowledge (17%). Based on these results, the educational activity was beneficial, can increase nurses' knowledge about oral hygiene care, and can be applied directly to patients. The suggestion is that nursing managers can control oral hygiene care to optimize nursing services.

EXPLORATION OF CARE CONTENTS AFFECTING STRESS VARIABILITY IN FAMILY CAREGIVERS OF OLDER PEOPLE WITH DEMENTIA

Abstract Support for family caregivers (FCs) caring for older people with dementia in the home settings is a common issue in developed countries. Previous studies have reported that the increase in the burden of FCs not only causes health problems, but also makes it difficult to continue care at home and causes serious problems such as abuse. However, it is not clear how FCs’ stress, which leads to increased burden, fluctuates within a day through daily care activities. The aim of this study was to explore care activities that influence the increase in FCs’ stress. We recruited one dyad of an older adult with dementia over the age of 65 and a FC. Data collection was performed for consecutive 7 days throughout 24 hours. We adopted hamon® developed by Mitsufuji Corp. Japan to measure Heart Rate Variability (HRV)-based stress. Moreover, we asked a FC to talk with Virtual Agent on a laptop freely to understand when and what kind of care activities were done and how FC’s feelings were. Kruskal-Wallis’s test and Bonferroni’s multiple comparison test were used to compare differences in stress in the care contents. Results showed that sleeping care, which is composed of such as assistance in using the toilet and changing clothes, gives more stress to FC, compared with morning care which includes such as assistance in changing clothes, eating breakfast, and taking medicine (p=0.042). this finding is beneficial for considering how to reduce FC’s stress on daily care activities.

Standards and quality of care for older persons in long term care facilities: a scoping review

BackgroundCaring for older persons has become a global necessity to ensure functional ability and healthy ageing. It is of paramount importance that standards of care are monitored, especially for older persons who live in long term care facilities (LTCF). We, therefore, scoped and summarised evidence relating to standards and the quality of care for older persons in LTCFs in gerontological literature globally.MethodsWe conducted a scoping review using Askey and O’Malley’s framework, including Levac et al. recommendations. PubMed, CINAHL, Health Sources, Scopus, Cochrane Library, and Google Scholar were searched with no date limitation up to May 2020 using keywords, Boolean terms, and medical subject headings. We also consulted the World Health Organization website and the reference list of included articles for evidence sources. This review also included peer-reviewed publications and grey literature in English that focused on standards and quality of care for older residents in LTCFs. Two reviewers independently screened the title, abstract, and full-text of evidence sources screening stages and performed the data extraction. Thematic content analysis was used, and a summary of the findings are reported narratively.ResultsSixteen evidence sources published from 1989 to 2017 met this study’s eligibility criteria out of 73,845 citations obtained from the broader search. The majority of the studies were conducted in the USA 56% (9/16), and others were from Canada, Hong Kong, Ireland, Norway, Israel, Japan, and France. The included studies presented evidence on the effectiveness of prompted voiding intervention for urinary incontinence in LTCFs (37.5%), the efficacy of professional support to LTCF staff (18.8%), and the prevention-effectiveness of a pressure ulcer programme in LTCFs (6.3%). Others presented evidence on regulation and quality of care (12.5%); nursing documentation and quality of care (6.3%); medical, nursing, and psychosocial standards on the quality of care (6.3%); medication safety using the Beer criteria (6.3%); and the quality of morning care provision (6.3%).ConclusionThis study suggests most studies relating to standards and quality of care in LTCFs focus on effectiveness of interventions, few on people-centredness and safety, and are mainly conducted in European countries and the United States of America. Future studies on people-centerdness, safety, and geographical settings with limited or no evidence are recommended.

Caregiver Singing Intervention: do Emotions and Resistance differ between Vascular dementia and Alzheimer’s?

