Aged Care Nurses Research Articles

Work Characteristics Associated with Workplace Aggression in Aged Care Nurses and Nursing Assistants

Employees in aged care are at high risk of workplace aggression. Research rarely examines the individual and contextual antecedents of aggression for specific types of workers within these settings...

노인간호 교육프로그램이 간호사의 노인에 대한 지식, 태도 및 간호수행도에 미치는 효과

Purpose: The purposes of this study were to develop an elderly care nursing education program and evaluate its effect on knowledge, attitudes and nursing performance of nurses toward older adults. Methods: A quasi-experimental study with a non-equivalent control group pretest-posttest design was used. Participants were recruited from two geriatric hospitals. The sample consisted of an intervention group (n=29) that participated in the educational program and a control group (n=30). The data were collected prior to and 6 weeks after the intervention using self-administered questionnaires. Data analyses utilized <TEX>$x^2$</TEX>-test, Fisher's exact probability test, and t-test. Results: After the intervention, knowledge and nursing performance about the elderly care increased significantly in the experimental group compared to the control group. However, there was no statistically significant difference between the groups in their attitudes toward the elderly. Conclusion: Findings indicate that to provide better nursing care to the elderly, nurses need to be able to practically apply the knowledge they have acquired from the elder-care nursing education programs in hands-on situations. To achieve this, nurses should work to change their personal attitudes about the elderly. Also, evidence-based guidelines for elderly nursing care, administrative support of institutions, and multidisciplinary approaches are required.

Learning from Errors at Work: A Replication Study in Elder Care Nursing

Learning from errors is an important way of learning at work. In this article, we analyse conditions under which elder care nurses use errors as a starting point for the engagement in social learning activities (ESLA) in the form of joint reflection with colleagues on potential causes of errors and ways to prevent them in future. The goal of our study was to investigate whether exploratory findings from an earlier study on hospital nurses’ ESLA (Bauer and Mulder Learning in Health and Social Care 6:121–133, 2011) replicate and generalise to the domain of elder care nursing. For this purpose, we surveyed a sample of N = 180 elder care nurses using vignette-based questionnaires. With these data, we tested a mediation model of nurses’ ESLA suggested by the earlier study. We firstly found a statistically significant indirect effect of error strain on ESLA that is completely mediated by the estimation of an error as relevant for learning (β = .16). Secondly, the perception of a safe social team climate at work has a statistically significant indirect effect on ESLA that is completely mediated by nurses’ tendency to cover up errors (β = .31). These results entirely cross-validate the exploratory findings of Bauer and Mulder (Learning in Health and Social Care 6:121–133, 2011) on hospital nurses’ ESLA and show that they generalise to the domain of elder care nursing.

The importance of the supervisor for the mental health and work attitudes of Australian aged care nurses

The work attitudes and psychological well-being of aged care nurses are important factors impacting on the current and future capacity of the aged care workforce. Expanding our understanding of the ways in which the psychosocial work environment influences these outcomes is important in order to enable organizations to improve the management of human resources in this sector. Using survey data from a sample of 222 Australian aged care nurses, regression analyses were employed to test the relative impact of a range of psychosocial work environment variables derived from the demand-control-support (DCS) model and organizational justice variables on satisfaction, commitment, well-being, and depression. The expanded model predicted the work attitudes and well-being of aged care nurses, particularly the DCS components. Specifically, demand was related to depression, well-being, and job satisfaction, job control was related to depression, commitment, and job satisfaction, and supervisor support and interpersonal fairness were related to well-being. The contributions of informational and interpersonal justice, along with the main and interaction effects of supervisor support, highlight the centrality of the supervisor in addressing the impact of job demands on aged care nurses. Psychosocial variables have utility beyond predicting stress outcomes to the work attitudes of nurses in an aged care setting and thus present further avenues of research for the retention of nurses and improved patient care.

