Long-term Nursing Care Research Articles

Work Disparities and the Health of Nurses in Long-Term Care: A Scoping Review.

Work disparities, such as unfairness in pay or unequal distribution of work experienced by nurses in long-term care (LTC), can impact the retention and health of this workforce. Background: Despite the significant impact of disparities on nurses' health in LTC, a literature review on work disparities of nurses in LTC has not been conducted. Method: This scoping review aimed to explore the nature and extent of research on meso-level work disparities experienced by nurses in LTC and its links with nurse health and well-being. Five databases were searched: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), SCOPUS, and CINAHL (EBSCO host). Results: Of the 5652 articles retrieved, 16 studies (14 quantitative and 2 qualitative) published between 1997 and 2024 met the inclusion criteria. A total of 53 work disparities were identified. Only four articles investigated the association of a work disparity with a variable of health (e.g., physical, mental, or poor general health). Conclusions: The results suggest that more attention to how disparities impact nurses' health and lived experiences is warranted. Meso-level disparities from this review provide an initial basis to consider possibilities in the workplace, especially in supporting equity and opportunities for health and well-being at work (e.g., through fair access to professional growth opportunities and a more equitable balance of work expectations and demands of nursing staff). Future studies of the intersection of macro- and meso-level factors are needed to inform better workplace practices and social and economic policies to support the well-being, health, and safety of nurses at work in LTC.

Concept Analysis: The Occupational Experiences of Long-Term Care Nurses-Navigating Fragmented Transitions.

Transitions are broadly defined as movements from one place, stage, or subject to another. However, transitions which are broken and incomplete are referred to fragmented transitions. The aims of this concept analysis were to analyze the navigation of fragmented occupational transitions among long-term care nurses and to develop a working conceptual definition of fragmented occupational transitions to inform diverse stakeholders. Concept analysis. Google Scholar, PubMed, and the Cumulative Index of Nursing and Allied Health Literature databases were accessed. Identified sources were interprofessional scholarly literature published between January 1, 2018, and January 1, 2024, and seminal references. Walker and Avant's eight-stage concept analysis method. Occupational transitions in long-term care are fragmented leading to grievous challenges across multiple aspects of nurses' lives. An analysis of the literature using a Transitions Theory lens reveals that their thoughts, feelings and ethical decisions are influenced over time by these transitions. Cardinal attributes include: (1) Fragmentation, (2) Ill-timing, (3) Disruption, (4) Liminality, (5) Ambiguity, (6) Ambivalence and (7) Facilitators/Inhibitors. Antecedents stem from external sources and facility-led initiatives. Consequences encompass product and process outcomes. Product outcomes include physical and psychological conditions, and process outcomes encompass resilience, flexibility, connection, coping, creativity, and communication. This concept analysis advances the science for understanding nurses' occupational transitional experiences in long-term care. It will assist in risk assessment and instrument development ultimately improving the quality of long-term care. Fragmented occupational transitions in long-term care are multifaceted and complex phenomena that require distinct responses from government, healthcare leaders, and scholars to improve the plight of long-term care nurses and stakeholders. Dr. A. I. Meleis contributed to this article by sharing her vast insight into transitions.

Dual-Eligible Nursing Home Residents: Enrollment Growth In Managed Care Plans That Coordinate Care, 2013-20.

Dual-eligible beneficiaries have insurance through two distinct and uncoordinated programs: Medicaid, which pays for long-term care; and Medicare, which pays for medical care, including hospital stays. Concern that this system leads to poor quality and inefficient care, particularly for dual-eligible nursing home residents, has led policy makers to test managed care plans that provide incentives for coordinating care across Medicare and Medicaid. We examined enrollment in three such plans among dual-eligible beneficiaries receiving long-term nursing home care. Two of those plans, Medicare-Medicaid plans and Fully Integrated Dual Eligible Special Needs Plans, are integrated care plans that establish a global budget including Medicare and Medicaid spending. The third, Institutional Special Needs Plans, puts insurers and nursing homes at risk for Medicare spending but not Medicaid spending. Among dual-eligible nursing home residents, enrollment in these plans increased from 6.5percent of residents per month in 2013 to 16.9percent in 2020. Enrollment varied across counties but did not vary appreciably with respect to nursing home characteristics, including the share of residents with Medicaid. As policy makers pursue strategies to coordinate medical and long-term care for dual-eligible beneficiaries, it remains critical to evaluate how these plans influence the care of dual-eligible nursing home residents.