Persons with dementia in residential care commonly express resistance of aggressiveness. Caregivers Singing (CS) - when caregivers sing for or together with persons with dementia during caring, has shown to reduce these expressions and increase communication and cooperation. Previous studies of CS have included both persons with Alzheimer’s disease (AD) and persons with Vascular dementia (VD), but no studies have been done focusing on possible differences regarding these diagnoses. As disabilities and symptoms differ between these diagnoses, the emotions and expressions, such as resistance may differ regarding response to CS. This polit study aims to describe emotions and resistiveness to care among persons with vascular or Alzheimer’s disease. Participants were five persons with AD and five persons with VD living at two different nursing homes. Video observations (VIO) occurred with them and their caregivers during morning care situations four times without CS and four times with CS. In all, 80 VIOs were rated using the Observed Emotion Rating Scale and the Resistiveness to Care Scale. These were then analyzed with descriptive statistics. Results revealed that for both persons with AD and VD, the positive emotion pleasure were never observed without CS while with CS it increased for both groups. In contrast to the positive emotion effect of CS, the negative emotions and resistiveness decreased more for persons with VD than for persons with AD. For persons with VD, the number of observations without anger increased, while observation without anger or anxiety/fear for persons with AD remind the same.

Monitors to improve indoor air carbon dioxide concentrations in the hospital: A randomized crossover trial

BackgroundVentilation has emerged as an important strategy to reduce indoor aerosol transmission of coronavirus disease 2019. Indoor air carbon dioxide (CO2) concentrations are a surrogate measure of respiratory pathogen transmission risk. ObjectivesTo determine whether CO2 monitors are necessary and effective to improve ventilation in hospitals. MethodsA randomized, placebo (sham)-controlled, crossover, open label trial. Between February and May 2021, we placed CO2 monitors in twelve double-bed patient rooms across two geriatric wards. Staff were instructed to open windows, increase the air exchange rate and reduce room crowding to maintain indoor air CO2 concentrations ≤800 parts per million (ppm). ResultsCO2 levels increased during morning care and especially in rooms housing couples (rooming-in). The median (interquartile range, IQR) time/day with CO2 concentration > 800 ppm (primary outcome) was 110 min (IQR 47–207) at baseline, 82 min (IQR 12–226.5) during sham periods, 78 min (IQR 20–154) during intervention periods and 140 min (IQR 19.5–612.5) post-intervention. The intervention period only differed significantly from the post-intervention period (P = 0.02), mainly due to an imbalance in rooming-in. Significant but small differences were observed in secondary outcomes of time/day with CO2 concentrations > 1000 ppm and daily peak CO2 concentrations during the intervention vs. baseline and vs. the post-intervention period, but not vs. sham. Staff reported cold discomfort for patients as the main barrier towards increasing ventilation. DiscussionIndoor air CO2 concentrations in hospital rooms commonly peaked above recommended levels, especially during morning care and rooming-in. There are many possible barriers towards implementing CO2 monitors to improve ventilation in a real-world hospital setting. A paradigm shift in hospital infection control towards adequate ventilation is warranted. Trial registrationClinicalTrials.gov Identifier: NCT04770597

Feasibility Study of a Digital Screen-Based Calming Device for Managing BPSD During Care

MindfulGarden (MG) is a digital device resembling a flat screen TV, with touchless sensors that react to voice and motion. In this study 13 long-term care home residents aged 74-100 exhibiting Behavioural and Psychological Symptoms of Dementia (BPSD) were randomized to treatment and control groups. On days 1-3 the treatment group received usual care plus exposure to MG during morning and evening care - events well documented to be problematic for residents and care staff; controls received usual care only. On day 4 both groups were exposed to MG with verbal cueing. A 26-item checklist was used to record frequency and types of disruptive BPSD exhibited; care duration was recorded in minutes. There was a trend toward reduction of BPSD and duration of care during morning care. Findings suggest that verbal cueing may be important for successful implementation of MG in calming residents with dementia during routine care.

The Use of Tag Questions in Person-centered Communication

Tag questions are imperative, declarative, exclamative or interrogative statements that have been modified to include a question (e.g.., It is hot out, isn’t it?). Tag questions have been characterized as elderspeak because it suggests an expected response from the person with dementia, thus limiting his/her ability to make a decision independently. However, tag questions serve multiple functions in conversation. There is limited research on the multidimensional nature of tag questions in conversations between formal caregivers and their clients with dementia. Accordingly, the purpose of this study was to investigate the functions of tag questions used by formal caregivers in utterances coded as person-centered. Conversations (N= 87) between formal caregivers and a simulated person with dementia were video-recorded during a 5-minute care interaction involving morning care. Caregivers’ utterances were coded for the use of the following types of person-centered communication: recognition, negotiation, facilitation, and validation. During secondary data analysis, the person-centered utterances were analyzed for the use and function of tag questions. Conversational analyses revealed two broad functions of tag questions: gather information and facilitate a desired action. Tag questions used to gather information included the following specific functions: acknowledge response, establish common ground, state fact or opinion, initiate topic, conversational joking, state what is being done and questions. Tag questions that facilitated a desired reaction included the following specific functions: offers, advice and suggestions and requests and commands. Findings from the current study reveal that tag questions are not exclusively elderspeak and can be used to illicit conversation.