Nursing and Health Policy Perspectives

I chose ‘access’ as my watchword for this ICN Quadrennium. By this I mean access by populations to health care, including primary health care (PHC), access by nurses to contemporary education programs, and access by governments and policy makers to nursing advice. The last notion is my focus for this column. More than ever before nurses are crucial to building and strengthening the health care systems within which they work. Nurses are the principal providers of PHC in the developing nations of the world. Their role will inevitably be enhanced as demographics change due to ageing populations and the increased incidence of chronic disease. Thus nurses must be central to the process of building and strengthening health systems. Whilst it may seem to be a ‘no brainer’ for governments to engage nurses in decision-making for health, the reality is often very different. In some situations nurses and their associations cannot gain access to the policy debate on which decision-making is predicated without forming partnerships with other groups. These groups may be other nursing bodies, consumer or employer groups, or organisations representing other health professionals with similar interests in the specific issue. Collaborating with other groups is not without risk as there may only be a narrow convergence of goals and lobbying activity will need to be contained. On the other hand, a consortium can often exert more power than a single group acting alone. Nurses and consumers are a formidable alliance and too often this potential grouping is overlooked. For such an alliance to be effective, both groups need well-articulated and congruent goals. Nurses can provide valuable perspectives on the population health needs of communities as well as on wider health system design. The International Council of Nurses (ICN) through contact with its more than 130 members is aware of many examples of nurses influencing access by consumers to health care at the country level. Let me illustrate the breadth of nurses’ influence by offering a few examples of lobbying and engagement efforts that resulted in enhanced health systems for consumers. In Denmark, nurses providing care for patients with back problems maintained regular contact with them by telephone, which had the effect of reducing hospital admissions by half. This program both increased access by patients to health care and reduced inpatient costs. In the area of tuberculosis care, nurses in Lesotho and the Philippines have led their countries in the prevention, care and treatment of tuberculosis, thus facilitating access by their populations to health care. An outstanding example of nurses’ power can be seen today in the United States. The American Nurses Association lobbied long and hard along with others to achieve passage of the Affordable Care Act, which contains provisions for extended health insurance coverage for people who were previously uninsured. Nurses’ engagement in this debate was critical since they understood the health system from a consumer perspective and saw how it needed to be changed to increase access to care. Another example is the successful campaign for reform of aged-care waged over some years by the Australian Nursing Federation in collaboration with a range of groups with similar goals. The campaign culminated in a significant increase in funding for all aspects of aged care benefiting both the aged population and aged-care nurses. These examples constitute but a snapshot of the power of nurses to influence the policy debate and decisions in health care. Nurses must continue to be engaged even though such involvement takes time and energy and may not always succeed. Because governments change, a key challenge for nursing organisations is to maintain the right level of exposure and interest in the health policy debate so that apolitical nursing advice can be sought. In most countries nurses constitute the largest group of health professionals. We have a unique role to play in health policy development and we must ensure that we fulfil it for the benefit of the populations we serve. It is critical that we share our successes and provide support to our colleagues across the globe.

Psychological consequences of bullying for hospital and aged care nurses

This study examines the psychological consequences of workplace bullying by negative affectivity (NA) and demographics for hospital and aged care nurses. Nurses are particularly vulnerable to workplace bullying, with suggestions that oppressed group behaviours may play a role. Bullying is a potent stressor that can negatively impact psychological well-being, which, with NA and demographics, may be important in understanding the consequences of nurse bullying. Such factors are yet to be examined together across different nursing contexts. A cross-sectional survey was conducted across hospital and aged care nurses working within a medium to large Australian healthcare organization in October 2009. The sample comprised 233 (29.1%) hospital and 208 (43.8%) aged care nurses. Analyses of covariance were used to evaluate the data. For hospital nurses, psychological distress was noted as an impact of bullying, while depression was the impact for aged care nurses. Full-time aged care nurses reporting bullying had higher psychological distress scores, compared with part-time workers in the same area. NA was a significant covariate across both outcomes in both contexts. This study demonstrates that bullying has detrimental consequences for the mental health of nurses in both hospital and aged care contexts. The results support the suggestion that nurses are an oppressed group at high risk of bullying, confirm the intrinsic nature of NA to the bullying process, and highlight the importance of employment type for aged care nurses. Given the shortage of nurses, managers need to give higher priority to addressing workplace bullying and implementing zero tolerance policies.

Demands, Resources and Negative Affectivity: Antecedents of Workplace Bullying and Violence

This paper examines the efficacy of the job demands-resources (JD-R) model and negative affectivity (NA) as antecedents of workplace aggression for aged care nurses. Nursing is a female gendered pr...

방문요양보호사의 직무만족도와 삶의 질의 관계 -경기도 지역 중심으로-

The subjects of the research were 275 aged care nurses working in Gyeonggi regions. The analysis result showed: job satisfaction in overall situation was 2.87 on a 5 point scale, indicating the level of job satisfaction was lower than average: the quality of life was 2.97, as with job satisfaction, also low. On the other hand, the research outcomes to discern if it affects the lower level of the quality of life, it was found that variables affecting psychological health include job, pay, co-workers, organization, changing an occupation/job; Social environment include job, pay, and promotion (reward), The maintenance of social relations, pay, promotion(reward) and co-workers, changing an occupation/job; variables affecting physical health include job, pay, promotion(reward), changing an occupation/job; The research outcomes confirm that the job satisfaction of aged visit care workers is an important factor affecting their quality of life.