The role of workday characteristics on perceived stress and time pressure among nurses in Finnish long-term care – a cross-sectional study

BackgroundAging populations and nursing workforce issues are causing challenges for long-term care globally, and therefore, improving the work-related wellbeing and retention of nurses is crucial. As such, gaining a further understanding of the factors that affect work strain in long-term care is important. Previously, the effect of job demands on the wellbeing of nurses has been researched principally by subjective instruments. In this study, we examined the relationship between indirectly measured workday characteristics and perceived stress and time pressure among nurses working in Finnish long-term care (assisted living facilities with 24-hour assistance).MethodsA total of 503 nurses from 44 assisted living facilities across Finland completed time measurement surveys and wellbeing questionnaires. The data were linked with client characteristics from the Resident Assessment Instrument register. The relationships between the measured number of care events during the workday, clients’ care needs, and the amount of breaktime and perceived stress and time pressure were analyzed using multivariate logistic regression.ResultsNurses who had more care events and clients with greater care needs were at higher odds of having high stress. More care events and reduced breaktime were associated with high time pressure. Disruptions during the workday were strongly associated with both high stress and time pressure. Last, nurses who were under high stress and time pressure worked more often in teams with lower team autonomy.ConclusionsOur findings on indirectly measured job demands indicate that dividing the workload equally among nurses through better work division can help reduce the stress and time pressure of nurses in long-term care. In addition, ensuring sufficient breaktime and preventing unnecessary disruptions is important. To help recruit and retain the care workforce, fair management of work that accounts for varying client care needs and workload is needed. In addition, legislative and governance tools, such as staffing level regulation, and further consideration of job demands might aid in reducing the job strain of nurses.Patient or public contributionPatients or nurses were not involved in the design of the study, analysis, or interpretation of the results, or in the preparation of the manuscript.

Telemedicine entrustable professional activities for nurses in long-term care: A modified Delphi study

BackgroundAs the use of telemedicine proliferates in community care, it is essential to ensure practice recommendations and guidelines are available to assist healthcare providers in providing telemedicine-based care. This study aimed to develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations. AimTo develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations. DesignModified Delphi study. MethodsThe study was conducted in two stages. First, content analysis of 28 healthcare provider interviews and literature review on telemedicine competencies was conducted to develop an initial list of EPAs. An expert workgroup comprising of an international panel of academics and clinicians reviewed the activities. In the second stage, a three-round e-Delphi technique was used to develop telemedicine EPAs for nurses in long-term care. Descriptive statistics and qualitative feedback were distributed to participants after each round. Agreement within survey rounds was computed. ResultsSix core telemedicine EPAs with 28 descriptors were developed, from preparing the resident for the teleconsultation encounter to follow-up care post-teleconsultation. Agreement coefficients were high across all Delphi rounds. ConclusionThis study identifies the core functions that long-term care nurses' are expected to perform in telemedicine consultations. The internationally relevant EPAs are sufficiently broad to be adapted to design telemedicine training and workplace-based assessment for nurses. Organisations may utilise the EPAs as a resource during the implementation process of telemedicine services in long-term care in designing nursing workflow and complement the learning and development of nurses for telemedicine services. Equipping long-term care nurses with this resource can ensure consistency, patient safety and quality of teleconsultations delivered to nursing home residents. However, further work is required to expand the EPAs for application to practice.