Autonomy Support of Nursing Home Residents With Dementia in Staff-Resident Interactions: Observations of Care

ObjectivesPeople with dementia living in nursing homes benefit from a social environment that fully supports their autonomy. Yet, it is unknown to what extent this is supported in daily practice. This study aimed to explore to which extent autonomy is supported within staff–resident interactions. DesignAn exploratory, cross-sectional study. Setting and ParticipantsIn total, interactions between 57 nursing home residents with dementia and staff from 9 different psychogeriatric wards in the Netherlands were observed. MethodsStructured observations were carried out to assess the support of resident autonomy within staff–resident interactions. Observations were performed during morning care and consisted of 4 main categories: getting up, physical care, physical appearance, and breakfast. For each morning care activity, the observers consecutively scored who initiated the care activity, how staff facilitated autonomy, how residents responded to staff, and how staff reacted to residents’ responses. Each resident was observed during 3 different mornings. In addition, qualitative field notes were taken to include environment and ambience. ResultsIn total, 1770 care interactions were observed. Results show that autonomy seemed to be supported by staff in 60% of the interactions. However, missed opportunities to engage residents in choice were frequently observed. These mainly seem to occur during interactions in which staff members took over tasks and seemed insensitive to residents’ needs and wishes. Differences between staff approach, working procedures, and physical environment were observed across nursing home locations. Conclusions and ImplicationsThe findings of this study indicate that staff members support resident autonomy in more than one-half of the cases during care interactions. Nonetheless, improvements are needed to support resident autonomy. Staff should be encouraged to share and increase knowledge in dementia care to better address residents’ individual needs. Especially for residents with severe dementia, it seems important that staff develop skills to support their autonomy.

Pain assessment of nursing home's residents by certified nursing assistants: a real-world study

In French care facilities for dependent aged people (NHDAP), prevalence of pain among residents with dementia is high, and source of behavior disturbances and quality of life impairment. However, in spite of many international expert statements, pain remains under-assessed and under-managed in these patients. Certified nursing assistants (CNA) are on the front-line in NHDAP to detect the presence of pain in residents with communication difficulties, while they received little training for pain management and directives for specific care. Moreover, no studies were presently devoted to the impact of demographic and socio-professional determinants of CNA on pain assessment. In our study, we assessed the presence and intensity of pain in cognitively impaired residents in NHDAP, by CNA performing as a pair for the morning care. 42 pairs were recruited and independently completed a standardized behavioral assessment for pain (Doloplus scale) as well as a numeric rating scale. CNA personal characteristics were investigated to analyse the determinants of potential assessment discrepancies between each of the pairs. Presence of pain was detected in 51.1 to 91.1% of the patients depending on the tool and analysis criteria. In 28.9% important discrepancies were observed in the pain assessment between the CNA pairs, which could be related to professional status and prior use of the observational assessment. These inter-rater discrepancies should be reduced providing clear pain assessment guidelines for CNA in NHDAP, and further studies should be completed to figure out the role of CNA personal determinants in the patients' pain assessment.

THE SUPPORT OF AUTONOMY FOR NURSING HOME RESIDENTS WITH DEMENTIA: OBSERVATION OF MORNING CARE

People with dementia in nursing homes need their social environment in supporting their autonomy. This study explored how this relational autonomy is supported by staff for residents with dementia during morning care in nursing homes. Structured observations (n=1815) were carried out to assess how resident choice is supported within staff-resident interaction. Observation of morning care consisted of four main categories: ‘getting up’, ‘physical care’, ‘physical appearance’ and ‘breakfast’. In addition, qualitative field notes were taken to support observations. In total, 55 residents with dementia were included from eight nursing home wards in The Netherlands. Results indicated that resident autonomy during morning care was only limitedly supported. Individual staff members took over tasks, regardless of resident’s individual capabilities to make a choice. Staff controlled resident’s choice for almost all observed categories. The findings of this study implicate that person-centered care during morning routine can be improved by addressing individual needs

Managing Paratonia in Persons With Dementia: Short-term Effects of Supporting Cushions and Harmonic Techniques

ObjectivesParatonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on paratonia was explored. DesignThis was a multicenter interventional clinical trial with AB/BA crossover design. Each intervention (SC or HT) was subsequently implemented over 1 week in each of the participants. Setting and participantsThe study included 22 participants with moderate to severe paratonia from 9 different nursing homes in Flanders, Belgium. MethodsMeasurements of biceps brachii and rectus femoris muscle tone (MyotonPRO), maximal elbow and knee extension (goniometer), and pain (Pain Assessment Checklist for Seniors With Limited Ability to Communicate) were performed on 3 different days within 1 week. The effect of HT on nursing care was evaluated with the Pain Assessment Checklist for Seniors With Limited Ability to Communicate and visual analog scale ratings of discomfort items. ResultsAfter 30 minutes of positioning with SC, participants had lower biceps brachii muscle tone (P = .041) and higher maximal elbow extension (P = .006) than without SC. After a 30-minute session of HT, a significant increase in biceps brachii muscle tone (P = .032) and maximal extension of elbow (P < .001) and knee (P = .028) was found. Pain (P = .003) and discomfort (P = .001 to P = .019) during morning care were significantly lower when care was preceded by 30 minutes of HT. Conclusions/ImplicationsThis explorative study revealed beneficial short-term effects on range of motion for both SC and HT and a positive effect of SC on upper limb muscle tone. Beneficial effects of HT were found on resident's pain and caregiver's discomfort during care. The results of the present study are encouraging and can contribute to the development of evidence-based interventions for paratonia.

By the Light of Day: Quality, Safety, and Education During the Overnight Admission Handoff.

BackgroundCurrent duty hour restrictions have led to increased patient handoffs as well as increased use of faculty in the nocturnist role. Nocturnists typically supervise residents and perform direct patient care leading to a diversity of provider experience level during morning handoffs. In this study, we explored how the presence of nocturnists impacts perceptions patient safety, quality, and educational value of morning care transitions.MethodsWe performed a cross-sectional survey examining the housestaff and attending perceptions of the morning sign-out of overnight admissions from both night float residents and nocturnists in July of 2016. Survey responses were Likert-style format, querying respondents’ level of agreement (1-5, strongly disagree to strongly agree) with statements. 108 providers responded (41% response rate)ResultsRelative to attendings, residents reported feeling like they had less time to ask questions (4.0 vs. 5.0, p < 0.001) and felt less comfortable asking questions of the nocturnist during handoff (4.0 vs. 5.0, p < 0.001). Residents were also less comfortable than attendings in changing a nocturnist’s plan of care (4.0 vs. 5.0, p < 0.001). Housestaff reported that receiving signout from the overnight resident was more likely to improve their confidence managing similar conditions (4.0 vs. 3.0, p < 0.001).ConclusionThe benefits of nocturnist supervision may come at an educational cost as trainees feel less comfortable asking questions or changing the plan of care. With increasingly prevalent night float systems and nocturnist providers, academic programs have to negotiate the balancing safe and high-quality patient care with creating positive learning environments and clear expectations.

Nursing Students&amp;apos; Opinions on Facilitating and Hindering Factors in the Clinical Training Setting

Clinical training for nursing students is essential in any nursing program because nursing is a discipline that requires students to apply theoretical knowledge into clinical training setting and acquire various skills to enhance their performance. The study aimed to identify nursing students’ opinions on facilitating and hindering factors in the clinical training setting. A descriptive cross-sectional design was used. The study was conducted in the Faculty of Nursing King Abdulaziz University on 86 student nurses enrolled in 2nd, 3rd, and 4th year. The tool was developed by the researchers and consists of two parts: Part I: Demographic characteristics. Part II: This part includes 42 items, 15 items related to facilitating factors and 27 items hindering factors. The study results showed that there was a statistically significant difference among all three academic years of the student nurses regarding common hindering factors named patient’s morning care, difficulty in being initiative or not being self-reliant, feeling of not being treated seriously/receiving condescending comments from the supervisor, and insufficient supervision or supervisors irritated or not interested. While no statistically significant difference among all three academic years of the student nurses opinions in relation to the common facilitating factors. Conclusions: The common facilitating factors among all students in the present study were patient family cooperation help me to be more confident, having opportunities to practice different tasks gives confidence, more practice makes learning from mistakes, being receiving feedback gives self-confidence, having a good collaboration with staff gives the confidence to ask questions or show weakness, and working with another student-helped make the work and care of the client go smoothly. Furthermore, the common hindering factors among all students were fear of making mistakes, evaluation by faculty, patient’s morning care, lack of time to accomplish the required tasks, difficulty in being initiative or not being self-reliant, receiving condescending comments from the supervisor, and insufficient supervision and supervisors not interested. Recommendations: Develop an organized supervision system, through specialized clinical supervisors, and assigned preceptors from the hospital to help the students in the clinical training. Develop a standardized evaluation form to support and fair evaluation. Prepare the students before direct contact with the patients, through attending simulation training to minimize mistakes when contact with the patients in the clinical setting.