An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities

Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression. A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facility managers took part in an interview to determine barriers to the effective implementation of the instrument. The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9-13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change. The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.

Experiences of registered nurses as managers and leaders in residential aged care facilities: a systematic review

The phenomenon of an ageing population is being experienced globally, as countries struggle to change and improve residential models of care and provide services to the elderly. The role of the registered nurse (RN) is considered crucial to the clinical governance and management of care given. To date, however, no systematic review has examined the RN's experience in leadership and management. The objective of this review is to critically appraise, synthesise and present best available evidence on the experiences of RNs as clinical leaders and managers in residential aged care facilities. This review considered qualitative research papers that addressed the experiences of RNs as clinical leaders and managers in residential aged care facilities. Participants of interest were RNs, nurse leaders, nurses holding registration and or regulation under a board of nursing, nurses working in residential aged care and long-term care facilities. The diversity and use of language to describe nurses' roles and models of care for the elderly care environment were considered in the review. The search strategy sought to find both published studies and papers, limited to the English language and published between January 1997 and February 2011. An initial limited search was done in Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature databases to identify the key words contained in the title or abstract and index terms used to describe the relevant terms in the article. A second extensive search was undertaken and extended to other relevant databases using all identified keywords and index terms. The third step involved searching reference lists and bibliographies of chosen articles for additional studies. Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appropriate critical appraisal instrument from the System for the Unified Management, Assessment and Review of Information package. As both reviewers were in agreement on all studies included, a third reviewer was not required. A final total of eight papers, qualitative in nature, were included in the review. The majority of papers examined the experiences of nurses' leadership styles and the management characteristics within their organisations. The qualitative papers were analysed using The Joanna Briggs Institute-Qualitative Assessment and Review Instrument.The process of meta-synthesis embodied in this programme involves the aggregation or synthesis of findings or conclusions. Five syntheses were derived with key themes related to education, professional nursing development, positive attitudes to aged care and the need for a supportive environment. Nurses that work in the aged care environment show a strong motivation to work in care and provide the best outcomes in nursing the elderly. Geriatric nursing is considered a specialised and complex area of healthcare by the nursing profession. Nurses experience a lack of professional support and collaboration from allied health and medical colleagues. There is a lack of specific education that is focused in clinical leadership and health team management. There is no current structured pathway of learning and development for nursing careers in aged care. Nurses identify with their leadership role in residential aged care, and experience paradoxical feelings of being valued by the clients and devalued by the system at the same time. Organisational barriers are strong in preventing continuing education and skills development for nurse leaders in aged care environments. Overall the themes presented in the review reported the negative experiences of nurses in residential aged care and geriatrics. Nurses will continue to be devalued if there is no professional identity and support for their roles and need to have a career pathway when making the decision to enter into aged and geriatric practice. Clinical leadership training is needed for nurses to transition through practice into specialised roles such as the RN team leader and Geriatric Nurse Practitioner (GNP). Providing a career structure and choice in the industry for the nurse to become a clinical leader or a manager of health services will improve recruitment and retention. IMPLICATION FOR RESEARCH: More research is needed to identify the skills gaps experienced by nurses in aged care and geriatric care. This research could lead to the design and implementation of a skills audit to identify candidates for specialised courses so that clinical leadership and governance in aged care are improved. More research is needed for role construction and the professional development of the GNP. Organisations can benefit from research currently being conducted on the role of the RN in aged care and geriatrics, by mapping the skills mix of candidate RNs to the key performance indicators in the role. Organisations must change their perception and value of RNs as clinical leaders in care teams.

The top eight issues Queensland Australia's aged-care nurses and assistants-in-nursing worried about outside their workplace: A qualitative snapshot

The attainment of a work-life balance is an important issue for recruitment, retention and workforce planning. This paper aims to report on the free text data provided by the aged-care sector nurses around perceptions of important work-life issues. Data were written responses of aged-care nurses to the open-ended request at the end of a survey, which asked them to list up to five political/social/environmental issues concerning them outside of their work. For aged-care nurses, when asked to list political/social/environmental issues they were concerned about outside of work in late 2007, there emerged considered issues around work and life. Among the top eight themes there is an intriguing balance between the themes work, industrial relations, aged care/elder care and health-care services compared with the themes environment, water, societal values and housing. Qualitative insights into the political/social/environmental issues aged-care nurses are concerned about outside of your work suggest their desire for a labour/life or work/life harmony. Aged-care nurses place an equal importance on the nature of labour and the basics of life. The findings provide information for aged-care sector managers and workforce planners on areas in need of consideration to recruit and retain a workforce within aged care.

Erratum to: Negative expertise: comparing differently tenured elder care nurses’ negative knowledge

Erratum to: Negative expertise: comparing differently tenured elder care nurses’ negative knowledge

Reasons to Prescribe Antipsychotics for the Behavioral Symptoms of Dementia: A Survey in Dutch Nursing Homes Among Physicians, Nurses, and Family Caregivers

Despite serious safety concerns, prescription rates of antipsychotics for the treatment of the behavioral and psychological symptoms of dementia remain high, especially in nursing homes. This high prevalence of antipsychotic use cannot be explained by the modest success rate reported in the literature. In this study, we aim at clarifying the reasons for prescribing an antipsychotic drug in behavioral and psychological symptoms of dementia and look at the role of nurses and family caregivers in the decision-making process that precedes the prescription of an antipsychotic drug. Questionnaire used in a one-on-one interview with elderly care physicians, nurses, and family caregivers. We conducted a survey in 23 nursing homes in the Netherlands. On each dementia ward, the physician selected 1 or 2 patients who started antipsychotics most recently. An interviewer then held a structured questionnaire with the physician, the nurse, and the first relative of the patient. The first part of the interview consisted of questions about the general ideas of the physicians and the second part consisted of case-related questions to physicians, nurses, and family caregivers. Physicians, nurses, and family caregivers generally consider the possible benefits of antipsychotics to outweigh the risk of side effects. The main reasons to start therapy are agitation and aggression. Physicians felt pressured by nurses to prescribe in 17% of cases. Physicians felt supported by the guideline of the Dutch Association of Elderly Care Physicians. The estimated average success rate in the discussed cases (the patient is expected to improve on the target behavior) among physicians was 50%, nurses reported 53%, and relatives 55%. The most frequently expected adverse reactions were increased fall risk, sedation, and parkinsonism. Nurses expected cognitive decline. The family felt insufficiently informed about the side effects in 44% of the cases. The interviewed nursing home physicians and nurses expect almost half of their patients with dementia and behavioral disturbances to benefit from antipsychotic therapy. Serious side effects were expected to occur only sporadically. These expectations may contribute to the high rate of antipsychotic use among these patients.

Tracing Error-Related Knowledge in Interview Data: Negative Knowledge in Elder Care Nursing

This paper empirically investigates elder care nurses' negative knowledge. This form of experiential knowledge is defined as the outcome of error-related learning processes, focused on how something is not, on what not to do in certain situations or on deficits in one's knowledge or skills. Besides this definition, we presume the existence of other forms of negative knowledge that relate to elder care nurses' professional competence and practice. Data were collected by means of the prompting-task methodology, which was applied among 37 elder care nurses from a nursing home institution. Content analysis confirmed declarative, procedural, and self-reflective negative knowledge to be relevant in the investigated domain. Additionally, the elder care nurses voiced vicarious negative knowledge. This knowledge was focused on what certain nursing home residents' are not able to do or are not aware of. For each of these forms of negative knowledge, different subfacets are identified and illustrated through sample statements. Moreover, the relationship of different types of workplace errors is outlined. We conclude that negative knowledge represents failure-critical aspects of work situations and, thus, represents a valuable resource for professionals' competence and practice.

Negative expertise: comparing differently tenured elder care nurses' negative knowledge

Negative expertise is conceptualised as the professional's ability to avoid errors during practice due to certain cognitive agencies. In this study, negative knowledge (i.e. knowledge about what is wrong in a certain context and situation) is conceptualised as one such agency. This study compares and investigates the negative knowledge of elder care nurses at three different levels of professional experience. Thereby, various forms of negative knowledge—declarative, procedural, self-reflective and vicarious—are investigated. Moreover, the specificity of negative knowledge is compared across different levels of professional experience. Verbal data was collected from a prompting task study of 37 elder care nurses. These were prompted 20 diagnoses of varying typicality for the professional field. The nurses were asked what was critical to pay attention to and what ought to be avoided in case of these diagnoses. The study's results reveal a significant superiority of highly tenured elder care nurses in vicarious negative knowledge, as well as in highly specified negative knowledge. Procedural and procedural negative knowledge (PNK)—which are the most important facets in quantitative terms—show an approximately parallel developmental pattern among the different groups. For declarative knowledge, a U-shaped intermediate effect was discovered. It is concluded that PNK has the most immediate error-preventive function. With regards to future research, the great specificity of highly tenured elder care nurses' negative knowledge discovered in this study is discussed here as one possible explanation as to why they are able to intentionally avoid errors (i.e. their negative expertise).