Socioeconomic Status Transition Throughout Life and Risk of Dementia

Socioeconomic status (SES) is associated with dementia. However, the role of SES transitions in dementia is less explored; such evidence would be useful to understand whether social mobility is associated with healthy longevity at older ages. To investigate the association of lifetime SES transition with risk of dementia. This prospective cohort study, conducted from August 2010 to December 2016, used data from the Japan Gerontological Evaluation Study for participants aged 65 years or older from 31 different areas in Japan. Individuals with missing SES values, loss of follow-up, or new dementia onset 1 year or less from baseline were excluded. Data analysis was performed from April 2022 to April 2023. Transitions in SES across the life course. The main outcome was risk of dementia incidence and corresponding loss or gain of dementia-free periods in a lifespan. The incidence of dementia was identified with a national registry of long-term nursing care services. A total of 9186 participants (4703 men [51.2%]) were included. The mean (SD) age at baseline was 74.2 (6.0) years. Six SES transitions were identified: upward, stable-high, upper-middle, lower-middle, downward, and stable-low. During the follow-up period, 800 cases of dementia were identified. Many dementia risk factors, including lifestyle behaviors, comorbidities, and social factors, were associated with SES transition patterns. Compared with lower-middle SES, the lowest risk of dementia was observed for upward transition (hazard ratio [HR], 0.66; 95% CI, 0.57-0.74) followed by stable-high (HR, 0.77; 95% CI, 0.69-0.86), downward (HR, 1.15; 95% CI, 1.09-1.23), and stable-low (HR 1.45; 95% CI, 1.31-1.61) transition (P < .001 for linearity); there was no association of upper-middle transition with risk of dementia (HR, 0.91; 95% CI, 0.79-1.03). The greatest increases in dementia-free years in the lifespan were also associated with upward SES transition (eg, 1.8 years [95% CI, 1.4-2.2 years] at age 65 years), while the downward transition was associated with the largest loss in lifetime dementia-free years at 75 years or older (eg, -1.4 years [95% CI, -2.4 to -0.4 years] at age 85 years). This cohort study of Japanese older adults identified that upward and downward SES transitions were associated with risk of dementia and the length of dementia-free periods over the lifespan. The results may be useful to understand the association between social mobility and healthy longevity.

Relationship between nutrition indicators and pneumonia risk among stable schizophrenia patients: a retrospective study.

It is reported that reduced physical activity and malnutrition may trigger pneumonia, and the utilisation of the geriatric nutritional risk index (GNRI) upon admission to long-term nursing care can enable the implementation of accurate and timely rehabilitation and nutritional support, which may, in turn, minimise pneumonia incidence. However, to date, there is no reported association between GNRI and pneumonia among stable schizophrenic patients. This is a retrospective investigation. We enrolled 434 hospitalised subjects aged ≥50 years, who were diagnosed with stable schizophrenia between January 2017 and June 2022. Baseline nutritional status information during the stable stage of schizophrenia was evaluated using body mass index, serum albumin, and GNRI. In addition, pneumonia-based information, including diagnosis and treatment, was retrospectively obtained within 1 year. To examine the potential association between nutrition indicators and pneumonia risk among stable schizophrenia patients, we employed a logistic regression analysis. The pneumonia incidence among all stable schizophrenia patients was 10.14%, and there were no statistically significant difference between sexes (male vs. female, 10.63% vs. 9.44%, P = 0.687). Based on the univariate analysis of nutrition indicators and pneumonia, female patients exhibited a strong correlation between serum albumin and pneumonia (P = 0.022). Furthermore, we adjusted for potential influencing factors of pneumonia infection, and confirmed that only serum albumin was linked to pneumonia risk in female stable schizophrenia patients (odds ratio = 0.854, 95% CI: 0.749-0.975, P = 0.02). Based on our analysis, serum albumin was strongly correlated with pneumonia risk in female stable schizophrenia patients.

Bridging Educational Grant in Nursing (BEGIN) students’ intentions for retention in long-term, home and community care: A survey protocol

IntroductionRetention of nurses in long-term care (LTC) and home and community care (HCC) settings is a growing concern. Previous evidence underscores factors which contribute to nurses’ intentions for retention in...

Comparing Peer and Physician Coaching for Long-Term Care Nurse Practitioners

Comparing Peer and Physician Coaching for Long-Term Care Nurse Practitioners

Cluttered spaces, strained bonds: Examining the correlation between hoarding symptoms and social functioning among long-term care facilities older adult residents

BackgroundSymptoms of hoarding, such as the inability to part with possessions, leading to significant clutter, are commonly observed among residents in long-term care facilities in Egypt. This behavior significantly impacts their social interactions and functioning. Therefore, this study examined the relationship between hoarding symptoms and social functioning among older adult residents in long-term care facilities. MethodsThe study employed a cross-sectional survey on a purposive sample of 300 older adults. ToolsSaving Inventory-Revised and Functional Idiographic Assessment Template-Questionnaire-Short Form were used. ResultsThe findings revealed a significant positive correlation between hoarding symptoms and social functioning (r = 0.682, p < 0.000). A linear regression analysis supported this correlation, establishing hoarding symptoms as a significant predictor of social functioning (adjusted R2 = 0.32). ConclusionThe current study highlighted that a significant proportion of long-term care older adult residents displayed moderate hoarding symptoms and compromised social functioning. A noticeable positive association was observed between hoarding symptoms and social functioning. These results underscore the potential impact of hoarding symptoms on various aspects of social functioning. Given these findings, long-term care nurses should comprehend the various facets of compulsive hoarding behavior and devise effective strategies for assessment and intervention. Establishing support groups within these facilities could provide a platform for these residents to share their experiences and coping strategies. This could reduce interpersonal conflicts and argumentativeness and foster emotional expression and intimacy.