Effects of care assistant communication style on communicative behaviours of residents with dementia: a systematic multiple case study.

ObjectivesTo determine whether varying the communication style of care assistants, encouraging them to use direct instructions and allowing more time for residents’ responses influenced the communicative behaviour of care home residents living with dementia.DesignThis study used a multiple systematic case study design. Participants were video‐recorded during morning care routines in three communication conditions: usual communication, direct instructions and pacing (allowing more time for resident responses). Each dyad acted as its own control.SettingThe study took place in a residential care home in the East Midlands, UK.ParticipantsThree dyads (person with dementia/care worker)MeasuresThe level of compliance with instructions was measured. Validated measures were used to rate positive communicative behaviour (engagement with care tasks, eye contact and initiation of interaction) and negative communicative behaviour (e.g. shouting and kicking).ResultsCare assistants were able to employ direct instructions after brief training. The use of direct instructions was positively correlated with positive communicative behaviour from residents (p < 0.05). The pacing condition was not employed adequately to evaluate effectiveness. Negative communicative behaviour (resistiveness to care) was rare.ConclusionThe use of direct instructions by care assistants holds promise for effective communication with people with dementia and warrants further investigation in larger samples and in varied contexts.

Revisiting Comfort Care

Revisiting Comfort Care

Reclaiming agency in resident–staff interaction: A case study from a Japanese eldercare facility

This article examines the problem of agency in resident–staff interaction in a Japanese eldercare facility. Data were collected during the morning care routines and analysed within the framework of Conversation Analysis. Focusing on the openings and closings, I show that the interactions in the setting under observation are marked by a clear dominance of the care workers. This becomes most obvious at the level of the turn-taking system, where the first pair part of a new sequence is commonly delivered by a care worker, thus assigning a mainly reactive role to the residents. However, the data also contain instances where this pattern is broken up by a reversal of the turn structure. I show how this sequential re-organisation enables a resident to take a more proactive role in determining the relevant next action, arguing that there is much potential for higher resident agency even in routine interactions such as the morning care activities. I also discuss the practical implications of these findings for care communication in general.

Person-centredness in direct care workers caring for residents with dementia: Effects of a psycho-educational intervention.

This study assessed the effects of a psycho-educational intervention on direct care workers' person-centredness during morning care to residents with dementia. A controlled pretest-posttest study was conducted in four aged-care facilities with 56 direct care workers (female, mean age 44.72 ± 9.02). Two experimental facilities received a psycho-educational intervention comprising person-centred care competences and stress management skills; control facilities received an education-only intervention, without stress support. In total, 112 video-recorded morning care sessions were coded using the Global Behaviour Scale. Both groups reported significantly higher scores on eight of 11 items of the Global Behaviour Scale and on the Global Behaviour Scale total score at posttest (F=10.59; p=0.02). Global Behaviour Scale total score improvements were higher for the experimental group, with values close to significance (F=3.90; p=0.054). The findings suggest that a psycho-educational intervention may increase care workers' person-centredness. Further research is needed to explore the long-term sustainability and extent of its benefits on workers and residents.

Ebbs and Flows in Daily Nursing Home Operations: A Demand and Workload Analysis

Nursing homes are challenged to develop staffing strategies that enable them to efficiently meet the needs of their clients in situations where the level of demand fluctuates. In this study we investigate how demand patterns of scheduled care of five Dutch nursing home departments fluctuate over time and over the course of a day. Furthermore, we examine the consequences of these fluctuations in terms of workload and waiting time, and take into account possible advantages of pooling care workers from multiple departments. The results show that especially during the morning care (7:00-9:30 hours) the workload is high which results in waiting times up to 40 minutes. We also show that pooling care work from multiple department can have a substantial positive effect on the average waiting times, but capacity adjustments are required during busy periods of the day.