Enhancing resilience in registered aged care nurses

To identify the factors that impact the resilience of registered aged care nurses, that is their capacity to adapt to the physical, mental and emotional demands of working in aged care facilities. This study explored the lived experience of nine registered nurses working in residential aged care facilities on the Sunshine Coast, Queensland, who were asked to reflect on the phenomenon of resilience in the workplace. This study found that clinical expertise, a sense of purpose in a holistic care environment, a positive attitude and work-life balance are important determinants of resilience in aged care nurses. Resilience in nurses in residential aged care facilities is enhanced when they are able to maintain long-term, meaningful relationships with residents. Collegial support that provides opportunities to debrief and validate experiences as well as the use of humour to defuse stress promotes well-being and builds resilience in the workplace.

Embodied reflection in practice—‘Touching the core of caring’

A study was performed with the aim of clarifying the integration of the caring act of touch with reflection on caring theory. Seven participant nurses in elderly care volunteered as 'coresearchers' and performed a caring act called Rhythmical Embrocation, together with reflective dialogues on caring theory. The project lasted for 6 months and at the end qualitative interviews with participants were used to evaluate the study. The findings showed an opening of awareness, embodied moments of presence and an extended ability to act creatively in caring. In this study, the movement between theory and practice was the integration of the caring act with reflection on basic caring concepts. Implications for praxis development are that implementation and reflection by teams over certain caring acts might open the door to an expanded view of one's own caring ability that in the long run will benefit the patient.

Constructions of dignity: a pre‐requisite for flourishing in the workplace?

To explore the relationship between nurses' understanding of dignity and how it is enhanced and developed in their practice environment. Dignity is a ubiquitous concept in an era of healthcare reform yet is referred to almost exclusively in terms of the quality of care delivered to support the experience of the patient rather than the caregivers engaged in the relationships of care. This article focuses on dignity in the professional life of nurses in aged care. This is part of a doctoral study of the implementation of a palliative approach in residential aged care using emancipatory practice development methodology. Constructions of dignity were co-created with participants through creative reflective activities and subsequently analysed using reflexive methods and data from other sources within the study. Constructions of dignity and subsequent actions taken by nurses on their own behalf to articulate their experiences of transforming practice are interconnected with dignity enhancing relationships and emancipatory ways of working in practice development. Dignity enhancing ways of working in an active learning group and workplace have been interlinked with actions that promote person-centredness in developing a palliative approach to care.

Workplace errors and negative knowledge in elder care nursing

Expert professionals excel in their domains not only because of their superior knowledge about how to proceed to attain goals, but also because of their experiential knowledge about what may endanger the attainment of a goal and should therefore be avoided. This negative knowledge is researched here by means of a case study with practitioners in elder care nursing. It explores (1) what forms of workplace errors negative knowledge is related to, and (2) draws conclusions on error-producing conditions at the participants' workplaces. The results indicate that negative knowledge mainly, but not exclusively, relates to knowledge- and rule-based errors. Moreover, it provides insights into underlying tensions at the elder care nurses' workplaces, such as the requirement to make the residents follow medical suggestions, while also respecting their biography and autonomy. With regard to its potential for better understanding the competence of professionals to avoid errors, it is concluded that the concept of negative knowledge should more purposefully be developed at the individual and the organizational level.

Relationships among living preferences during the care period, the availability of elderly nursing care facilities, and intergenerational differences for residents of small isolated islands

This study investigated living preferences during the care period in two small island villages with elderly nursing care facilities in Okinawa Prefecture and two comparably sized villages without such facilities and analyzed intergenerational differences regarding the availability of elderly nursing care facilities. Village residents older than 20 years of age were asked to complete a questionnaire and 417 responses were received.Subjects were divided regarding to island group based on the availability of nursing facility care. To estimate the behavioral dimensions of subjects based on data similarities and mutual relationships, correlation axes for preferences about living on or off the island and with families or independently were extracted using Hayashi’s third method of quantification.In the facility-available island group, living with family off the island was most common among elderly people, while most young and middle-aged people wanted to remain on the island, representing significant intergenerational differences. In contrast, in the facility-unavailable island group, living on the island was common in all generations.These results indicate that living preferences during the care period for elderly people living on small isolated islands are influenced by the current state of nursing care for the elderly both on and off isolated islands.