Nurses' encounters with patients having end-of-life dreams and visions in an acute care setting - A cross-sectional survey study.

This study aimed to estimate the proportion of acute care nurses witnessing end-of-life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. A cross-sectional survey study was conducted from February 2023 to May 2023. Participants were medical and surgical nurses from a 200-bed acute care hospital in metropolitan Australia. Fifty-seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end-of-life dreams and visions. The nature of end-of-life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end-of-life dreams and visions but identified an unmet need for education and training on this aspect of end-of-life care. Our results suggest that nurses in acute care encounter end-of-life dreams and visions in a similar proportion to oncology and long-term care but lower than in palliative care settings. Education and training regarding end-of-life dreams and visions are needed to ensure the provision of comprehensive, patient-centred end-of-life care. No patient or public contribution. Research in sub-acute and long-term care settings suggests that end-of-life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high-income countries. This study demonstrates that acute care nurses encounter end-of-life dreams and visions in similar proportions to oncology and long-term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end-of-life dreams and visions to enable the provision of holistic person-centred end-of-life care. This study was reported using the STROBE Checklist for cross-sectional studies.

Intent to stay, moral distress, and nurse practice environment among long-term care nurses: A cross-sectional questionnaire survey study.

Many long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment. The purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress. This study was a descriptive, cross-sectional survey using targeted sampling. A total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting. This study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses. The mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001). Since the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession. Our study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

'Confidence and fulfillment': a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses.

To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes. A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively. Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings. The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC.

Co-existence of malnutrition and sarcopenia and its related factors in a long-term nursing care facility: A cross-sectional study

ObjectivesMalnutrition and sarcopenia often co-exist in older patients. This condition, called co-MS, shows a worse prognosis than either condition alone but is often overlooked and undertreated. We aimed to clarify the prevalence of co-MS and its associated factors with a focus on prescription in a long-term nursing care facility in Japan. MethodsPatients aged >65 years who resided in a long-term nursing care facility in Hyogo, Japan, were recruited for this cross-sectional study, which was conducted from July 1 to July 30, 2022. Sarcopenia and malnutrition were diagnosed using the Asian Working Group for Sarcopenia and Global Leadership Initiative on Malnutrition criteria, respectively. Patients who met both criteria were classified as having co-MS. Potentially associated factors, including age, sex, length of stay, activities of daily living, comorbidity, oral function and hygiene, swallowing ability, and the number and type of prescriptions, were assessed. ResultsThe prevalence of sarcopenia was 92 % (72/78). All malnourished patients were sarcopenic (40.3 %) and were classified as having co-MS. Oral function and hygiene, swallowing ability, comorbidity, and the presence of potentially inappropriate medications showed significant associations in univariate analyses. Of particular note, potentially inappropriate medication was an independent factor in the multivariate analysis. ConclusionsCo-MS is prevalent in long-term nursing care facilities; thus, healthcare workers should pay attention to relevant factors to identify patients at risk of co-MS and to provide appropriate care and intervention.

Work engagement, psychological empowerment and relational coordination in long-term care: A mixed-method examination of nurses' perceptions and experiences.

Nurse engagement, empowerment and strong relationships among staff, residents and families, are essential to attract and retain a suitably qualified and skilled nursing workforce for safe, quality care. There is, however, limited research that explores engagement, empowerment and relational coordination in long-term care (LTC). Nurses from an older persons' mental health and dementia LTC unit in Australia participated in this study. Forty-one nurses completed a survey measuring psychological empowerment, work engagement and relational coordination. Twenty-nine nurses participated in individual interviews to further explore these concepts. Although nurses reported high psychological empowerment and work engagement, their relationships with key stakeholders varied. Our findings suggest that nurses in LTC require both supports and opportunities to contribute as active members of the multiprofessional care team that includes tailored education, professional development and positive interactions within the care team. Regular support is needed to enable nurses to feel empowered, foster relationships and communication, and facilitate work engagement. Based on these findings, we suggest that it is important to find ways to ensure that all who provide care perceive that they are part of the whole care team and able to contribute to the care and well-being of people in LTC.

The role of self-endangering cognitions between long-term care nurses' altruistic job motives and exhaustion.

Due to demographic change and staff shortages nurses suffer under high work strain. As a consequence, caregivers' absenteeism due to mental stress, in particular burnout, is high. To explain the development of nurses' burnout more research is needed on nurses' individual resources and coping strategies. Self-endangering is a potentially harmful coping strategy. To expand the perspective of the Job Demand-Resources Model by including caregivers' intraindividual resources and the coping construct of self-endangering as a mediator between personal resources and nurses' emotional exhaustion. A longitudinal questionnaire survey was conducted between July 2020-March 2021 among nurses in long-term care in Germany. The final analysis sample consisted of wave 1 = 416 and wave 1,2 = 50. Data were analysed by a multiverse analytic strategy using regression analysis with measurement repetition and cross-lagged-panel design for waves one and two. Variables used for regression analysis and cross-lagged-panel were: Independent variables: An altruistic job motivation, team identification and self-esteem, dependent variables: Exhaustion and disengagement, and mediators: Self-endangering cognitions and behavior tendencies. A highly altruistic job motivation leads to more self-endangering cognitions and to more self-endangering behavior tendencies. Mixed model analysis and cross-sectional path analysis confirmed mediation effects from altruism over self-endangering to exhaustion. Our findings are at odds with some research findings about altruism in nursing, such that too much altruism can lead to harmful self-endangering. We also introduce a new instrument to capture self-endangering in nursing care. Future research should investigate various facets of self-endangering in nursing. We assume that leadership behavior could have influence on self-endangering. New health policy structures are needed to improve working conditions in nursing and thus prevent self-endangering.

Economic effects of pension reform: applying the overlapping generations model to long-term nursing care

Economic effects of pension reform: applying the overlapping generations model to long-term nursing care

Examining Human Capital Among Foreign- and U.S.-Educated Nurses in Long-term Care

Examining Human Capital Among Foreign- and U.S.-Educated Nurses in Long-term Care

The work status of nurses in long-term care institutions in elderly care: A qualitative descriptive study.

To understand the work status of nurses in long-term care institutions in China for elderly care to provide a reference for further formulating management strategies and promoting the development of long-term care teams. Using qualitative descriptive research methods, 31 nurses from three long-term care institutions were selected through purposive sampling for in-depth interviews, and a three-week participatory observation was conducted on the daily work of nurses in the above three long-term care institutions. Content analysis was used to analyse data. In our sample, nurses in long-term care institutions had insufficient manpower, generally had low academic qualifications, and lacked professional ability. Their work enthusiasm and initiative need to be further improved. Long-term care nurses were moderately paid, and their salary satisfaction was lower than in other trades. At the same time, the social understanding of the long-term care industry was insufficient, and the social identity of nurses in long-term care institutions was low. The development of long-term care requires the joint efforts of nurses, medical institutions, and society. By improving the system, cultivating talents and building a harmonious atmosphere, we aim to enhance the work enthusiasm of long-term care nurses and promote the stable and orderly development of the long-term care team. Nurses in long-term care institutions are at the core of the ageing age and play a vital role in coping with the ageing problem, meeting long-term care needs, improving the quality of life of old people and reducing the cost of long-term care. The training and management of nurses in long-term care institutions and the construction of the entire long-term care system should be based on China's national conditions and actual needs.

PCR209 Comparing the Value of Daily Measurement of Wellbeing for Individuals with Alcohol Use Disorder Versus Reimbursement-Based Timing

Centers for Medicare and Medicaid Services (CMS) require patients to be evaluated using setting-specific patient assessment instruments for clinical assessment, payment, and quality assurance. This research examines how wellbeing is assessed in skilled nursing facilities (SNFs) and the role of measurement timing in understanding dimensions of disability, functional limitations, and wellbeing among individuals with alcohol use disorder (AUD). SNFs are central to caregiving and provide short- and long-term skilled nursing care.